[Analysis of clinical effect of arthroscopic release at different time in treating knee adhesion after arthroscopic surgery]

Objective: To explore the efficacy of arthroscopic release in treating postoperative knee adhesion and investigate the influence of release timing on the treatment outcomes. Methods: A total of 50 patients who accepted arthroscopic release in Peking University Third Hospital from February 2017 to December 2021 were included in the retrospective cohort. The study cohort comprised 28 men and 22 women, with a mean age of (30.8±11.9) years. All the primary surgeries were manipulated under arthroscopes. A comparison was made between pre-and postoperative range of motion (ROM), visual analog scale (VAS), International Knee Documentation Committee (IKDC) scores, and Tegner activity scale scores for the patients. According to the interval between the appearance of adhesion and arthroscopic release, the patients were divided into four groups:<3 months group (n=12), 3-6 months group (n=16),>6-12 months group (n=14), and>12 months group (n=8). Inter-group comparisons on postoperative ROM, IKDC scores, and Tegner activity scale scores and improvement values of each outcome were conducted. Results: All the patients were followed up for (36.4±19.7) months. Patients gained significant improvement in flexion, extension, IKDC scores, and Tegner scores (125.0°±20.0° vs 75.7°±27.5°, 2.3°±4.8° vs 7.4°±7.3°, 69.8±17.7 vs 51.4±12.8, 4.1±2.1 vs 2.2±1.1) (all P<0.05), while the VAS scores did not show significant improvement. There were no significant differences among different groups in postoperative extension, IKDC scores or Tegner scores, nor in their improvements. However, patients in the ≤6 months group could gain better postoperative flexion and improvement in flexion than those in the >6 months group (129.9°±20.0° vs 118.8°±17.4°, 58.6°±32.8° vs 37.3°±23.1°) (P<0.05). Conclusions: Arthroscopic release presents a great effect in treating knee adhesion after arthroscopic operation. Once the symptoms of adhesion appear and physical rehabilitation fails to improve the ROM, one should accept early surgical intervention (less than 6 months) for a better outcome.

[Effects of Rhodiola rosea injection on intrapulmonary shunt and blood IL-6 and TNF-α levels during single lung ventilation in patients undergoing radical resection of esophageal cancer]

OBJECTIVE

To explore the effects of Rhodiola rosea injection on pulmonary shunt and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels during single lung ventilation in patients undergoing radical resection of esophageal cancer.

METHODS

Forty-six patients undergoing radical operation for esophageal cancer were randomized equally into control group and Rhodiola rosea injection group. In the Rhodiola group, 10 mL of Rhodiola rosea injection was added into 250 mL of normal saline or 5% glucose solution for slow intravenous infusion, and normal saline of the same volume was used in the control group after the patients entered the operation room. At T0, T1 and T3, PaO2 of the patient was recorded and 2 mL of deep venous blood was collected for determination of serum TNF-α and IL-6 levels. The incidence of postoperative atelectasis of the patients was recorded.

RESULTS

Compared with those in the control group, the patients receiving Rhodiola rosea injection had significantly higher PaO2 and Qs/Qt at T1 and T2 (P<0.05) and lower serum IL-6 and TNF-α levels at T3 (P<0.05). No significant difference in the incidence of postoperative atelectasis was observed between the two groups (P>0.05).

CONCLUSION

Rhodiola rosea injection before anesthesia induction can reduce intrapulmonary shunt during single lung ventilation, improve oxygenation, reduce serum IL-6 and TNF-α levels, and alleviate intraoperative lung injury in patients undergoing radical resection of esophageal cancer.

Predictive effect of net water uptake on futile recanalisation in patients with acute large-vessel occlusion stroke

AIM

To determine whether net water uptake (NWU) based on automated software evaluation could predict futile recanalisation in patients with acute anterior circulation large-vessel occlusion (LVO).

MATERIALS AND METHODS

Patients with acute anterior circulation LVO undergoing mechanical thrombectomy in Jinling Hospital were evaluated retrospectively. NWU and other baseline data were evaluated by performing univariate and multivariate analyses. The primary endpoint was 90-day modified Rankin scale score ≥3. A nomogram to predict poor clinical outcomes was developed based on multivariate logistic regression analysis.

RESULTS

Overall, 135 patients who underwent thrombectomy with a TICI grade ≥2b were enrolled. In multivariate logistic regression analysis, the following factors were identified as independent predictors of futile recanalisation: age (odds ratio [OR]: 1.055, 95 % confidence interval [CI]: 1.004-1.110, p=0.035), female (OR: 0.289, 95 % CI: 0.098-0.850, p=0.024), hypertension (OR: 3.182, 95 % CI: 1.160-8.728, p=0.025), high blood glucose level (OR: 1.36, 95 % CI: 1.087-1.701, p=0.007), admission National Institutes of Health Stroke Scale score (OR: 1.082, 95 % CI: 1.003-1.168, p=0.043), and NWU (OR: 1.312, 95 % CI: 1.038-1.659, p=0.023).

CONCLUSIONS

NWU based on Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) could be used to predict the occurrence of futile recanalisation in patients with acute anterior circulation LVO ischaemic stroke.

Novel calcium hypochlorite/ferrous iron as an ultrafiltration membrane pretreatment process for purifying algae-laden water

Algal fouling has become one of the most critical factors hindering the large-scale development of membrane processes in algae-laden water treatment. Herein, novel calcium hypochlorite (Ca(ClO)2)/ferrous iron (Fe(II)) process was proposed as an ultrafiltration (UF) membrane pretreatment technology, and its effects on membrane fouling and water properties were systematically studied. Results showed that the terminal specific fluxes were significantly elevated to 0.925 and 0.933, with the maximum removal ratios of reversible resistance reaching 99.65% and 96.99% for algae-laden water and extracellular organic matter (EOM), respectively. The formation of cake filtration was dramatically delayed, accompanied by a significant reduction of the adhesion free energy, and the contaminants attached to the membrane surface were effectively decomposed. With respect to water quality, the removal ratios of OD685 and turbidity achieved 81.25-95.31% and 90.16-97.72%, individually. The maximum removal rates of DOC, UV254 and fluorescent organics in influent water reached 46.14%, 55.17% and 75.77%, respectively. Furthermore, the generated reactive species (e.g., •OH, Cl•, Cl2•- and ClO•) could efficiently degrade EOM, which appreciably reduced the electrostatic repulsion between the algal foulants while ensuring the integrity of algal cells. At the Ca(ClO)2/Fe(II) dosage of 0.04/0.24 mM, the zeta potential changed from -32.9 mV to -10.8 mV, and a large range of aggregates was formed. The macromolecules in the algal solution were significantly removed, and the proportion of micromolecular organics was increased to some extent. Coagulation of in-situ formed Fe(III) dominated the membrane fouling mitigation, and the reactive species also contributed to the improvement of filtration performance. Overall, Ca(ClO)2/Fe(II) pretreatment has an exceptional prospect for efficient degradation of algal pollutants and enhancement of UF capability.

Global trends in coronary artery disease and artificial intelligence relevant studies: a bibliometric analysis

OBJECTIVE

Coronary artery disease (CAD) is a major global cause of death, greatly affecting life expectancy and quality of life for populations. With the advent of artificial intelligence (AI), there is new hope for accurately managing CAD. While recent studies have shown remarkable progress in AI and CAD research, there is a gap in comprehensive bibliometric analysis in this field. Therefore, this study aims to provide a thorough analysis of trends and hotspots in AI and CAD-related research utilizing bibliometrics.

MATERIALS AND METHODS

Publications on AI and CAD relevant research from 2009 to 2023 were searched through the WoS core database (WoSCC). CiteSpace, VOSviewer and Excel 365 were used to conduct the bibliometric analysis.

RESULTS

The bibliometric analysis included 1,248 publications, indicating a steady increase in AI and CAD-related publications annually. The United States of America (USA), China, and Germany were identified as the most influential countries in this field. Research institutions such as Cedars Sinai Med Ctr, Med Univ South Carolina, Harvard Med Sch and Capital Med Univ were the main contributors to research production. FRONT CARDIOVASC MED is the top-ranked journal, while J AM COLL CARDIOL emerged as the most cited journal. Schoepf, U. Joseph, Slomka, Piotr J., Berman, Daniel S. and Dey, Damini were the most prolific authors, while U. Rajendra Acharya was the most frequently co-cited author. Research related to the AI calculation of coronary flow reserve fraction and coronary artery calcification, based on coronary CT to identify CAD and cardiovascular risk, was a key research topic in this field. The potential link between cardiovascular risk stratification and radiomics is currently at the forefront of the field.

CONCLUSIONS

This study is the first to use a bibliometric approach to visualize and analyze AI and CAD-related research. The findings provide insights into recent research trends and hotspots in the field and can serve as a reference for scholars to identify critical issues in this field.

Sulfate radical-based advanced oxidation process effects on tire wear particles aging and ecotoxicity

Tire wear particles (TWPs) are widely distributed in natural water and pose as major pollutants in aquatic environments. In this study, heat-activated persulfate (HPT) and ultraviolet-activated persulfate treatments (UPT) were employed to investigate the influence of sulfate radical (SO4-•)-based advanced oxidation process (SAOPs) on TWP physicochemical properties and to clarify their ecotoxic effects in laboratory-level studies. Results showed that the specific surface areas of TWPs increased after UPT but decreased after HPT. In terms of chemical properties, the increase of oxygen-containing functional groups on the surfaces of TWPs was more evident in UPT than that in HPT. The atrazine (ATZ) adsorption capacity of TWPs after HPT and UPT was increased compared with the untreated TWPs. Atrazine adsorbed by TWPs was easily resolved and released in artificial intestinal fluid (1.89-2.08 mg/g) and artificial gastric fluid (1.60-2.04 mg/g) conditions. Acute toxicity experiments of Photobacterium phosphoreum and SEM-EDS detection results suggested that various heavy metals (e.g., Zn2+, Cu2+) in the TWPs would be released into the water system in SAOPs. ATZ released from TWPs that adsorbed ATZ herbicide, rather than TWPs themselves, had a negative effect on aquatic plant growth (e.g., C. vulgaris). The leaching solution of oxidized TWPs (after HPT and UPT) showed a more significant inhibition effect on the zebrafish survival compared with that of untreated TWPs, which was possibly caused by the generation of oxidation byproducts such as N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine-quinone.

Responses of Chlorella vulgaris to the native bacteria in real wastewater: Improvement in wastewater treatment and lipid production

Alga-bacterium interaction can improve wastewater treatment efficiency. To unravel the mystery of the interaction between microalgae and bacteria in wastewater, mono-cultures and co-cultures of Chlorella vulgaris and native bacteria in pretreated biochemical wastewater from landfill leachate were investigated. The results showed that the microalgae selected dominant commensal bacteria, creating a further reduction in species richness for the co-culture, which in turn aids in the dominant commensal bacteria's survival, thereby enhancing algal and bacterial metabolic activity. Strikingly, the lipid productivity of Chlorella in co-culture - namely 41.5 mg/L·d - was 1.4 times higher than in algal monoculture. Additionally, pollutant removal was enhanced in co-cultures, attributed to the bacterial community associated with pollutants' degradation. Furthermore, this study provides an important advance towards observations on the migration and transformation pathways of nutrients and metals, and bridges the gap in algal-bacterial synergistic mechanisms in real wastewater, laying the theoretical foundation for improving wastewater treatment.

A risk model based on the tumor microenvironment to predict survival and immunotherapy efficacy for ovarian cancer

OBJECTIVE

Based on the interactions between immune components in the tumor microenvironment and ovarian cancer (OC) cells, immunotherapies have been demonstrated to be effective in dramatically increasing survival rates. This study aimed to identify landmark genes, develop a prognostic risk model, and explore its relevance to the efficacy of immunotherapy.

MATERIALS AND METHODS

A risk model was built based on the immune- and stromal-related genes, which were extracted from the OC gene expression data of "The Cancer Genome Atlas" (TCGA) database. Survival analysis and receiver operating characteristic (ROC) analysis were then conducted through the model's risk score pattern, which was established depending on the TCGA training cohort and verified based on the internal TCGA cohort and external "Gene Expression Omnibus" (GEO) datasets. Furthermore, the immune-related characteristics and prognostic values of the risk model were evaluated.

RESULTS

The prognostic risk model for ovarian cancer demonstrated excellent performance in predicting survival rates, as validated in both the TCGA and GEO databases. The model showed significant associations with 17 functional immune cells, 17 immune checkpoints, PD-1, and several immune pathways, suggesting its potential to enhance the efficacy of immunotherapy in OC.

CONCLUSIONS

The risk model developed in this study has the potential to serve as a prognostic marker for OC, enabling the development of personalized immunotherapy protocols and providing a theoretical basis for novel combinations of immunotherapeutic approaches.

Overlooked flocs in electrocoagulation-based ultrafiltration systems: A new understanding of the structural interfacial properties

An integrated ferrate-induced electrocoagulation-ultrafiltration (FECUF) process is proposed to cope with the growing demand for water treatment. Although flocs formed during the electrocoagulation (EC) process are useful for contaminant reduction and mitigation of membrane fouling, few studies have been focused on their structures and properties. Herein, we investigated the formation and structural transformations of flocs and their responses to organic matter, as well as the relationships between their interfacial properties and membrane fouling mitigation. It was found that ferrate contributed to the fast formation of flocs during the ferrate-induced electrocoagulation (FEC) process, which accelerated the FECUF process. Physicochemical analyses indicated that the flocs formed in the FEC process were mainly composed of Fe(III)-(hydr)oxides with abundant hydroxyl groups and poor crystallinity, which allowed complexation with NOM. Therefore, the mobilities of the NOM and the soluble coagulant ions were reduced. The responses of flocs to NOM suggested that the period of 0-20 min resulted in the most efficient NOM removal. In addition, two patterns revealed the relationships between the interfacial properties of the small colloidal particles (SCPs) and the membrane filtration performance: i) the decline in the initial flux was closely related to the composition (gel-type substances or metal-(hydr)oxides) of the SCPs and ii) the steady-state flux was influenced by the energy barrier between the SCPs. However, when the SCPs had the same composition, the interfacial properties influenced both the initial flux and the steady-state flux. This study provides an alternative FECUF process for intensive upgrades of centralized water treatment systems.

[Predictive value of aMAP risk score for early recurrence of small hepatocellular carcinoma after microwave ablation]

Objective: To explore the value of the aMAP risk score (age, male, albumin-bilirubin, and platelets) to predict early recurrence within one year after microwave ablation in patients with small hepatocellular carcinoma. Methods: This was a retrospective study that enrolled 142 patients diagnosed with hepatocellular carcinoma who were treated with microwave ablation in the Department of Hepatology Unit of Nanfang Hospital, Southern Medical University from July 2016 to July 2021. The cohort enrolled 121 male and 21 female patients, including 110 patients that were <60 years old. All the patients were followed-up after microwave ablation to evaluate residual tumor and recurrence of tumor by computed tomography or magnetic resonance imaging. The observation indices mainly included general data and imaging data of patients. Using the X-tile tools, patients were divided into two groups: a high aMAP score group and a low aMAP score group. Multivariate Cox regression analysis was conducted for comparison of independent risk factors. Results: Multivariate Cox regression showed that high aMAP score, maximum tumor diameter >20 mm, and high AFP were the independent risk factors of early recurrence (all P<0.05). Kaplan-Meier survival curves showed that the median recurrence-free survival was 25.5 months in the low aMAP score group and 6.1 months in the high aMAP score group (P=0.001). Conclusions: The aMAP score could predict the early recurrence within 1 year of small hepatocellular carcinoma after microwave ablation. Patients with high aMAP score should undergo rigorous postoperative follow-up evaluations..

Activation of peroxymonosulfate with biochar-supported CuO (CuO@BC) for natural organic matter removal and membrane fouling control

To achieve excellent activation efficiency of peroxymonosulfate (PMS), this work prepared a biochar-supported CuO (CuO@BC) catalyst, and the CuO@BC/PMS system was proposed to remove the organic matter in natural surface water and reduce the fouling of ultrafiltration membrane. The successful synthesis of CuO@BC was demonstrated through characterization of its microscopic morphology and chemical composition by various techniques. The prepared heterogeneous catalyst showed a strong catalytic effect on PMS, which significantly removed natural organic matter through the production of active substances (•OH, SO4•-, O2•- and 1O2) from water. With respective degradation rates of 39.4% and 59.4%, the concentrations of DOC and UV254 dropped to 1.702 mg/L and 0.026 cm-1, respectively. Additionally, the CuO@BC/PMS oxidation displayed potent oxidation capabilities for contaminants and fluorescent organics with various molecular weights. The system effectively decreased the amount of organic matter that caused reversible and irreversible fouling of polyethersulfone membranes in natural water by 85.8% and 56.3%, respectively. The main fouling mechanisms changed as well, with standard and complete blocking dominating the entire filtration process. The results demonstrated the capacity of the CuO@BC/PMS system to remove contaminants in natural water and mitigate membrane fouling.

Mechanistic insight into single-atom Fe loaded catalytic membrane with peracetic acid and visible light activation

Advanced oxidation is an effective method for removing hard-to-degrade organic pollutants from water. In this paper, a novel structure of a single atom Fe anchored g-C3N4 (FeCN) membrane was proposed to remove pollutants from water by coupling membrane technology with photocatalytic and peroxyacetic acid oxidation. The presence of zero-dimensional Fe atoms in FeCN membranes allows for the removal of acetaminophen (APAP) in mobile membrane filtration systems without compromising permeation performance by simultaneously possessing visible photocatalytic capability and peroxyacetic acid (PAA) activation. Existence of inter-membrane domain-limiting conditions led to 100 % degradation of APAP within 10.5 ms, which is 5 orders of magnitude faster than conventional catalytic systems. Notably, photo-generated electrons/holes generated by light and HClO generated by Cl- promote the conversion of Fe(V) and the removal of pollutants during the catalytic process. The spatial separation ability of the membrane catalytic layer surface mitigates the catalyst's passivation by macromolecular organics. Furthermore, surface photocatalysis of the membrane and interlayer catalysis generated by PAA mitigate the surface and interlayer pollutants of the membrane, respectively. This study explores a novel approach for the development of highly efficient atom-catalyzed membrane systems with multiple purposes.

Enhanced hydroxyl radical generation for micropollutant degradation in the In2O3/Vis-LED process through the addition of periodate

Periodate (PI) as an oxidant has been extensively studied for organic foulants removal in advanced oxidation processes. Here PI was introduced into In2O3/Vis-LED process to enhance the formation of ·OH for promoting the degradation of organic foulants. Results showed that the addition of PI would significantly promote the removal of sulfamethoxazole (SMX) in the In2O3/Vis-LED process (from 9.26% to 100%), and ·OH was proved to be the dominant species in the system. Besides, the process exhibited non-selectivity in the removal of different organic foulants. Comparatively, various oxidants (e.g., peroxymonosulfate, peroxydisulfate, and hydrogen peroxide) did not markedly promote the removal of SMX in the In2O3/Vis-LED process. Electrochemical analyses demonstrated that PI could effectively receive photoelectrons, thus inhibiting the recombination of photogenerated electron-hole (e-/h+) pairs. The holes then oxidized the adsorbed H2O to generate ·OH, and the PI converted to iodate at the same time. Additionally, the removal rate of SMX reduced from 100% to 17.2% as Vis-LED wavelengths increased from 440 to 560 nm, because of the low energy of photons produced at longer wavelengths. Notably, the species of PI do not affect its ability to accept electrons, resulting in the degradation efficiency of SMX irrespective of pH (4.0-10.0). The coexistence of inorganic cations and anions (such as Cl-, CO32-/HCO3-, SO42-, Ca2+, and Mg2+) also had an insignificant effect on SMX degradation. Furthermore, the process also showed excellent degradation potential in real water. The proposed strategy provides a new insight for visible light-catalyzed activation of PI and guidance to explore green catalytic processes for high-efficiency removal of various organic foulants.

[The association between cortical venous outflow and futile recanalization in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation]

Objective: To explore the association of baseline venous outflow (VO) profile with futile recanalization in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation. Methods: The clinical and imaging data of patients presented with large vessel occlusion in the anterior circulation and underwent emergency endovascular treatment at Huashan Hospital from March 2015 to December 2021 were retrospectively included in the study. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) at baseline.Baseline VO profile was determined by a 0-6 semi-quantitative scoring system which assessed opacification of the ipsilateral superficial middle cerebral vein, vein of Labbé and vein of Trolard on single-phase CT angiography (CTA) images. A 90-day telephone follow-up was performed and functional outcome was evaluated by 90 d modified Rankin scale (mRS). Successful recanalization of the occluded artery, defined as final modified Thrombolysis in Cerebral Infarction scale (mTICI) 2b-3, was considered to be futile if patients failed to achieve functional independence (90 d mRS 0-2). Univariate analysis and receiver operating characteristic (ROC) curve analysis were used to explore the optimal cutoff predicting functional indendence. The associations between cortical VO in ischemic area and futile recanalization were evaluated using binary logistic regression analysis and backward linear regression based on Akaike information criterion (AIC). Results: A total of 150 patients met the inclusion criteria, with 92 males (61.3%) and 58 females (38.7%). The median age [M(Q1, Q3)]was 71 (61, 78) years and the median baseline National Institute of Health Stroke Scale (NIHSS) score [M(Q1, Q3)]was 15 (11, 18). Univariate logistic regression analysis showed that baseline VO was associated with 90-day functional independence (OR=1.587, 95%CI: 1.185-2.1873). After classifying VO into two categories based on the receiver operating characteristic (ROC) curve, VO≥4 showed an independent association with functional independence (OR=5.133, 95%CI: 1.530-9.361) after adjusting for age, baseline glucose, NIHSS score, baseline infarct core volume, modified Tan (mTan) score, hypoperfusion intensity ratio (HIR), etiological classification, recanalization, presence of any hemorrhagic transformation and final infarct volume. Futile recanalization was observed in 44 (48.4%) of the 91 patients who achieved successful recanalization. Stepwise logistic regression revealed that VO≥4 was an independent protective factor for futile recanalization (OR=0.234, 95%CI: 0.054-0.878). Moreover, in patients with mTICI 2c-3, VO≥4 showed a stronger association with futile recanalization (OR=0.018, 95%CI: 0-0.255). Conclusion: A favorable VO profile at onset protects against futile recanalization in patients with large vessel occlusion in the anterior circulation, and provides a simple and feasible auxiliary method for predicting the prognosis of endovascular therapy in such patients.

Calcium sulfite oxidation activated by ferrous iron integrated with membrane filtration for removal of typical algal contaminants

Oxidation treatment of algae-laden water may cause cells rupture and emission of intracellular organics, thus restricting its further popularization. As a moderate oxidant, calcium sulfite could be slowly released in the liquid phase, thus exhibiting a potential to maintain the cells integrity. To this end, calcium sulfite oxidation activated by ferrous iron was proposed integrated with ultrafiltration (UF) for removal of Microcystis aeruginosa, Chlorella vulgaris and Scenedesmus quadricauda. The organic pollutants were significantly eliminated, and the repulsion between algal cells was obviously weakened. Through fluorescent components extraction and molecular weights distribution analyses, the degradation of fluorescent substances and the generation of micromolecular organics were verified. Moreover, the algal cells were dramatically agglomerated and formed larger flocs under the premise of maintaining high cell integrity. The terminal normalized flux was ascended from 0.048 to 0.072 to 0.711-0.956, and the fouling resistances were extraordinarily decreased. Due to the distinctive spiny structure and minimal electrostatic repulsion, Scenedesmus quadricauda was easier to form flocs, and its fouling was more readily mitigated. The fouling mechanism was remarkably altered through postponing the formation of cake filtration. The membrane interface characteristics including microstructures and functional groups firmly proved the fouling control efficiency. The reactive oxygen species (i.e., SO₄^•- and ¹O₂) generated through the principal reactions and Fe-Ca composite flocs played dominant roles in alleviating membrane fouling. Overall, the proposed pretreatment exhibits a brilliant application potential for enhancing UF in algal removal.

Improving ultrafiltration of algae-laden water with chitosan quaternary ammonium salt enhanced by sodium percarbonate

Ultrafiltration (UF) is extensively used for algae removal because of its ability to retain algal cells with high efficiency, but it still faces the problem of membrane fouling and low retention capacity of dissolved organics. Hence, a strategy of coagulation with chitosan quaternary ammonium salt (HTCC) enhanced by sodium percarbonate (SPC) pre-oxidation was proposed to improve the UF performance. The fouling resistances were calculated by a resistance-in-series model based on Darcy's formula, and the membrane fouling mechanism was evaluated using a pore plugging-cake filtration model. The effect of SPC-HTCC treatment on the properties of algal foulants was explored, and the result showed that the water quality was improved with the maximum removal rates of 78.8 %, 52.4 % and 79.5 % for algal cells, dissolved organic carbon and turbidity, respectively. The SPC could achieve a mild oxidation effect that degraded the electronegative organics attached to algal cells without destroying the cell integrity, making the algal pollutants easier to agglomerate through subsequent HTCC coagulation by forming larger flocs. In terms of membrane filtration, the terminal normalized flux was increased from 0.25 to 0.71, with the reversible and irreversible resistances reduced by 90.8 % and 40.2 %, individually. The synergistic treatment reduced the accumulation of algal cells and algae-derived organics on the membrane surface as inferred from the interface fouling characteristics. The interfacial free energy analysis showed that the synergistic treatment reduced the adhesion of contaminants to the membrane surface, as well as the attraction among pollutants. Overall, the proposed process has high application prospects for algae-laden water purification.

The Mechanism of the Anti-Cardiac Hypertrophy Effect of Glycyrrhizic Acid Is Related to Reducing STIM1-Dependent Store-Operated Calcium Entry

We explored the anti-cardiac hypertrophy mechanism of glycyrrhizic acid from the perspective of calcium regulation under pathological conditions. For this purpose, we used a rat model of myocardial hypertrophy induced by pressure overload. The effect of glycyrrhizic acid on BP was measured non-invasively with a sphygmomanometer and recorded in PC. In rats with modeled cardiac hypertrophy, the effect of GA on expression of type 1 matrix interaction molecules was determined in horizontal tissues and cultured cardiomyocytes of the left ventricle. The laser confocal microscopy and calcium ion probe Fluo-4 AM were used to assess the effect of glycyrrhizic acid on stromal interaction molecule 1 (STIM1)-dependent store-operated calcium entry in cultured cardiomyocytes derived from the hypertrophic myocardium. Glycyrrhizic acid exerted the anti-hypertrophic effect in rats with hypertrophic myocardium by down-regulating STIM1 protein expression and reducing the intensity of STIM1-dependent store-operated calcium entry.

[Visceral leishmaniasis in Xinjiang Uygur Autonomous Region during the COVID-19 pandemic: a case report]

OBJECTIVE

To perform an epidemiological investigation on a case of visceral leishmaniasis reported from Shule County, Kashi Prefecture, Xinjiang Uygur Autonomous Region in 2021, so as to provide insights into differential diagnosis of visceral leishmaniasis during the COVID-19 pandemic.

METHODS

The epidemiological history of this case was collected, and the case was diagnosed for Leishmania infection with the immunochromatographic (rK39) strip test, bone marrow smear microscopy and PCR assay.

RESULTS

The patient had typical clinical symptoms of leishmaniasis, including irregular fever, hepatosplenomeg- aly, low serum albumin and elevated globulin. Bone marrow smear microscopy identified L. donovani amastigotes, and both rK39 strip test and PCR assay were positive, while the case was tested negative for SARS-CoV-2. COVID-19 was therefore excluded and visceral leishmaniasis was diagnosed. Standard full-dose treatment with sodium stibogluconate was given, and no Leishmania was found on blood smears during the reexamination. No recurrence was found during the followup after discharge for hospital.

CONCLUSIONS

During the COVID-19 pandemic, it is recommended to increase the perception of differential diagnosis of visceral leishmaniasis among first-contact doctors, and reinforce the capability of differential diagnosis and health education of visceral leishmaniasis among medical and healthcare institutions at all levels, to prevent missed diagnosis and misdiagnosis of visceral leishmaniasis.

Ultra-high-resolution observations of persistent null-point reconnection in the solar corona

Magnetic reconnection is a key mechanism involved in solar eruptions and is also a prime possibility to heat the low corona to millions of degrees. Here, we present ultra-high-resolution extreme ultraviolet observations of persistent null-point reconnection in the corona at a scale of about 390 km over one hour observations of the Extreme-Ultraviolet Imager on board Solar Orbiter spacecraft. The observations show formation of a null-point configuration above a minor positive polarity embedded within a region of dominant negative polarity near a sunspot. The gentle phase of the persistent null-point reconnection is evidenced by sustained point-like high-temperature plasma (about 10 MK) near the null-point and constant outflow blobs not only along the outer spine but also along the fan surface. The blobs appear at a higher frequency than previously observed with an average velocity of about 80 km s^-1 and life-times of about 40 s. The null-point reconnection also occurs explosively but only for 4 minutes, its coupling with a mini-filament eruption generates a spiral jet. These results suggest that magnetic reconnection, at previously unresolved scales, proceeds continually in a gentle and/or explosive way to persistently transfer mass and energy to the overlying corona.

[Research advances on invasive fungal infections after burns]

Invasive fungal infection (IFI) is one of the serious complications in burn patients. The gradual development and application of broad-spectrum antibiotics in recent years has led to a serious dysbiosis of the flora, while the widespread prophylactic use of antifungal drugs has led to an increasing number of drug-resistant fungi. The clinical treatment of IFI is difficult and the prognosis is poor. The mortality of burn patients caused by IFI is increasing year by year. This paper reviews the epidemiologic characteristics, related risk factors, diagnostic methods, and treatment progress of IFI after burns, aiming to provide new ideas and reference for the prevention and treatment of IFI after burns.

Secondary pollution of microplastic hetero-aggregates after chlorination: Released contaminants rarely re-adsorbed by the second-formed hetero-aggregates

In urban waters, microplastics (MPs) usually form hetero-aggregates through adsorption of organics and microbes. However, the effects of hetero-aggregates on water quality are rarely reported. In this study we found that the hetero-aggregates, which accumulated contaminants, were like a "time bomb". Chlorination was able to trigger the "time bomb" through destruction of hetero-aggregates, lysis of microbial cells and elevation of the concentration of low-molecular-mass organics. Thereupon previously adhered organics desorbed from MPs, intracellular metabolites were released from lysed cells, and re-formation of hetero-aggregates was limited. This process rapidly increased the concentration of organics but prevented the re-adsorption of organics, which leads to secondary pollution. Thus, to alleviate the risks of secondary pollution caused by hetero-aggregates, the choice of oxidant species and dose should be optimized based on the characteristics of existent hetero-aggregates when purifying urban waters containing MPs.

Effect of ferrous-activated calcium peroxide oxidation on forward osmosis treatment of algae-laden water: Membrane fouling mitigation and mechanism

Forward osmosis (FO) is a high-efficiency and low-energy consumption way for algae-laden water treatment, whereas membrane fouling is still an unavoidable problem in its practical application. In this work, a strategy of ferrous-activated calcium peroxide (Fe(II)/CaO₂) was proposed to control FO membrane fouling in the purification of algae-laden water. With the treatment of Fe(II)/CaO₂, the aggregation of algal contaminants was promoted, the cell viability and integrity were well preserved, and the fluorescent organics were efficiently removed. With respect to the fouling of FO membrane, the flux decline was generally alleviated, and the flux recovery was promoted to varying degrees under different process conditions. It could be revealed through the extended Derjaguin-Landau-Verwey-Overbeek theory that the adhesion of contaminants and membrane surfaces was reduced by Fe(II)/CaO₂ treatment. The interface morphologies and functional groups of membrane verified that Fe(II)/CaO₂ could mitigate the fouling by reducing the amount of algal contaminants adhering to the FO membrane. The co-coagulation of in-situ Fe(III) together with Ca(OH)₂, as well as the oxidation of ^•OH were the main mechanisms for fouling mitigation. In sum, the Fe(II)/CaO₂ process could effectively improve the efficiency of FO for algae-laden water treatment, and has broad application prospects.

Mutual activation between ferrate and calcium sulfite for surface water pre-treatment and ultrafiltration membrane fouling control

In this work, ferrate (Fe(VI)) and calcium sulfite (CaSO₃) were combined to treat surface water for improving ultrafiltration (UF) performance. During the pre-treatment process, the Fe(VI) and CaSO₃ activated each other and a variety of active species (Fe(V), Fe(IV), OH, SO₄^-, ¹O₂, etc.) were generated. All of the five fluorescent components were effectively eliminated to different extents. With Fe(VI)/CaSO₃ = 0.05/0.15 mM, the dissolved organic carbon and UV₂₅₄ reduced by 44.33 % and 50.56 %, respectively. After UF, these values were further decreased with the removal rate of 50.27 % and 70.79 %. In the UF stage, the terminal J/J₀ increased to 0.42 from 0.17, with the reversible and irreversible fouling decreased by 67.08 % and 79.45 % at most. The membrane pore blocking was significantly mitigated, as well as the foulants deposition on membrane surfaces was decreased to some extent. The complete blocking was altered to standard blocking and intermediate blocking, the volume when entering cake filtration was also delayed slightly. The extended Derjaguin-Landau-Verwey-Overbeek theory was employed to judge the interface fouling behavior, and the results indicated that the foulants became more hydrophilic, as well as the adhesion trend between foulants and membrane surface was weakened. Overall, these results provide a theoretical foundation for the practical application of the combined Fe(VI)/CaSO₃-UF process in surface water purification.

Proteotoxic stress disrupts epithelial integrity by inducing MTOR sequestration and autophagy overactivation

Macroautophagy/autophagy, an evolutionarily conserved degradation system, serves to clear intracellular components through the lysosomal pathway. Mounting evidence has revealed cytoprotective roles of autophagy; however, the intracellular causes of overactivated autophagy, which has cytotoxic effects, remain elusive. Here we show that sustained proteotoxic stress induced by loss of the RING and Kelch repeat-containing protein C53A5.6/RIKE-1 induces sequestration of LET-363/MTOR complex and overactivation of autophagy, and consequently impairs epithelial integrity in C. elegans. In C53A5.6/RIKE-1-deficient animals, blocking autophagosome formation effectively prevents excessive endosomal degradation, mitigates mislocalization of intestinal membrane components and restores intestinal lumen morphology. However, autophagy inhibition does not affect LET-363/MTOR aggregation in animals with compromised C53A5.6/RIKE-1 function. Improving proteostasis capacity by reducing DAF-2 insulin/IGF1 signaling markedly relieves the aggregation of LET-363/MTOR and alleviates autophagy overactivation, which in turn reverses derailed endosomal trafficking and rescues epithelial morphogenesis defects in C53A5.6/RIKE-1-deficient animals. Hence, our studies reveal that C53A5.6/RIKE-1-mediated proteostasis is critical for maintaining the basal level of autophagy and epithelial integrity.Abbreviations: ACT-5: actin 5; ACTB: actin beta; ALs: autolysosomes; APs: autophagosomes; AJM-1: apical junction molecule; ATG: autophagy related; C. elegans: Caenorhabditis elegans; CPL-1: cathepsin L family; DAF: abnormal dauer formation; DLG-1: Drosophila discs large homolog; ERM-1: ezrin/radixin/moesin; EPG: ectopic P granule; GFP: freen fluorescent protein; HLH-30: helix loop helix; HSP: heat shock protein; LAAT-1: lysosome associated amino acid transporter; LET: lethal; LGG-1: LC3, GABARAP and GATE-16 family; LMP-1: LAMP (lysosome-associated membrane protein) homolog; MTOR: mechanistic target of rapamycin kinase; NUC-1: abnormal nuclease; PEPT-1/OPT-2: Peptide transporter family; PGP-1: P-glycoprotein related; RAB: RAB family; RIKE-1: RING and Kelch repeat-containing protein; SLCF-1: solute carrier family; SQST-1: sequestosome related; SPTL-1: serine palmitoyl transferase family.

Insights into olation reaction-driven coagulation and adsorption: A pathway for exploiting the surface properties of biochar

In this study, characterization of biochar for the efficient removal of cadmium was investigated. Biochar has a specific distribution of functional groups on its surface and has a natural electronegativity. Using carbonate as an olation reagent, the biochar coagulates with the olation reaction products. The maximum removal capacity reached 430.4 mg/g at pH = 4 (Langmuir Fit). Carbonate hydrolyzed on the surface of biochar, Cd2+ in solution undergoes olation with OH- and forms specially structured nanochains that are positively charged on the surface. The biochar with electronegativity on the surface coagulates with the cadmium hydroxide nanochains, and the cadmium-containing colloid formed by electrostatic attraction settles rapidly and removed. The biochar's re-flocculation performance was consistent, and the loadings could be changed to effectively remove cadmium while keeping the pH neutral at equilibrium.

Enhancing ultrafiltration of algal-rich water using ferrate activated with sodium percarbonate: Foulants variation, membrane fouling alleviation, and collaborative mechanism

Ultrafiltration (UF) is a reliable method to treat algal-rich water, whereas severe membrane fouling has impeded its actual application. To improve UF performance and alleviate membrane fouling resulted by algal foulants, a novel strategy coupling ferrate (Fe(VI)) and sodium percarbonate (SPC) was proposed. During the coupling process, Fe(VI) was activated by SPC to generate high-valent Fe intermediates (Fe(V) and Fe(IV)), which played a crucial role in high-efficiency oxidation for algal foulants, and the in-situ formed Fe(III) particles decomposed by Fe(VI) also enhanced the coagulation and adsorption capacity to the coupling system. Under the triple effects of coagulation, adsorption and oxidation, the algal foulants were efficiently eliminated. The zeta potential increased from -32.70 mV to -6.56 mV at most, the particle size was significantly enlarged, and the generated flocs possessed a great settleability. The morphology, viability, and integrity of algae cells were effectively maintained. The dissolved organic matters and fluorescent organics were efficiently removed, as well as macromolecular organics were reduced into lower molecular weight components. With the collaborative effect of Fe(VI) and SPC, the terminal specific flux was increased from 0.29 to 0.92, and the reversible and irreversible fouling resistances were reduced by 98.5% and 69.4%, individually. The surface functional groups were changed, and the dominant mechanisms were also converted to pore blocking from cake layer filtration. Overall, the experimental results would provide some new thoughts in actual production for algal-rich water treatment and UF membrane fouling alleviation.

Investigation of membrane fouling and mechanism induced by extracellular organic matter during long-term exposure to pharmaceuticals and personal care products

This study investigated ultrafiltration membrane fouling by extracellular organic matter (EOM) and the mechanism operating during long-term exposure to pharmaceuticals and personal care products. The results indicated that carbamazepine and diclofenac in algal-laden water altered the filtration flux and membrane fouling by EOM. Exposure to low-concentration carbamazepine (0.25 μg/L) improved the filtration flux and the total (R_tot) and reversible fouling resistance (R_c), whereas the filtration flux and R_tot and R_c were reduced when EOM was used during long-term exposure to high carbamazepine concentrations (>1 μg/L). Both R_tot and R_c were increased when algae were exposed to 0.25 μg/L diclofenac, whereas the filtration flux and R_tot and R_c were alleviated when algae were exposed to >1 μg/L diclofenac. Moreover, carbamazepine and diclofenac (0.25 μg/L - 1000 μg/L) in water enhanced the irreversible fouling resistance (R_b) when ultrafiltration was used to treat algal-laden waters. The mechanism indicated that membrane fouling induced by standard blocking was transformed to complete blocking when EOM was exposed to high levels of carbamazepine (>0.25 μg/L) in the initial filtration process, whereas cake layer formation played an important role during the later filtration process; with low carbamazepine levels (0.25 μg/L), standard blocking of EOM was dominant during the entire filtration process. The membrane fouling mechanism also changed when algal-laden waters were exposed to diclofenac, the membrane fouling was transformed from complete blocking to standard blocking when DFC was present in the initial filtration process, whereas cake layer formation exerted an important role during the late filtration process. This research provides important information on the long-term risks caused by pharmaceutical and personal care products and potential threats to membrane treatment.

Effects of UV/Fe(II)/sulfite pre-treatment on NOM-enhanced Ca2+ scaling during nanofiltration treatment: Fouling mitigation, mechanisms, and correlation analysis of membrane resistance

This study was aimed to evaluate the effects of a pre-treatment involving sulfite (S(IV)) synergistically activated by ultraviolet (UV)/Fe(II) on natural organic matter (NOM)-enhanced Ca²⁺ scaling during nanofiltration treatment. Based on the variations in the physicochemical properties and correlation analyses of irreversible resistance, the intrinsic fouling mechanisms were revealed from two aspects: bulk crystallization (interaction between NOM and inorganic ions) and surface crystallization (morphology of surface crystallization and a change in the Ca²⁺ concentration in the scaling layer). Furthermore, the degradation contribution rates of different free radicals during the UV/Fe(II)/S(IV) (UFS) treatment process were evaluated. During the reactions in the UFS, three free radicals (SO·-4, OH^·- and e- aq) were generated, and in-situ Fe(III) was formed in-situ. The carboxyl groups of the NOM were attacked by the free radicals, resulting in decreased of carboxyl concentration and density. In addition, the bond between Ca²⁺ and NOM weakened, and hydrophobic (HPO) substances were mineralized. However, the Fe(III) formed in-situ was active and electropositive, competing with Ca²⁺ for the complexation active sites on the NOM. The synergy effect of bulk crystallization and surface crystallization led to a significant decrease in the particle size of feed solution. The crystal size and roughness of membrane surface also decreased, which was conducive to reducing the membrane irreversible resistance. Correlation analysis revealed that the HPO ratio, carboxyl density and particle size (> 100 nm) ratio were effective characterization parameters for predicting irreversible resistance. This study not only provides guidance for alleviating membrane fouling caused by NOM-enhanced Ca²⁺ scaling during the nanofiltration process, but also presents the rationality of irreversible resistance during nanofiltration process and various indicators with strong linear correlation.

Effect of peroxydisulfate oxidation catalyzed with ordered mesoporous carbons on controlling ultrafiltration membrane fouling by algal organic matter

As typical ordered mesoporous carbons (OMCs) materials, CMK-3 and CMK-8 were proposed for catalyzing peroxydisulfate (PDS), and the OMCs/PDS process was combined with membrane filtration to remove algal extracellular organic matter and mitigate membrane fouling. The CMK-3/PDS process achieved substantial reduction of dissolved organic carbon and UV₂₅₄, followed by CMK-8/PDS. The degradation behavior of fluorescent organics demonstrated the superior performance of OMCs/PDS, while the decomposition of high molecular weight (MW) compounds and generation of lower MW organics were observed. Generally, CMK-3 possessed higher catalytic activity on PDS compared with CMK-8 and powdered activated carbon. The CMK-3/PDS process distinctly decreased the fouling resistances for polyether sulfone and polyvinylidene fluoride membranes, with the reversible resistance reduced by 59.5-83.2% and irreversible resistance declined by 71.7-73.0%. In the meanwhile, CMK-3/PDS prolonged the volumes to the transition period, and postponed the cake layer's generation. The characterization of the membrane morphologies and chemical compositions also showed effective alleviation of fouling. The generated SO₄^-, OH, O₂^- and ¹O₂ as major active oxidation species provided radical as well as non-radical reaction ways for pollutants removal. Overall, our study provides some new ideas for membrane-based combined water purification processes.

Degradation of iopamidol by UV365/NaClO: Roles of reactive species, degradation mechanism, and toxicology

The degradation of iopamidol (IPM) was investigated using a UV₃₆₅/NaClO system. The reactive species (HO·, ClO·, ozone, Cl·, and Cl₂^-·) in the system were identified, and the changing trends of the percentage contributions of these reactive species to IPM removal under various conditions were systematically evaluated. The results showed that ClO· and HO· played the most significant roles in the apparent pseudo-first-order rate constants of IPM degradation (k_obs, min^-1) in the control experiment, and their percentage contributions to k_obs were 41.31% and 34.45%, respectively. In addition, Cl· and Cl₂^-· together contributed 22% to the k_obs. Furthermore, the contribution of ozone to the IPM removal could be neglected. The concentrations of these species increased significantly when the concentration of NaClO was increased from 50 µM to 200 µM, while the percentage contribution of ClO· to k_obs was greatly increased. The concentrations and percentage contributions of HO· and ClO· decreased significantly as the solution pH increased from 5 to 9, with Cl₂^-· playing a greater role in the degradation of IPM under alkaline conditions. While Cl^- or HCO₃^-/CO₃^2- significantly promoted the generation of Cl₂^-· or CO₃^-·, neither had an obvious effect on k_obs, suggesting that Cl₂^-· and CO₃^-· should have a certain reactivity with IPM. Compared with that of Cl₂^-·, the percentage contribution of ClO· and Cl· to k_obs was more likely to be inhibited by NOM. In addition, the organic and inorganic oxidation products of IPM were detected. The oxidation mechanisms of IPM degradation in the UV₃₆₅/NaClO system, such as the H-extraction reaction, deiodination, substitution reaction, amide hydrolysis, and amine oxidation, were proposed according to the obtained 15 organic products. No effect on acute toxicity towards Vibrio fischeri and Photobacterium phosphoreum was detected during the oxidation of IPM by the UV₃₆₅/NaClO system. Furthermore, the engineering feasibility of the oxidation system was demonstrated, by the effective degradation of IPM in actual water. However, HOI rapidly accumulated during the removal of IPM in the UV₃₆₅/NaClO system, which poses certain environmental risks and will needs to be investigated.

CuO@carbon nanofiber as an efficient peroxymonosulfate catalyst for mitigation of organic matter fouling in the ultrafiltration process

Persulfate oxidation has been increasingly integrated with membrane separation for water purification, whereas the oxidizing ability of persulfate is relatively limited, and appropriate activation methods are urgently required. In this work, a novel catalyst of carbon nanofiber (CNF) supported CuO (CuO@CNF) was synthesized for peroxymonosulfate (PMS) activation. The micro-morphology showed that CuO nanoparticles were well dispersed on the CNF support, which solved the agglomeration problem of nanoparticles and improved the catalytic ability. Furtherly, PMS oxidation activated by CuO@CNF was proposed as a pre-processing means for improving ultrafiltration (UF) water purification efficiency and mitigating membrane fouling. The prepared CuO@CNF was more efficient than individual CNF and CuO in activating PMS for the reduction of various typical natural organic matter, improving permeation flux, and mitigating membrane fouling. The fouling control efficiencies were also verified by characterizing the membrane surface functional groups. The CuO@CNF catalyst could signally promote the oxidative capacity by generating a series of reactive oxygen species, thus enhancing the removal of organics with varying species and molecular weight ranges in surface water. With respect to the fouling condition, the specific permeation flux after filtration was improved from 0.25 to 0.61, with the removal rate of reversible fouling resistance reached 89.6%. The fouling mechanism was apparently altered, with both standard and complete blocking dominated throughout the filtration process. The findings are beneficial for the development of new strategies to improve membrane-based water purification efficiency.

In Situ Chemical Modification with Zwitterionic Copolymers of Nanofiltration Membranes: Cure for the Trade-Off between Filtration and Antifouling Performance

Breaking the trade-off between filtration performance and antifouling property is critical to enabling a thin-film nanocomposite (TFC) nanofiltration (NF) membrane for a wide range of feed streams. We proposed a novel design route for TFC NF membranes by grafting well-defined zwitterionic copolymers of [2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl)ammonium hydroxide (SBMA) and 2-aminoethyl methacrylate hydrochloride (AEMA) on the polyamide surfaces via an in situ surface chemical modification process. The successful grafting of a zwitterionic copolymer imparted the modified NF membranes with better surface hydrophilicity, a larger actual surface area (i.e., nodular structures), and a thinner polyamide layer. As a result, the water permeability of the modified membrane (i.e., TFC-10) was triple that of the pristine TFC membrane while maintaining high Na₂SO₄ rejection. We further demonstrated that the TFC-10 membrane possessed exceptional antifouling properties in both static adsorption tests and three cycles of dynamic protein and humic acid fouling tests. To recap, this work provides valuable insights and strategies for the fabrication of TFC NF membranes with simultaneously enhanced filtration performance and antifouling property.

[Construction of prediction model combined dual-energy CT quantitative parameters and conventional CT features for assessing the Ki-67 expression levels in invasive breast cancer]

Objective: To develop a model combined with dual-energy CT quantitative parameters and conventional CT features for evaluating the expression level of Ki-67 in invasive breast cancer. Methods: A total of 191 patients with histologically confirmed invasive breast cancer in Lishui Central Hospital from March 2019 to December 2020, were retrospectively enrolled, all of them were females, aged from 25 to 77 (53.2±11.3) years. All patients underwent preoperative non-contrast chest and contrast-enhanced Dual energy CT scans, and the normalized iodine concentration (NIC) of lesions on arterial and venous phase, spectral curve slope (λ_HU), and normalized effective atomic number (nZ_eff) were measured and calculated, and their conventional CT characteristics were assessed. According to the results of immunohistochemistry (IHC), the patients were divided into Ki-67 high expression group (n=129 patients) and low expression group (n=62 patients) level. The differences in clinical data, conventional CT characteristics and dual-energy CT quantitative parameters between the two groups were analyzed. The receiver operating characteristic curve (ROC) curve was conducted to assess the efficacy of each individual model and joint model in evaluating Ki-67 expression levels, and the area under the curve (AUC), sensitivity, specificity, and accuracy were calculated, respectively. Results: In the analysis of CT features, the longest diameter, shape and enhancement pattern of the tumor were significantly difference between the two groups (all P<0.05). The NIC, nZ_eff on the arterial phase and NIC, nZ_eff and λ_HU [M(Q₁,Q₃)] on the venous phase were higher in the high Ki-67 expression group compared to the low expression group [0.13 (0.12, 0.16) vs 0.11 (0.08, 0.14), 0.71 (0.70, 0.75) vs 0.70 (0.67, 0.72), 0.40 (0.32, 0.48) vs 0.23 (0.17, 0.32), 3.10 (2.58, 3.63) vs 2.86 (2.19, 3.48), 0.88 (0.85, 0.92) vs 0.85 (0.84, 0.86), all P<0.05]. The logistic regression model, which integrated significant conventional CT features and dual-energy CT quantitative parameters, demonstrated the highest diagnostic performance for assessing Ki-67 expression levels, with an AUC of 0.924, sensitivity of 88.37%, specificity of 83.87%, and accuracy of 86.91%; the AUC of the dual-energy CT parameter model was 0.908, sensitivity of 82.17%, specificity of 88.71%, and accuracy of 84.29%. Though the diagnostic efficacy was no significant difference (P=0.238), both models showed superior to the conventional CT feature model (all P<0.001). Conclusion: A dual-energy CT quantitative parameter combined with a conventional CT feature model was successfully constructed, which has a good evaluation performance on the expression level of Ki-67 in invasive breast cancer.

Circulating myeloid-derived suppressors cells correlate with clinicopathological characteristics and outcomes undergoing neoadjuvant chemoimmunotherapy in non-small cell lung cancer

PURPOSE

Myeloid-derived suppressors cells (MDSCs) are heterogeneous immunosuppressive cells, closely related to the development, efficacy and prognosis in various tumors. The relationship between clinicopathological characteristics, efficacy of neoadjuvant chemoimmunotherapy (NCIO) and circulating MDSCs in patients with non-small cell lung cancer (NSCLC) was investigated in this study.

METHODS

This study analyzed the clinical data of patients diagnosed at Department of Thoracic Surgery, Beijing Chest Hospital from November 2020 to August 2021. MDSCs and T cells subgroups were measured in fresh peripheral blood mononuclear cells(PBMCs) at baseline. Flow cytometry was used to detect MDSCs and T cells subgroups.

RESULTS

A total of 78 patients with NSCLC and 20 patients with benign nodule underwent direct surgery. 23 patients with NSCLC scheduled to accept NCIO before surgery. NSCLC had elevated levels of total MDSCs, PMN-MDSCs and M-MDSCs compared to patients with benign nodule. MDSCs subgroups were correlated to the pTNM stage in NSCLC patients. The frequency of total MDSCs were moderately positively correlated with regulatory T cells (Tregs)(r = 0.3597, P < 0.01) and negatively correlated with CD4 + T cells(r = 0.2714, P < 0.05). The baseline levels of total MDSCs, PMN-MDSCs and Tregs in pCR patients were significantly decreased than those of non-pCR patients (P < 0.05).

CONCLUSION

Circulating MDSCs were increased in NSCLC patients. MDSC subgroups were related to pTNM stage in NSCLC patients. Total MDSCs were positively correlated with Tregs levels and negatively correlated with CD4 + T cells in peripheral blood. The level of MDSCs and Tregs in peripheral blood may have potential value in predicting pathological response in NSCLC.

[Role and mechanism of Vγ4 T cells in impaired wound healing of rapamycin-induced full-thickness skin defects in mice]

Objective: To investigate the role and mechanism of Vγ4 T cells in impaired wound healing of rapamycin-induced full-thickness skin defects in mice. Methods: The experimental research methods were applied. Eighty-six C57BL/6J male mice (hereinafter briefly referred to as wild-type mice) aged 8-12 weeks were selected for the following experiments. Vγ4 T cells were isolated from axillary lymph nodes of five wild-type mice for the following experiments. Intraperitoneal injection of rapamycin for 42 mice was performed to establish rapamycin-treated mice model for the following experiments. Eighteen wild-type mice were divided into normal control group without any treatment, trauma only group, and trauma+CC chemokine ligand 20 (CCL20) inhibitor group according to the random number table (the same grouping method below), with 6 mice in each group. The full-thickness skin defect wound was made on the back of mice in the latter two groups (the same wound model below), and mice in trauma+CCL20 inhibitor group were continuously injected subcutaneously with CCL20 inhibitor at the wound edge for 3 days after injury. Another 6 rapamycin-treated mice were used to establish wound model as rapamycin+trauma group. On post injury day (PID) 3, the epidermal cells of the skin tissue around the wound of each trauma mice were extracted by enzyme digestion, and the percentage of Vγ4 T cells in the epidermal cells was detected by flow cytometry. In normal control group, the epidermal cells of the normal skin tissue in the back of mice were taken at the appropriate time point for detection as above. Five wild-type mice were used to establish wound models. On PID 3, the epidermal cells were extracted from the skin tissue around the wound. The cell populations were divided into Vγ4 T cells, Vγ3 T cells, and γδ negative cells by fluorescence-activated cell sorter, which were set as Vγ4 T cell group, Vγ3 T cell group, and γδ negative cell group (with cells in each group being mixed with B16 mouse melanoma cells), respectively. B16 mouse melanoma cells were used as melanoma cell control group. The expression of interleukin-22 (IL-22) mRNA in cells of each group was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-PCR), with the number of samples being 6. Thirty rapamycin-treated mice were used to establish wound models, which were divided into Vγ4 T cell only group and Vγ4 T cell+IL-22 inhibitor group performed with corresponding injections and rapamycin control group injected with phosphate buffer solution (PBS) immediately after injury, with 10 mice in each group. Another 10 wild-type mice were taken to establish wound models and injected with PBS as wild-type control group. Mice in each group were injected continuously for 6 days. The percentage of wound area of mice in the four groups was calculated on PID 1, 2, 3, 4, 5, and 6 after injection on the same day. Six wild-type mice and 6 rapamycin-treated mice were taken respectively to establish wound models as wild-type group and rapamycin group. On PID 3, the mRNA and protein expressions of IL-22 and CCL20 in the peri-wound epidermis tissue of mice in the two groups were detected by real-time fluorescence quantitative RT-PCR and Western blotting, respectively. The Vγ4 T cells were divided into normal control group without any treatment and rapamycin-treated rapamycin group. After being cultured for 24 hours, the mRNA and protein expressions of IL-22 of cells in the two groups were detected by real-time fluorescence quantitative RT-PCR and Western blotting, respectively, with the number of samples being 6. Data were statistically analyzed with independent sample t test, analysis of variance for repeated measurement, one-way analysis of variance, Bonferroni method, Kruskal-Wallis H test, and Wilcoxon rank sum test. Results: The percentage of Vγ4 T cells in the epidermal cells of the skin tissue around the wound of mice in trauma only group on PID 3 was 0.66% (0.52%, 0.81%), which was significantly higher than 0.09% (0.04%, 0.14%) in the epidermal cells of the normal skin tissue of mice in normal control group (Z=4.31, P<0.01). The percentages of Vγ4 T cells in the epidermal cells of the skin tissue around the wound of mice in rapamycin+trauma group and trauma+CCL20 inhibitor group on PID 3 were 0.25% (0.16%, 0.37%) and 0.24% (0.17%, 0.35%), respectively, which were significantly lower than that in trauma only group (with Z values of 2.27 and 2.25, respectively, P<0.05). The mRNA expression level of IL-22 of cells in Vγ4 T cell group was significantly higher than that in Vγ3 T cell group, γδ negative cell group, and melanoma cell control group (with Z values of 2.96, 2.45, and 3.41, respectively, P<0.05 or P<0.01). Compared with that in wild-type control group, the percentage of wound area of mice in rapamycin control group increased significantly on PID 1-6 (P<0.01), the percentage of wound area of mice in Vγ4 T cell+IL-22 inhibitor group increased significantly on PID 1 and PID 3-6 (P<0.05 or P<0.01). Compared with that in rapamycin control group, the percentage of wound area of mice in Vγ4 T cell only group decreased significantly on PID 1-6 (P<0.05 or P<0.01). Compared with that in Vγ4 T cell only group, the percentage of wound area of mice in Vγ4 T cell+IL-22 inhibitor group increased significantly on PID 3-6 (P<0.05 or P<0.01). On PID 3, compared with those in wild-type group, the expression levels of IL-22 protein and mRNA (with t values of -7.82 and -5.04, respectively, P<0.01) and CCL20 protein and mRNA (with t values of -7.12 and -5.73, respectively, P<0.01) were decreased significantly in the peri-wound epidermis tissue of mice in rapamycin group. After being cultured for 24 hours, the expression levels of IL-22 protein and mRNA in Vγ4 T cells in rapamycin group were significantly lower than those in normal control group (with t values of -7.75 and -6.04, respectively, P<0.01). Conclusions: In mice with full-thickness skin defects, rapamycin may impair the CCL20 chemotactic system by inhibiting the expression of CCL20, leading to a decrease in the recruitment of Vγ4 T cells to the epidermis, and at the same time inhibit the secretion of IL-22 by Vγ4 T cells, thereby slowing the wound healing rate.

[Consensus of experts on the medical risk prevention for the patients with cardiovascular diseases during dental treatment (2022 edition)]

With the aging process of population in the society, the prevalence of cardiovascular diseases (CVD) in China is increasing continuously and the number of dental patients with CVD is increasing gradually too. Due to the lack of guidelines for dental patients with CVD in our country, how to implement standardized preoperative evaluation and perioperative risk prevention remains a problem to be solved for dentists at present. The present expert consensus was reached by combining the clinical experiences of the expert group of the Fifth General Dentistry Special Committee, Chinese Stomatological Association and respiratory and cardiology experts in diagnosis and treatment for CVD patients, and by systematically summarizing the relevant international guidelines and literature regarding the relationship between CVD and oral diseases and the diagnosis and treatment of dental patients with heart failure, hypertension and antithrombotic therapy. The consensus aims to provide, for the dental clinicians, the criteria on diagnosis and treatment of CVD in dental patients in China so as to reduce the risk and complications, and finally to improve the treatment levels of dental patients with CVD in China.

[Pretreatment evaluation of 18F-FDG PET-CT in extranodal NK/T-cell lymphoma]

Objective: To investigate the clinical value of pretreatment ¹⁸F-fluorodeoxy glucose positron emission tomography/computed tomography (¹⁸F-FDG PET-CT) in extranodal NK/T-cell lymphoma. Methods: Eighty-one patients with pathologically confirmed extranodal NK/T-cell lymphoma and pretreatment with PET-CT scan in Cancer Hospital, Chinese Academy of Medical Sciences from August 2006 to December 2017 were enrolled in the study. The clinical, follow-up and imaging data were analyzed retrospectively. The relationship between maximum standard uptake value (SUV_max) and prognosis were evaluated by Mann-Whitney U test and Spearman rank correlation analysis. Results: Among the 81 patients, 98.8% (80/81) were upper aerodigestive tract (UAT) involved. Lesions at extra-UAT sites were detected in 7 cases, involving parotid gland (n=1), breast (n=1), spleen (n=1), pancreas (n=1), skin and subcutaneous soft tissue (n=1), muscle (n=1), lung (n=2) and bone (n=3). Lymph node involvement were demonstrated in 33 cases. All of the lesions had increased uptake of PET, the median SUV_max was 8.6. PET-CT changed staging in 15 cases, and 12 cases were adjusted treatment methods. 21 cases were changed radiotherapy target because of PET-CT. The 1-, 2-year progression-free survival (PFS) rates were 88.7% and 80.3% while 1-, 2-year overall survival (OS) rates were 97.2% and 94.4% respectively. The median SUV_max of patients with local lymph nodes involvement was significantly higher than those without local lymph nodes involvement (P=0.007). The SUV_max was positively associated with Ann Arbor stage (r=0.366, P=0.001), lactate dehydrogenase (r=0.308, P=0.005) and Ki-67 level (r=0.270, P=0.017). The SUV_max was inversely associated with lymphocyte count (r=-0.324, P=0.003) and hemoglobin content (r=-0.225, P=0.043). Conclusions: Extranodal NK/T-cell lymphoma predominantly occurs in extra-nodal organs, mainly in the upper respiratory and gastrointestinal tracts, with marked FDG-addiction. Compared with conventional imaging, ¹⁸F-FDG PET-CT is sensitive and comprehensive in detecting extra-nodal NK/T-cell lymphoma involvement, assisting in accurate clinical staging and treatment planning. Pretreatment SUV_max is potential for prognosis evaluation since it is correlated with prognostic factors.