Sarcopenia is associated with leukopenia in urothelial carcinoma patients who receive tislelizumab combined with gemcitabine and cisplatin therapy

BACKGROUND

In the era of combination therapy, there has been limited research on body composition. Specific body composition, such as sarcopenia, possesses the potential to serve as a predictive biomarker for toxic effects and clinical response in patients with urothelial carcinoma (UC) undergoing tislelizumab combined with gemcitabine and cisplatin (T + GC).

MATERIALS AND METHODS

A total of 112 UC patients who received T + GC were selected at the Affiliated Hospital of Xuzhou Medical University from April 2020 to January 2023. Baseline patient characteristics and detailed hematological parameters were collected using the electronic medical system and laboratory examinations. The computed tomography images of patients were analyzed to calculate psoas muscle mass index (PMI). We evaluated the association between sarcopenia (PMI < 4.5 cm2/m2 in men; PMI < 3.3 cm2/m2 in women) and both hematological toxicity and tumor response.

RESULTS

Overall, of the 112 patients (65.2% male, median age 56 years), 43 (38.4%) were defined as sarcopenia. Patients with sarcopenia were notably older (p = 0.037), more likely to have hypertension (p = 0.009), and had poorer ECOG-PS (p = 0.027). Patients with sarcopenia were more likely to develop leukopenia (OR 2.969, 95% CI 1.028-8.575, p = 0.044) after receiving at least two cycles of T + GC. However, these significant differences were not observed in thrombocytopenia and anemia. There were no significant differences in the tumor response and grade 3-4 hematological toxicity between patients with sarcopenia and those without sarcopenia.

CONCLUSIONS

Patients with sarcopenia were more likely to develop leukopenia after receiving T + GC. There were no notable alterations observed in relation to anemia or thrombocytopenia. No significant difference was found between the sarcopenia group and non-sarcopenia group in terms of tumor response and grade 3-4 hematological toxicity.

The addition of tislelizumab to gemcitabine and cisplatin chemotherapy increases thrombocytopenia in patients with urothelial carcinoma: A single-center study based on propensity score matching

PURPOSE

Whether the addition of tislelizumab to gemcitabine and cisplatin (GC) chemotherapy increases the incidence of myelosuppression has not been well established. This study identified the risk factors for the development of myelosuppression in patients with urothelial carcinoma (UC) after receiving GC chemotherapy with or without tislelizumab.

MATERIALS AND METHODS

We enrolled 192 UC patients who received GC with or without tislelizumab at the Affiliated Hospital of Xuzhou Medical University between July 2014 and November 2022. Patient baseline characteristics were included in the statistical analyses after adjusting for previously reported risk factors affecting survival using propensity score matching (1:1). Binary logistic regression analysis was used to identify the risk factors associated with posttreatment myelosuppression.

RESULTS

A total of 192 patients were enrolled, of whom 96 were treated with tislelizumab plus gemcitabine and cisplatin (T + GC) and 96 with GC alone. The incidence of leukopenia, anemia, and thrombocytopenia of any grade was 50.0%, 70.8%, and 42.7%, respectively, in the T + GC group and 41.7%, 72.9%, and 20.8%, respectively, in the GC group. In multivariate analysis, patients aged over 70 years (OR = 2.486, 95% CI: 1.067-5.792, p = 0.035) and those who received T + GC (OR = 3.119, 95% CI: 1.576-6.173, p = 0.001) were more likely to develop thrombocytopenia. Patients aged over 70 years (OR = 3.213, 95% CI: 1.254-8.237, p = 0.015) were more likely to develop anemia, and patients with renal insufficiency (OR = 2.105, 95% CI: 1.035-4.280, p = 0.040) were more likely to develop leukopenia. Eventually, 99 (51.6%) patients with UC successfully completed all the treatment cycles.

CONCLUSIONS

This study demonstrates that the addition of tislelizumab to GC chemotherapy led to a considerable increase in the occurrence of thrombocytopenia, whereas no significant changes were observed regarding anemia or leukopenia. It is crucial to fully inform patients at increased risk for myelosuppression of potential risks and closely monitor changes in their blood routines.

Increase in Lactulose Content in a Hot-Alkaline-Based System through Fermentation with a Selected Lactic Acid Bacteria Strain Followed by the β-Galactosidase Catalysis Process

In this study, lactic acid bacteria (LAB) fermentation and β-galactosidase catalysis methods were combined to increase the lactulose concentration and reduce the galactose and lactose content in a hot-alkaline-based system. The optimal conditions for chemical isomerization were 70 °C for 50 min for lactulose production, in which the concentration of lactulose was 31.3 ± 1.2%. Then, the selection and identification of LAB, which can utilize lactose and cannot affect lactulose content, were determined from 451 strains in the laboratory. It was found that Lactobacillus salivarius TM-2-8 had weak lactulose utilization and more robust lactose utilization. Lactobacillus rhamnosus grx.21 was weak in terms of lactulose utilization and strong in terms of galactose utilization. These two strains fermented the chemical isomerization system of lactulose to reduce the content of lactose and galactose. The results showed that the lactose concentration was 48.96 ± 2.92 g/L and the lactulose concentration was 59.73 ± 1. 8 g/L for fermentation lasting 18 h. The β-galactosidase was used to increase the content of lactulose in the fermented system at this time. The highest concentration of 74.89 ± 1.68 g/L lactulose was obtained at an enzymatic concentration of 3 U/mL and catalyzed at 50 °C for 3 h by β-galactosidase.

A Lightweight Human Fall Detection Network

The rising issue of an aging population has intensified the focus on the health concerns of the elderly. Among these concerns, falls have emerged as a predominant health threat for this demographic. The YOLOv5 family represents the forefront of techniques for human fall detection. However, this algorithm, although advanced, grapples with issues such as computational demands, challenges in hardware integration, and vulnerability to occlusions in the designated target group. To address these limitations, we introduce a pioneering lightweight approach named CGNS-YOLO for human fall detection. Our method incorporates both the GSConv module and the GDCN module to reconfigure the neck network of YOLOv5s. The objective behind this modification is to diminish the model size, curtail floating-point computations during feature channel fusion, and bolster feature extraction efficacy, thereby enhancing hardware adaptability. We also integrate a normalization-based attention module (NAM) into the framework, which concentrates on salient fall-related data and deemphasizes less pertinent information. This strategic refinement augments the algorithm's precision. By embedding the SCYLLA Intersection over Union (SIoU) loss function, our model benefits from faster convergence and heightened detection precision. We evaluated our model using the Multicam dataset and the Le2i Fall Detection dataset. Our findings indicate a 1.2% enhancement in detection accuracy compared with the conventional YOLOv5s framework. Notably, our model realized a 20.3% decrease in parameter tally and a 29.6% drop in floating-point operations. A comprehensive instance analysis and comparative assessments underscore the method's superiority and efficacy.

Samarium-Doped Lead Magnesium Niobate-Lead Titanate Ceramics Fabricated by Sintering the Mixture of Two Different Crystalline Phases

The fabrication method plays a key role in the performance of lead magnesium niobate-lead titanate-based ceramics. (1 - w)[Pb(Mg1/3Nb2/3)0.67Ti0.33O3]-w[Pb1-1.5xSmx(Mg1/3Nb2/3)yTi1-yO3] piezoelectric ceramics were prepared by sintering the mixture of two different crystalline phases in which two pre-sintered precursor powders were mixed and co-fired at designated ratios (w = 0.3, 0.4, 0.5, 0.6). The X-ray diffraction results show that all the ceramics presented a pure perovskite structure. The grains were closely packed and the average size was ~5.18 μm based on observations from scanning electron microscopy images, making the ceramics have a high density that is 97.8% of the theoretical one. The piezoelectric, dielectric, and ferroelectric properties of the ceramics were investigated systematically. It was found that the properties of the ceramics were significantly enhanced when compared to the ceramics fabricated using the conventional one-step approach. An outstanding piezoelectric coefficient d33 of 1103 pC/N and relative dielectric permittivity ε33/ε0 of 9154 was achieved for the ceramics with w = 0.5.

The effect of different ferrule heights and crown-to-root ratios on fracture resistance of endodontically-treated mandibular premolars restored with fiber post or cast metal post system: an in vitro study

BACKGROUND

This study aimed to investigate the effects of different ferrule heights and crown-to-root ratios on the fracture resistance of endodontically-treated premolars restored with fiber post or cast metal post system.

METHODS

Eighty extracted human mandibular first premolars with single root canal were treated endodontically and cut from 2.0 mm above the buccal cemento-enamel junction, to create horizontal residual roots. The roots were randomly divided into two groups. The roots in group FP were restored with a fiber post-and-core system, while the roots in group MP were restored with a cast metal post-and-core system. Each group was divided into five subgroups with different ferrule heights (0: no ferrule; 1: 1.0 mm ferrule; 2: 2.0 mm ferrule; 3: 3.0 mm ferrule; 4: 4.0 mm ferrule). All specimens were subsequently restored with metal crowns and embedded in acrylic resin blocks. The crown-to-root ratios of the specimens were controlled at approximately 0.6, 0.8, 0.9, 1.1, and 1.3 of the five subgroups, respectively. Fracture strengths and fracture patterns of the specimens were tested and recorded by a universal mechanical machine.

RESULTS

Mean fracture strengths (mean ± standard deviation (kN)) of FP/0 to FP/4 and MP/0 to MP/4 were: 0.54 ± 0.09, 1.03 ± 0.11, 1.06 ± 0.17, 0.85 ± 0.11; 0.57 ± 0.10, 0.55 ± 0.09, 0.88 ± 0.13, 1.08 ± 0.17, 1.05 ± 0.18 and 0.49 ± 0.09, respectively. Two-way ANOVA revealed significant effects of different ferrule heights and crown-to-root ratios on the fracture resistance (P < 0.001), but no difference in fracture resistance between two post-and-core systems (P = 0.973). The highest fracture strengths of the specimen were found with the ferrule length of 1.92 mm in group FP and 2.07 mm in group MP, the crown-to-root ratio of which in 0.90 and 0.92 respectively., there is a significant difference in fracture patterns among the groups(P < 0.05).

CONCLUSIONS

When a certain height of ferrule is prepared and a cast metal or fiber post-and-core system is restored for the residual root, the clinical crown-to-root ratio of the tooth after restoration should be kept within 0.90 to 0.92, so as to improve the fracture resistance of endodontically-treated mandibular first premolars.

Prevalence of strabismus among preschool children in eastern China and comparison at a 5-year interval: a population-based cross-sectional study

OBJECTIVE

To update data on strabismus and evaluate the changes in prevalence and patterns among preschoolers in eastern China over a period of 5 years.

DESIGN

Nanjing Eye Study, a longitudinal population-based study.

SETTING

Recruitment and testing in kindergartens in Yuhuatai District, Nanjing.

PARTICIPANTS

2300 eligible children.

MAIN OUTCOME MEASURES

Comprehensive ocular examinations were conducted in 1986 children aged 48-<60 months in Nanjing Eye Study (NES, 2016-2017), including visual acuity, ocular alignment, refractive error and ocular structures evaluation. The prevalence rate and pattern of strabismus were calculated and compared with those from the Nanjing Pediatric Vision Project (NPVP, 2011-2012) in children of the same age, of the same area and using the same diagnostic criteria.

RESULTS

The overall prevalence rate of strabismus in NES was 5.56% (95% CI 4.54% to 6.57%), which was not significantly different from that in NPVP (4.99%, 95% CI 4.13% to 5.84%, p=0.40). The prevalence of subtypes of strabismus underwent significant changes, with significant increase in intermittent exotropia (IXT) in NES (2.78% vs 4.69%, p=0.001) and significant decrease in constant exotropia (1.17% vs 0.15%, p<0.001). Significant change in pattern was observed in IXT, where the proportion of the convergence insufficiency type (2.90% vs 27.17%) increased and exceeded the divergence excess type (20.29% vs 11.96%) to be the second common type (p<0.001).

CONCLUSION

The prevalence of strabismus appeared stable in children aged 48-<60 months in eastern China at a 5-year interval. The prevalence of IXT increased significantly, and the convergence insufficiency type became more prevalent in patients with IXT. Timely detection and intervention of IXT are important among preschoolers.