Causal relationship between cigarette smoking behaviors and the risk of hernias: a Mendelian randomization study

PURPOSE

As the global population continues to age, there is a noticeable yearly rise in the incidence of hernias. Simultaneously, smoking, a widespread addictive behavior and a significant contributor to mortality, has evolved into a pervasive public health concern. Existing literature has already established a connection between smoking and an increased risk of postoperative recurrence and postoperative infections following hernia surgery. However, there remains a dearth of research exploring the association between smoking and hernia morbidity. In this study, our objective is to systematically evaluate the causal relationship between cigarette smoking behaviors and hernia morbidity using a Mendelian randomization (MR) approach.

METHODS

Hernia-related data were sourced from the FinnGen Biobank database, while cigarette smoking behavior data were gathered from the GWAS and Sequencing Consortium of Alcohol and Nicotine Use. To assess the causal relationship, we employed five methods: the weighted median, the weighted mode the inverse variance weighted (IVW), MR-Egger, and the simple mode. Sensitivity analysis was conducted, incorporating Cochran's Q test, the MR-Egger intercept test, leave-one-out analysis, and funnel plot. The presentation of the causal relationship is expressed as an odds ratio (OR) along with their corresponding 95% confidence intervals (CI).

RESULTS

Employing the IVW method as the reference standard, we found that smoking intensity is associated with an increased risk of diaphragmatic hernia (OR = 1.21, 95% CI 1.00-1.46, P = 0.047). These consistent findings were further corroborated by the weighted median and weighted mode methods (OR = 1.26, 95% CI 1.03-1.54, P = 0.026; OR = 1.25, 95% CI 1.02-1.52, P = 0.045). Conversely, when applying the IVW method, we identified no statistically significant causal relationship between smoking age, smoking initiation status, smoking cessation status, and the incidence of hernia.

CONCLUSIONS

Our MR study has uncovered genetic evidence linking smoking intensity and the occurrence of diaphragmatic hernia. The risk of developing diaphragmatic hernia rises in tandem with the intensity of smoking. This emphasizes the crucial role of regularly advising patients to cease smoking in clinical settings.

Multi-ancestry Genome-Wide Association Study of Early Childhood Caries

Early childhood caries (ECC) is the most common non-communicable childhood disease. It is an important health problem with known environmental and social/behavioral influences that lacks evidence for specific associated genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multi-ancestry population of U.S. preschool-age children (n=6,103) participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used ICDAS criteria to measure ECC with the primary trait using the dmfs index with decay classified as macroscopic enamel loss (ICDAS ≥3). We estimated heritability, concordance rates, and conducted genome-wide association analyses to estimate overall genetic effects; the effects stratified by sex, household water fluoride, and dietary sugar; and leveraged the combined gene/gene-environment effects using the 2-degree-of-freedom (2df) joint test. The common genetic variants explained 24% of the phenotypic variance (heritability) of the primary ECC trait and the concordance rate was higher with a higher degree of relatedness. We identified 21 novel non-overlapping genome-wide significant loci for ECC. Two loci, namely RP11-856F16 . 2 (rs74606067) and SLC41A3 (rs71327750) showed evidence of association with dental caries in external cohorts, namely the GLIDE consortium adult cohort (n=∼487,000) and the GLIDE pediatric cohort (n=19,000), respectively. The gene-based tests identified TAAR6 as a genome-wide significant gene. Implicated genes have relevant biological functions including roles in tooth development and taste. These novel associations expand the genomics knowledge base for this common childhood disease and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations of oral health.

Association between infarct location and haemorrhagic transformation of acute ischaemic stroke after intravenous thrombolysis

AIM

To evaluate the association between computed tomography (CT)-based imaging variables at the time of admission and haemorrhagic transformation (HT) after intravenous thrombolysis (IVT).

MATERIALS AND METHODS

One hundred and eight patients who were treated with IVT for acute ischaemic stroke (AIS) during January 2021 to July 2023 were analysed retrospectively. The infarct location was classified as cortical or subcortical in accordance with the Alberta Stroke Program Early CT Score (ASPECTS) system. Logistic regression and receiver operating characteristic curve analyses were performed to determine the relationship between ischaemic variables and HT.

RESULTS

Of the total, 18 (16.7%) patients had HT and seven (6.5%) had symptomatic intracerebral haemorrhage (sICH). Multivariate analysis revealed that cortical ASPECTS was independently associated with HT (odds ratio [OR], 0.197; 95% confidence interval [CI], 0.076-0.511; p=0.001) and cortical ASPECTS was independently associated with sICH (OR, 0.066; 95% CI, 0.009-0.510; p=0.009). To predict HT and sICH, cortical ASPECTS (HT area under the curve [AUC] = 0.881, sICH AUC = 0.971) provided a higher AUC compared with ASPECTS (HT AUC = 0.850, sICH AUC = 0.918).

CONCLUSION

Cortical ASPECTS seen on CT at the time of admission is associated with HT and sICH after IVT.

Isolation and application of Bacillus thuringiensis LZX01: Efficient membrane biofouling mitigation function and anti-toxicity potential

Significant progress has been made in mitigating membrane biofouling by microbial quorum quenching (QQ). More efficient and survivable QQ strains need to be discovered. A new strain named Bacillus thuringiensis LZX01 was isolated in this study using a low carbon source concentration "starving" method from a membrane bioreactor (MBR). LZX01 secreted intracellular lactonase to enable QQ behavior and was capable of degrading 90 % of C8-HSL (200 ng/mL) within 30 min, which effectively delayed biofouling by inhibiting the growth of bacteria associated with biofouling and improving the hydrophilicity of bound extracellular polymeric substances. As a result, the membrane biofouling rate of MBR adding LZX01 was four times slower than that of the control MBR. Importantly, LZX01 maintains its QQ activity even in environments contaminated with typical toxic pollutants. Therefore, with high efficiency, toxicity resistance, and easy culture, LZX01 holds great potential and significant promise for biofouling control applications.

[Construction and preliminary validation of a risk prediction model for the recurrence of diabetic foot ulcer in diabetic patients]

Objective: To develop a risk prediction model for the recurrence of diabetic foot ulcer (DFU) in diabetic patients and primarily validate its predictive value. Methods: Meta-analysis combined with retrospective cohort study was conducted. The Chinese and English papers on risk factors related to DFU recurrence publicly published in China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and PubMed, Embase, Cochrane Library, and Web of Science, and the search time was from the establishment date of each database until March 31st, 2022. The papers were screened and evaluated, the data were extracted, a meta-analysis was performed using RevMan 5.4.1 statistical software to screen risk factors for DFU recurrence, and Egger's linear regression was used to assess the publication bias of the study results. Risk factors for DFU recurrence mentioned in ≥3 studies and with statistically significant differences in the meta-analysis were selected as the independent variables to develop a logistic regression model for risk prediction of DFU recurrence. The medical records of 101 patients with DFU who met the inclusion criteria and were admitted to Affiliated Hospital of Guizhou Medical University from January 2019 to June 2022 were collected. There were 69 males and 32 females, aged (63±14) years. The receiver operating characteristic (ROC) curve of the predictive performance of the above constructed predictive model for DFU recurrence was drawn, and the area under the ROC curve, maximum Youden index, and sensitivity and specificity at the point were calculated. Dataset including data of 8 risk factors for DFU recurrence and the DFU recurrence rates of 10 000 cases was simulated using RStudio software and a scatter plot was drawn to determine two probabilities for risk division of DFU recurrence. Using the β coefficients corresponding to 8 DFU recurrence risk factors ×10 and taking the integer as the score of coefficient weight of each risk factor, the total score was obtained by summing up, and the cutoff scores for risk level division were calculated based on the total score × two probabilities for risk division of DFU recurrence. Results: Finally, 20 papers were included, including 3 case-control studies and 17 cohort studies, with a total of 4 238 cases and DFU recurrence rate of 22.7% to 71.2%. Meta-analysis showed that glycosylated hemoglobin >7.5% and with plantar ulcer, diabetic peripheral neuropathy, diabetic peripheral vascular disease, smoking, osteomyelitis, history of amputation/toe amputation, and multidrug-resistant bacterial infection were risk factors for the recurrence of DFU (with odds ratios of 3.27, 3.66, 4.05, 3.94, 1.98, 7.17, 11.96, 3.61, 95% confidence intervals of 2.79-3.84, 2.06-6.50, 2.50-6.58, 2.65-5.84, 1.65-2.38, 2.29-22.47, 4.60-31.14, 3.13-4.17, respectively, P<0.05). There were no statistically significant differences in publication biases of diabetic peripheral neuropathy, diabetic peripheral vascular disease, glycosylated hemoglobin >7.5%, plantar ulcer, smoking, multidrug-resistant bacterial infection, or osteomyelitis (P>0.05), but there was a statistically significant difference in the publication bias of amputation/toe amputation (t=-30.39, P<0.05). The area under the ROC curve of the predictive model was 0.81 (with 95% confidence interval of 0.71-0.91) and the maximum Youden index was 0.59, at which the sensitivity was 72% and the specificity was 86%. Ultimately, 29.0% and 44.8% were identified respectively as the cutoff for dividing the probability of low risk and medium risk, and medium risk and high risk for DFU recurrence, while the corresponding total scores of low, medium, and high risks of DFU recurrence were <37, 37-57, and 58-118, respectively. Conclusions: Eight risk factors for DFU recurrence are screened through meta-analysis and the risk prediction model for DFU recurrence is developed, which has moderate predictive accuracy and can provide guidance for healthcare workers to take interventions for patient with DFU recurrence risk.

TIM-3 regulates the proliferation by BDNF-mediated PI3K/AKT axis in the process of endometriosis

BACKGROUND

T cell immunoglobulin and mucin domain-containing molecule-3 (TIM-3) initially discovered on the surface of Th1 cells, negatively regulates immune responses and mediates apoptosis of Th1 cells. An increasing number of studies have since shown that TIM-3 is crucial in the genesis and development of immune diseases, cancers, and chronic infectious illnesses. However, the effect of TIM-3 on endometriosis is still unknown.

METHODS

Quantitative real-time polymerase chain reaction, western blotting, and immunohistochemistry were used to measure TIM-3 levels in endometriosis. Cell Counting Kit-8, 5-ethynyl-2'-deoxyuridine, colony-forming, Transwell® migration, Matrigel® invasion, and flow cytometry assays were used to explore the function of TIM-3 in vitro, and xenograft experiments in nude mice were used to assess its role in vivo. According to the RNA seq, brain-derived neurotrophic factor (BDNF) was screened. The involvement of specific proliferation-related signaling molecules was determined by transfecting a plasmid and adding an inhibitor in vivo and in vitro.

RESULTS

TIM-3 mRNA and protein expression levels were significantly higher in eutopic and ectopic endometrial tissues than in normal endometrial tissues. By examining the effects of TIM-3 overexpression and knockdown on cell proliferation, migration, and invasion in vitro, and lesions formation in vivo, we found that the expression of TIM-3 was positively correlated with cell proliferation and clone formation in vitro, as well as lesions growth in nude mice. By adding the phosphatidylinositol 3 kinase/protein kinase B(PI3K/AKT) pathway inhibitor LY294002 and knocking down PI3K, we further verified that TIM-3 promotes proliferation in vivo and in vitro via the PI3K pathway. By transfecting the plasmid into ESC cells and gave inhibitors to endometriotic rats models, we tested that TIM-3 regulates the proliferation by BDNF-mediated PI3K/AKT axis.

CONCLUSION

TIM-3 can promote the proliferation of endometriosis by BDNF-mediated PI3K/AKT axis in vivo and in vitro, which may provide a new therapeutic target for the treatment of endometriosis.

Generation and identification of 1O2 in catalysts/peroxymonosulfate systems for water purification

Catalysts for peroxymonosulfate (PMS) activation are appealing in the purification of organic wastewater. Singlet oxygen (1O2) is widely recognized as a crucial reactive species for degrading organic contaminants in catalysts/PMS systems due to its adamant resistance to inorganic anions, high selectivity, and broad pH applicability. With the rapid growth of studies on 1O2 in catalysts/PMS systems, it becomes necessary to provide a comprehensive review of its current state. This review highlights recent advancements concerning 1O2 in catalysts/PMS systems, with a primary focus on generation pathways and identification methods. The generation pathways of 1O2 are summarized based on whether (distinguished by the geometric structures of metal species) or not (distinguished by the active sites) the metal element is included in the catalysts. Furthermore, this review thoroughly discusses the influence of metal valence states and metal species with different geometric structures on 1O2 generation. Various potential strategies are explored to regulate the generation of 1O2 from the perspective of catalyst design. Identification methods of 1O2 primarily include electron paramagnetic resonance (EPR), quenching experiments, reaction in D2O solution, and chemical probe tests in catalysts/PMS systems. The principles and applications of these methods are presented comprehensively along with their applicability, possible disagreements, and corresponding solutions. Besides, an identifying procedure on the combination of main identification methods is provided to evaluate the role of 1O2 in catalysts/PMS systems. Lastly, several perspectives for further studies are proposed to facilitate developments of 1O2 in catalysts/PMS systems.

Connections between cross-tissue and intra-tissue biomarkers of aging biology in older adults

Background

Saliva measures are generally more accessible than blood, especially in vulnerable populations. However, connections between aging biology biomarkers in different body tissues remain unknown.

Methods

The present study included individuals (N = 2406) who consented for saliva and blood draw in the Health and Retirement Telomere length study in 2008 and the Venous blood study in 2016 who had complete data for both tissues. We assessed biological aging based on telomere length in saliva and DNA methylation and physiology measures in blood. DNA methylation clocks combine information from CpGs to produce the aging measures representative of epigenetic aging in humans. We analyzed DNA methylation clocks proposed by Horvath (353 CpG sites), Hannum (71 CpG sites), Levine or PhenoAge, (513 CpG sites), GrimAge, (epigenetic surrogate markers for select plasma proteins), Horvath skin and blood (391 CpG sites), Lin (99 CpG sites), Weidner (3 CpG sites), and VidalBralo (8 CpG sites). Physiology measures (referred to as phenotypic age) included albumin, creatinine, glucose, [log] C-reactive protein, lymphocyte percent, mean cell volume, red blood cell distribution width, alkaline phosphatase, and white blood cell count. The phenotypic age algorithm is based on parametrization of Gompertz proportional hazard models. Average telomere length was assayed using quantitative PCR (qPCR) by comparing the telomere sequence copy number in each patient's sample (T) to a single-copy gene copy number (S). The resulting T/S ratio was proportional to telomere length, mean. Within individual, relationships between aging biology measures in blood and saliva and variations according to sex were assessed.

Results

Saliva-based telomere length showed inverse associations with both physiology-based and DNA methylation-based aging biology biomarkers in blood. Longer saliva-based telomere length was associated with 1 to 4 years slower biological aging based on blood-based biomarkers with the highest magnitude being Weidner (β = - 3.97, P = 0.005), GrimAge (β = - 3.33, P < 0.001), and Lin (β = - 3.45, P = 0.008) biomarkers of DNA methylation.

Conclusions

There are strong connections between aging biology biomarkers in saliva and blood in older adults. Changes in telomere length vary with changes in DNA methylation and physiology biomarkers of aging biology. We observed variations in the relationship between each body system represented by physiology biomarkers and biological aging, particularly at the DNA methylation level. These observations provide novel opportunities for integration of both blood-based and saliva-based biomarkers in clinical care of vulnerable and clinically difficult to reach populations where either or both tissues would be accessible for clinical monitoring purposes.

[A study on alveolar ridge augmentation guided by orthodontic forced eruption in patients with severe periodontitis]

Objective: To evaluate the clinical effect of alveolar bone augmentation in teeth with severe periodontitis using orthodontic forced eruption. Methods: Twelve patients (5 males and 7 females) with severe periodontitis and malocclusion who visited the Department of Orthodontics and Department of Periodontology, Peking University School and Hospital of Stomatology from October 2018 to May 2022 were included in this retrospective study. The age was (38.8±6.6) years (24-49 years). A total of 16 maxillary incisors that could not be retained due to severe periodontitis were included. The orthodontic fixed appliance was used to extrude the teeth. Cone-beam CT (CBCT) images of the patients before and after orthodontic forced eruption were collected. The voxel-based registration was used to superpose the images before and after orthodontic forced eruption. The height, thickness, and apical alveolar bone area were measured on the sagittal plane. The alveolar bone volume before and after orthodontic forced eruption was measured using three-dimensional reconstruction technique, and the influencing factors related to the alveolar volume change were analyzed. Results: The results of this study showed that the eruption distance of the teeth was (2.37±0.82) mm, and the alveolar bone height increased by (1.11±0.79) and (0.98±0.79) mm (t=3.73, P=0.010; t=4.85, P<0.001). The proximal and distal alveolar bone height increased by (1.10±0.78) and (0.86±1.08) mm, respectively (t=5.59, P<0.001; t=3.18, P=0.006). The alveolar bone thickness decreased (0.30±0.31) mm (t=-3.75, P=0.002) and alveolar bone area increased (6.84±5.86) mm2 (t=3.71, P<0.001). The alveolar bone volume increased (53±49) mm3 (t=4.38, P<0.001). The alveolar bone volume was moderately positively correlated with eruption distance, apical and mesial alveolar bone thickness (r=0.55, P=0.028; r=0.63, P=0.008; r=0.67, P=0.005). Conclusions: Orthodontic forced eruption results in a favorable increase of the alveolar bone in the upper incisor that cannot be retained due to severe periodontitis, which provides better periodontal hard tissue conditions for subsequent dental implant.

A photo-controlled, all-solid, and frequency-tunable ultra-wideband pulse generator

With the continuous exploration of the bioelectric effect, nanosecond and picosecond pulsed electric fields used in cancer therapy and drug introduction have attracted great attention. In this paper, an ultrashort pulsed electric field generator is proposed, which connects two photoconductive semiconductor switches in parallel to generate unipolar and bipolar pulses. We described the experimental scheme of the generator and the simulation of the radio frequency combiner. A 532 nm laser with pulse widths of 1 ns and 500 ps is used to trigger the photoconductive semiconductor switches. The experimental results show that the scheme can achieve adjustments of 357 and 720 MHz for the center frequency and the 3 dB bandwidth, respectively. The results confirm that this proposed scheme can be used for unipolar/bipolar frequency-adjustable ultra-wideband pulse generation.

A Comparative Population-Based Study of Tracheal and Lung Adenoid Cystic Carcinoma

PURPOSE/OBJECTIVE(S)

Thoracic adenoid cystic carcinoma (ACC) is very rare, and its clinicopathological characteristics, treatment and prognosis have not been fully elucidated. Previous studies did not differentiate between tracheal and lung lesions.

MATERIALS/METHODS

We identified tracheal ACC (TACC) and lung and bronchus ACC (LACC) patients from our cancer center (from 2005 to 2022) and the Surveillance, Epidemiology, and End Results (SEER) database (from 2000 to 2009). Incidence was calculated and trends were quantified. Significant prognostic factors for overall survival (OS) were reviewed and analyzed by using Cox proportional hazards regression. Then, two nomograms predicting OS of TACC and LACC were constructed based on the SEER database and validated externally by using the separate cohort.

RESULTS

There was an upward trend from 2000 to 2019 for LACC while a downward trend from 2000 to 2009 was shown for TACC. Totally, 55 TACC and 25 LACC were included in our cohort, 121 TACC and 162 LACC included in the SEER cohort. There were larger tumor sizes, more lymph nodes and distant metastases for LACC patients than TACC patients. The proportion of patients receiving radiotherapy were higher for TACC than LACC. More patients with TACC received surgery and perioperative radiotherapy than those with LACC. Patients with LACC had significantly worse OS than patients with TACC (SEER cohort: 93.7 mons vs. 127.0 mons, p = 0.001, our cohort: 72.2 months vs. 130.8months, p = 0.061). Age, lymph node metastasis, distant metastasis and radiation and/or surgery were identified as independent prognostic factors for OS of TACC. Laterality, distant metastasis and surgery were identified for LACC. The discrimination of the nomogram revealed good prognostic accuracy and clinical applicability as indicated by C-index values of 0.753 and 0.833 for the training cohort and the external validation cohort for TACC, and 0.739 and 0.786 for LACC.

CONCLUSION

TACC and LACC are different in incidence, clinical features, prognosis. Compared with LACC, radiotherapy combined with surgery is more important for TACC. Two nomograms were established for TACC and LACC respectively to help physicians make more individualized survival predictions and clinical decisions.

Effects of Vascular Risk Factors on the Association of Blood-Based Biomarkers with Alzheimer's Disease

Background

Comorbidities may influence the levels of blood-based biomarkers for Alzheimer's disease (AD). We investigated whether differences in risk factors or comorbid conditions might explain the discordance between clinical diagnosis and biomarker classifications in a multi-ethnic cohort of elderly individuals.

Aims

To evaluate the relationship of medical conditions and other characteristics, including body mass index (BMI), vascular risk factors, and head injury, with cognitive impairment and blood-based biomarkers of AD, phosphorylated tau (P-tau 181, P-tau 217), in a multi-ethnic cohort.

Methods

Three-hundred individuals, aged 65 and older, were selected from a prospective community-based cohort for equal representation among three racial/ethnic groups: non-Hispanic White, Hispanic/Latino and African American/Black. Participants were classified into four groups based on absence (Asym) or presence (Sym) of cognitive impairment and low (NEG) or high (POS) P-tau 217 or P-tau 181 levels, determined previously in the same cohort: (Asym/NEG, Asym/POS, Sym/NEG, Sym/POS). We examined differences in individual characteristics across the four groups. We performed post-hoc analysis examining the differences across biomarker and cognitive status.

Results

P-tau 217 or P-tau 181 positive individuals had lower BMI than P-tau negative participants, regardless of symptom status. Symptomatic and asymptomatic participants did not differ in terms of BMI. BMI was not a mediator of the effect of P-tau 217 or P-tau 181 on dementia. Frequencies of other risk factors did not differ between the four groups of individuals.

Conclusions

Participants with higher levels of P-tau 217 or P-tau 181 consistent with AD had lower BMI regardless of whether the individual was symptomatic. These findings suggest that weight loss may change with AD biomarker levels before onset of cognitive decline. They do not support BMI as a confounding variable. Further longitudinal studies could explore the relationship of risk factors with clinical diagnoses and biomarkers.

A comparison of reward processing during Becker-DeGroot-Marschak and Vickrey auctions: An ERP study

Vickrey auctions (VA) and Becker-DeGroot-Marschak auctions (BDM) are strategically equivalent demand-revealing mechanisms, differentiated only by a human opponent in the VA, and a random-number-generator opponent in the BDM. Game parameters are such that players are incentivized to reveal their private subjective values (SV) and behavior should be identical in both tasks. However, this has been repeatedly shown not to be the case. In this study, the neural correlates of outcome feedback processing during VA and BDM were directly compared using electroencephalography. Twenty-eight healthy participants bid for household products which were then divided into high- and low-SV categories. The VA included a human opponent deception to induce a social environment, while in reality a random-number-generator was used in both tasks. A P3 component peaking at 336 ms over midline parietal sites showed more positive amplitudes for high bid values, and for win outcomes in the VA but not the BDM. Both auctions also elicited a Reward Positivity potential, maximal at 275 ms along the central midline electrodes, that was not modulated by auction task or SV. Further, an exploratory N170 potential in the right occipitotemporal electrodes and a vertex positive potential component were stronger in the VA relative to the BDM. Results point to an enhanced cortical response to bid outcomes during VA task in a potential component associated with emotional control, and to the occurrence of face-sensitive potentials in VA but not in BDM auction. These findings suggest modulation of bid outcome processing by the social-competitive aspect of auction tasks. Directly comparing two prominent auction paradigms affords the opportunity to isolate the impact of social environment on competitive, risky decision-making. Findings suggest that feedback processing as early as 176 ms is facilitated by the presence of a human competitor, and later processing is modulated by social context and subjective value.

Directional atherectomy combined with drug-coated balloon angioplasty for superficial femoral arteriosclerosis obliterans

INTRODUCTION

This study is an analysis of the therapeutic effects of directional atherectomy combined with drug-coated balloon angioplasty (DA+DCB) in treating superficial femoral arteriosclerosis obliterans.

METHODS

Patients in our hospital with superficial femoral arteriosclerosis obliterans who received DA+DCB during the period June 2016 to February 2019 were identified retrospectively. Preoperative demographics, operative details and postoperative follow-up outcomes were analysed statistically.

RESULTS

Between June 2016 and February 2019, 48 patients were enrolled in this retrospective study. The average age of the patients was 66.85 ± 11.28 years; 83.3% of the patients were male. During the procedure, flow-limiting dissection occurred frequently (9/48 patients) and there were six bailout stent implantations owing to flow-limiting dissections. The incidence rate of target artery thrombosis was 4.2% (2/48). There was no vessel perforation, embolism or operation-related death. The technical success rate was estimated at 100%. The mean ankle-brachial index of the patients was 0.54 ± 0.28 before the operation and 0.93 ± 0.13 before discharge (p < 0.0001). The mean follow-up time was 19.6 ± 9.0 months. The primary patency rate was 89.4%, 82.4% and 76.5% at 12, 24 and 36 months. The freedom from target lesion revascularisation (TLR) was 97.9%, 93.8% and 84.4% at 12, 24 and 36 months.

CONCLUSION

The use of DA+DCB showed good clinical benefit for superficial femoral arteriosclerosis obliterans, which had good primary patency and freedom from TLR. Multicentre randomised controlled trials with long-term follow-up are needed.

[Summary of the best evidence on exercise for the prevention and treatment of diabetic foot]

Objective: To summarize the best evidence on exercise for the prevention and treatment of diabetic foot. Methods: A bibliometric approach was used. Systematic searches were carried out to retrieve all the publicly published evidences till July 2022 on exercise for the prevention and treatment of diabetic foot, including guidelines, evidence summary, recommended practices, expert consensus, systematic review, and original research, from foreign language databases including BMJ Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Practice Database, Cochrane Library, Embase, PubMed, Guideline International Network, National Guideline Clearinghouse, Chinese databases including China National Knowledge Infrastructure, Wanfang Database, VIP Database, China Biology Medicine disc, China Clinical Guidelines Library, and the official websites of relevant academic organizations including National Institute for Health and Care Excellence of the United Kingdom, Registered Nurses' Association of Ontario of Canada, the International Working Group on the Diabetic Foot, International Diabetes Federation, American College of Sports Medicine, American Diabetes Association, and Chinese Diabetes Society. The literature was screened and evaluated for the quality, from which the evidences were extracted and evaluated to summarize the best evidences. Results: Nine guidelines, three expert consensuses, one evidence summary (with two systematic reviews being traced), two systematic reviews, 6 randomized controlled trials were retrieved and included, with good quality of literature. Totally 33 pieces of best evidences on exercise for the prevention and treatment of diabetic foot were summarized from the aspects of appropriate exercise prevention of diabetic foot, exercise therapy of diabetic foot, precautions for exercise, health education, and establishment of a multidisciplinary limb salvage team. Conclusions: Totally 33 pieces of best evidences on exercise for the prevention and treatment of diabetic foot were summarized from 5 aspects, providing decision-making basis for clinical guidance on exercise practice for patients with diabetic foot.

[An improved 4-vessel intermittent occlusion method for establishing rat models of global cerebral ischemia-reperfusion injury]

OBJECTIVE

To improve the classical 4-vessel occlusion (4VO) model established by Pulsinelli and Brierley.

METHODS

Thirty-two male SD rats were randomized into sham operation group, I4VO-Con10 group, I4VO-Int10 group and I4VO-Int15 group. The sham surgery group underwent exposure of the bilateral vertebral arteries and carotid arteries without occlusion to block blood flow. The I4VO-Con10 group experienced continuous ischemia by occluding the bilateral vertebral arteries and carotid arteries for 10 minutes followed by reperfusion for 24 hours. The I4VO-Int10 and I4VO-Int15 groups were subjected to intermittent ischemia. The I4VO- Int10 group underwent 5 minutes of ischemia, followed by 5 minutes of reperfusion and another 5 minutes of ischemia, and then reperfusion for 24 hours. The I4VO-Int15 group experienced 5 minutes of ischemia followed by two cycles of 5 minutes of reperfusion and 5 minutes of ischemia, and then reperfusion for 24 hours. The regional cerebral blood flow (rCBF) was monitored with laser Doppler scanning, and survival of the rats was observed. HE staining was used to observe hippocampal pathologies to determine the optimal method for modeling. Another 48 rats were randomized into 6 groups, including a sham operation group and 5 model groups established using the optimal method. The 5 I4VO model groups were further divided based on the reperfusion time points (1, 3, 7, 14, and 28 days) into I4VO-D1, I4VO-D3, I4VO-D7, I4VO- D14, and I4VO- D28 groups. Body weight changes and survival of the rats were recorded. HE staining was used to observe morphological changes in the hippocampal, retinal and optic tract tissues. The Y-maze test and light/dark box test were used to evaluate cognitive and visual functions of the rats in I4VO-D28 group.

RESULTS

Occlusion for 5 min for 3 times at the interval of 5 min was the optimal method for 4VO modeling. In the latter 48 rats, the body weight was significantly lower than that of the sham-operated rats at 1, 3, 7, 14 and 28 days after modeling without significant difference in survival rate among the groups. The rats with intermittent vessel occlusion exhibited progressive deterioration of hippocampal neuronal injury and neuronal loss. Cognitive impairment was observed in the rats in I4VO-D28 group, but no obvious ischemic injury of the retina or the optic tract was detected.

CONCLUSION

The improved 4VO model can successfully mimic the main pathological processes of global cerebral ischemia-reperfusion injury without causing visual impairment in rats.

Measurement of Direct-Photon Cross Section and Double-Helicity Asymmetry at sqrt[s]=510 GeV in p[over →]+p[over →] Collisions

We present measurements of the cross section and double-helicity asymmetry A_{LL} of direct-photon production in p[over →]+p[over →] collisions at sqrt[s]=510  GeV. The measurements have been performed at midrapidity (|η|<0.25) with the PHENIX detector at the Relativistic Heavy Ion Collider. At relativistic energies, direct photons are dominantly produced from the initial quark-gluon hard scattering and do not interact via the strong force at leading order. Therefore, at sqrt[s]=510  GeV, where leading-order-effects dominate, these measurements provide clean and direct access to the gluon helicity in the polarized proton in the gluon-momentum-fraction range 0.02<x<0.08, with direct sensitivity to the sign of the gluon contribution.

MHC class II antigen presentation by intestinal epithelial cells fine-tunes bacteria-reactive CD4 T cell responses

Although intestinal epithelial cells (IECs) can express major histocompatibility complex class II (MHC II), especially during intestinal inflammation, it remains unclear if antigen presentation by IECs favours pro- or anti-inflammatory CD4⁺ T cell responses. Using selective gene ablation of MHC II in IECs and IEC organoid cultures, we assessed the impact of MHC II expression by IECs on CD4⁺ T cell responses and disease outcomes in response to enteric bacterial pathogens. We found that intestinal bacterial infections elicit inflammatory cues that greatly increase expression of MHC II processing and presentation molecules in colonic IECs. Whilst IEC MHC II expression had little impact on disease severity following Citrobacter rodentium or Helicobacter hepaticus infection, using a colonic IEC organoid-CD4⁺ T cell co-culture system, we demonstrate that IECs can activate antigen-specific CD4⁺ T cells in an MHC II-dependent manner, modulating both regulatory and effector Th cell subsets. Furthermore, we assessed adoptively transferred H. hepaticus-specific CD4⁺ T cells during intestinal inflammation in vivo and report that IEC MHC II expression dampens pro-inflammatory effector Th cells. Our findings indicate that IECs can function as non-conventional antigen presenting cells and that IEC MHC II expression fine-tunes local effector CD4⁺ T cell responses during intestinal inflammation.

[Immune function and research progress of pentraxin 3 in pulmonary infectious diseases]

Pentraxins3 (PTX3) is an acute-phase protein of the pentraxin family that is synthetized and stored in a variety of cells. As an important mediator of innate immunity, PTX3 is rapidly released during microbial invasion and inflammatory response. It promotes the recognition of pathogens by myeloid cells through regulating complement activation. Recent studies have indicated that PTX3 concentrations in peripheral blood or tissues increase rapidly after infection, and the increased level is associated with the severity of the disease. Thus, PTX3 appears to be a vital clinical biomarker in the diagnosis and prognosis of pulmonary infectious diseases.

Coalescence of As(II) with •OH: The pivot for co-processing of As(III) and butyl xanthate

Although water metalloid pollution is widely studied, the effect of the combined pollution of organic matter and metalloids in mining water and, especially, the possible interaction mechanisms between metalloids and flotation reagents, are both poorly understood. Existence of mixed pollution of metalloids and organic compounds tends to cause more serious harm to natural organisms. In this study, a synergistic removal of arsenite (As(III)) and butyl xanthate (Bx) in an advanced oxidation system was reported using biochar-based catalyst loaded with nano-zero-valent iron from an inexpensive iron source (iron slag) to activate peroxodisulfate. The removal efficiencies were improved by 30 % in the co-existence of As(III) and Bx compared to those of the single pollutant. The theoretical calculations, especially frontier molecular orbital theory, revealed the generation of [AsO₂-OH]^•- by the combination of As(II) with •OH. This [AsO₂-OH]^•- participated in the oxidative degradation of Bx with high activity and combined with the sulfur falling off Bx after the reaction to form a novel Fe-As-S complex as indicated by X-ray absorption +fine structure analysis. Overall, this study reports the generation of low-valent arsenic active substances of [AsO₂-OH]^•- and their effect on the removal of organic pollution containing S atoms in advanced oxidation systems under typical mining water conditions with the coexistence of As(III) and expands the understanding and application of traditional free radicals.

Enhancing quorum quenching media with 3D robust electrospinning coating: A novel biofouling control strategy for membrane bioreactors

Bacterial quorum quenching (QQ) is an effective strategy for controlling biofouling in membrane bioreactor (MBR) by interfering the releasing and degradation of signal molecules during quorum sensing (QS) process. However, due to the framework feature of QQ media, the maintenance of QQ activity and the restriction of mass transfer threshold, it has been difficult to design a more stable and better performing structure in a long period of time. In this research, electrospun fiber coated hydrogel QQ beads (QQ-ECHB) were fabricated by using electrospun nanofiber coated hydrogel to strengthen layers of QQ carriers for the first time. The robust porous PVDF 3D nanofiber membrane was coated on the surface of millimeter-scale QQ hydrogel beads. Biocompatible hydrogel entrapping quorum quenching bacteria (sp.BH4) was employed as the core of the QQ-ECHB. In MBR with the addition of QQ-ECHB, the time to reach transmembrane pressure (TMP) of 40 kPa was 4 times longer than conventional MBR. The robust coating and porous microstructure of QQ-ECHB contributed to keeping a lasting QQ activity and stable physical washing effect at a very low dosage (10g beads/5L MBR). Physical stability and environmental-tolerance tests also verified that the carrier can maintain the structural strength and keep the core bacteria stable when suffering long-term cyclic compression and great fluctuations in sewage quality.

[Opportunities and challenges for the high-quality development of hernia and abdominal wall surgery in China]

Hernia and abdominal wall surgery is a relatively new subspecialty in surgery. Although it started late in China, after 25 years of rapid development, it has made remarkable achievements and has become an important part of surgery, laying a solid foundation for the further development of the discipline. At the same time, one should also be soberly aware of the present deficiencies in this field. The development of the field should be more detailed and in-depth from the following aspects: correct understanding of new concepts of hernia and abdominal wall surgery, establishment of hernia patient registration and quality control system, technological innovation and development of technical equipment, especially the expansion of robot surgical systems, materials science progression to hernia and abdominal wall surgery. Faced with this challenge, China is expected to achieve high-quality development in the field of hernia and abdominal surgery.

A 2-Stage Root Analog Implant with Compact Structure, Uniform Roughness, and High Accuracy

Immediate implant placement has the advantages of shortening the operation time, reducing the treatment cycle and cost. At present, this technology has been used widely, but the indications of immediate implantation are still limited. Here, a novel type of root analog implant (RAI) was manufactured by selective laser melting technology to address the limitation. Under optimized condition, RAIs were printed with the internal density of 99.73% and the uniform surface roughness of 11 μm (Sa). Besides, the deviation between RAI specimen and design models is controlled within 0.15 mm after optimizing scanning parameters. The substrate printed could promote human bone marrow stromal cell proliferation, spreading, and osteogenic differentiation. The bone-implant contact (BIC, 75% ± 7%) and bone volume/total volume (BV/TV, 74% ± 7%) of RAIs were significantly higher than that of conventional implants (BIC, 66% ± 5%; BV/TV, 62% ± 5%) in in vivo experiments. Further, customized abutments were designed for the RAIs, improving the masticatory ability of the beagle dogs after crown restoration. This study aims to design a personalized 2-stage RAI with compact structure and uniform roughness, in order to achieve better fracture resistance, initial osseointegration efficiency, and dispersed stress in immediate implantation. It provides a certain guiding value for standardizing the manufacture and clinical application of RAI in immediate implantation.

The feasibility of a novel computer-aided classification system for the characterisation and diagnosis of breast masses on ultrasound: a single-centre preliminary test study

AIM

To introduce a novel computer-aided classification (CAC) system and investigate the feasibility of characterising and diagnosing breast masses on ultrasound (US).

MATERIALS AND METHODS

A total of 246 breast masses were included. US features and the final assessment categories of the breast masses were analysed by a radiologist and the CAC system according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The CAC system evaluated the BI-RADS assessment from the fusion of multi-view and colour Doppler US images without (SmartBreast) or with combining clinical variables (m-CAC system). The diagnostic performance and agreement of US characteristics between the radiologist and the CAC system were compared.

RESULTS

The agreement between the radiologist and the CAC system was substantial for mass shape (κ = 0.673), orientation (κ = 0.682), margin (κ = 0.622), posterior features (κ = 0.629), calcifications in a mass (κ = 0.709) and vascularity (κ = 0.745), fair for echo pattern (κ = 0.379), and moderate for BI-RADS assessment (κ = 0.575). With BI-RADS 4a as the cut-off value, the specificity (52.5% versus 25%, p<0.0001) and accuracy (73.98% versus 62.6%, p=0.0002) of the m-CAC system were improved without significant loss of sensitivity (94.44% versus 98.41%, p=0.1250) compared with the SmartBreast. The m-CAC system showed similar specificity (52.5% versus 45.83%, p=0.2430) and accuracy (73.98% versus 73.58%, p=1.0000) as the radiologist, but a lower sensitivity (94.44% versus 100%, p=0.0156).

CONCLUSION

The CAC system showed an acceptable agreement with the radiologist for characterisation of breast lesions. It has the potential to mimic the decision-making behaviour of radiologists for the classification of breast lesions.

Polygenic indices for cognition in healthy aging; the role of brain measures

Background

Genome-wide association studies (GWAS) have identified large numbers of genetic variants associated with cognition. However, little is known about how these genetic discoveries impact cognitive aging.

Methods

We conducted polygenic-index (PGI) analysis of cognitive performance in n = 168 European-ancestry adults aged 20-80. We computed PGIs based on GWAS of cognitive performance in young/middle-aged and older adults. We tested associations of the PGI with cognitive performance, as measured through neuropsychological evaluation. We explored whether these associations were accounted for by magnetic resonance imaging (MRI) measures of brain-aging phenotypes: total gray matter volume (GM), cortical thickness (CT), and white matter hyperintensities burden (WMH).

Results

Participants with higher PGI values performed better on cognitive tests (B = 0.627, SE = 0.196, p = 0.002) (age, sex, and principal components as covariates). Associations remained significant with inclusion of covariates for MRI measures of brain aging; B = 0.439, SE: 0.198, p = 0.028). PGI associations were stronger in young and middle-aged (age<65) as compared to older adults. For further validation, linear regression for Cog PGI and cognition in the fully adjusted model and adding the interaction between age group and Cog PGI, showed significant results (B = 0.892, SE: 0.325, p = 0.007) driven by young and middle-aged adults (B = -0.403, SE: 0.193, p = 0.039). In ancillary analysis, the Cognitive PGI was not associated with any of the brain measures.

Conclusions

Genetics discovered in GWAS of cognition are associated with cognitive performance in healthy adults across age, but most strongly in young and middle-aged adults. Associations were not explained by brain-structural markers of brain aging. Genetics uncovered in GWAS of cognitive performance may contribute to individual differences established relatively early in life and may not reflect genetic mechanisms of cognitive aging.

A critical review on microbial ecology in the novel biological nitrogen removal process: Dynamic balance of complex functional microbes for nitrogen removal

The novel biological nitrogen removal process has been extensively studied for its high nitrogen removal efficiency, energy efficiency, and greenness. A successful novel biological nitrogen removal process has a stable microecological equilibrium and benign interactions between the various functional bacteria. However, changes in the external environment can easily disrupt the dynamic balance of the microecology and affect the activity of functional bacteria in the novel biological nitrogen removal process. Therefore, this review focuses on the microecology in existing the novel biological nitrogen removal process, including the growth characteristics of functional microorganisms and their interactions, together with the effects of different influencing factors on the evolution of microbial communities. This provides ideas for achieving a stable dynamic balance of the microecology in a novel biological nitrogen removal process. Furthermore, to investigate deeply the mechanisms of microbial interactions in novel biological nitrogen removal process, this review also focuses on the influence of quorum sensing (QS) systems on nitrogen removal microbes, regulated by which bacteria secrete acyl homoserine lactones (AHLs) as signaling molecules to regulate microbial ecology in the novel biological nitrogen removal process. However, the mechanisms of action of AHLs on the regulation of functional bacteria have not been fully determined and the composition of QS system circuits requires further investigation. Meanwhile, it is necessary to further apply molecular analysis techniques and the theory of systems ecology in the future to enhance the exploration of microbial species and ecological niches, providing a deeper scientific basis for the development of a novel biological nitrogen removal process.

[Endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma]

Objective: To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma, based on anatomic studies and surgeries. Methods: Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen. The anatomical landmarks and the extent of exposure were recorded. Six clinical cases who were treated in Eye & ENT Hospital, Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages, including 3 males and 3 females, aged 42 to 69 years old. Descriptive analysis was used in this research. Results: On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle, this approach could fully expose the parapharyngeal, petrosal and paraclival segment internal carotid arteries, and safely deal with the lesions of jugular foramen and petroclival region. The 6 patients in our study tolerated the procedure well. Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction. Conclusion: Endoscopic transoral approach is a safe, minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.

UCHL1 Impairs Periodontal Ligament Stem Cell Osteogenesis in Periodontitis

Periodontitis comprises a series of inflammatory responses resulting in alveolar bone loss. The suppression of osteogenesis of periodontal ligament stem cells (PDLSCs) by inflammation is responsible for impaired alveolar bone regeneration, which remains an ongoing challenge for periodontitis therapy. Ubiquitin C-terminal hydrolase L1 (UCHL1) belongs to the family of deubiquitinating enzymes, which was found to play roles in inflammation previously. In this study, the upregulation of UCHL1 was identified in inflamed PDLSCs isolated from periodontitis patients and in healthy PDLSCs treated with tumor necrosis factor-α or interleukin-1β, and the higher expression level of UCHL1 was accompanied with the impaired osteogenesis of PDLSCs. Then UCHL1 was inhibited in PDLSCs using the lentivirus or inhibitor, and the osteogenesis of PDLSCs suppressed by inflammation was rescued by UCHL1 inhibition. Mechanistically, the negative effect of UCHL1 on the osteogenesis of PDLSCs was attributable to its negative regulation of mitophagy-dependent bone morphogenetic protein 2/Smad signaling pathway in periodontitis-associated inflammation. Furthermore, a ligature-induced murine periodontitis model was established, and the specific inhibitor of UCHL1 was administrated to periodontitis mice. The histological results showed increased active osteoblasts on alveolar bone surface and enhanced alveolar bone regeneration when UCHL1 was inhibited in periodontitis mice. Besides, the therapeutic effects of UCHL1 inhibition on ameliorating periodontitis were verified, as indicated by less bone loss and reduced inflammation. Altogether, our study proved UCHL1 to be a key negative regulator of the osteogenesis of PDLSCs in periodontitis and suggested that UCHL1 inhibition holds promise for alveolar bone regeneration in periodontitis treatment.

Aging-induced down-regulation of Pka/Bkca pathway in rat cerebral arteries

The incidence of cerebrovascular diseases increases significantly with aging. This study aimed to test the hypothesis that aging may influence the protein kinase A (PKA)-dependent vasodilation via RyR/BKCa pathway in the middle cerebral arteries (MCA). Male Sprague-Dawley rats were randomly divided into control (4-6 month-old) and aged (24-month-old) groups. The functions of MCA and ion channel activities in smooth muscle cells were examined using myograph system and patch-clamp. Aging decreased the isoproterenol/forskolin-induced relaxation in the MCA. Large-conductance Ca2+-activated-K+ (BKCa) channel inhibitor, iberiotoxin, significantly attenuated the forskolin-induced vasodilatation and hyperpolarization in the young group, but not in the aged group. The amplitude and frequency of spontaneous transient outward currents (STOCs) were significantly decreased in the aged group. Single channel recording revealed that the mean open time of BKCa channels were decreased, while an increased mean closed time of BKCa channels were found in the aged group. The Ca2+/voltage sensitivity of the channels was decreased accompanied by reduced BKCa α and β1-subunit, the expression of RyR2, PKA-Cα and PKA-Cβ subunits were also declined in the aged group. Aging induced down-regulation of PKA/BKCa pathway in cerebral artery in rats. The results provides new information on further understanding in cerebrovascular diseases resulted from age-related cerebral vascular dysfunction.

Investigating the mechanism of interactive regulation of B-cell lymphoma-2/Beclin 1 through electroacupuncture intervention during reperfusion in myocardial ischemia-reperfusion injury in a rat model

To observe the regulation of B-cell lymphoma-2 (Bcl-2)/Beclin 1 interaction through electroacupuncture (EA) intervention during reperfusion and to investigate the EA mechanism of apoptosis-autophagy interactive regulation against myocardial ischemia-reperfusion injury (MIRI). A total of 48 adult Sprague Dawley (SD) rats were randomly divided into the sham-operated group (group Sham), the model group (group Model), the EA group (group EA), and the JNK inhibitor (SP600125) group (group JNK), with 12 rats in each group. Biospecimens were collected randomly from six rats in each group four hours after reperfusion. Evans Blue and triphenyl tetrazolium chloride double-staining were applied to observe each group's myocardial damage area and risk area. We collected 4 ml of blood by abdominal aortic method to detect serum troponin cTnI level by enzyme-linked immunosorbent assay (ELISA). For the remaining six in each group, a part of myocardial tissue below the ligation line was stored in 4% paraformaldehyde for immunohistochemistry and TUNEL staining; the other amount of myocardial tissue was detected by Western blotting to determine the expression levels of Bcl-2, Beclin1, and the phosphorylation levels of Thr69, Ser70, and Ser87 in Bcl-2. In results: electroacupuncture (EA) intervention during reperfusion significantly reduced the myocardial infarction area, cTnI level, and myocardial apoptosis, upregulated Bcl-2 expression, downregulated Beclin 1 expression and inhibited phosphorylation levels of Thr69, Ser70, and Ser87 in Bcl-2. We concluded that EA effectively inhibited apoptosis by upregulating Bcl-2 expression and inhibiting the phosphorylation of Thr69, Ser70, and Ser87 in Bcl-2. This reduced the separation of Bcl-2 and Beclin 1, restrains excessive autophagy, alleviates MIRI, and has a protective effect on myocardial tissue.

[Clinical efficacy and safety of endobronchial one-way valves for the treatment of bronchopleural fistula]

Objective: To investigate the efficacy and safety of interventional endobronchial one-way valves (EBV) for the treatment of peripheral bronchopleural fistula (BPF). Methods: A total of 33 patients with peripheral BPF who underwent EBV implantation in Endoscopy Center of Shanghai Pulmonary Hospital from August 2017 to December 2021 were selected as the research objects. All the patients were diagnosed with peripheral BPF before the implantation surgery. The detailed medical records of the patients were collected, and the etiology, lesion location, treatment method and operation process, treatment efficacy and postoperative complications were analyzed to evaluate the efficacy and safety of EBV implantation. Results: Of the 33 patients in our study, 26 were male and 7 were female. The median age was 54.7 (28-86) years. There were 18 cases of BPF after thoracic surgery (54.5%), 6 cases of chronic obstructive pulmonary disease complicated with spontaneous pneumothorax (18.2%), and 12 cases of pulmonary tuberculosis and non-tuberculous mycobacterial infection with spontaneous pneumothorax (36.4%). A total of 63 valves were inserted in the 33 cases, and a maximum of valves and at least one were inserted in a single case. The lesions were located in the right lower lobe in 16 cases (48.5%) and the left upper lobe in 12 cases (36.4%). Of the 33 patients undergoing EBV placement, 22 (66.7%) were successful, with chest drainage tube indwelling duration of (88.5±36.6) days and (29.6±11.4) days, respectively, before and after EBV treatment. The time from EBV placement to successful withdrawal of EBV was (102.2±31.3) days. During a postoperative follow-up of 6 months after EBV treatment, the main complications were 29 cases with attachment of secretions to the EBV (90.6%) and 13 cases (40.6%) with mild granulation proliferation. In addition, there were five patients with moderate to severe granulation proliferation (15.6%), one with valve displacement or shedding (3.1%), and one with bleeding (3.1%). Conclusions: In this study, the success rate of EBV placement and occlusion was 66.7%. Transbronchoscopic EBV placement in the treatment of peripheral BPF is a effective treatment with relatively minor complications.

[The application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma]

Objective: To summarize the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma (rNPC), and to provide guidance for the repair of extensive skull base defects in salvage rNPC. Methods: A total of 54 patients with the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced rNPC were retrospectively analyzed, including 42 males and 12 females, aging from 29 to 71 years. There were 36 patients with rT3 and 18 patients with rT4. The surgical methods of temporalis muscle flap repair were summarized. The general situation, survival time and postoperative complications of patients were recorded, and the advantages and disadvantages of temporalis muscle flap were discussed. Results: The temporal muscle flap could completely cover the defect area of nasopharynx and skull base, without the need for other autologous repair materials. The follow-up period was 2 to 28 months. The survival rate of temporalis flap was 98.1% (53/54). The 1-year overall survival rate was 84.5% while 1-year progression-free survival rate was 49.0%. None of the patients had facial nerve injury. Three patients (5.6%) had necrosis of the cranial membrane required surgical intervention and four patients (7.4%) required a chonoplasty due to severe chonostril stenosis or chonostril atresia. Eleven cases (20.4%) had mouth opening restriction, chewing weakness, dysphagia and other eating difficulties. Conclusions: Temporalis muscle flap is an alternative flap for the salvage nasopharyngectomy for advanced rNPC. Temporal muscle flap shows high survival rate and wide coverage, but the surgeon should apprehend the possible complications and reduce the occurrence of them.

[Management and short-term outcomes of neonates born to mothers infected with SARS-CoV-2 Omicron variant]

Objective: To summarize the management and short-term outcomes of neonates delivered by mothers infected with SARS-CoV-2 Omicron variant. Methods: A retrospective study was performed on 158 neonates born to mothers infected with SARS-CoV-2 Omicron variant admitted to the isolation ward of Children's Hospital of Fudan University from March 15^th, 2022 to May 30^th, 2022. The postnatal infection control measures for these neonates, and their clinical characteristics and short-term outcomes were analyzed. They were divided into maternal symptomatic group and maternal asymptomatic group according to whether their mothers had SARS-CoV-2 symptoms. The clinical outcomes were compared between the 2 groups using Rank sum test and Chi-square test. Results: All neonates were under strict infection control measures at birth and after birth. Of the 158 neonates, 75 (47.5%) were male. The gestational age was (38⁺³±1⁺³) weeks and the birth weight was (3 201±463)g. Of the neonates included, ten were preterm (6.3%) and the minimum gestational age was 30⁺¹ weeks. Six neonates (3.8%) had respiratory difficulty and 4 of them were premature and required mechanical ventilation. All 158 neonates were tested negative for SARS-COV-2 nucleic acid by daily nasal swabs for the first 7 days. A total of 156 mothers (2 cases of twin pregnancy) infected with SARS-CoV-2 Omicron variant, the time from confirmed SARS-CoV-2 infection to delivery was 7 (3, 12) days. Among them, 88 cases (56.4%) showed clinical symptoms, but none needed intensive care treatment. The peripheral white blood cell count of the neonates in maternal symptomatic group was significantly higher than that in maternal symptomatic group (23.0 (18.7, 28.0) × 10⁹ vs. 19.6 (15.4, 36.6) × 10⁹/L, Z=2.44, P<0.05). Conclusions: Neonates of mothers infected with SARS-CoV-2 Omicron variant during third trimester have benign short-term outcomes, without intrauterine infection through vertical transmission. Strict infection control measures at birth and after birth can effectively protect these neonates from SARS-CoV-2 infection.

Excimer laser atherectomy combined with drug-coated balloon angioplasty for the treatment of femoropopliteal arteriosclerosis obliterans

INTRODUCTION

It has been reported that excimer laser atherectomy combined with a drug-coated balloon (ELA+DCB) can achieve better results than simple balloon angioplasty, especially for the treatment of femoropopliteal in-stent restenosis. However, reports on the application of ELA+DCB in China for femoropopliteal arteriosclerosis obliterans are lacking. This study focuses on analysing the effectiveness and safety of ELA+DCB.

METHODS

This was a single-centre retrospective study that enrolled patients from November 2016 to January 2019 who had femoropopliteal arteriosclerosis obliterans treated by ELA+DCB. Preoperative demographics, operative details and postoperative follow-up outcomes were analysed statistically.

RESULTS

There were 43 patients with an average patient age of 68.0±8.6 years; 79.1% were male. In 30 cases, the lesions were de novo and the others were in-stent restenosis (ISR). During the procedure, flow-limiting dissection (48.8%) was the main adverse event and there were 17 bailout stent implantations due to dissection. Mean (±sd) ankle-brachial index (ABI) in the patients was 0.42±0.31 before the operation and 0.83±0.13 before discharge. The mean (±sd) follow-up time was 29.35±9.71 months. The primary patency rate was 66.8%, 64.3% and 60.9% at 12, 24 and 36 months. Freedom from target lesion revascularisation (TLR) was 85.7%, 80.7% and 75.3% at 12, 24 and 36 months. Rutherford categories also greatly improved during follow-up. Overall mortality was 6.9% (3/48), and no deaths were related to the intervention.

CONCLUSION

The use of ELA+DCB had good clinical benefit for femoropopliteal arteriosclerosis obliterans, which had good primary patency and freedom from TLR, although intraoperative complications still required attention. Multicentre randomised controlled trials with long-term follow-up are needed.

MicroRNA-9a-5p inhibits mucosal barrier injury in inflammatory bowel disease

Our previous research found that FOXO1 aggravates the mucosal barrier injury in inflammatory bowel disease (IBD) by regulating TLR4/MD2 signaling. In this study, we further reveal the mechanism of action whereby miRNA-9a-5p inhibits the mucosal barrier injury after regulating FOXO1. An IBD model was established in C57BL/6N mice using dextran sulfate sodium (DSS). The effects of endogenous miRNA-9a-5p were mimicked/antagonized by intraperitoneally injecting miRNA-9a-5p agomir and antagomir. Body weights of mice were monitored and the disease activity index scores were assessed. H&E staining was performed to examine pathological changes, while immunohistochemical (IHC) staining was conducted to measure the expressions of TJ proteins (ZO-1, Occludin), as well as FOXO1 and TLR4. The mucosal permeability was assessed by FITC-D, the tissue inflammatory cytokines were detected by enzyme linked immunosorbent assay, and the expressions of ZO-1 and Occludin were measured through Western blot analysis. Caco-2 cells were cultured in vitro to establish a monolayer model of the mucosal barrier. TNF-α was used to induce the cell damage, while agomir and antagomir were transfected to mimic/antagonize the miRNA-9a-5p action, followed by determination of barrier permeability. There was a targeted regulatory relationship between MiRNA-9a-5p and FOXO1. MiRNA-9a-5p could suppress the FOXO1 expression, thereby downregulating the TLR4 signaling activation, inhibiting the mucosal barrier injury, and elevating the expressions of TJ proteins. We also found in Caco-2 cells that miRNA-9a-5p could protect cells from inflammatory injury and reduce permeability. In rescue experiments, the effect of agomir was found inhibited by the overexpression of FOXO1 in agomir-treated cells. This study found that miRNA-9a-5p could inhibit the TLR4 signaling activation by targeting FOXO1, thereby exerting a protective effect on the mucosal barrier injury in IBD.

Speciation and release risk of heavy metals bonded on simulated naturally-aged microplastics prepared from artificially broken macroplastics

The negative impact of microplastics (MPs) act as metals vectors to environment and ecosystem have been paid more and more attention, and the accumulation risk of them to human body through the food chains and food webs needs to attract attention. In addition, the MPs bonded with heavy metals transport from river into the sea with high salinity may also have metals release risk. Herein, natural aged microplastics prepared from artificially broken macroplastics adsorbed with heavy metals accumulated from the natural environment were tested for their states and release risk in several simulated solution (NaCl and gastrointestinal solutions) to understand their effects on environment and human health. The adsorption capacity of different heavy metals on MPs was different during natural aging process proved by four-acid digestion method. Metals with high accumulation (including Pb, As, Cr, Mn, Ni, Zn, Co, Cu and Cd) on NAMPs were selected for further study. Results obtained via three-step extraction method showed that these heavy metals were mainly present as acid-extractable and reducible ions, which were characterized by high bioavailability. Release experiments suggested the notable Mn, Zn, As, Cr, Cu and Ni release in NaCl solution, and significant release of Mn, Zn, As, Cr, Cu, Pb and Ni in gastrointestinal solutions. The high metal release ratio in the simulated gastric solution was attributed to the weak binding of metal ions to NAMPs in acidic environment. This study will play a vital rule in assessing the ecological risks associated with MPs in natural environment.

[Analysis of the efficacy and safety of low-dose aspirin in preventing renal artery stenosis in kidney transplantation]

Objective: To evaluate the clinical value of aspirin as a prophylactic for transplant renal artery stenosis (TRAS). Methods: From January 2017 to November 2019, clinical data of 307 patients who had undergone renal transplant in Zhengzhou University People's Hospital were collected. Patients were divided into two groups: the treatment group (124 recipients who had taken oral aspirin 100 mg/d after transplant) and the control group (183 recipients who had not taken aspirin after transplant). The general data, incidence of initially diagnosed and confirmed TRAS, type of renal artery anastomosis vessels, duration of stenosis, location of stenosis, and complications were compared between the two groups. The treatment group was further divided into two subgroups, the early group (92 recipients) and the delayed group (32 recipients), according to the time of starting aspirin after operation. Subgroup analysis was performed. Results: Among all 307 patients included, there were 241 males and 66 females, aged 19-64 years. There were no statistical difference between the treatment and control groups in terms of gender, age, comorbidities, number of arterial vessels, type of graft, and acute rejection all P>0.05. Among 46 initially diagnosed TRAS patients, 13 (10.5%) and 33 (18.0%) cases were in the treatment and control group respectively, with no statistically significant difference in stenosis rate (P>0.05). The number of confirmed TRAS patients was 1 (0.8%) and 24 (13.1%) in the treatment and control group respectively, with statistically significant difference in stenosis rate (P<0.001). The proportion of patients with bleeding disorders in the treatment group was slightly higher than that in the control group (13.7% vs 8.7%), and the proportion of infarct diseases was slightly lower than that in the control group (1.6% vs 4.9%). But there was no significant difference in aspirin-related complications between the two groups (P>0.05). Subgroup analysis showed that there was no significant difference in initially diagnosed and confirmed TRAS and aspirin-related complications between the early group and the delayed group (all P>0.05). Conclusions: Oral low-dose aspirin after kidney transplantation can effectively reduce the incidence of TRAS, without increasing the risk of aspirin-related complications.

[Systematic evaluation of qualitative research on the real experience of burn patients during rehabilitation]

Objective: To systematically evaluate and integrate the real experience of burn patients during rehabilitation, and to provide theoretical guidance for the continual nursing care for burn patients. Methods: The systematic evaluation method was adopted. Databases including the China National Knowledge Internet, Wanfang Database, China Biology Medicine disc were retrieved with the search terms in Chinese version of "/, //, ////", and PubMed, Embase, CINAHL, PsycINFO, Cochrane Library were retrieved with the search terms of "burn/burns, rehabilitation/recovery/survivor/survive, experience/views/perceptions/, qualitative/phenomenon/interview/grounded theory". The qualitative studies on the real experience of burn patients during rehabilitation published from the establishment of each database to June 2020 were searched. The quality of the included studies was evaluated according to the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center. The research country, research method, research object, research content, and main research result were summarized, and meta-synthesis of the research results was conducted with the aggregative integration method. Results: A total of 12 studies were included, and the quality of all the studies was grade B. The studies were conducted in 8 countries including Australia, Canada, Norway, etc., the research method mainly was phenomenological research method, and all the studies were focused on adult burn patients. A total of 46 specific themes were extracted with totally 10 new categories formed after summarization, and 3 integrated results were obtained as follows: burn patients suffered from both physical and psychological burdens, and their normal life was broken; burn patients gained post-traumatic growth and could actively adjust to cope with life difficulties; burn patients had multiple needs. Conclusions: Burn patients experience both physical and psychological pains during rehabilitation, so they long for multiple support from family and society. Medical staff, social groups, and family members should pay attention to the psychological experience and needs of burn patients with different characteristics during rehabilitation, and build a multi-directional social support system to help patients return to the society and rebuild their lives.

Cerebral Phospho-Tau Acts Synergistically with Soluble Aβ42 Leading to Mild Cognitive Impairment in AAV-AD Rats

BACKGROUND

Alzheimer's disease (AD) is a continuum of events beginning with an increase in brain soluble Aβ42 followed by the appearance of hyperphosphorylated tau (P-tau, asymptomatic stage). Mild Cognitive Impairment (MCI) then appears (prodromal stage). However, the individual contribution of these two soluble proteins in the onset of the first cognitive symptoms remains unclear.

OBJECTIVES

We sought to understand the specific impact of p-tau on the development of MCI in the AAV-AD rat model, a model of late-onset Alzheimer's disease (LOAD) predementia.

METHODS

We specifically reduced the phosphorylation level of tau while leaving Aβ42 levels unchanged using a DYRK1A protein kinase inhibitor, Leucettine L41, in an adeno-associated virus-based Alzheimer's disease (AAV-AD) rat model. Leucettine L41 was administered by intraperitoneal injection at 20 mg/kg per day in AAV-AD rats from 9 (late asymptomatic phase) to 10 (prodromal phase) months of age.

RESULTS

Decreased soluble forms of P-tau induced by chronic administration of Leucettine L41 did not change soluble Aβ42 levels but prevented MCI onset in 10-month-old AAV-AD rats.

CONCLUSIONS

The present study argues that P-tau is required to induce the development of MCI. Consistent with our previous findings that soluble Aβ42 is also required for MCI onset, the data obtained in the AAV-AD rat model confirm that the transition from the asymptomatic to the prodromal stage may be caused by the combined presence of both soluble brain forms of Aβ42 and p-tau, suggesting that the development of MCI may be the consequence of their synergistic action.