A Case report: Synovial sarcoma of the mediastinum in an 18-year-old teenager

Synovial sarcomas (SSs) are a rare group of malignant tumors originating from pluripotential mesenchymal cells, which commonly occur as the primary tumor in the soft tissues near the articular surface, tendons, and articular synovium. Herein, we report a rare case of mediastinal SS in an 18-year-old teenager who initially presented with cough as the primary symptom. In this case, plain chest CT and contrast-enhanced CT clearly revealed the lesion presenting as a round-like and uneven density mass in the mediastinum with heterogeneous enhancement, which compressed the trachea and invaded the adjacent vessels. Based on the results of immunohistochemistry and fluorescence in situ hybridization (FISH), combined with the differential diagnosis with other types of tumors in the mediastinum on imaging, we were able to diagnose the tumor as an SS located in the mediastinum. Subsequent resection of the lesion coupled with chemotherapy and immunotherapy led to an improvement in the patient's symptoms.

Neuroprotection of low dose carbon monoxide in Parkinson's disease models commensurate with the reduced risk of Parkinson's among smokers

Paradoxically, cigarette smoking is associated with a reduced risk of Parkinson's disease (PD). This led us to hypothesize that carbon monoxide (CO) levels, which are constitutively but modestly elevated in smokers, might contribute to neuroprotection. Using rodent models of PD based on α-synuclein (αSyn) accumulation and oxidative stress, we show that low-dose CO mitigates neurodegeneration and reduces αSyn pathology. Oral CO administration activated signaling cascades mediated by heme oxygenase-1 (HO-1), which have been implicated in limiting oxidative stress, and in promoting αSyn degradation, thereby conferring neuroprotection. Consistent with a neuroprotective effect of smoking, HO-1 levels in cerebrospinal fluid were higher in human smokers compared to nonsmokers. Moreover, in PD brain samples, HO-1 levels were higher in neurons without αSyn pathology. Thus, CO in rodent PD models reduces pathology and increases oxidative stress responses, phenocopying possible protective effects of smoking evident in PD patients. These data highlight the potential for low-dose CO modulated pathways to slow symptom onset and limit pathology in PD patients.

Development of a radiomics-based model to predict occult liver metastases of pancreatic ductal adenocarcinoma: a multicenter study

BACKGROUND

Undetectable occult liver metastases block the long-term survival of pancreatic ductal adenocarcinoma (PDAC). This study aimed to develop a radiomics-based model to predict occult liver metastases and assess its prognostic capacity for survival.

MATERIALS AND METHODS

Patients who underwent surgical resection and were pathologically proven with PDAC were recruited retrospectively from five tertiary hospitals between January 2015 and December 2020. Radiomics features were extracted from tumors, and the radiomics-based model was developed in the training cohort using LASSO-logistic regression. The model's performance was assessed in the internal and external validation cohorts using the area under the receiver operating curve (AUC). Subsequently, the association of the model's risk stratification with progression-free survival (PFS) and overall survival (OS) was then statistically examined using Cox regression analysis and the log-rank test.

RESULTS

A total of 438 patients [mean (SD) age, 62.0 (10.0) years; 255 (58.2%) male] were divided into the training cohort ( n =235), internal validation cohort ( n =100), and external validation cohort ( n =103). The radiomics-based model yielded an AUC of 0.73 (95% CI: 0.66-0.80), 0.72 (95% CI: 0.62-0.80), and 0.71 (95% CI: 0.61-0.80) in the training, internal validation, and external validation cohorts, respectively, which were higher than the preoperative clinical model. The model's risk stratification was an independent predictor of PFS (all P <0.05) and OS (all P <0.05). Furthermore, patients in the high-risk group stratified by the model consistently had a significantly shorter PFS and OS at each TNM stage (all P <0.05).

CONCLUSION

The proposed radiomics-based model provided a promising tool to predict occult liver metastases and had a great significance in prognosis.

Synergistic effects of trace sulfadiazine and corrosion scales on disinfection by-product formation in bulk water of cast iron pipe

The effects of trace sulfadiazine (SDZ) and cast-iron corrosion scales on the disinfection by-product (DBP) formation in drinking water distribution systems (DWDSs) were investigated. The results show that under the synergistic effect of trace SDZ (10 μg/L) and magnetite (Fe3O4), higher DBP concentration occurred in the bulk water with the transmission and distribution of the drinking water. Microbial metabolism-related substances, one of the important DBP precursors, increased under the SDZ/Fe3O4 condition. It was found that Fe3O4 induced a faster microbial extracellular electron transport (EET) pathway, resulting in a higher microbial regrowth activity. On the other hand, the rate of chlorine consumption was quite high, and the enhanced microbial EET based on Fe3O4 eliminated the need for microorganisms to secrete excessive extracellular polymeric substances (EPS). More importantly, EPS could be continuously secreted due to the higher microbial activity. Finally, high reactivity between EPS and chlorine disinfectant resulted in the continuous formation of DBPs, higher chlorine consumption, and lower EPS content. Therefore, more attention should be paid to the trace antibiotics polluted water sources and cast-iron corrosion scale composition in the future. This study reveals the synergistic effects of trace antibiotics and corrosion scales on the DBP formation in DWDSs, which has important theoretical significance for the DBP control of tap water.

Effect of micropollutants on disinfection byproducts and antibiotic resistance genes in drinking water in the process of biological activated carbon treatment

The biofilm stress response of biological activated carbon (BAC) was investigated under prolonged exposure to sulfadiazine and 2,4-Dichlorophenoxyacetic acid, simulating complex emerging organic contaminants (EOCs) that are mainly involved in the formation of nitrogenous disinfection byproducts (N-DBPs) and antibiotic resistance genes (ARGs). Under trace complex EOCs condition (2 µg/L), N-DBP precursors and abundance of ARGs increased significantly in BAC effluent. The total formation potential of haloacetonitriles (HANs) and halonitromethanes (HNMs) was 751.47 ± 2.98 ng/L, which was much higher than the control group (440.67 ± 13.38 ng/L without EOCs). Similarly, the relative abundance of ARGs was more than twice that in the control group. The complex EOCs induce excessive extracellular polymeric substance secretion (EPS), thereby causing more N-DBP precursors and stronger horizontal gene transfer. Metagenome analysis revealed that functional amino acid and protein biosynthesis genes were overexpressed compared to the control group, causing more EPS to be secreted into the external environment. Complex EOCs promote Cobetia, Clostridium, and Streptomyces dominance, contributing to the production of N-DBP precursors and ARGs. For the first time, in addition to the direct hazards of the EOCs, this study successfully revealed the indirect water quality risks of complex EOCs from the microbial stress response during BAC treatment. Synergistic regulation of EOCs and microorganisms is important for tap water security.

Low Dose Iodinated Contrast Material and Radiation for Virtual Monochromatic Imaging in Craniocervical Dual-Layer Spectral Detector Computed Tomography Angiography: A Prospective and Randomized Study

RATIONALE AND OBJECTIVES

To investigate the feasibility of virtual monochromatic imaging (VMI) of dual-layer spectral detector computed tomography (SDCT) to reduce iodinated contrast material (CM) and radiation dose in craniocervical computed tomography angiography (CTA).

MATERIALS AND METHODS

A total of 280 consecutively selected patients performed craniocervical CTA with SDCT were prospectively selected and randomly divided into four groups (A, DoseRight index (DRI) 31, iopromide 370mgI/mL, volume 0.8 mL/kg; B, DRI 26, iopromide 370mgI/mL, volume 0.4 mL/kg; C, DRI 26, ioversol 320mgI/mL, volume 0.4 mL/kg; D, DRI 26, iohexol 300mgI/mL, volume 0.4 mL/kg). 50-70 kiloelectron volts (keV) VMIs in group B were reconstructed and compared to group A to select the optimal keV. Then, the optimal keV in groups B, C and D was reconstructed and compared. Objective image quality, including vascular attenuation, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), was evaluated. Subjective image quality was assessed using a 5-point Likert scale. In addition, the effective dose (ED), iodine load and iodine delivery rate (IDR) were compared between groups A and D.

RESULTS

55 keV VMI was the optimal VMI in group B. The objective and subjective image quality of 55 keV VMI in group B were equal to or better than those of the CI in group A. The SNR, CNR and subjective image quality in group D were similar to those in group B (P > 0.05). The ED, iodine load and IDR of group D were reduced by 44%, 59% and 19%, respectively, when compared to those of group A.

CONCLUSION

Low dose iodinated CM and radiation for 55 keV VMI in craniocervical CTA using SDCT could still provide equivalent or better image quality than the conventional scanning protocol.

Purification mechanism of microbial metabolism in kitchen-oil wastewater enhanced by cationic vacancies on γ-Al2O3

The use of catalyst materials to mediate the enhancement of microbial degradation in wastewater is a new economic and energy saving breakthrough in water treatment technology. In this study, γ-Al2O3, which is commonly used as catalyst/carrier, is used as biological filler to treat kitchen-oil wastewater with low biodegradability, and the COD removal rate is about 50 %. It is found that the complexation of cationic vacancies on Al2O3 surface with extracellular polymeric substance (EPS) secreted by microorganisms in wastewater lead to the polarization of electron distribution on biofilm. The efficient degrading bacteria are enriched on reaction interface and obtain electrons to maintain electron dynamic balance by enhancing the transmembrane metabolism of pollutants. The aluminum vacancies on Al2O3 surface accelerate the microbial degradation of pollutants. The cationic vacancies in the structure of catalyst accelerate the acquisition of exogenous electrons by microorganisms without the addition of external energy, which provides a new idea for catalytic fillers to enhance wastewater degradation.

Effects of oleanolic acid on acute liver injury triggered by lipopolysaccharide in broiler chickens

1. Infectious injury caused by lipopolysaccharide (LPS), a metabolite of gram-negative bacteria, can induce stress responses in animals and is a significant cause of morbidity and mortality in young birds. The purpose of this study was to investigate the effects of dietary supplementation with oleanolic acid (OA) on acute liver injury in broiler chickens challenged with LPS.2. In total, 120 broiler chickens were randomly divided into six groups and fed a basal diet containing 0, 50, 100, or 200 mg/kg OA or 100 mg/kg aureomycin. On d 15, broiler chickens were injected with either LPS or an equivalent volume of normal saline. Six hours after LPS injection, two broiler chicks were randomly selected for sampling in each replicate.3. The results indicated that dietary aureomycin was ineffective in alleviating LSP-associated liver injury, but protected broiler chickens from LPS-induced liver damage. This promoted a significant reduction in the levels of malondialdehyde and an increase in the levels of superoxide dismutase in liver. In addition, OA was found to cause significant reductions in the relative expression of IL-1β, IL-6, and TNF-α in broiler liver tissues, whereas the relative expression of IL-10 was significantly increased.4. In conclusion, oleanolic acid can alleviate oxidative stress and injury in the livers of broiler chickens induced by lipopolysaccharide. Consequently, oleanolic acid has potential utility as a novel anti-inflammatory and antioxidant feed additive.

Nomogram Based on Dual-Layer Spectral Detector CTA Parameter for the Prediction of Infarct Core in Patients with Acute Ischemic Stroke

(1) Background: Acute ischemic stroke (AIS) is time-sensitive. The accurate identification of the infarct core and penumbra areas in AIS patients is an important basis for formulating treatment plans, and is the key to dual-layer spectral detector computed tomography angiography (DLCTA), a safer and more accurate diagnostic method for AIS that will replace computed tomography perfusion (CTP) in the future. Thus, this study aimed to investigate the value of DLCTA in differentiating infarct core from penumbra in patients with AIS to establish a nomogram combined with spectral computed tomography (CT) parameters for predicting the infarct core and performing multi-angle evaluation. (2) Methods: Data for 102 patients with AIS were retrospectively collected. All patients underwent DLCTA and CTP. The patients were divided into the non-infarct core group and the infarct core group, using CTP as the reference. Multivariate logistic regression analysis was used to screen predictors related to the infarct core and establish a nomogram model. The receiver operating characteristic (ROC) curve, the calibration curve, and decision curve analysis (DCA) were used to evaluate the predictive efficacy, accuracy, and clinical practicability of the model, respectively. (3) Results: Multivariate logistic analysis identified three independent predictors: iodine density (OR: 0.022, 95% CI: 0.003-0.170, p < 0.001), hypertension (OR: 7.179, 95% CI: 1.766-29.186, p = 0.006), and triglycerides (OR: 0.255, 95% CI: 0.109-0.594, p = 0.002). The AUC-ROC of the nomogram was 0.913. Calibration was good. Decision curve analysis was clinically useful. (4) Conclusions: The spectral CT parameters, specifically iodine density values, effectively differentiate between the infarct core and penumbra areas in patients with AIS. The nomogram, based on iodine density values, showed strong predictive power, discrimination, and clinical utility to accurately predict infarct core in AIS patients.

Synergetic effects of catalyst-surface dual-electric centers and microbes for efficient removal of ciprofloxacin in water

Antibiotics and antibiotic resistance genes (ARGs) are still a problem in biological treatment. Herein, we propose a synergetic strategy between microbes and dual-electric centers catalysts (CCN/Cu-Al2O3/ceramsite) for Ciprofloxacin (CIP)-contained (5 mg/L) water treatment in an up-flow biological filter. CIP was cleaved into small molecules by the catalyst, bringing a 57.6% removal and reducing 10.5% ARG. The characterization results verified that a Cu-π electrostatic force occurs on the catalyst surface, forming electron-rich areas around Cu and electron-poor areas at the carbon-doped g-C3N4 (CCN) aromatic ring. Thus, the electrons of adsorbed CIP were delocalized and then captured by the adsorbed extracellular polymeric substance at the electron-rich areas. Therefore, the synergetic process weakened the stress of CIP on bacteria and reduced ARG accumulation. It also enriched more electro-active bacteria on the surface of CCN/Cu-Al2O3/ceramsite, promoting the expression of extracellular electron transfer-related genes and reconstructing the energy metabolism mode. This result provides an opportunity for refractory antibiotic treatment in the biological process.

[Analysis on the secondary attack rates of SARS-CoV-2 Omicron variant and the associated factors]

Objective: To evaluate the secondary attack rates of the SARS-CoV-2 Omicron variant and the associated factors. Methods: A total of 328 primary cases and 40 146 close contacts of the SARS-CoV-2 Omicron variant routinely detected in local areas of Jiangsu Province from February to April 2022 were selected in this study, and those with positive nucleic acid test results during 7 days of centralized isolation medical observation were defined as secondary cases. The demographic information and clinical characteristics were collected, and the secondary attack rate (SAR) and the associated factors were analyzed by using a multivariate logistic regression model. Results: A total of 1 285 secondary cases of close contacts were reported from 328 primary cases, with a SAR of 3.2% (95%CI: 3.0%-3.4%). Among the 328 primary cases, males accounted for 61.9% (203 cases), with the median age (Q1, Q3) of 38.5 (27, 51) years old. Among the 1 285 secondary cases, males accounted for 59.1% (759 cases), with the median age (Q1, Q3) of 34 (17, 52) years old. The multivariate logistic regression model showed that the higher SAR was observed in the primary male cases (OR=1.632, 95%CI: 1.418-1.877), younger than 20 years old (OR=1.766, 95%CI: 1.506-2.072),≥60 years old (OR=1.869, 95%CI: 1.476-2.365), infected with the BA.2 strain branch (OR=2.906, 95%CI: 2.388-3.537), the confirmed common cases (OR=2.572, 95%CI: 2.036-3.249), and confirmed mild cases (OR=1.717, 95%CI: 1.486-1.985). Meanwhile, the higher SAR was observed in the close contacts younger than 20 years old (OR=2.604, 95%CI: 2.250-3.015),≥60 years old (OR=1.287, 95%CI: 1.052-1.573) and exposure for co-residence (OR=27.854, 95%CI: 23.470-33.057). Conclusion: The sex and age of the primary case of the Omicron variant, the branch of the infected strain, case severity of the primary case, as well as the age and contact mode of close contacts are the associated factors of SAR.

Deep Learning for Automated Contouring of Primary Gross Tumor Volumes by MRI for Radiation Therapy of Brain Metastasis

PURPOSE/OBJECTIVE(S)

Radiotherapy is one of the most effective methods for the treatment of brain metastases (BMs). Traditional manual delineation of primary gross tumor volumes (GTV) of multiple BMs (especially small metastases) in radiotherapy practice is extremely labor intensive and highly dependent on oncologists' experience, achieving the precise and efficient automatic delineation of BMs is of great significance for efficient and homogeneous one-stop adaptive radiotherapy.

MATERIALS/METHODS

We retrospectively collected 62 MRI (non-enhanced T1-weighted sequences) sequences of 50 patients with BMs from January 2020 to July 2021. An automatic model (BUC-Net) for automatic delineation BMs was proposed in this work, which was based on deep learning by combining 3D bottler layer module and the cascade architecture to improve the accuracy and efficient of BMs' automatic delineation, especially for small metastases with tiny size and relatively low contrast. The prosed method was compared with the existing 3D U-Net (U-Net) and 3D U-Net Cascade (U-Net Cascade). The performance of our proposed method was evaluated by Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95) and average surface distance (ASD) with human experts.

RESULTS

The automatic segmentation results of BUC-Net evaluated with 310 BMs in 13 test patients was summarized in Table 1. These BMs in each test patient were automatically delineated by two types of contours: as a whole tumor contour (Whole-delineation) and the multiple tumor contours (Multiple-delineation). BUC-Net performed the best mean DSC and HD95, which is significantly outperformed U-Net (Whole-delineation: 0.911 & 0.894 of DSC, Multiple-delineation: 0.794 & 0.754 of DSC, P < 0.05 for both) and U-Net cascade (Whole-delineation: 0.947 & 7.141 of HD95, Multiple-delineation: 0.902 & 1.171 of HD95, P < 0.05 for both); Additionally, BUC-Net achieved the best mean ASD for Whole-delineation and comparable ASD (0.290 & 0.277, P > 0) for Multiple-delineation with U-Net Cascade.

CONCLUSION

Our results showed that the proposed approach is promising for the automatic delineation of BMs in MRI, which can be integrated into a radiotherapy workflow to significantly shorten segmentation time.

The Effect of Three Different Positioning Approaches for Prone Rectum Radiotherapy on Positioning Accuracy and Treatment Margins

PURPOSE/OBJECTIVE(S)

The positioning accuracy of rectal radiotherapy patients was greatly affected by the immobilization gadget, breathing motion, bladder volume etc. Prone is one of the common treatment positions for rectum radiotherapy patients as it can displace the small bowels to reduce side effects. Our team would like to further enhance positioning accuracy by evaluating different positioning approaches.

MATERIALS/METHODS

A total of 16 patients from each group were selected retrospectively. All patients fulfilled the bladder (±20% of CT-sim bladder volume) and bowel (empty bowel before the treatment) protocol before entering the treatment unit. Group A patients were positioned using commercial prone pelvic board (Orfit, Belgium) combined with thermoplastic membrane and skin markings; Group B patients were fixed with innovative prone pelvic board and vac-bag which positioned using skin markings. First three fractions and once weekly CBCT images were retrieved for data analysis. Group C patients were fixed the same as Group B and positioned using skin markings during the first fraction. New reference surface for the SGRT system (Vision RT Ltd, UK) was captured after CBCT shifts applied. The subsequent treatment, patient was aligned to ±0.1 cm and ±1.5° according to the new reference surface. CBCT shifts that were taken at fraction 2, 3, 4 and once weekly were recorded in 6 degrees of freedom.

RESULTS

A total of 112 sets of data were retrieved from each groups respectively. The results were compared using nonparametric tests based on the normal distribution of the data. PTV margins (M) were calculated using the formula M = 2.5Σ+0.7σ. Positioning errors were shown in Table 1. The median positioning errors was statistically significant in lateral, vertical, roll and yaw for Group A and B. Whereas, Group C positioning errors was superior to Group B in all axes (p<0.05) except roll and yaw directions. The margins of Group A, B and C were 0.68cm, 1.17cm and 0.62cm; 0.56cm, 0.99cm and 0.75cm; 0.39cm, 0.36cm and 0.34cm in lateral, longitudinal and vertical directions. The results shown that Group B margins was smaller than Group A in lateral and longitudinal directions. Group C required the least margins.

CONCLUSION

Positioning prone rectum patients using innovative pelvic board with the aid of surface guidance resulted in higher accuracy and smaller margins especially in longitudinal direction. Accurate positioning and good reproducibility could potentially reduce the margins from 6mm to 4mm for our prone rectum radiotherapy patients.

The image quality and diagnostic performance of CT perfusion-derived CT angiography versus that of conventional CT angiography

Background

The combination of computed tomography angiography (CTA) and computed tomography perfusion (CTP) evaluation of cerebral perfusion status and vascular conditions can improve the diagnostic accuracy of infarction, ischemia, and vascular occlusion in stroke patients, as well as a comprehensive assessment of cerebral edema, collateral circulation, and blood perfusion in the lesion area. However, the consequent radiation safety and contrast agent nephropathy have aroused increasing concern. The purpose of this study was to assess the image quality and diagnostic accuracy of CTA images derived from CTP data, and to explore the feasibility of replacing conventional CTA.

Methods

A total of 31 consecutive patients with suspected acute ischemic stroke were retrospectively analyzed. All patients underwent head and neck CTA and brain CTP examinations. All the CTP images were transmitted to the ShuKun artificial intelligence system, which reconstructs CTA derived from CTP (CTA-DF-CTP). The images were divided into 2 groups, including CTA-DF-CTP (Group A) and conventional CTA (Group B). The CT attenuation values, subjective image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), image quality, CT volume dose index (CTDIvol), dose length product (DLP), and effective radiation dose (ED) were compared between the 2 groups. Moreover, the consistency of vascular stenosis and stenosis degree between the 2 groups were measured and evaluated.

Results

There were no significant differences in image noise, SNR, or CNR between Groups A and B (P>0.05). The CT attenuation values of the arteries were higher in Group A than in B [internal carotid artery (ICA) =548±112 vs. 454±85 Hounsfield units (HU), middle cerebral artery (MCA) =453±118 vs. 388±70 HU, and basilar artery (BA) =431±99 vs. 360±83 HU] (P<0.01). The image quality of the 2 groups met the requirement of clinical diagnosis (4.97±0.18 vs. 4.94±0.25). No significant difference was found in subjective evaluation (P>0.05). In Group A compared with Group B, the following reductions were observed: CTDIvol (10.7%; 100.8 vs. 112.9 mGy), DLP (23.0%; 1,613±0 vs. 2,093±88 mGy·cm), and ED (23.0%; 5.00±0.00 vs. 6.49±0.27 mSv).

Conclusions

CTA-DF-CTP data provide diagnostic accuracy and image quality similar to those of conventional CTA of head and neck CTA.

Dosimetric Benefits of Online Adaptive Radiotherapy in Nasopharyngeal Carcinoma

PURPOSE/OBJECTIVE(S)

Online adaptive radiotherapy (ART) has the advantage of compensating for potential underdosing to targets and overdosing to organs-at-risk (OARs) caused by variations in patient anatomy and tumor geometry. Artificial intelligence (AI)-assisted rapid generation of new plans makes online ART possible. We aimed to evaluate the dosimetric benefits of online ART on tumor coverage and OARs sparing in nasopharyngeal carcinoma (NPC).

MATERIALS/METHODS

Twenty patients diagnosed with NPC (19 with stage III and 1 with stage II according to the 8th edition of the AJCC/UICC staging system) who underwent definitive radiotherapy or concurrent chemoradiotherapy and received online ART on CT-Linac between April 2022 and December 2022 were included in this study, consisting of 14 males and 6 females with a median age of 48 years (range: 29-68 years). The prescription dose was 6996 cGy/33 fractions for primary gross tumor volume (GTVp), 6600-6996 cGy/33 fractions for gross tumor volume of nodes (GTVn), 6006 cGy/33 fractions for high-risk clinical tumor volume (CTV1), 5412 cGy/33 fractions for low-risk clinical tumor volume (CTV2). The majority of the patients (15/20) received online ART during the fourth to fifth week of their radiotherapy treatment The auto-segmented contours and auto-plan generated by AI were manually reviewed and edited by radiotherapists and physicists. The paired samples t-test was used to compare the dose and volumes metrics of targets and OARs between scheduled plan and online ART plan.

RESULTS

The results of this study showed that compared to the scheduled plan, the online ART plan resulted in significant reductions in the volumes of all targets and 8/12 OARs (temporal lobes, optic nerves, lenses, eyes, parotids, submandibulars, mandibles, and thyroid) (P<0.05). The online ART plan also improved target coverage, with D98% for GTVp in the scheduled plan compared to the online ART plan being 7063.4 ± 76.1 cGy and 7096.1 ± 53.9 cGy (P = 0.1), CTV1 being 6266.7 ± 114.9 cGy and 6208.7 ± 54.7 cGy (P<0.05), and CTV2 being 4142.5 ± 1700.9 cGy and 5416.4 ± 23.8 cGy (P<0.01), respectively. The dose to all 12 OARs was reduced with the use of online ART, with 5/12 OARs showing statistical significance. The D0.03cm3 for the spinal cord in the scheduled plan and online ART plan were 3630.9 ± 197.6 and 3454.1 ± 132.0 cGy; for the temporal lobes were 7075.2 ± 303.0 and 6994.2 ± 345.1 cGy; and 4396.0 ± 2575.0 and for the pituitary were 4214.5 ± 2499.2 cGy. Meanwhile the Dmean for the eyes in the scheduled plan and online ART plan was 769.0 ± 232.0 and 714.8 ± 200.1 cGy; and for the mandibles were 3187.7 ± 211.5 and 3066.0 ± 152.1 cGy.

CONCLUSION

Online ART was effective in protecting most of the OARs in NPC patients, while simultaneously indicating a trend towards enhancing target coverage. This study demonstrated the promising potential of online ART for patients with NPC. This approach will be tested in an upcoming phase III trial.

CREB3L2 Regulates Hemidesmosome Formation during Epithelial Sealing

The long-term success rate of dental implants can be improved by establishing a favorable biological sealing with a high-quality epithelial attachment. The application of mesenchymal stem cells (MSCs) holds promise for facilitating the soft tissue integration around implants, but the molecular mechanism is still unclear and the general application of MSC sheet for soft tissue integration is also relatively unexplored. We found that gingival tissue-derived MSC (GMSC) sheet treatment significantly promoted the expression of hemidesmosome (HD)-related genes and proteins in gingival epithelial cells (GECs). The formation of HDs played a key role in strengthening peri-implant epithelium (PIE) sealing. Further, high-throughput transcriptome sequencing showed that GMSC sheet significantly upregulated the PI3K/AKT pathway, confirming that cell adhesion and HD expression in GECs were regulated by GMSC sheet. We observed that the expression of transcription factor CREB3L2 in GECs was downregulated. After treatment with PI3K pathway inhibitor LY294002, CREB3L2 messenger RNA and protein expression levels were upregulated. Further experiments showed that overexpression or knockdown of CREB3L2 could significantly inhibit or promote HD-related genes and proteins, respectively. We confirmed that CREB3L2 was a transcription factor downstream of the PI3K/AKT pathway and participated in the formation of HDs regulated by GMSC sheet. Finally, through the establishment of early implant placement model in rats, we clarified the molecular function of CREB3L2 in PIE sealing as a mechanical transmission molecule in GECs. The application of GMSC sheet-implant complex could enhance the formation of HDs at the implant-PIE interface and decrease the penetration distance of horseradish peroxidase between the implant and PIE. Meanwhile, GMSC sheet reduced the length of CREB3L2 protein expression on PIE. These findings elucidate the potential function and molecular mechanism of MSC sheet regulating the epithelial sealing around implants, providing new insights and ideas for the application of stem cell therapy in regenerative medicine.

Exploring atherosclerosis imaging with contrast-enhanced MRI using PEGylated ultrasmall iron oxide nanoparticles

Plaque rupture is a critical concern due to its potential for severe outcomes such as cerebral infarction and myocardial infarction, underscoring the urgency of noninvasive early diagnosis. Magnetic resonance imaging (MRI) has gained prominence in plaque imaging, leveraging its noninvasiveness, high spatial resolution, and lack of ionizing radiation. Ultrasmall iron oxides, when modified with polyethylene glycol, exhibit prolonged blood circulation and passive targeting toward plaque sites, rendering them conducive for MRI. In this study, we synthesized ultrasmall iron oxide nanoparticles of approximately 3 nm via high-temperature thermal decomposition. Subsequent surface modification facilitated the creation of a dual-modality magnetic resonance/fluorescence probe. Upon intravenous administration of the probes, MRI assessment of atherosclerotic plaques and diagnostic evaluation were conducted. The application of Flash-3D sequence imaging revealed vascular constriction at lesion sites, accompanied by a gradual signal amplification postprobe injection. T1-weighted imaging of the carotid artery unveiled a progressive signal ratio increase between plaques and controls within 72 h post-administration. Fluorescence imaging of isolated carotid arteries exhibited incremental lesion-to-control signal ratios. Additionally, T1 imaging of the aorta demonstrated an evolving signal enhancement over 48 h. Therefore, the ultrasmall iron oxide nanoparticles hold immense promise for early and noninvasive diagnosis of plaques, providing an avenue for dynamic evaluation over an extended time frame.

T1 Mapping for Differentiating of Haemorrhagic Transformation from Extravasation of Iodine Contrast Agents: A Phantom Study

OBJECTIVE

To evaluate T1 mapping values in different concentrations of iodine and mixed blood and to simulate the application of T1 mapping in differentiating iodine contrast extravasation and haemorrhage transformation after revascularisation in acute ischemic stroke.

STUDY DESIGN

A phantom-based experimental study. Place and Duration of the Study: Department of Radiology, the Second Affiliated Hospital of Soochow University, China, from October 2020 to December 2021.

METHODOLOGY

Fresh blood, pure iodine, blood-iodine mixtures (75/25, 50/50, and 25/75 ratios), and diluted iodine (at a concentration of 2.1 mmol I/L) were scanned in a phantom on 3-T MR T1 mapping imaging. A total of 10 layers in the middle section of tubes were scanned. The mean value of T1 mapping and 95% confidence interval for the investigated sample compositions were calculated and compared by ANOVA.

RESULTS

The mean values (95% CI) for fresh blood, [2/3] blood +[1/3] iodine, [1/2] blood +[1/2] iodine, [1/3] blood +[2/3] iodine, and pure iodine were 2108.69 ± 1966.68-2250.71(ms), 1991.72 ± 1763.22-2220.21(ms), 1811.62 ± 1614.79-2008.45(ms), 1624.39 ± 1442.41-1806.37(ms), 1294.68 ± 1172.92-1416.44(ms), respectively. The differences between the T1 mapping values of all compositions were significant (p <0.01), except for fresh blood and the sample consisting of 67% blood. The mean value on T1 mapping (95% CI) was 1294.68 ± 1172.92-1416.44 (ms) in the samples only with diluted iodine, which was significantly different from other investigated samples (p <0.01). The intra-class correlation coefficient between the two times drawing of radiologist A was excellent (ICC=0.913, p<0.01), and between radiologists A and B was 0.99.

CONCLUSION

Iodine contrast extravasation in a phantom setting might be distinguished from haemorrhagic transformation using T1 mapping.

KEY WORDS

Acute ischemic stroke, Haemorrhage transformation, Contrast extravasation, Magnetic resonance imaging, T1 mapping, 3T MRI.

Energy spectrum CT index-based machine learning model predicts the effect of intravenous thrombolysis in lower limbs

To develop a noninvasive machine learning (ML) model based on energy spectrum computed tomography venography (CTV) indices for preoperatively predicting the effect of intravenous thrombolytic treatment in lower limbs. A total of 3492 slices containing thrombus regions from 58 veins in lower limbs in a cohort of 18 patients, divided in good and poor thrombolysis prognosis groups, were analyzed. Key indices were selected by univariate analysis and Pearson correlation coefficient test. A support vector machine classifier-based model was developed through ten-fold cross validation. Model performance was assessed in terms of discrimination, calibration, and clinical usefulness at both per-slice and per-vessel levels. Continuous variables and categorical variables were compared between good and poor thrombolysis prognosis group by Mann-Whitney U-test and chi-square test, respectively. A nomogram was built by integrating clinical factors and the energy spectrum CTV index-based score calculated by the model. Six indices selected from 192 indices were used to build the predictive model. The ML model achieved area under the curves (AUCs) of 0.838 and 0.767 [95% CI (confidence interval), 0.825-0.850, 0.752-0.781] in the training and validation datasets at the per-slice level, and the per-vessel level AUCs were 0.945 and 0.876 (95% CI, 0.852-0.988, 0.763-0.948) in the training and validation datasets, respectively. The nomogram showed better performance with the per-vessel level AUC, accuracy, sensitivity and specificity, yielding 0.901(95% CI, 0.793-0.964), 86.2%, 87.9% and 84.0% in the validation dataset, respectively. There was no significant difference in the vessel distribution between good and poor thrombolysis prognosis groups (chi-square test, p = 0.671). The energy spectrum CTV index-based ML model achieved favorable effectiveness in predicting the outcome of vessel-level intravenous thrombolysis. A nomogram integrating clinical factors, and risk score calculated by the developed model showed improved performance and had potential to be used as a noninvasive preoperative tool for clinicians.

[Association between blood pressure during 12-28 weeks gestation and pre-eclampsia: predictive value of blood pressure trajectories constructed by latent class growth modeling]

Objective: To explore the associations between blood pressure trajectories during pregnancy and risk of future pre-eclampsia in a large cohort enrolling pregnant women at gestational age of ~12 weeks from community hospitals in Tianjin. Latent class growth modeling (LCGM) was used to model the blood pressure trajectories. Methods: This was a large prospective cohort study. The study enrolled pregnant women of ~12 weeks of gestation in 19 community hospitals in Tianjin from November 1, 2016 to May 30, 2018. We obtained related information during 5 antepartum examinations before gestational week 28, i.e., week 12, week 16, week 20, week 24 and week 28. LCGM was used to model longitudinal systolic (SBP) and diastolic blood pressure (DBP) trajectories. For the association study, the predictors were set as SBP and DBP trajectory membership (built separately), the outcome was defined as the occurrence of preeclampsia after 28 weeks of gestation. Results: A total of 5 809 cases with known pregnant outcomes were documented. After excluding 249 cases per exclusion criteria, 5 560 cases with singleton pregnancy were included for final analysis. There were 128 cases preeclampsia and 106 cases gestational hypertension in this cohort. Univariate logistic regression and multivariate logistic regression showed the higher baseline SBP level and DBP level were related with increased risk of preeclampsia. Four distinctive SBP trajectories and DBP trajectories from 12 weeks to 28 weeks of gestation were identified by LCGM. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for SBP latent classification trajectory_ 4 was 4.023 (95%CI: 2.368 to 6.835, P<0.001), and the OR for SBP latent classification trajectory_3 was 1.854 (95%CI: 1.223 to 2.811, P=0.004). Logistic regression showed that: using the DBP latent classification trajectory_1 as the reference group, the OR for DBP latent classification trajectory_4 was 4.100 (95%CI: 2.571 to 6.538, P<0.001), and 2.632 (95%CI: 1.570 to 4.414, P<0.001) for DBP latent classification trajectory_2. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for DBP_traj_4 was 2.527 (95%CI: 1.534 to 4.162, P<0.001), and the OR for DBP_traj_3 was 1.297 (95%CI: 0.790 to 2.128, P=0.303), and 2.238 (95%CI: 1.328 to 3.772, P=0.002) for DBP_traj_2. Therefore, BP trajectories from 12 weeks to 28 weeks identified by LCGM served as novel risk factors that independently associated with the occurrence of preeclampsia. Receiver operating characteristic (ROC) curve analysis showed incremental diagnostic performance by combing baseline blood pressure levels with blood pressure trajectories. Conclusion: By applying LCGM, we for the first time identified distinctive BP trajectories from gestational week 12 to 28, which can independently predict the development of preeclampsia after 28 weeks of gestation.

Case report: Primary mediastinal Ewing's sarcoma presenting with chest tightness

Ewing's sarcoma is a part of a rare group of malignant neoplasms, whose pathological morphological features are small round cells. Extraskeletal Ewing's sarcoma is a more uncommon primary tumor. Herein, we report the case of a 66-year-old man who complained of chest tightness. Subsequent chest CT scans revealed an irregular and uneven density mass on the right side of the anterior mediastinum with invasion of the superior vena cava, pericardium and right lung. The patient's clinical symptoms were improved after performing excision of the mediastinal lesions under cardiopulmonary bypass. Based on histological and immunohistochemical findings, the tumor was diagnosed as extraskeletal Ewing's sarcoma.

[Prevalence of Anisakise infections in marine fishes in Eastern Fujian Fishing Ground of Fujian Province]

OBJECTIVE

To investigate the prevalence of Anisakis infection in marine fishes in Eastern Fujian Fishing Ground of Fujian Province, so as to provide insights into the development of the anisakiasis control strategy.

METHODS

Marine fish samples were randomly collected from Jiaocheng District, Fuding City and Xiapu County around Eastern Fujian Fishing Ground in Fujian Province from September to December, 2021. All fishes were dissected, and the abdominal contents were collected. Parasites were sampled under a stereomicroscope and the Anisakis species were identified through morphology. The prevalence and intensity of Anisakis infections were calculated.

RESULTS

A total of 177 marine fishes belonging to 24 species were dissected, and Anisakis was detected in 73 marine fishes (41.2%) belonging to 16 species (66.7%), with a mean infection intensity of 14.3 parasites per fish. High prevalence of Anisakis infection was found in Ilisha elongata (5/5), Miichthys miiuy (3/3), Plectorhynchus cinctus (2/2), Scomberomorus niphonius (12/13), Trichiurus lepturus (19/23), Pennahia argentata (6/11) and Ditrema temmincki (14/27), with mean infection intensities of 9.2, 2.7, 4.5, 10.9, 39.2, 4.5 parasites per fish and 2.1 parasites per fish. The Anisakis larvae were characterized as Anisakis and Hysterothylacium.

CONCLUSIONS

High prevalence of Anisakis infection is detected in marine fishes in Eastern Fujian Fishing Ground of Fujian Province. The health education pertaining to food health is required to be reinforced to prevent the development of human anisakiasis.

Evaluation of Anti-Burst Performance in Mining Roadway Support System

The hazardous effect of a mine earthquake on a roadway is not only related to its energy scale but also to its distance from the roadway. In this study, a signal attenuation model and a disaster-causing model were established to evaluate the mine earthquake effects based on peak particle velocity (PPV) data recorded for 37221-1 upper roadway of the Dongxia Coal Mine, China. The characteristic of dynamic loads due to mine earthquake propagation to roadway surfaces was researched, and critical PPV values were identified using FLAC^3D numerical simulation, which can be used to evaluate the roadway anti-burst performance under the existing support system. The results show that the support system is able to resist a mine earthquake with energy below 2.33 × 10³ J; however, considering the energy accumulation volume of surrounding rocks and the range of source fracture, the maximum resistible mine earthquake energy can be up to 7.09 × 10⁶ J when the roadway is 50 m away from the source. The validity and applicability of the disaster-causing models was verified by two rockburst cases that occurred during the excavation of the working face.

Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism

Our purpose was to devise a radiomics model using preoperative computed tomography angiography (CTA) images to differentiate new from old emboli of acute lower limb arterial embolism. 57 patients (95 regions of interest; training set: n = 57; internal validation set: n = 38) with femoral popliteal acute lower limb arterial embolism confirmed by pathology and with preoperative CTA images were retrospectively analyzed. We selected the best prediction model according to the model performance tested by area under the curve (AUC) analysis across 1,000 iterations of prediction from three most common machine learning methods: support vector machine, feed-forward neural network (FNN), and random forest, through several steps of feature selection. Then, the selected best model was also validated in an external validation dataset (n = 24). The established radiomics signature had good predictive efficacy. FNN exhibited the best model performance on the training and validation groups: its AUC value was 0.960 (95% CI, 0.899-1). The accuracy of this model was 89.5%, and its sensitivity and specificity were 0.938 and 0.864, respectively. The AUC of external validation dataset was 0.793. Our radiomics model based on preoperative CTA images is valuable. The radiomics approach of preoperative CTA to differentiate new emboli from old is feasible.

Effects of 24-week basketball programme on body composition and functional fitness on adults with Down syndrome

BACKGROUND

The body index [body mass, body mass index (BMI), waist circumference and waist-height ratio] and functional fitness (aerobic capacity, muscular strength, balance, flexibility and functional ability) of people with Down syndrome (DS) are substantially lower than those in the general population, as DS has an overall negative impact on health.

AIMS

This study explored the effect of a 24-week basketball training programme on the body composition and functional fitness of adults with DS.

METHODS AND PROCEDURE OUTCOMES

Twenty-two adults with DS (24 ± 6 years; 25 ± 4 kg/m² ) were randomly allocated to the experimental (n = 11, 67.04 kg) and control groups (n = 11, 69.36 kg). The experimental group performed 24 weeks of basketball programme training (3 times per week, 60 min per session), while the control group maintained their daily activities without any special physical training. Body composition and functional fitness parameters were measured before and after the intervention. To evaluate the differences between groups, an analysis of covariance (ANCOVA) was used while controlling for differences at baseline.

RESULTS

Hip circumference and waist-height ratio were statistically different at baseline between the intervention and control groups. After the 24-week basketball training programme, the results showed significant differences between the exercise and control groups for hip circumference, body mass, BMI, waist circumference, hip circumference, waist-height ratio, flexibility, aerobic capacity, static and dynamic balance, balance and basketball functional ability (P < 0.05). The exercise group showed significant improvements in all variables of body composition and functional fitness (P < 0.05) except for the waist-hip ratio. There was no statistical significance between all physical composition and functional health variables in the control group except for the standing long jump (P > 0.05), with effect sizes ranging from small to large.

CONCLUSIONS AND IMPLICATIONS

The basketball training programme improved body composition and functional fitness of adults with DS.

Comparative Sensitivity of Solid-Phase Versus PEG Enhancement Assays for Detection and Identification of Red Blood Cell Antibodies

Introduction/Objective

Identifying antibodies to red blood cell (RBC) antigens is one of transfusion medicine’s most critical and challenging issues. There are 354 RBC antigens recognized by the International Society of Blood Transfusion. Accurate identification of clinically significant alloantibodies is imperative for identifying and preventing hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. We compared the performance of the tube (polyethylene glycol–indirect antiglobulin test [PEG-IAT]) and solid-phase techniques for antibody identification.

Methods/Case Report

We performed a retrospective study on all antibody screens and identifications performed between 2007–2021 at Stanford Hospital. Over this period, 631,535 antibody screens were performed predominantly using an automated solid-phase technique. Subsequent antibody identification studies were performed using manual tube testing (PEG-IAT) and automated solid-phase techniques.

Results (if a Case Study enter NA)

Antibody screening resulted in 28,316 (4.5%) positive samples with at least one antibody. Antibody identification performed on both platforms identified 50 discordant [DMH1] samples. 8 anti-Jka, 2 anti-Jkb, 1 anti-S, and 1 anti-M were detected by automatic solid-phase technique but were not detected by PEG-IAT. 20 anti-E, 6 anti-K, 2 anti-Fya, 2 anti-c , 2 anti-C, 2 anti-Fyb, 1 anti-cE[DMH2] , 1 anti-e,1 anti-M, and 1 anti-S were detected by PEG-IAT but were negative by automated solid-phase technique. Anti-E had the least sensitivity (98.99%) in the automated solid-phase technique, while anti-Jkb had the least sensitivity (98.78%) in PEG-IAT.

Conclusion

This is the first robust 15-year study comparing methodologic sensitivity to detect clinically significant alloantibodies. The incidence of discordant results between the PEG-IAT and solid-phase technique was low. Among discordant samples, anti-Jka was commonly detected by solid-phase but not by PEG-IAT. In contrast, anti-E was commonly detected by PEG-IAT but not by the solid phase.

Workflow Improvement after Implementing Remote Blood Allocation Devices at an Academic Medical Center Blood Bank

Introduction/Objective

Patients with hematological cancer routinely receive red blood cell (RBC) transfusions in the outpatient infusion clinical setting as part of their clinical therapy. Typically, RBCs are delivered to the outpatient infusion clinic via the pneumatic tube (P-tube). However, due to the recent expansion of the hospital footprint and the new location of the transfusion services, the P-tube encountered challenges that impacted the reliability of the delivery of RBC, which can delay patient care and affect patient satisfaction. This study’s purpose is to evaluate the pre-and post-implementation of the Haemobank-20 (HB20), remote blood storage and dispensing device, by reviewing the turn-around time (TAT) and the number of orders fulfilled outside of the transfusion service.

Methods/Case Report

Blood products are stocked to the HB in the infusion center. An electronic transfusion schedule is reviewed the night before scheduled transfusions to ensure appropriate inventory. When a patient is ready for the transfusion, the clinical nurse will use the device to retrieve blood products for the patient from the HB20. The average timed delivery time from the transfusion service to the outpatient infusion center is about 11 minutes. Data was retrospectively gathered from a 10-month interval before and after HB20 implementation to evaluate the number of orders fulfilled by the HB20.

Results (if a Case Study enter NA)

The HB has helped maintain nurse-to-patient ratios, reduced traffic at the blood bank issue window, and significantly sped up the turnaround time of RBCs from 11 minutes to less than 60 seconds. Before HB implementation, staff at the blood bank received 2853 units of RBCs through the blood bank window. This has been decreased by 61.2 percent to 1136 RBCs.

Conclusion

Implementing the Haemobank-20 in the outpatient infusion center has successfully reduced the turnaround time and the workload within the Transfusion Services. The current results study demonstrate that the remote blood-release system is safe and helpful in improving the efficiency of blood issue for patients in remote outpatient locations.

Racial Disparity in Antibody Against High Prevalence Antigen; Anti-U

Introduction/Objective

Anti-U is an IgG antibody directed against the U antigen, which usually forms after exposure to U antigen via blood transfusion and/or pregnancy. U antigen is located on glycophorin B (GYPB) as part of the MNS blood group system. Approximately 2% of the African American population lacks this antigen, making them prone to developing anti-U. Anti-U can cause hemolytic disease of fetus and newborn (HDFN) and hemolytic transfusion reactions (HTR).

Methods/Case Report

A 60-year-old African American male underwent aortic valve surgery. The patient was A Pos with a negative antibody screen. During surgery, the patient was transfused with 3 random units of packed red blood cells (PRBCs). The postoperative course was uncomplicated, and the patient was discharged home. 6 months later, the patient was admitted for another procedure and was expected to require blood products. Thus, a type and screen test was ordered, revealing pan reactivity on screening cells. This prompted further investigation. Antibody detection was performed with the solid-phase technique followed by the tube method with Polyethylene glycol (PEG) as an enhancement medium. PEG technique is the next choice of method if the solid phase requires extended antibody work up, which was the case in our patient. PEG tube method successfully identified Anti-U, and the patient's phenotype was confirmed to be U negative.

Results (if a Case Study enter NA)

N/A.

Conclusion

It is imperative to stress the importance of racial disparity while investigating antibodies against high prevalence. In our case, our suspicion was high for Anti-U, given that patient was of African American descent. Tube methods with PEG and Solid Phase techniques are usually used for antibody identification. It is recommended that patients with rare antibodies carry an Antibody ID card indicating the rare antibody they have to prevent further exposure.

[Association between weight gain during the first half of pregnancy and the risk of hypertension disorder of pregnancy: a prospective cohort study]

Objective: To explore the association between weight gain during the first half of pregnancy and the risk of hypertension disorder of pregnancy (HDP). Methods: This prospective cohort study recruited singleton pregnant women in the first trimester from November 2016 to March 2019 at 19 community hospitals in Tianjin. According to pre-pregnancy body mass index (BMI), the cohort was divided into 3 groups: underweight(BMI<18.5 kg/m²), normal-weight(18.5-24.9 kg/m²), and overweight/obese(≥25.0 kg/m²). The basic information of the participants was gathered through questionnaires, and the height, weight, and blood pressure of the participants were measured along with routine pregnancy examinations. The rate of gestational weight gain (rGWG) in the 3 periods (0-13⁺⁶, 14⁺⁰-20⁺⁶, and 0-20⁺⁶ weeks) of the participants was calculated. To observe the occurrence of HDP, the participants were followed up to 42 days postpartum. Using a generalized linear model, the association between rGWG at the 3 periods during the first half of pregnancy and HDP after 20 weeks of gestation was evaluated. Results: A total of 9 805 pregnant women were finally included, with the age of (30.6±3.8) years old, 9 418 (96.1%) Han ethnicity, and 6 845 (69.8%) primipara. There were 1 184 (12.1%), 6 831 (69.7%) and 1 790 (18.3%) participants in the underweight, normal-weight, and overweight/obese groups. Five hundreds and eight pregnant women were diagnosed with HDP (5.2%). The incidences of HDP were 1.8% (21/1 184), 3.9% (269/6 831), and 12.2% (218/1 790), respectively, in underweight, normal-weight, and overweight/obese groups. Adjusted for age, pre-pregnancy BMI, primipara, and family history of hypertension, women in the entire cohort with rGWG ≥ 0.18 kg/week before 13⁺⁶ weeks of pregnancy had a 28% higher HDP risk than those with rGWG ≤ 0.00 kg/week (RR=1.28, 95%CI 1.04-1.55, P=0.015), and the risk of HDP was increased by 39% in the overweight/obese group (RR=1.39, 95%CI 1.04-1.85, P=0.026), while no correlation was found between rGWG and HDP in underweight and normal-weight pregnant women (P>0.05). Weight gain during 14⁺⁰-20⁺⁶ weeks of pregnancy in any group was not related to the risk of HDP (P>0.05).In the entire cohort, compared to rGWG ≤0.14 kg/week, rGWG≥0.28 kg/week prior to 20⁺⁶ weeks increased HDP risk by 36% (RR=1.36, 95%CI 1.11-1.67, P=0.003). Normal-weight pregnant women with rGWG≥0.29 kg/week faced a 46% higher risk of HDP than those with rGWG≤0.15 kg/week (RR=1.46, 95%CI 1.11-1.93, P=0.008).In the overweight/obese group, excessive weight gain before 20⁺⁶ weeks seemed to increased risk of HDP, but the difference was not statistically significant (RR=1.35,95%CI 0.99-1.85, P=0.059), while the connection was nonexistent in underweight women. Conclusions: Except for pre-pregnancy underweight women, excessive weight gain during the first half of pregnancy is associated with increased risk of HDP among pregnant women.

Influence of pore fluid salinity on shrinkage and water retention characteristics of biochar amended kaolin for landfill liner application

Biochar amended clay layer has emerged as a sustainable hydraulic barrier for hazardous municipal waste containment system. The effects of pore fluid salinity on soil shrinkage and water retention characteristics of biochar amended clay are unknown. This study aims to investigate the behavior of soil shrinkage and water retention of biochar amended kaolin under different pore fluid salinity. A series of volumetric shrinkage and water retention tests were conducted on biochar amended kaolin in sodium chloride solution at initial concentrations of 1 %, 5 %, and 10 %. Biochar addition increased the shrinkage limit and minimum void ratio of kaolin by up to 17 % and 11 %, respectively. Air entry value of kaolin increased by 6-88 times with an increase in pore fluid salinity, caused by interparticle aggregation. Micrographs showed that biochar intrapore was filled by kaolin particles, partially hindering the interparticle aggregation of clay in the salt solution. Biochar addition lowered zeta potential on the surface of kaolin particles by 50-75 %, indicating that the immobilisation of excess sodium ions was achieved by biochar. Correspondingly, osmotic suction of pore fluid decreased by 21-64 % due to biochar's ion absorption. The findings highlighted that biochar addition to kaolin specimens minimises NaCl-induced soil shrinkage and reduces the pore fluid salinity. This study indicates that biochar could be potentially helpful for desalinisation and mitigating volumetric change issues for geo-environmental infrastructures.

345 Not Just Metal Hips: Correcting Peri-Operative Anaemia and Iron Levels in Emergency Neck of Femur Surgery

Aim

Method

44 orthogeriatric patients’ records who underwent NOF surgery between December 2019 and March 2020 were examined in the first round. The following data were extracted from the electronic records: age, pre- and post-operative haemoglobin, uptake of pre- and post-operative haematinics, blood, and iron transfusions throughout the surgical period. Subsequently, two more rounds of data collection were undertaken, and they followed the same method. These involved 58 patients between January and April 2021 and the 26 patients between May and June 2021, respectively.

Results

Our first cycle saw uptake of pre-operative haematinics increase by 31% (from 20% to 51%). The final round saw uptake of pre-operative haematinics decrease to 27%. In addition, more than 1/3 patients (37%) who received blood had not met transfusion criteria according to NICE guidelines. Almost half of patients (46%) who received iron transfusion did not have confirmed iron deficiency anaemia.

Conclusions

Pre-operative anaemia continues to be poorly investigated despite an initial increase in haematinics uptake. This could be attributed to the changeover of teams in April. To sustain the level of previous improvement, a hospital-wide educational session for clinicians is needed and this is best incorporated into the induction programme.

A Patient With Erdheim-Chester Disease Presenting With Intestinal Obstruction as the Initial Symptom: A Case Report

Erdheim-Chester disease (ECD) is a rare and systemic non-Langerhans cell histiocytosis. Recently, ECD was classified as an inflammatory medullary tumor that affects a diverse group of organ systems. The purpose of this report is to present the radiological features of this disease in a 51-year-old man with intestinal obstruction as the initial presentation. In this case, X-ray computed tomography (CT) and emission computed tomography (ECT) clearly showed lesions in various systems, especially in the skeletal images. The survival benefit of treatment with interferon α (IFN-α) and BRAF inhibitors is well established, while other treatments focus on symptom relief.

Low-dose three-dimensional CT angiography for the evaluation of posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: a quantitative anatomical comparison study of the rotational and neutral positions

AIM

To investigate the changes in relevant anatomical parameters of posterolateral protrusion of the vertebral artery (VA) between head-neck rotational and neutral positions using low-dose three-dimensional computed tomography angiography (3D-CTA).

MATERIALS AND METHODS

Low-dose 3D-CTA images obtained for various craniocervical diseases in 36 non-dominant VA side patients with neutral, left and right head-neck rotational positions were evaluated. The relevant parameters from superior and inferior views, including external diameter (ED), internal diameter (ID), transverse diameter (TD), heights and diameters of posterolateral protrusion of the VA over the posterior arch of the atlas in the neutral and rotational positions, were recorded and compared.

RESULTS

There was no significant differences in the rotational angle (left/right: 31.23 ± 6.60/29.94 ± 6.09°, p>0.05). There were no significant differences in heights and diameters of bilateral VA between rotational and neutral positions (all p>0.05). The contralateral ID, ED, and TD of the rotational positions were significantly shorter than those of the neutral position (all p<0.05), while there were no significant differences in the three ipsilateral diameters (all p>0.05).

CONCLUSIONS

Posterolateral protrusion of the VA is not uncommon in the population, and surgeons should be aware of its presence, especially the increased possibility of injury to the VA caused by head-neck rotation, during the operation; thus, preoperative evaluation by low-dose 3D-CTA should be considered.

METTL3-Dependent Glycolysis Regulates Dental Pulp Stem Cell Differentiation

N⁶-methyladenosine (m⁶A) is a eukaryotic messenger RNA modification catalyzed by methyltransferase-like 3 (METTL3), which is involved in various developmental and disease processes. However, the connection between the epigenetic modification of m⁶A and glucose metabolism during osteogenesis is still unclear. Here, we show that interference with METTL3 in dental pulp stem cells (DPSCs) inhibits cell proliferation and osteogenic differentiation. Moreover, transcriptome sequencing and metabolic testing were used to explore the mechanism between glucose metabolism and m⁶A modification in METTL3-knockdown DPSCs. Methylated RNA immunoprecipitation-quantitative polymerase chain reaction and RNA stability assays were used to determine the target genes of METTL3. Mechanistically, METTL3 directly interacts with ATP citrate lyase (ACLY) and a mitochondrial citrate transporter (SLC25A1) and then further affects the glycolytic pathway. M⁶A-mediated ACLY and SLC25A1 stability depends on the m⁶A readers IGF2BP2 and IGF2BP2/3, respectively. Our experiments uncovered the potential molecular mechanism of epigenetic modification in osteogenic differentiation, providing new ideas for the clinical application of stem cells and the intervention of metabolic bone diseases.

Growth curve, blood parameters and carcass traits of grass-fed Angus steers

The increasing demand for natural products is currently transforming the meat industry, making grass-fed and finished beef a valuable option for improving profits. However, the transformation of conventional operations to grass-fed systems comprises many modifications, such as logistical, technological, and financial that could be very complex and expensive, involving economic risk. Therefore, in this study, we analyzed the growth curve, critical economic traits, and carcass quality and finished characteristics over several consecutive years in closely related grass-fed and finished Angus steers, to reduce the genetic effect on the results. We found that grass-fed steers require around 188 additional days to reach the market weight (approx. 470 kg) and had approximately 70% less average daily gain compared to the grain-fed and finished steers. Regression analysis demonstrated an interaction between feed and age (P < 0.01); thus, individual regressions were fitted for each regimen style, obtaining almost perfect linear curves for both treatments, which could be straightforwardly used in practical situations due to its simplicity. Six of eight carcass traits were different between grain-fed and grass-fed and finished steers. Hot-carcass weight, dressing, back fat, and quality grade were superior in grain-fed individuals, contrarily to yield grade and ribeye area/carcass ratio, which were better in grass-fed and finished steers (P < 0.05). Interestingly, the meat tenderness was certainly low and similar in both treatments (P = 0.25), indicating the feasibility of producing tender meat with animals under a grass-fed diet. Nevertheless, according to the quality grade analysis, grain-fed carcasses were greater ranked compared to grass-fed bodies (P < 0.01), regardless of their same tenderness. The results will provide valuable information for better understanding beef cattle in grass-feeding finishing systems, especially from weaning to harvest. Additionally, the study will expand the knowledge about the quality of meat obtained from animals that received grass exclusively, becoming relevant information for economic evaluation and management decisions for grass-based cattle operations.

392 Magseed-Guided Wide Local Excision During the COVID-19 Pandemic: A Tenable Solution to Barriers in Accessing Elective Breast Cancer Surgery

Introduction

Magseed-guided localisation has emerged as a suitable alternative to wire-guided localisation (WGL) for impalpable breast cancers, with advantages including advanced insertion and simpler logistical planning. Given the severe disruption to elective surgeries during the Covid-19 pandemic, a local Magseed pathway was developed enabling safe patient flow. Magseed was inserted well in advance of the operation, enabling time to self-isolate and obtain a negative COVID swab prior to admission to a dedicated COVID -free suite. We present the patient-reported outcomes of the new pathway.

Method

A prospective service evaluation was conducted in a University hospital. Patients undergoing Magseed-guided wide local excision (WLE) from 01/07/2020 to present were surveyed to detail their experiences on the Magseed pathway. Qualitative data investigating anxiety and comfort post-insertion were reported using 10-fold Likert scales. Quantitative data was collected on patient demographics and tumour specification.

Results

41/46 women who underwent Magseed localisation WLE completed the survey, with median age 65 years (IQR 53-72) and median BMI 26.5 kg/m2 (IQR 22.4-30.8). 71% had invasive ductal carcinoma with or without ductal carcinoma in-situ. 10% women found the procedure uncomfortable (&lt;5) and 98% women reported low anxiety (&lt;5) over seed displacement. If given the choice, 98% patients would prefer Magseed over WGL.

Conclusions

The new Magseed pathway is regarded positively among patients, despite ongoing disruption in elective breast cancer services. Given the progression of the second wave and likelihood of future outbreaks, Magseed localisation could be adopted widely to ensure continuous provision of safe elective surgeries.

Development and validation of a three-immune-related gene signature prognostic risk model in papillary thyroid carcinoma

PURPOSE

Increasing evidence indicates that there is a correlation between papillary thyroid carcinoma (PTC) prognosis and the immune signature. Our goal was to construct a new prognostic tool based on immune genes to achieve more accurate prognosis predictions and earlier diagnoses of PTC.

METHODS

The 493 PTCs samples and 58 tumor-adjacent normal tissues were obtained from The Cancer Genome Atlas database (TCGA). Immune genes were obtained from the ImmPort database. First, this cohort was randomly divided into training cohort and testing cohort. Second, the differentially expressed (DE) immune genes from the training set were used to construct the prognostic model. Then, the testing and entire data cohorts were used to validate the model, and the data were analyzed to determine the correlation of the clinical prognostic model with immune cell infiltration and expression profiles of human leukocyte antigen (HLA) genes. Finally, an analysis of the gene ontology (GO) annotation was performed.

RESULTS

A total of 189 upregulated and 128 downregulated DE immune genes were identified. We developed and validated a three-immune gene model for PTC that includes Hsp70, NOX5, and FGF23. This model was demonstrated to be an independent prognostic variable. In addition, the overall immune activity of the high-risk group was higher than that of the low-risk group.

CONCLUSIONS

We developed and validated a three-immune gene model for PTC that includes HSPA1A, NOX5, and FGF23. This model can be used as a validated tool to predict outcomes in PTC.

High-Efficiency Arbitrary Quantum Operation on a High-Dimensional Quantum System

The ability to manipulate quantum systems lies at the heart of the development of quantum technology. The ultimate goal of quantum control is to realize arbitrary quantum operations (AQUOs) for all possible open quantum system dynamics. However, the demanding extra physical resources impose great obstacles. Here, we experimentally demonstrate a universal approach of AQUO on a photonic qudit with the minimum physical resource of a two-level ancilla and a log_{2}d-scale circuit depth for a d-dimensional system. The AQUO is then applied in a quantum trajectory simulation for quantum subspace stabilization and quantum Zeno dynamics, as well as incoherent manipulation and generalized measurements of the qudit. Therefore, the demonstrated AQUO for complete quantum control would play an indispensable role in quantum information science.

Experimental Simulation of Open Quantum System Dynamics via Trotterization

Digital quantum simulators provide a diversified tool for solving the evolution of quantum systems with complicated Hamiltonians and hold great potential for a wide range of applications. Although much attention is paid to the unitary evolution of closed quantum systems, dissipation and noise are vital in understanding the dynamics of practical quantum systems. In this work, we experimentally demonstrate a digital simulation of an open quantum system in a controllable Markovian environment with the assistance of a single ancillary qubit. By Trotterizing the quantum Liouvillians, the continuous evolution of an open quantum system is effectively realized, and its application in error mitigation is demonstrated by adjusting the simulated noise intensities. High-order Trotter for open quantum dynamics is also experimentally investigated and shows higher accuracy. Our results represent a significant step toward hardware-efficient simulation of open quantum systems and error mitigation in quantum algorithms in noisy intermediate-scale quantum systems.

Artificial Intelligence and Ethics in Dentistry: A Scoping Review

Dentistry increasingly integrates artificial intelligence (AI) to help improve the current state of clinical dental practice. However, this revolutionary technological field raises various complex ethical challenges. The objective of this systematic scoping review is to document the current uses of AI in dentistry and the ethical concerns or challenges they imply. Three health care databases (MEDLINE [PubMed], SciVerse Scopus, and Cochrane Library) and 2 computer science databases (ArXiv, IEEE Xplore) were searched. After identifying 1,553 records, the documents were filtered, and a full-text screening was performed. In total, 178 studies were retained and analyzed by 8 researchers specialized in dentistry, AI, and ethics. The team used Covidence for data extraction and Dedoose for the identification of ethics-related information. PRISMA guidelines were followed. Among the included studies, 130 (73.0%) studies were published after 2016, and 93 (52.2%) were published in journals specialized in computer sciences. The technologies used were neural learning techniques for 75 (42.1%), traditional learning techniques for 76 (42.7%), or a combination of several technologies for 20 (11.2%). Overall, 7 countries contributed to 109 (61.2%) studies. A total of 53 different applications of AI in dentistry were identified, involving most dental specialties. The use of initial data sets for internal validation was reported in 152 (85.4%) studies. Forty-five ethical issues (related to the use AI in dentistry) were reported in 22 (12.4%) studies around 6 principles: prudence (10 times), equity (8), privacy (8), responsibility (6), democratic participation (4), and solidarity (4). The ratio of studies mentioning AI-related ethical issues has remained similar in the past years, showing that there is no increasing interest in the field of dentistry on this topic. This study confirms the growing presence of AI in dentistry and highlights a current lack of information on the ethical challenges surrounding its use. In addition, the scarcity of studies sharing their code could prevent future replications. The authors formulate recommendations to contribute to a more responsible use of AI technologies in dentistry.

Analysis of the MCL-1 gene in Chinese women with idiopathic premature ovarian insufficiency

OBJECTIVE

Animal studies have demonstrated that myeloid cell leukemia-1 (Mcl-1) gene deficiency leads to premature ovarian failure and decreased reproductive ability in mice. This study investigated the relationship between MCL-1 gene variation and idiopathic premature ovarian insufficiency (POI) in Chinese women.

METHODS

A total of 200 idiopathic POI patients and 100 healthy controls were recruited for this study, and peripheral blood was collected. First, genomic DNA was extracted from peripheral leukocytes. Then, the entire coding region and splice sites of the MCL-1 gene were amplified by polymerase chain reaction. Chi-squared tests were used to compare the genotype distribution and allele frequency of single nucleotide polymorphisms between the POI and control groups.

RESULTS

Three mutations of the MCL-1 gene (c.-36C > T, c.-131C > T and c.78C > T) were identified. After data analysis, c.-36C > T and c.-131C > T in the 5'-untranslated region were both found in the POI group and the control group. No difference was found in the genotype distribution or allelic frequency of either variant between the POI group and the control group (p > 0.05). The synonymous variant (c.78C > T) in exon 1 was discovered in only one of the control subjects and did not result in a change in amino acid sequence (p.Gly26Gly).

CONCLUSION

MCL-1 gene mutation may not be associated with idiopathic POI in Chinese women.

Case Report: Primary Extraskeletal Osteosarcoma in the Lung and Pulmonary Artery

Extraskeletal osteosarcoma is an uncommon and high-grade soft tissue malignancy. The incidence is even lower when the lung and pulmonary artery are the primary site. The purpose of this report is to present the radiological features of this neoplasm in a 52-year-old man. In our case, contrast-enhanced CT and 3D-CT reconstruction clearly showed the primary lesion and its invasion into surrounding tissues. Although wide local excision of the primary tumor is the treatment of choice, local recurrence and metastasis rates remain high, and this progression can be clearly shown on CT and SPECT/CT examinations.

Disturbance observer-based control with partially coupled inverse model for stable TITO processes with time delays

This paper presents a modified multivariable disturbance observer-based (MDOB) control method for stable two-input-two-output (TITO) processes with multiple time delays. Different from the existing MDOB control strategies with diagonal or full elements inverse model, a partially coupled inverse model is used here to provide better disturbance rejection performance. First, an interaction measure, relative input disturbance gain (RIDG), is defined to quantify the disturbance rejection capabilities of the two common types of MDOB techniques. Based on RIDG, the partially coupled inverse model is derived. Then, to deal with the cross terms of the filter elements in the outputs, a single iteration strategy is presented to derive them one by one. Meanwhile, analytical forms of the filter elements are obtained by minimizing the 2-norm of the outputs. Finally, filter parameters are tuned taking into account criteria of performance and robustness. And application of the proposed strategy on simulation examples verifies its effectiveness and superiority.

The significance of Hashimoto's thyroiditis for postoperative complications of thyroid surgery: a systematic review and meta-analysis

INTRODUCTION

Hashimoto's thyroiditis (HT) is one of the most common immune-mediated diseases. It makes thyroid surgery more complicated and difficult because there may be adhesions between the thyroid gland and surrounding structures. However, it is still controversial whether HT patients carry a high risk for postoperative complications of thyroid surgery. The purpose of this study was to investigate the significance of HT for the postoperative complications of thyroid surgery.

METHODS

A search for studies assessing the postoperative complication risks of HT patients compared with that of patients with benign nodules (BNs) was performed in PubMed, EMBASE and Web of Science. Nine studies (20,118 cases, 1,582 cases of HT and 18,536 cases of BN) were identified, and the data from the relevant outcomes were extracted and analysed.

RESULTS

There were no significant differences between the HT group and BN group in recurrent laryngeal nerve palsy (RLNP) and permanent hypoparathyroidism (PHP). The rate of transient hypocalcaemia (THC) was significantly higher in the HT group (16.85%) than in the BN group (13.20%).

CONCLUSIONS

The meta-analysis showed that HT only increased the risk of the postoperative complication THC compared to BN. Understanding the significance of HT in postoperative hypoparathyroidism after thyroid surgery would help clinicians perform sufficient preoperative (and postoperative) assessments and to optimise surgical planning.

[Application of Two Kinds of Automatic Nucleic Acid Purifiers]

Abstract

Objective To investigate the effect of automatic nucleic acid purifiers QIAsymphony SP and QIAcube in the DNA extraction of samples of trace amount or mixed with inhibitors. Methods Different kinds of purification methods using QIAsymphony SP and QIAcube were applied to extract swabs which contained 30, 100, 150 and 300 cells and other samples which contained six types of inhibitors-heme, humic acid, lard, soil, rust and grease. PCR amplification and STR typing were performed on the extracted DNA templates to compare extracting efficiency and inhibitor removal ability of four different purification methods. Results Different purification methods showed similar extraction effects, 70.83%-100.00% of loci could be detected by amplification of DNA extracted from samples with 30, 100 and 300 cells, and the six types of inhibitors could be removed well. Conclusion The two automatic nucleic acid purifiers have a good inhibitor removal effect. For swabs with only 30 cells, after DNA extraction and amplification, the locus detection rate of samples can still be high, which can meet the requirements of local DNA laboratory work, and realize the standardization construction of the laboratory.