Augmented reality technology shortens aneurysm surgery learning curve for residents

OBJECTIVES

We aimed to prospectively investigate the benefit of using augmented reality (AR) for surgery residents learning aneurysm surgery.

MATERIALS AND METHODS

Eight residents were included, and divided into an AR group and a control group (4 in each group). Both groups were asked to locate an aneurysm with a blue circle on the same screenshot after their viewing of surgery videos from both AR and non-AR tests. Only the AR group was allowed to inspect and manipulate an AR holographic representation of the aneurysm in AR tests. The actual location of the aneurysm was defined by a yellow circle by an attending physician after each test. Localization deviation was determined by the distance between the blue and yellow circle.

RESULTS

Localization deviation was lower in the AR group than in the control group in the last 2 tests (AR Test 2: 2.7 ± 1.0 mm vs. 5.8 ± 4.1 mm, p = 0.01, non-AR Test 2: 2.1 ± 0.8 mm vs. 5.9 ± 5.8 mm, p < 0.001). The mean deviation was lower in non-AR Test 2 as compared to non-AR Test 1 in both groups (AR: p < 0.001, control: p = 0.391). The localization deviation of the AR group decreased from 8.1 ± 3.8 mm in Test 2 to 2.7 ± 1.0 mm in AR Test 2 (p < 0.001).

CONCLUSION

AR technology provides an effective and interactive way for neurosurgery training, and shortens the learning curve for residents in aneurysm surgery.

Pt nanoparticles anchored by oxygen vacancies in MXenes for efficient electrocatalytic hydrogen evolution reaction

The improvement of the hydrogen evolution reaction (HER) performance of nanomaterials is associated with the interfacial synergistic interaction and their hydrogen adsorption kinetics. Nevertheless, it is still a challenge to accelerate the proton transfer and optimize the HER kinetics by constructing Pt-supported heterostructures based on the hydrogen spillover phenomenon. Herein, oxygen vacancies on the surface of MXene nanosheets were constructed via a high-temperature annealing method, which was employed to anchor/stabilize Pt nanoparticles and fabricate a Pt/MXene heterostructure. EPR and XPS analyses verified the presence of oxygen vacancies, which could enhance the intrinsic HER activity of the MXene. The HER catalytic performance was investigated by taking into account the surface structure of the MXene affected by the annealing temperature, the concentration of Pt and the number of deposition cycles. Electrochemical results showed that Pt/MXene with higher utilization of Pt was obtained at 900 °C and 0.05 mgPt mL-1. The 0.05-Pt/MXene-900 obtained at deposition of 60 cycles in 0.5 M H2SO4 solution exhibited the optimized HER activity. The overpotential was 22 mV at a current density of 10 mA cm-2 and the Tafel slope was 42.41 mV dec-1. Furthermore, the accelerated HER kinetics was mainly due to the electron trapping ability of the MXene, small particles of Pt, as well as the enhanced charge transfer between the oxygen vacancies of the MXene and Pt. This strategy for constructing Pt-supported heterostructures based on the vacancy anchoring effects provides new ideas for the design of well-defined electrocatalysts toward the HER.

Regulating Mo-based alloy-oxide active interfaces for efficient alkaline hydrogen evolution assisted by hydrazine oxidation

Improving the efficiency of overall water splitting (OWS) is crucial due to the slow four-electron transfer process in the oxygen evolution reaction (OER). The coupling of the thermodynamically favorable hydrazine oxidation reaction (HzOR) with the hydrogen evolution reaction (HER) significantly boosts hydrogen production. A Ru-decorated MoNi/MoO2 micropillar (Ru-MoNi/MoO2) has been synthesized using a hydrothermal followed by reduction annealing. Benefiting from Ru moderating the active interface of Mo-based alloys/oxides and the unique one-dimensional micropillar morphology. The synthesized Ru-MoNi/MoO2 exhibits outstanding bifunctional activity for HER and HzOR, achieving 10 mA cm-2 at merely -13 mV and -34 mV in 1 M KOH and 1 M KOH + 0.5 M N2H4, respectively. Notably, with Ru-MoNi/MoO2 in a dual-electrode setup, only 0.57 V is needed to achieve 50 mA cm-2, demonstrating good stability and facilitating hydrazine-assisted water splitting (OHzS). This work offers insights into the modulation of alloy/metal oxide active interfaces, contributing to the development of efficient bifunctional catalysts for HER and HzOR.

CCDet: Confidence-Consistent Learning for Dense Object Detection

Modern detectors commonly employ classification scores to reflect the localization quality of detection results. However, there exists an inconsistency between them, misguiding the selection of high-quality predictions and providing unreliable results for downstream applications. In this paper, we find that the root of this confidence inconsistency lies in the inaccurate IoU estimation and the spatial misalignment of the learned features between the classification and localization tasks. Therefore, a Confidence-Consistent Detector (CCDet) which includes the Distribution-based IoU Prediction (DIP) and Consistency-aware label assignment (CLA), is proposed. DIP provides more stable and accurate IoU estimation by learning the probability distribution over the IoU range and employing the expectation as the predicted IoU. CLA adopts both the prediction performance and consistency degree of samples as assignment metrics to select positives, which guides the classification and localization tasks to promote similar feature distribution. Comprehensive experiments demonstrate that CCDet can effectively mitigate the confidence inconsistency between classification and localization, and achieve stable improvement across different baselines. On the test-dev set of MS COCO, CCDet acquires a single-model single-scale AP of 50.1%, surpassing most of the existing object detectors.

Oxygen-Vacancy-Induced Formation of Pt-Based Intermetallics on MXene with Strong Metal-Support Interactions for Efficient Oxygen Reduction Reaction

The Pt-based alloys can moderate the binding energies of oxygenated species on the catalytic surface, endowing the superior catalytic performance towards oxygen reduction reaction (ORR). Nevertheless, it is still challenging to explore general methods to synthesize structurally ordered intermetallics with uniform distributions. Herein, the strong metal-support interaction is employed to facilitate the interdiffusion of Pt/M atoms by establishing a tunnel of oxygen vacancy on ultrathin Ti3 C2 Tx (MXene) sheets, synthesizing the ordered PtFe, PtCo, PtZn, PdFe, PdZn intermetallics loaded onto Ti3 C2 Tx . Furthermore, the in-situ generation of Ti-O from Ti3 C2 Tx could be bonded with Pt and forming Pt-O-Ti, resulting in charge redistribution through Pt-O-Ti structure. Theoretical calculations demonstrate that the valuable charge redistribution can be observed at the interface and extended even to at the distance of two nanometers from the interface, which can modulate the Pt-Pt distance, optimize Pt-O binding energy and enhance intrinsic activity towards ORR. The strong coupling interaction between PtFe and Ti3 C2 Tx containing the titanium oxide layer endows the high stability of the composites. This work not only presents a general synthesis strategy for intermetallics but also provides a new insight that metal-support interaction is essential for the structural evolution of intermetallics on materials with oxygen vacancies.

Vegetation-fire feedbacks increase subtropical wildfire risk in scrubland and reduce it in forests

Climate dictates wildfire activity around the world. But East and Southeast Asia are an apparent exception as fire-activity variation there is unrelated to climatic variables. In subtropical China, fire activity decreased by 80% between 2003 and 2020 amid increased fire risks globally. Here, we assessed the fire regime, vegetation structure, fuel flammability and their interactions across subtropical Hubei, China. We show that tree basal area (TBA) and fuel flammability explained 60% of fire-frequency variance. Fire frequency and fuel flammability, in turn, explained 90% of TBA variance. These results reveal a novel system of scrubland-forest stabilized by vegetation-fire feedbacks. Frequent fires promote the persistence of derelict scrubland through positive vegetation-fire feedbacks; in forest, vegetation-fire feedbacks are negative and suppress fire. Thus, we attribute the decrease in wildfire activity to reforestation programs that concurrently increase forest coverage and foster negative vegetation-fire feedbacks that suppress wildfire.

Safety and efficacy of the flow diverter device for treating middle cerebral artery aneurysms of the proximal (M1) segment related to the lenticulostriate arteries: A single-center experience

BACKGROUND

Experience using flow diverter devices (FDDs) to treat proximal (M1) middle cerebral artery aneurysms associated with the lenticulostriate artery (M1A-LA) remains limited. This study aimed to examine the efficacy and safety of an FDD to manage M1A-LA.

METHOD

Patients with M1A-LA who received FDD treatment at a single center were included in the analysis. Data on the baseline characteristics, postoperative conditions, and follow-up results of the participants were recorded and analyzed. The aneurysms were categorized into three subtypes based on morphology and location. Aneurysms confined to the M1 segment were categorized as subtype A. Those extending to the M2 segment were classified as subtype B. Aneurysms designated as subtype C were confined to the M1 segment but with another independent aneurysm in the distal artery and the presence of healthy vessels between the two. Subgroup analyses were conducted on these subtypes and aneurysm sizes. To assess the consistency of follow-up results, Cronbach's kappa/alpha was used to calculate inter-rater variability. Somers's D coefficient was used to assess the correlation between each subgroup and the imaging outcomes; Fisher's exact test was used to compare the variability among the subgroups.

RESULT

The cohort comprised 11 patients. Their Modified Rankin Scale scores between the perioperative and follow-up periods did not differ. During the follow-up period, four patients had completely occluded aneurysms, and five patients had partial occlusions. The remaining patients did not present with changes in their aneurysms. The kappa coefficient was 0.864 (p < 0.001). M1A-LA was divided into subtypes A, B, and C. Subtype A (defined as an aneurysm completely located in the M1 segment) had a higher complete occlusion rate than that of subtypes B and C, Somers's D R/C correlation coefficient was 0.553, with a 95% confidence interval of 0.1229-0.9823 (p = 0.009). The radiographic follow-up findings were not significantly correlated with the size of the aneurysm (p = 0.121) or the use of coiling (p = 0.903). No significant differences in subtypes (p = 0.264), aneurysm size (p = 0.657), or coiling use (p > 0.999) were observed.

CONCLUSION

FDDs were safe and possibly effective against M1A-LA. However, they were not as effective as for intracranial aneurysms in other locations. FDDs are a satisfactory treatment option for M1A-LA, particularly for subtype A aneurysms.

Synergistic Effects of Pyrrolic N/Pyridinic N on Ultrafast Microwave Synthesized Porous CoP/Ni2P to Boost Electrocatalytic Hydrogen Generation

Transition metal phosphides are ideal inexpensive electrocatalysts for water-splitting, but the catalytic activity still falls behind that of noble metal catalysts. Therefore, developing valid strategies to boost the electrocatalytic activity is urgent to promote large-scale applications. Herein, a microwave combustion strategy (20 s) is applied to synthesize N-doped CoP/Ni2P heterojunctions (N-CoP/Ni2P) with porous structure. The porous structure expands the specific surface area and accelerates the mass transport efficiency. Importantly, the pyrrolic N/pyridinic N content is adjusted by changing the amount of urea during the synthesis process and then optimizing the adsorption/desorption capacity for H*/OH* to enhance the catalyst activity. Then, the synthesized N-CoP/Ni2P exhibits small overpotentials of 111 and 133 mV for HER in acidic and alkaline electrolytes and 290 mV for OER in alkaline electrolytes. This work provides an original and efficient approach to the synthesis of porous metal phosphides.

Microwave Phosphine-Plasma-Assisted Ultrafast Synthesis of Halogen-Doped Ru/RuP2 with Surface Intermediate Adsorption Modulation for Efficient Alkaline Hydrogen Evolution Reaction

Anionic modification engineering is a crucial approach to develop highly efficient electrocatalysts for hydrogen evolution reaction. Herein, halogen elements (X = Cl, Br, and I)-modified Ru-based nanosheets (X-Ru/RuP2 ) are designed by rapid and eco-friendly microwave-phosphide plasma approach within 60 s. Experimental and density functional theory calculations verify that the introduced halogen element, especially Br, can optimize the surface intermediates adsorption. Specially, the designed Br-Ru/RuP2 favors the water dissociation and following hydrogen adsorption/desorption process. Then, the as-synthesized Br-Ru/RuP2 exhibits low overpotential of 34 mV to reach 10 mA cm-2 coupled with small Tafel slope of 27 mV dec-1 in alkaline electrolyte with excellent long-term stability. Moreover, the electrocatalytic performances in acid and neutral media are also boosted via Br element modification. This work paves a novel way to regulate the electronic structure of Ru-based compounds, and then can boost the electrocatalytic kinetics.

[Femtosecond laser assisted cataract surgery in a complicated cataract patient with reverse implantable collamer len: a case report]

The patient is a 33-year-old female who, 11 years ago, underwent bilateral posterior chamber phakic intraocular lens (pIOL) implantation due to myopia. She presented with a 2-year history of declining vision in her right eye and sought medical attention. She received femtosecond laser-assisted cataract surgery combined with pIOL extraction. Anterior segment optical coherence tomography and ultrasound biomicroscopy both showed an inverted pIOL in the right eye. Good visual results were achieved, and there were no complications during the six-month follow-up.

Ultrasmall RuM (Mo, W, Cr) Decorated on Nitrogen-doped Carbon Nanosheet with Strong Metal-support Interactions for Electrocatalytic Hydrogen Generation in Wide pH Range

Developing efficient electrocatalysts for hydrogen evolution reaction (HER) in full pH range can promote the practical applications of hydrogen energy. In this work, nitrogen doped carbon nanosheets supported RuM (Mo, W, Cr) (RuM/NCN) are prepared through an ultrafast microwave approach. The carbon nanosheet structure coupled with the ultrasmall RuM nanoparticles can expose rich active sites to optimize the catalytic activity. Moreover, the strong metal-support interactions also favor to accelerate the reactions kinetics and improve stability. Thus, the developed RuMo/NCN (RuW/NCN) show excellent HER catalytic activities with overpotentials of 72 (75) mV, 82 (82) mV and 124 (119) mV to reach current density of 10 mA cm -2 in 1 M KOH, 0.5 M H2SO4 and alkaline seawater, respectively, and also achieve excellent performance in 1 M PBS. This work provides a valid and novel avenue to design efficient electrocatalysts in renewable energy-related fields.

Aggregated chromosomes/chromatin transfer: a novel approach for mitochondrial replacement with minimal mitochondrial carryover: the implications of mouse experiments for human aggregated chromosome transfer

Nuclear transfer techniques, including spindle chromosome complex (SC) transfer and pronuclear transfer, have been employed to mitigate mitochondrial diseases. Nevertheless, the challenge of mitochondrial DNA (mtDNA) carryover remains unresolved. Previously, we introduced a method for aggregated chromosome (AC) transfer in human subjects, offering a potential solution. However, the subsequent rates of embryonic development have remained unexplored owing to legal limitations in Japan, and animal studies have been hindered by a lack of AC formation in other species. Building upon our success in generating ACs within mouse oocytes via utilization of the phosphodiesterase inhibitor 3-isobutyl 1-methylxanthine (IBMX), this study has established a mouse model for AC transfer. Subsequently, a comparative analysis of embryo development rates and mtDNA carryover between AC transfer and SC transfer was conducted. Additionally, the mitochondrial distribution around SC and AC structures was investigated, revealing that in oocytes at the metaphase II stage, the mitochondria exhibited a relatively concentrated arrangement around the spindle apparatus, while the distribution of mitochondria in AC-formed oocytes appeared to be independent of the AC position. The AC transfer approach produced a marked augmentation in rates of fertilization, embryo cleavage, and blastocyst formation, especially as compared to scenarios without AC transfer in IBMX-treated AC-formed oocytes. No significant disparities in fertilization and embryo development rates were observed between AC and SC transfers. However, relative real-time PCR analyses revealed that the mtDNA carryover for AC transfers was one-tenth and therefore significantly lower than that of SC transfers. This study successfully accomplished nuclear transfers with ACs in mouse oocytes, offering an insight into the potential of AC transfers as a solution to heteroplasmy-related challenges. These findings are promising in terms of future investigation with human oocytes, thus advancing AC transfer as an innovative approach in the field of human nuclear transfer methodology.

Prevalence and influencing factors of depressive and anxiety symptoms among hospital-based healthcare workers during the surge period of the COVID-19 pandemic in the Chinese mainland: a multicenter cross-sectional study

BACKGROUND

From November 2022 to February 2023, the Chinese mainland experienced a surge in COVID-19 infection and hospitalization, and the hospital-based healthcare workers (HCWs) might suffer serious psychological crisis during this period. This study aims to assess the depressive and anxiety symptoms among HCWs during the surge of COVID-19 pandemic and to provide possible reference on protecting mental health of HCWs in future infectious disease outbreaks.

METHODS

A multicenter cross-sectional study was carried out among hospital-based HCWs in the Chinese mainland from 5 January to 9 February 2023. The PHQ-9 (nine-item Patient Health Questionnaire) and GAD-7 (seven-item Generalized Anxiety Disorder Questionnaire) were used to measure depressive and anxiety symptoms. Ordinal logistic regression analysis was performed to identify influencing factors.

RESULTS

A total of 6522 hospital-based HCWs in the Chinse mainland were included in this survey. The prevalence of depressive symptoms among the HCWs was 70.75%, and anxiety symptoms was 47.87%. The HCWs who perceived higher risk of COVID-19 infection and those who had higher work intensity were more likely to experience depressive and anxiety symptoms. Additionally, higher levels of mindfulness, resilience and perceived social support were negatively associated with depressive and anxiety symptoms.

CONCLUSION

This study revealed that a high proportion of HCWs in the Chinese mainland suffered from mental health disturbances during the surge of the COVID-19 pandemic. Resilience, mindfulness and perceived social support are important protective factors of HCWs' mental health. Tailored interventions, such as mindfulness practice, should be implemented to alleviate psychological symptoms of HCWs during the COVID-19 pandemic or other similar events in the future.

Anchoring a Pt-based alloy on oxygen-vacancy-defected MXene nanosheets for efficient hydrogen evolution reaction and oxygen reduction reaction

Rational design and controllable synthesis of Pt-based materials with intimate interfacial contact open up the possibility for boosting the performance of the ORR (oxygen reduction reaction) and HER (hydrogen evolution reaction). However, it is still challenging to prevent the oxidation of Pt during the formation of alloys and to clarify the interfacial synergistic effects on the catalytic performance between Pt alloys and the dispersed substrate. Herein, the wet chemical stripping and intercalation methods were employed to synthesize a two-dimensional (2D) MXene with abundant defect sites, which can anchor Pt3Co/Pt3Ni nanoparticles and prevent the oxidation of Pt during the process of atomic rearrangement at high temperatures. The obtained Pt3Co/MXene and Pt3Ni/MXene displayed different phase compositions and alloying degrees on adjusting the annealing temperature. Electrochemical test results showed that the optimized HER and ORR electrocatalytic activities occurred at 700 °C. Compared with Pt3Ni/MXene-700, Pt3Co/MXene-700 exhibited an HER overpotential of 1.3 mV at a current density of 10 mA cm-2, and a Tafel slope of 27.11 mV dec-1 in 0.1 M HClO4 solution. Furthermore, Pt3Co/MXene-700 exhibited an ORR half-wave potential of 0.897 V, and a mass activity of 241.1 mA mg-1Pt in 0.1 M HClO4 solution. This can be attributed to the formation of intermetallic compounds in Pt3Co/MXene. The electronic structure analysis showed that the enhanced performance could be assigned to the electron-capturing capability of the MXene, less oxidation of Pt and synergistic interactions between the Pt alloy and the MXene substrate. These findings provide a new strategy for the synthesis of highly active HER/ORR catalysts and broaden the way for the design of MXene-based catalysts.

CoNiFe alloy nanoparticles encapsulated into nitrogen-doped carbon nanotubes toward superior electrocatalytic overall water splitting in alkaline freshwater/seawater under large-current density

Developing bifunctional catalysts for overall water splitting with high activity and durability at high current density remains a challenge. In an attempt to overcome this bottleneck, in this work, unique CoNiFe-layered double hydroxide nanoflowers are in situ grown on nickel-iron (NiFe) foam through a corrosive approach and following a chemical vapor deposition process to generate nitrogen-doped carbon nanotubes at the presence of melamine (CoNiFe@NCNTs). The coupling effects between various metal species act a key role in accelerating the reaction kinetics. Moreover, the in situ formed NCNTs also favor promoting electrocatalytic activity and stability. For oxygen evolution reaction it requires low overpotentials of 330 and 341 mV in 1M KOH and 1M KOH + seawater to drive 500 mA cm-2. Moreover, water electrolysis can be operated with CoNiFe@NCNTs as both anode and cathode with small voltages of 1.95 and 1.93 V to achieve 500 mA cm-2 in 1M KOH and 1M KOH + seawater, respectively.

HPV Circulating Cell-Free DNA Kinetics in Cervical Cancer Patients Undergoing Definitive Chemoradiation

PURPOSE/OBJECTIVE(S)

The human papilloma virus (HPV) is a significant cause of cervical cancer and viral DNA can be detected in the blood of patients with cervical cancer (cfHPV-DNA). We hypothesized that detecting HPV cfDNA before, during and after chemoradiation (CRT) could provide insights into disease extent, clinical staging, and treatment response.

MATERIALS/METHODS

Forty-seven patients with cervical cancer were enrolled on this study between 2017 and 2022, either as part of a standard-of-care (SOC) treatment banking protocol (33 patients) or as part of a clinical trial combining a therapeutic HPV vaccine (PDS0101; Immunocerv, 14 patients). Longitudinal plasma samples were collected from each patient as baseline, during week 1, 3 or 5 of CRT. cfHPV-DNA was quantified using droplet digital PCR targeting the HPV E6/E7 oncogenes of 13 high-risk types based on analysis of cervical tumor genotype (AmpFire). Clinical covariates, including FIGO stage, primary tumor size, and treatment response were studied using appropriate statistical tests.

RESULTS

All 47 patients had detectable HPV cfDNA during CRT with 38 out of 47 having HPV type 16 detected. The median cfDNA at baseline was 24.5 copies/mL, with a range of 0 to 157,638 copies/mL. Of the 35 patients with at least three measurements, 20 (57%) had peak cfDNA counts at week 3, and 30 out of 35 showed a decline in cfDNA counts at week 5 compared to week 3. The proportion of patients who cleared cfDNA (<16 copies/mL) increased with each week of CRT, reaching 75% at week 5. Baseline cfDNA counts were associated with para-aortic nodal involvement (p<0.0001) but not with FIGO stage or gross tumor volume. A greater proportion of patients treated with therapeutic HPV-directed vaccine had clearance of cfDNA counts as compared to those treated with SOC (at week 3, 38% vs 5%, P = 0.02 and week 5, 79% vs 22%, P = 0.0054) CONCLUSION: HPV cfDNA levels change dynamically throughout definitive CRT and peak during the first 3 weeks for the majority of patients. Treatment with a therapeutic HPV vaccine was associated with a more rapid decline in cfHPV DNA. Further analysis of cfDNA kinetics could provide valuable information on the relationship between cfDNA levels, treatment response, and clinical outcomes.

Long-Term Outcome of Rectal Cancer Patients Treated by High-Dose Radiotherapy and Concurrent Chemotherapy

PURPOSE/OBJECTIVE(S)

To explore the therapeutic efficacy and adverse effects of high-dose radiotherapy concurrently with chemotherapy in treating patients with non-metastatic rectal cancer.

MATERIALS/METHODS

Patients were enrolled if they were diagnosed with stage I-III rectal adenocarcinoma, refused surgery and received high-dose pelvic radiotherapy and concurrent chemotherapy instead. Their clinical data were retrospectively analyzed for calculating local control and survival rates. Treatment related toxicities was evaluated according to the Common Terminology Criteria for Adverse Events (version 5.0).

RESULTS

Between April 2006 and February 2021, a total of 93 patients in our medical center were eligible for this study, with a median age of 61 (range, 21-84) years. Of those, 86 (92.5%) patients had tumors located within 5 cm of the anal verge. There were 8 (8.6%), 30 (32.3%) and 55 (59.1%) patients diagnosed with stage I, II and III, respectively. All patients received fluorouracil-based chemotherapy (single-agent fluorouracil or FOLFOX regimen). The irradiation techniques included three-dimensional conformal and intensity-modulated radiation therapy. The median total radiation dose for gross tumor volume (GTV) was 80 (range, 60-90) Gy. The 15 (16.1%) patients refusing surgery before treatment received one course of radiation (60-70 Gy/30-35 Fr). And a 2-course radiation (Course 1, 45-50 Gy/25 Fr; Course 2: 24-40 Gy/12-20 Fr) were given to the 78 (83.9%) patients who failed to achieve clinical complete remission (cCR) after neoadjuvant chemoradiotherapy but still refused surgery, with a median interval of 79 (range, 35-195) days. The median follow-up duration was 66 (range, 10-161) months. The 3- and 5-year overall survival (OS) rates for all patients were 90.5% and 72.7%, respectively. The clinical complete remission rate at the end of chemoradiotherapy was 69.9%. Colostomy was performed in the 14 patients whose rectal tumor did not attain cCR or progressed. There was no grade 4/5 severe acute toxicity. No patient suffered from intestinal perforation. Only one patient developed anal stenosis. Because of rectal bleeding, blood transfusion was performed in 7 patients, and one patient underwent an enterostomy.

CONCLUSION

High-dose radiotherapy concurrent with chemotherapy brought encouraging survival outcomes, satisfactory organ preservation and acceptable short- and long-term side effects. It might be a safe and non-invasive alternative to abdominoperineal resection in rectal cancer patients refusing or unsuitable for surgery, especially for those with a low-position tumor.

Ultrafast Microwave Synthesis of Ru-Doped MoP with Abundant P Vacancies as the Electrocatalyst for Hydrogen Generation in a Wide pH Range

Molybdenum phosphide (MoP) has received increasing attention for the hydrogen evolution reaction (HER) due to its Pt-like electronic structure and high electrical conductivity. In this work, a flake-like Ru-doped MoP with phosphorus vacancy (Ru-MoP-P_V) electrocatalyst is synthesized for the first time by a simple and rapid room-temperature microwave approach within 30 s. The created abundant phosphorus vacancies provide rich active sites and favor rapid electron transfer. The introduced Ru also enhances the catalytic activity of the synthesized electrocatalyst efficiently. Then, the designed Ru-MoP-P_V possesses low overpotentials for HER with 79, 100, and 161 mV in 1.0 M KOH, 0.5 M H₂SO₄, and 1.0 M phosphate-buffered saline to obtain 10 mA cm^-2. The Ru-MoP-P_V and NiFe-layered double hydroxide are used as the cathode and the anode, respectively, to drive water splitting and just need a low cell voltage of 1.6 V to achieve 10 mA cm^-2. This work provides a feasible way for the rapid production of metal phosphides for energy conversion and storage applications.

Ultrafast synthesis of halogen-doped Ru-based electrocatalysts with electronic regulation for hydrogen generation in acidic and alkaline media

Developing a facile and time-saving method for preparing hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) electrocatalysts can accelerate the practical applications of hydrogen energy. In this study, halogen (X = F, Cl, Br and I) doped Ru-RuO₂ on carbon cloth (CC) (X-Ru-RuO₂/MCC) was synthesized via an ultrafast microwave-assisted method for 30 s. Particularly, the doped Br (Br-Ru-RuO₂/MCC) significantly improved the electrocatalytic performances of the catalyst through the regulation of electronic structures. Then, the Br-Ru-RuO₂/MCC catalyst featured HER overpotentials of 44 mV and 77 mV in 1.0 M KOH and 0.5 M H₂SO₄, and the OER overpotential of 300 mV at 10 mA cm^-2 in 1.0 M KOH. This study provides a novel method for developing of halogen-doped catalysts.

In situ synthesis of two-dimensional graphene-like nickel-molybdenum nitride as efficient electrocatalyst towards water-splitting under large-current density

Transition metal nitride (TMNs) electrocatalysts have attracted tremendous attentions for their unique electron structure, high activity, and excellent stability. Herein, a two-dimensional (2D) graphene-like structured nickel-molybdenum nitride (Ni-MoN) on nickel foam (NF), is prepared via facile hydrothermal and following nitridation process. The as-prepared Ni-MoN-450 (pyrolysis at 450 °C) displays good hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) performances in alkaline media. Only 22 mV and 117 mV are needed to achieve current densities of 10 mA cm^-2 and 500 mA cm^-2 in 1.0 M KOH, respectively, toward HER. The assembled two-electrode system, with the synthesized Ni-MoN-450 as the anode and cathode, exhibits good performance to achieve 1000 mA cm^-2 in 1.0 M KOH + 25 °C and 6.0 M KOH + 80 °C. Moreover, it also presents long-term stability under large-current density, which verified its robust property.

Microwave Synthesis of Pt Clusters on Black TiO2 with Abundant Oxygen Vacancies for Efficient Acidic Electrocatalytic Hydrogen Evolution

Oxygen vacancies-enriched black TiO₂ is one promising support for enhancing hydrogen evolution reaction (HER). Herein, oxygen vacancies enriched black TiO₂ supported sub-nanometer Pt clusters (Pt/TiO₂ -O_V ) with metal support interactions is designed through solvent-free microwave and following low-temperature electroless approach for the first time. High-temperature and strong reductants are not required and then can avoid the aggregation of decorated Pt species. Experimental and theoretical calculation verify that the created oxygen vacancies and Pt clusters exhibit synergistic effects for optimizing the reaction kinetics. Based on it, Pt/TiO₂ -O_V presents remarkable electrocatalytic performance with 18 mV to achieve 10 mA cm^-2 coupled with small Tafel slope of 12 mV dec^-1 . This work provides quick synthetic strategy for preparing black titanium dioxide based nanomaterials.

One Stone, Two Birds: A Peptide-Au(I) Infinite Coordination Supermolecule for the Confederate Physical and Biological Radiosensitization in Cancer Radiation Therapy

Over half of cancer patients are subjected to radiotherapy, but owing to the deficient amount of reactive oxygen radicals (ROS) and DNA double-strand breaks (DSBs), a fair number of them suffer from radiotherapy resistance and the subsequent short-term survival opportunity. To overcome it, many successes have been achieved in radiosensitizer discovery using physical strategy and/or biological strategy, but significant challenges remain regarding developing clinically translational radiosensitizers. Herein, a peptide-Au(I) infinite coordination supermolecule termed PAICS is developed that combined both physical and biological radiosensitization and possessed pharmaceutical characteristics including adequate circulatory stability, controllable drug release, tumor-prioritized accumulation, and the favorable body eliminability. As expected, monovalent gold ion endowed this supermolecule with high X-ray absorption and the subsequent radiosensitization. Furthermore, a peptide targeting CRM1, is assembled into the supermolecule, which successfully activates p53 and apoptosis pathway, thereby further sensitizing radiotherapy. As a result, PAICS showed superior ability for radiotherapy sensitization in vivo and maintained a favorable safety profile. Thus, the PAICS reported here will offer a feasible solution to simultaneously overcome both the pharmaceutical obstacles of physical and biological radiosensitizers and will enable the development of a class of nanomedicines for tumor radiotherapy sensitization.

18F-FDG PET and a classifier algorithm reveal a characteristic glucose metabolic pattern in adult patients with moyamoya disease and vascular cognitive impairment

Vascular cognitive impairment (VCI) is a critical issue in moyamoya disease (MMD). However, the glucose metabolic pattern in these patients is still unknown. This study aimed to identify the metabolic signature of cognitive impairment in patients with MMD using ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography (¹⁸F-FDG PET) and establish a classifier to identify VCI in patients with MMD. One hundred fifty-two patients with MMD who underwent brain ¹⁸F-FDG PET scans before surgery were enrolled and classified into nonvascular cognitive impairment (non-VCI, n = 52) and vascular cognitive impairment (VCI, n = 100) groups according to neuropsychological test results. Additionally, thirty-three health controls (HCs) were also enrolled. Compared to HCs, patients in the VCI group exhibited extensive hypometabolism in the bilateral frontal and cingulate regions and hypermetabolism in the bilateral cerebellum, while patients in the non-VCI group showed hypermetabolism only in the cerebellum and slight hypometabolism in the frontal and temporal regions. In addition, we found that the patients in the VCI group showed hypometabolism mainly in the left basal ganglia compared to those in the non-VCI group. The sparse representation-based classifier algorithm taking the SUVr of 116 Anatomical Automatic Labeling (AAL) areas as features distinguished patients in the VCI and non-VCI groups with an accuracy of 82.4%. This study demonstrated a characteristic metabolic pattern that can distinguish patients with MMD without VCI from those with VCI, namely, hypometabolic lesions in the left hemisphere played a more important role in cognitive decline in patients with MMD.

Laparoscopic radical resection for rectal cancer in a patient with uncorrected truncus arteriosus type IV: A case report

Persistent truncus arteriosus is a rare congenital heart malformation which if not corrected, results in the death of about 50% of the patients, while fewer than 20% of the patients survive the first year of life. Here, we report the successful anesthetic management of an adult patient with uncorrected truncus arteriosus who presented for the laparoscopic radical resection of rectal cancer.

Hierarchical Porous NiFe-P@NC as Efficient Electrocatalyst for Alkaline Hydrogen Production and Seawater Electrolysis at Large-Current-density

Economical, efficient and stable transition-metal electrocatalysts are considered as great candidatures for replacing noble-metal materials for alkaline hydrogen production. Hence, corrosion engineering and mild phosphating processes is adopted to construct...

Long-term outcome of a tailored embolization strategy with Gamma Knife radiosurgery for high-grade brain arteriovenous malformations: a single-center experience

OBJECTIVE

The safety and efficacy of embolization with Gamma Knife radiosurgery (GKRS) for high-grade brain arteriovenous malformations (bAVMs) are uncertain. The purpose of this study was to elucidate the long-term outcome of a tailored embolization strategy with GKRS and identify the independent factors associated with bAVM obliteration.

METHODS

Between January 2014 and January 2017, a consecutive cohort of 159 patients with high-grade bAVMs who underwent embolization with GKRS was enrolled in this prospective single-center cohort study. All patients received a tailored embolization strategy with GKRS. The primary outcome was defined as bAVM obliteration. Secondary outcomes were neurological function and complications.

RESULTS

After a mean follow-up of 40.4 months, 5 patients were lost to follow-up. One hundred eighteen of the remaining 154 patients had favorable neurological outcomes with complete bAVM obliteration. A decrease in bAVM nidus size was observed in 36 patients. Five patients developed intracranial hemorrhage during the latency period, and 2 patients died. The Kaplan-Meier analysis showed that the obliteration rate increased each year and reached the peak point at approximately 3 years. The multivariate Cox regression analysis of factors affecting bAVM obliteration revealed that postembolization bAVM volume < 10 cm3 (p = 0.02), supratentorial location (p < 0.01), staged embolization prior to GKRS (p < 0.01), and mean Spetzler-Martin (SM) grade (p < 0.01) were independent factors associated with a high obliteration rate.

CONCLUSIONS

These data suggested that high-grade bAVMs treated using a tailored embolization strategy with GKRS were associated with a favorable clinical outcome and obliteration rate. Postembolization bAVM volume < 10 cm3, supratentorial location, staged embolization prior to GKRS, and low mean SM grade were associated with a high obliteration rate.

Modified exosomal SIRPα variants alleviate white matter injury after intracerebral hemorrhage via microglia/macrophages

Background

Despite limited efficiency, modulation of microglia/macrophages has shown to attenuate neuroinflammation after intracerebral hemorrhage (ICH). In this context, we evaluated the efficacy of modified exosomal signal regulatory protein α (SIRPα) variants (SIRPα-v Exos) in microglia/macrophages and neuroinflammation-associated white matter injury after ICH.

Methods

SIRPα-v Exos were engineered to block CD47-SIRPα interactions. After obtaining SIRPα-v Exos from lentivirus-infected mesenchymal stem cells, C57BL/6 mice suffering from ICH underwent consecutive intravenous injections of SIRPα-v Exos (6 mg/kg) for 14 days. Afterwards, the volume of hematoma and neurological dysfunctions were assessed in mice continuously until 35 days after ICH. In addition, demyelination, electrophysiology and neuroinflammation were evaluated. Furthermore, the mechanisms of microglial regulation by SIRPα-v Exos were investigated in vitro under coculture conditions.

Results

The results demonstrated that the clearance of hematoma in mice suffering from ICH was accelerated after SIRPα-v Exo treatment. SIRPα-v Exos improved long-term neurological dysfunction by ameliorating white matter injury. In addition, SIRPα-v Exos recruited regulatory T cells (Tregs) to promote M2 polarization of microglia/macrophages in the peri-hematoma tissue. In vitro experiments further showed that SIRPα-v Exos regulated primary microglia in a direct and indirect manner in synergy with Tregs.

Conclusion

Our studies revealed that SIRPα-v Exos could accelerate the clearance of hematoma and ameliorate secondary white matter injury after ICH through regulation of microglia/macrophages. SIRPα-v Exos may become a promising treatment for ICH in clinical practice.

Graphical Abstract

Metallic-Bonded Pt-Co for Atomically Dispersed Pt in the Co4N Matrix as an Efficient Electrocatalyst for Hydrogen Generation

Exploiting highly efficient electrocatalysts toward hydrogen evolution reaction (HER) has a significant role in the mass production of hydrogen energy through water electrolysis. Herein, ginkgo leaf-like Co₄N coupled with trace Pt with metallic bond Pt-Co on nickel foam via solvothermal, tannic acid treated, and nitridation procedures for HER (T-Pt-Co₄N) is developed. It only requires low overpotentials of 31 mV and 27 mV to achieve 10 mA cm^-2 in alkaline and neutral electrolytes, respectively, surpassing the benchmark Pt/C and previously reported values. Moreover, it presents excellent long-term stability in the studied media and also can drive overall water splitting under the assistance of sustainable energies. The specific nanostructure favors the acceleration of the electrocatalytic process by exposing abundant active sites and providing numerous mass transport channels during the catalytic process. Moreover, experimental and theoretical calculation demonstrate that the atomic Pt coordinates with Co to form metallic bond Pt-Co also act as crucial role to boost the electrocatalytic performance by optimizing the reaction kinetics for HER.

Involvement of the gut-brain axis in vascular depression via tryptophan metabolism: A benefit of short chain fatty acids

Cerebral hemodynamic dysfunction and hypoperfusion have been found to underlie vascular depression, but whether the gut-brain axis is involved remains unknown. In this study, a rat model of bilateral common carotid artery occlusion (BCCAO) was adopted to mimic chronic cerebral hypoperfusion. A reduced sucrose preference ratio, increased immobility time in the tail suspension test and forced swim test, and compromised gut homeostasis were found. A promoted conversion of tryptophan (Trp) into kynurenine (Kyn) instead of 5-hydroxytryptamine (5-HT) was observed in the hippocampus and gut of BCCAO rats. Meanwhile, 16S ribosomal RNA gene sequencing suggested a compromised profile of the gut SCFA-producing microbiome, with a decreased serum level of SCFAs revealed by targeted metabolomics analysis. With SCFA supplementation, BCCAO rats exhibited ameliorated depressive-like behaviors and improved gut dysbiosis, compared with the salt-matched BCCAO group. Enzyme-linked immunosorbent assays and quantitative RT-PCR suggested that SCFA supplementation suppressed the conversion of Trp to Kyn and rescued the reduction in 5-HT levels in the hippocampus and gut. In addition to inhibiting the upregulation of inflammatory cytokines, SCFA supplementation ameliorated the activated oxidative stress and reduced the number of microglia and the expression of its proinflammatory markers in the hippocampus post BCCAO. In conclusion, our data suggested the participation of the gut-brain axis in vascular depression, shedding light on the neuroprotective potential of treatment with gut-derived SCFAs.

The microbiota-gut-brain axis participates in chronic cerebral hypoperfusion by disrupting the metabolism of short-chain fatty acids

BACKGROUND

Chronic cerebral hypoperfusion (CCH) underlies secondary brain injury following certain metabolic disorders and central nervous system (CNS) diseases. Dysregulation of the microbiota-gut-brain axis can exacerbate various CNS disorders through aberrantly expressed metabolites such as short-chain fatty acids (SCFAs). Yet, its relationship with CCH remains to be demonstrated. And if so, it is of interest to explore whether restoring gut microbiota to maintain SCFA metabolism could protect against CCH.

RESULTS

Rats subjected to bilateral common carotid artery occlusion (BCCAO) as a model of CCH exhibited cognitive impairment, depressive-like behaviors, decreased gut motility, and compromised gut barrier functions. The 16S ribosomal RNA gene sequencing revealed an abnormal gut microbiota profile and decreased relative abundance of some representative SCFA producers, with the decreased hippocampal SCFAs as the further evidence. Using fecal microbiota transplantation (FMT), rats recolonized with a balanced gut microbiome acquired a higher level of hippocampal SCFAs, as well as decreased neuroinflammation when exposed to lipopolysaccharide. Healthy FMT promoted gut motility and gut barrier functions, and improved cognitive decline and depressive-like behaviors by inhibiting hippocampal neuronal apoptosis in BCCAO rats. Long-term SCFA supplementation further confirmed its neuroprotective effect in terms of relieving inflammatory response and hippocampal neuronal apoptosis following BCCAO.

CONCLUSION

Our results demonstrate that modulating the gut microbiome via FMT can ameliorate BCCAO-induced gut dysbiosis, cognitive decline, and depressive-like behaviors, possibly by enhancing the relative abundance of SCFA-producing floras and subsequently increasing SCFA levels. Video abstract.

An in situ generated 3D porous nanostructure on 2D nanosheets to boost the oxygen evolution reaction for water-splitting

Efficient oxygen evolution reaction (OER) electrocatalysts can accelerate the reaction kinetics of water-splitting for large-scale hydrogen generation. In this work, 2D nanosheets decorated with a 3D porous nanostructure, including Fe, Co and Ni elements, are developed via anodic cyclic voltammetry scanning (ACVs) in the presence of sodium sulfide (FeCoNi-NS-ACVs). The formed 2D nanosheets provide metal ions during ACVs to generate a 3D porous structure and also construct a hierarchical morphology to favor the transport of the electrolyte and release of produced gas bubbles. What's more, the developed FeCoNi-NS-ACVs possesses superhydrophilic and excellent electroconductivity properties. Benefiting from the above merits, FeCoNi-NS-ACVs exhibits excellent electrocatalytic performances for the OER with low overpotentials of 170 mV and 198 mV to drive 50 mA cm^-2 and 100 mA cm^-2, respectively, with a small Tafel slope of 64 mV dec^-1 and remarkable durability over 50 h. Moreover, the FeCoNi-NS-ACVs also exhibits outstanding electrocatalytic activity and stability toward overall water-splitting.

[Study of vital inflamed pulp therapy in immature permanent teeth with irreversible pulpitis and apical periodontitis]

To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (F=18.80, P<0.001) and root length (F=4.64, P=0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.

Phosphorous Doped Two-dimensional CoFe2O4 Nanobelt Decorated with Ru Nanoclusters and Co-Fe Hydroxide as Efficient Electrocatalysts Toward Hydrogen Generation

Developing efficient and durable hydrogen evolution reaction (HER) electrocatalysts has attracted considerable concerns for large-scale hydrogen generation. In this work, phosphorous doped two-dimensional (2D) CoFe2O4 nanobelt decorated with Ru and...

Ru nanoclusters confined on α/β cobalt hydroxide nanosheets as efficient bifunctional oxygen electrocatalysts for Zn–air batteries

Ru nanoclusters anchored on the α/β-Co(OH)2 nanostructures could yield bifunctional catalysts, which displayed high power density and long-cycling performance when used as the air electrode in practical Zn-air battery.

Integrated analysis of whole genome and transcriptome sequencing reveals a frameshift mutation associated with recessive embryonic lethality in Holstein cattle

Embryo loss is an important factor affecting fertility in dairy production. HH2 was identified as a haplotype on chromosome 1 associated with embryonic lethality in Holstein cattle. In the current study, both short- and long-read WGS was performed on four carriers and four non-carriers of HH2 to screen for variants in concordance with HH2 haplotype status. Sequence variation analysis revealed five putative functional variants of protein-coding genes, including a frameshift mutation (g.107172616delT) in intraflagellar transport protein 80 (IFT80) gene. Transcriptome analysis of whole blood indicated that no gene exhibited significantly differential expression or allele-specific expression between carriers and non-carriers in the candidate region. This evidence points to g.107172616delT as the highest priority causative mutation for HH2. Protein prediction reveals that the frameshift mutation results in a premature stop codon to reduce the peptide chain from 760 to 383 amino acids and greatly alters the structure and function of IFT80 protein. Our results demonstrate that the use of a combination of multiple high-throughput sequencing technologies is an efficient strategy to screen for the candidate causative mutations responsible for Mendelian traits, including genetic disorders.

Genetic parameters and weighted single-step genome-wide association study for supernumerary teats in Holstein cattle

Supernumerary teats (SNT) are a common epidermal abnormality of udders in mammals. The SNT negatively affect machine milking ability, udder health, and animal welfare and sometimes act as reservoirs for undesirable bacteria, resulting in economic losses on calves and lactating cows due to the cost of SNT removal surgery, early culling, and low milk yield. This study aimed to analyze the incidence and genetic parameter of SNT and detect SNT-related genes in Chinese Holstein cattle. In this study, the incidence of SNT was recorded in 4,670 Chinese Holstein cattle (born between 2008 and 2017) from 2 farms, including 734 genotyped cows with 114,485 SNPs. The SNT had a total frequency of 9.8% and estimated heritability of 0.22 (SE = 0.07), which were obtained using a threshold model in the studied Chinese Holstein population. Furthermore, we calculated approximate genetic correlations between SNT and the following indicator traits: 12 milk production, 28 body conformation, 5 fertility and reproduction, 5 health, and 9 longevity. Generally, the estimated correlations, such as 305-d milk yield for third parity (-0.55; SE = 0.02) and age at first calving in heifer (0.19; SE = 0.03), were low to moderate. A single-step GWAS was implemented, and 10 genes associated with SNT located in BTA4 were identified. The region (112.70-112.90 Mb) on BTA4 showed the highest genetic variance for SNT. The quantitative trait loci on BTA4 was mapped into the RARRES2 gene, which was previously shown to affect adipogenesis and hormone secretion. The WIF1 gene, which was located in BTA5, was also considered as a candidate gene for SNT. Overall, these findings provide useful information for breeders who are interested in reducing SNT.

Progression in Moyamoya Disease: Clinical Feature, Neuroimaging Evaluation and Treatment

Moyamoya disease (MMD) is a chronic cerebrovascular disease characterized by progressive stenosis of the arteries of the circle of Willis, with the formation of collateral vascular network at the base of the brain. Its clinical manifestations are complicated. Numerous studies have attempted to clarify the clinical features of MMD, including its epidemiology, genetic characteristics, and pathophysiology. With the development of neuroimaging techniques, various neuroimaging modalities with different advantages have deepened the understanding of MMD in terms of structural, functional, spatial, and temporal dimensions. At present, the main treatment for MMD focuses on neurological protection, cerebral blood flow reconstruction, and neurological rehabilitation, such as pharmacological treatment, surgical revascularization, and cognitive rehabilitation. In this review, we discuss recent progress in understanding the clinical features, in the neuroimaging evaluation and treatment of MMD.

Automated Quantitative Analysis of Blood Flow in Extracranial-Intracranial Arterial Bypass Based on Indocyanine Green Angiography

Microvascular imaging based on indocyanine green is an important tool for surgeons who carry out extracranial–intracranial arterial bypass surgery. In terms of blood perfusion, indocyanine green images contain abundant information, which cannot be effectively interpreted by humans or currently available commercial software. In this paper, an automatic processing framework for perfusion assessments based on indocyanine green videos is proposed and consists of three stages, namely, vessel segmentation based on the UNet deep neural network, preoperative and postoperative image registrations based on scale-invariant transform features, and blood flow evaluation based on the Horn–Schunck optical flow method. This automatic processing flow can reveal the blood flow direction and intensity curve of any vessel, as well as the blood perfusion changes before and after an operation. Commercial software embedded in a microscope is used as a reference to evaluate the effectiveness of the algorithm in this study. A total of 120 patients from multiple centers were sampled for the study. For blood vessel segmentation, a Dice coefficient of 0.80 and a Jaccard coefficient of 0.73 were obtained. For image registration, the success rate was 81%. In preoperative and postoperative video processing, the coincidence rates between the automatic processing method and commercial software were 89 and 87%, respectively. The proposed framework not only achieves blood perfusion analysis similar to that of commercial software but also automatically detects and matches blood vessels before and after an operation, thus quantifying the flow direction and enabling surgeons to intuitively evaluate the perfusion changes caused by bypass surgery.

POS0664 A MULTICENTER RANDOMIZED STUDY IN RHEUMATOID ARTHRITIS TO COMPARE IGURATIMOD, METHOTREXATE, OR COMBINATION: 52 WEEK EFFICACY AND SAFETY RESULTS OF THE SMILE TRIAL

Background:

Iguratimod (IGU) has demonstrated efficacy and safety for active rheumatoid arthritis (RA) patients in double-blind clinical trials in China and Japan as a new disease-modifying anti-rheumatic drug (DMARD). There are no studies evaluating the radiographic progression of structural joint damage of IGU for the treatment of RA using the mTSS as the primary endpoint.

Objectives:

Our study was to evaluate the efficacy and safety of IGU monotherapy and IGU combined methotrexate (MTX) compared with MTX monotherapy, including the inhibitory effects of joint destruction.

Methods:

This randomized, double-blind, parallel-controlled, multicenter study in patients with active RA who have not previously used MTX and biological DMARDs (bDMARDs) (ClinicalTrials.gov Identifier NCT01548001) was carried out in China. Patients were randomized 1:1:1 to receive IGU 25 mg twice a day (bid), MTX 10mg once a week(qw) for the first 4 weeks and 15 mg once a week(qw) for week 5 to 52, or IGU combined MTX (IGU+MTX) for 52 weeks. The primary endpoints were to assess and compare American College of Rheumatology 20% (ACR20) response and the change of modified total Sharp scoring (mTSS) score over 52 weeks (Intention-to-treat, ITT analysis). The non-inferiority test was used to analyze the difference of ACR20 response at 52 weeks between the IGU monotherapy and the MTX monotherapy arms, and the non-inferiority limit value was 10%. The difference test was used for the comparison between the IGU+MTX and MTX monotherapy arms. Two-way ANOVA was used to analyze the difference of the changes of mTSS score of each arm compared with baseline value (0 week).

Results:

A total of 895 patients were randomized to IGU 25mg bid (n =297), MTX 10-15mg qw(n=293), and IGU+MTX (n=305). Baseline characteristics were comparable between the arms (Table 1).

Table 1.

Demographic and Other Baseline Characteristics (SAS)

IGUMTXIGU+MTXNumber of Subjects297293305Age, mean (SD) years46.87(10.67)47.63(10.70)48.37(10.69)Female/male, %77.44/22.5679.18/20.8278.03/21.97Duration of RA, mean(SD) years11.67±7.1611.60±7.9811.67±7.27CRP, mean(SD) mg/L222.32±35.4720.67±26.6119.74±31.38Tender joint count, mean (SD)14.59±9.1614.83±9.3014.93±9.88Swollen joint count, mean (SD)9.81±6.639.73±7.209.51±6.22DAS28-CRP, mean (SD)5.084±0.9945.102±0.9795.103±0.956HAQ score, mean (SD)15.82±11.2515.24±10.9316.06±10.92

SAS: Safety Analysis Set; CRP: C-reactive protein;

DAS28: disease activity score; HAQ: Health Assessment Questionnaire

The study met its primary endpoints. More concretely, IGU monotherapy and IGU+MTX were found to be superior to MTX at week 52 with a higher ACR20 response of 77.44%(230/297, P=0.0019) and 77.05%(235/305, P=0.0028) versus 65.87%(193/293) (fig 1). As shown in fig 1, the structural remission (ΔmTSS≤0.5) was statistically significant for IGU monotherapy (57.4%, P=0.0308) but not for IGU+MTX arm (55%) versus MTX monotherapy (47.8%).

Overall incidence of the adverse events (AEs) leading to study discontinuation were reported in 13.8% (41/297) in IGU monotherapy arm, 11.26% (33/293) in MTX monotherapy arm and 11.51% (35/305) patients in IGU+MTX arm. The incidence of adverse drug reactions (ADR) leading to study discontinuation were 11.45% (34/297), 8.53% (25/293) and 9.21% (28/305), respectively. There was no one death and no significant difference in all the safety indicators among the three arms.

Conclusion:

Iguratimod alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX for patients with active RA who have not previously used MTX bDMARDs.

Disclosure of Interests:

None declared

Temporal-Spatial Feature Extraction of DSA Video and Its Application in AVM Diagnosis

Objectives: Brain arteriovenous malformation (AVM) is one of the most common causes of intracranial hemorrhage in young adults, and its expeditious diagnosis on digital subtraction angiography (DSA) is essential for clinical decision-making. This paper firstly proposed a deep learning network to extract vascular time-domain features from DSA videos. Then, the temporal features were combined with spatial radiomics features to build an AVM-assisted diagnosis model. Materials and method: Anteroposterior position (AP) DSA videos from 305 patients, 153 normal and 152 with AVM, were analyzed. A deep learning network based on Faster-RCNN was proposed to track important vascular features in DSA. Then the appearance order of important vascular structures was quantified as the temporal features. The structure distribution and morphological features of vessels were quantified as 1,750 radiomics features. Temporal features and radiomics features were fused in a classifier based on sparse representation and support vector machine. An AVM diagnosis and grading system that combined the temporal and spatial radiomics features of DSA was finally proposed. Accuracy (ACC), sensitivity (SENS), specificity (SPEC), and area under the receiver operating characteristic curve (AUC) were calculated to evaluate the performance of the radiomics model. Results: For cerebrovascular structure detection, the average precision (AP) was 0.922, 0.991, 0.769, 0.899, and 0.929 for internal carotid artery, Willis circle, vessels, large veins, and venous sinuses, respectively. The mean average precision (mAP) of five time phases was 0.902. For AVM diagnosis, the models based on temporal features, radiomics features, and combined features achieved AUC of 0.916, 0.918, and 0.942, respectively. In the AVM grading task, the proposed combined model also achieved AUC of 0.871 in the independent testing set. Conclusion: DSA videos provide rich temporal and spatial distribution characteristics of cerebral blood vessels. Clinicians often interpret these features based on subjective experience. This paper proposes a scheme based on deep learning and traditional machine learning, which effectively integrates the complex spatiotemporal features in DSA, and verifies the value of this scheme in the diagnosis of AVM.

[Treatment of lumbar degenerative diseases with recapping laminoplasty and nerve root canal's decompression preserving the continuity of supraspinous ligament]

Objective: To explore the clinical effect of lumbar discectomy and nerve root canal's enlargement preserving the continuity of supraspinous ligament in the treatment of lumbar degenerative disease. Methods: The data of patients with lumbar degenerative disease who underwent operation from 2016 to 2018 were analyzed retrospectively, and the patients were divided into two groups according to the different operation. The treatment group (17 cases) was treated with recapping laminoplasty, lumbar discectomy and nerve root canal's enlargement, and the control group (28 cases) was treated with total laminectomy, nerve root canal's enlargement, lumbar discectomy, interbody fusion and internal fixation (PLIF). All patients were followed up for 12 to 27 months (mean 17.8 months). Japanese Orthopaedic Association Scores(JOA) and visual analogue scale(VAS) of pain were used to evaluate the clinical effect before and after the operation, lumbar dynamical X-ray and Cobb angle were collecting for imaging evaluation, and the adjacent segment degeneration at the last follow-up was recorded. Results: There was no significant difference in preoperative JOA score, VAS score and Lumbar Cobb angle between the two groups (all P>0.05). The operation time in the treatment group was shorter than that in the control group, and the blood loss during operation in the treatment group was lower than that in the control group, the bed rest time of the treatment group after operation was shorter than that in the control group ((79±14) vs (118±17) min, (151±38) vs (324±70) ml and (3.4±0.7) vs (4.3±1.0) d,respectively; t=-8.508, -10.724, -3.244, all P<0.01). In addition, compared with the control group, the volume of postoperative drainage in the treatment group also decreased significantly (t=-5.637, P<0.01). There was no significant difference in JOA score between the two groups 1 year after the operation (P>0.05), but there was significant difference in VAS score between the two groups, the treatment group was better than the control group (P<0.05). Compared with the control group, the lumbar Cobb angle in the treatment group increased significantly one year after the operation (55.3°±3.2° vs 38.4°±6.2°, t=10.391, P<0.05). During the follow-up, no loosening or fracture of the implants was found in all patients. Conclusion: Treatment of lumbar degenerative diseases with recapping laminoplasty and nerve root canal's decompression preserving the continuity of supraspinous ligament by ultrasound osteotome has the same clinical effect as PLIF. It has the advantages of shortening operation time, less bleeding, better maintenance of lumbar lordosis after operation and reduction of adjacent segment degeneration.