Changes in nutritional status and the development of obesity and metabolic syndrome following pediatric heart transplantation

BACKGROUND

Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre-operative nutrition status has been shown to affect post-operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long-term in the post-transplant period.

METHODS

A single-center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1-year, and 3-year follow-up post-transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z-score, were utilized in secondary analyses.

RESULTS

Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3-year follow-up. No underweight patients at listing became overweight/obese at follow-up. Of patients who were overweight/obese at listing, 88% maintained that status at 3-year follow-up. Overweight/obese status at listing, 1-year, and 3-year post-transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post-transplant metabolic syndrome.

CONCLUSIONS

The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities.

[Progress of circulating tumor DNA methylation for gastric cancer screening and management]

Circulating tumor DNA (ctDNA) is cell-free DNA released by tumors or circulating tumor cells, containing abundant tumor-specific information that can serve as biomarkers for cancer early screening, monitoring, prognosis, and prediction of treatment response. This is particularly attractive in the field of gastric cancer, where high-quality screening, monitoring, and prediction methods are currently lacking. Gastric cancer exhibits significant tumor heterogeneity, with large differences in genetic and epigenetic characteristics among different subgroups. Methylated ctDNA has high sensitivity and specificity, which can help clarify tumor genotyping and facilitate the formulation of precise diagnostic and therapeutic strategies. Furthermore, numerous studies have confirmed the unique advantages of methylated DNA in predicting treatment response, adjuvant therapy, and drug resistance assessment, which may be used in the future to enhance the efficacy of chemotherapy regimens and improve patient chemotherapeutic response, and even treat multidrug resistance. However, there are several challenges associated with methylated ctDNA, such as low sensitivity and specificity at single-target sites, limited association between some gastric cancer subtypes and ctDNA, off-target risks, and the lack of large-scale and high-quality clinical research evidence. This review mainly summarizes current research on the methylation status of ctDNA in gastric cancer and connects these findings to early screening, recurrence monitoring, and potential treatment opportunities for gastric cancer. With advances in technology and the deepening of interdisciplinary research, ctDNA detection will reveal more disease information and become an essential foundation for gastric cancer research and precision medicine treatment.

Cardiac MRI feature-tracking-derived torsion mechanics in systolic and diastolic dysfunction in systemic light-chain cardiac amyloidosis

AIM

To describe the myocardial torsion mechanics in cardiac amyloidosis (CA), and evaluate the correlations between left ventricle (LV) torsion mechanics and conventional parameters using cardiac magnetic resonance imaging feature tracking (CMR-FT).

MATERIALS AND METHODS

One hundred and thirty-nine patients with light-chain CA (AL-CA) were divided into three groups: group 1 with preserved systolic function (LV ejection fraction [LVEF] ≥50%, n=55), group 2 with mildly reduced systolic function (40% ≤ LVEF <50%, n=51), and group 3 with reduced systolic function (LVEF <40%, n=33), and compared with age- and gender-matched healthy controls (n=26). All patients underwent cine imaging and late gadolinium-enhancement (LGE). Cine images were analysed offline using CMR-FT to estimate torsion parameters.

RESULTS

Global torsion, base-mid torsion, and peak diastolic torsion rate (diasTR) were significantly impaired in patients with preserved systolic function (p<0.05 for all), whereas mid-apex torsion and peak systolic torsion rate (sysTR) were preserved (p>0.05 for both) compared with healthy controls. In patients with mildly reduced systolic function, global torsion and base-mid torsion were lower compared to those with preserved systolic function (p<0.05 for both), while mid-apex torsion, sysTR, and diasTR were preserved (p>0.05 for all). In patients with reduced systolic function, only sysTR was significantly worse compared with mildly reduced systolic function (p<0.05). At multivariable analysis, right ventricle (RV) end-systolic volume RVESV index and NYHA class were independently related to global torsion, whereas LVEF was independently related to sysTR. RV ejection fraction (RVEF) was independently related to diasTR. LV global torsion performed well (AUC 0.71; 95% confidence interval [CI]: 0.61, 0.77) in discriminating transmural from non-transmural LGE in AL-CA patients.

CONCLUSION

LV torsion mechanics derived by CMR-FT could help to monitor LV systolic and diastolic function in AL-CA patients and function as a new imaging marker for LV dysfunction and LGE transmurality.

Observation of Seven Astrophysical Tau Neutrino Candidates with IceCube

We report on a measurement of astrophysical tau neutrinos with 9.7 yr of IceCube data. Using convolutional neural networks trained on images derived from simulated events, seven candidate ν_{τ} events were found with visible energies ranging from roughly 20 TeV to 1 PeV and a median expected parent ν_{τ} energy of about 200 TeV. Considering backgrounds from astrophysical and atmospheric neutrinos, and muons from π^{±}/K^{±} decays in atmospheric air showers, we obtain a total estimated background of about 0.5 events, dominated by non-ν_{τ} astrophysical neutrinos. Thus, we rule out the absence of astrophysical ν_{τ} at the 5σ level. The measured astrophysical ν_{τ} flux is consistent with expectations based on previously published IceCube astrophysical neutrino flux measurements and neutrino oscillations.

Rev-erbα attenuates refractory periapical periodontitis via M1 polarization: An in vitro and in vivo study

AIM

Rev-erbα has been reported to regulate the healing of inflammatory lesions through its effect on the immune system in a variety of inflammatory disease. Moreover, the balance of macrophages polarization plays a crucial role in immune response and inflammatory progression. However, in refractory periapical periodontitis (RAP), the role of Rev-erbα in inflammatory response and bone resorption by regulating macrophage polarization remains unclarified. The aims of the present study were to investigate the expression of Rev-erbα in experimental RAP and to explore the relationship between Rev-erbα and macrophage polarization through the application of its pharmacological agonist SR9009 into the in vivo and in vitro experiments.

METHODOLOGY

Enterococcus faecalis-induced RAP models were established in SD rats. Histological staining and micro-computed tomography scanning were used to evaluate osteoclastogenesis and alveolar bone resorption. The expression of Rev-erbα and macrophage polarization were detected in the periapical tissues from rats by immunofluorescence, flow cytometry, and western blots. Furthermore, immunohistochemical staining and enzyme-linked immunosorbent assay were performed to explore the relationship between Rev-erbα and inflammatory cytokines related to macrophage polarization.

RESULT

Compared to healthy periapical tissue, the expression of Rev-erbα was significantly down-regulated in macrophages from inflammatory periapical area, especially in Enterococcus faecalis-induced periapical lesions, with obvious type-1 macrophage (M1)-like dominance and the production of pro-inflammatory cytokines. In addition, Rev-erbα activation by SR9009 could induce type-2 macrophage (M2)-like polarization in periapical tissue and THP1 cell line, followed by increased secretion of anti-inflammatory cytokines IL-10 and TGF-β. Furthermore, intracanal application of SR9009 reduced the lesion size and promoted the repair of RAP by decreasing the number of osteoclasts and enhancing the formation of mineralized tissue in periapical inflammatory lesions.

CONCLUSIONS

Rev-erbα played an essential role in the pathogenesis of RAP through its effect on macrophage polarization. Targeting Rev-erbα might be a promising and prospective therapy method for the prevention and management of RAP.

Isoniazid urine spectrophotometry for prediction of serum pharmacokinetics in adults with TB

BACKGROUND

Isoniazid (INH) is an important drug in many TB regimens, and unfavorable treatment outcomes can be caused by suboptimal pharmacokinetics. Dose adjustment can be personalized by measuring peak serum concentrations; however, the process involves cold-chain preservation and laboratory techniques such as liquid chromatography (LC)/mass spectrometry (MS), which are unavailable in many high-burden settings. Urine spectrophotometry could provide a low-cost alternative with simple sampling and quantification methods.

METHODS

We enrolled 56 adult patients on treatment for active TB. Serum was collected at 0, 1, 2, 4, 6, and 8 h for measurement of INH concentrations using validated LC-MS/MS methods. Urine was collected at 0-4, 4-8, and 8-24 h intervals, with INH concentrations measured using colorimetric methods.

RESULTS

The median peak serum concentration and total serum exposure over 24 h were 4.8 mg/L and 16.4 mg*hour/L, respectively. Area under the receiver operator characteristic curves for urine values predicting a subtherapeutic serum concentration (peak <3.0 mg/L) were as follows: 0-4 h interval (AUC 0.85, 95% CI 0.7-0.96), 0-8 h interval (AUC 0.85, 95% CI 0.71-0.96), and 0-24 h urine collection interval (AUC 0.84, 95% CI 0.68-0.96).

CONCLUSION

Urine spectrophotometry may improve feasibility of personalized dosing in high TB burden regions but requires further study of target attainment following dose adjustment based on a urine threshold.

[Inhibitory effect of Streptococcus mutans antisense vicK RNA regulating the cariogenicity of oral streptococci multi-species biofilm]

Objective: To investigate the regulative effects of Streptococcus mutans (Sm) antisense vicK RNA (ASvicK) on the multi-species biofilm formed by three common oral streptococci (Sm, Streptococcus sanguinis, and Streptococcus gordonii) (Sm+Ss+Sg). Methods: ASvicK over-expression strain was constructed by using a recombinant plasmid, and three-species biofilm UA159+Ss+Sg and ASvicK+Ss+Sg were cultured. The phenotypes of biofilms were detected by scanning electron microscopy (SEM). Crystal violet (CV) assay was used to detect biofilm biomass. Lactate kit and anthrone-sulfuric acid colorimetric assay were used to determine the abilities of lactic acid and exopolysaccharides production, respectively. The proportions of three-species and expression levels of the cariogenic-related genes in biofilms were detected by TaqMan fluorescence quantitative PCR and real-time fluorescence quantitative PCR. A biofilm demineralization model of human enamel slabs was further constructed, and the hardness of enamel surface was detected. Results: Compared to UA159+Ss+Sg, over-expression of ASvicK could inhibit biofilm formation and lactic acid production in ASvicK+Ss+Sg biofilm significantly decreased by 78.93% (P<0.001) and 62.23% (P<0.001), respectively. With ASvicK over-expression, the amounts of water-insoluble and-soluble glucoses in ASvicK+Ss+Sg biofilm were reduced respectively by 39.13% (P<0.001) and 68.00% (P<0.001). Compared to the UA159+Ss+Sg Group, the proportion of Sm, the cariogenic bacteria, showed 33.00% reduction (P<0.01) in Sm+Ss+Sg biofilm, and the gene expressions of cariogenic-relative genes vicK/X, gtfB/C/D, and ftf significantly decreased (P<0.05). The micro-hardness value of enamel slabs after demineralization by ASvicK+Ss+Sg biofilm was significantly increased to 183.84% (P<0.001). Conclusions: ASvicK over-expression could reduce the Sm proportion and weaken the cariogenicity of oral Streptococcus biofilm, thereby possibly slowing down the progression of caries.

A comprehensive assessment of environmental factors in aircraft cockpit based on fuzzy evaluation

BACKGROUND

The cockpit of an aircraft is the main place where the pilot controls the aircraft on a mission. An excellent cockpit environment not only ensures the pilot's basic survival needs but also improves the comfort level and alleviates fatigue when performing missions.

OBJECTIVE

On the basis of domestic and international airworthiness standards, a top-down refinement method is deployed to determine the initial goal, and the environmental criteria are fully discussed and balanced in a dynamic process to build a comprehensive evaluation system for environmental factors in the aircraft cockpit.

METHODS

Based on the fuzzy comprehensive evaluation theory, an evaluation model for environmental factors is constructed by combining analytic hierarchical analysis (AHP) and particle swarm optimization (PSO). Then the feasibility of the evaluation model is verified by an illustrative example.

RESULTS

The results suggest that the light environment gains the highest score among the 4 environmental criteria followed by the thermal environment, while both sound environment and microenvironment have relatively low scores.

CONCLUSION

As for the 27 environmental sub-criteria, temperature, illumination, lighting clarity, light-color coordination, noise duration and pressure score the highest. The evaluation findings can provide important environmental control criteria for the subsequent environmental control system in the cockpit of the aircraft.

Correlation of serum levels of HIF-1α, SMAD3, and HDAC3 with the disease severity in stroke patients

OBJECTIVE

Explore serum levels of hypoxia-inducible factor-1α (HIF-1α), signal transduction molecule 3 (SMAD3), and histone deacetylase (HDAC) and their correlation with the severity of the condition of stroke patients.

PATIENTS AND METHODS

Clinical records of 93 stroke patients and 93 healthy individuals were retrospectively analyzed. Serum levels of HIF-1α, SMAD3, and HDAC3 in patients with different disease degrees and lesion areas were compared between the two groups. Correlation between serum levels of HIF-1α, SMAD3, and HDAC3 and the severity and lesion area of the observation group were analyzed.

RESULTS

Serum levels of HIF-1α, SMAD3, and HDAC3 in the observation group were higher than those in the control group (p<0.05). Serum levels of HIF-1α, SMAD3, and HDAC3 in patients with moderate and severe disease were significantly higher than those in patients with mild disease and were the highest in patients with severe disease (p<0.05). Serum levels of HIF-1α, SMAD3, and HDAC3 in patients with moderate and large areas of cerebral infarction were significantly higher than those in patients with small areas of cerebral infarction and the highest in patients with large areas of cerebral infarction (p<0.05). Spearman correlation analysis showed that serum levels of HIF-1α, SMAD3, and HDAC3 significantly positively correlated with the severity of stroke and lesion area (p<0.05).

CONCLUSIONS

Serum levels of HIF-1α, SMAD3, and HDAC3 in stroke patients are highly expressed, and the increase positively correlates with the severity of the disease and the area of the lesion.

Occupational stress, respect, and the need for psychological counselling in Chinese nurses: a nationwide cross-sectional study

OBJECTIVES

This study aimed to explore occupational stress, perceived respect, and the need for psychological counselling among nurses in China.

STUDY DESIGN

This was a nationwide cross-sectional study.

METHODS

Chinese nurses from 311 cities were randomly selected through a simple random sampling method. Occupational stress, perceived respect, and psychological counselling need were assessed using an online questionnaire validated by experts. The underlying associated factors were analysed using multiple logistic regression analyses.

RESULTS

We collected and analysed 51,406 valid online questionnaires. Family factors and low income were the most commonly cited sources of occupational stress, and 91.9% and 80.0% of nurses, respectively, perceived that individuals in society and patients did not give adequate respect. Furthermore, 75.5% and 79.7%, respectively, believed they were not respected by clinical managers and doctors. As a result, 64.7% nurses believed they had a moderate or high need for psychological counselling. However, 80.7% indicated that receiving adequate respect could decrease the need for stress-related psychological counselling. Indeed, multiple logistic regression analyses showed that lower respect perceived by nurses was associated with higher need for psychological counselling, particularly regarding criticism that nurses perceived from nursing managers (a little: odds ratio [OR], 1.597; 95% confidence interval [CI], 1.176-2.170; P = 0.003; moderately: OR, 1.433; 95% CI, 1.180-1.741; P < 0.001) and the difficulty of receiving respect from patients and their families (a little: OR, 1.389; 95% CI, 1.044-1.850; P = 0.024).

CONCLUSIONS

Nurses in China perceive high levels of occupational stress and low levels of respect and often seek psychological counselling.

A Vehicle Simulation Study Examining the Effects of System Interface Design Elements on Performance in Different Vibration Environments Below 3 Hz

OBJECTIVE

This study aimed to explore the relationship between system interface elements' design features and interaction performance in simulated vehicle vibration environments.

BACKGROUND

Touch screens have been widely used in vehicle information systems, but few studies have focused on the decline of touchscreen interaction performance and task load increase when driving on unpaved roads.

METHOD

The interaction performance (reaction time and task accuracy rate) with vibration frequencies below 3 Hz (1.5, 2.0, and 2.5 Hz) and different interface design elements was investigated employing a touch screen computer and E-prime software.

RESULTS

The results indicate that vehicle vibration (below 3 Hz) can significantly reduce interaction performance with a vehicle information system interface.

CONCLUSION

An appropriate increase in the physical size of the interface design features (visual stimulus materials and touch buttons) can help to mitigate this negative effect of vibration.

APPLICATION

The results and findings of this study can be utilized for the design of information system interfaces as it relates to the vibration scenario of unpaved roads.

[Alterations in erythrocytic oligomeric alpha-synuclein in patients with Parkinson's disease and multiple system atrophy]

Objective: To analyze the content of α-synuclein oligomer(O-α-Syn) in erythrocytes in patients with Parkinson's disease (PD) and multiple system atrophy (MSA) and the correlation with clinical symptoms. Methods: Two hundred and ninety-six PD patients and 85 MSA patients were recruited from the Department of Functional Neurosurgery and Neurology of Xuanwu Hospital, Capital Medical University from July 2020 to October 2021. Four hundred and three healthy controls (HC) were recruited from the Beijing Longitudinal Study of Aging community cohort during the same period. The levels of RBC-O-α-Syn were measured by enzyme-linked immunosorbent assay (ELISA). Univariate linear regression model was used to analyze the correlation between the content of RBD-O-α-Syn and various motor and non-motor functional scores, such as Unified Parkinson Disease Rating Scale (UPDRS) Ⅲ, Unified Multiple System Atrophy Rating Scale (UMSARS) Ⅲ, Mini-Mental State Examination (MMSE), rapid eye movement sleep disorder questionnaire-HongKong(RBDQ-HK) and Montreal Cognitive Assessment (MoCA). Receiver operating characteristic (ROC) curves was used to evaluate the specificity, sensitivity, and the area under the curve (AUC) of RBC-O-α-Syn in distinguishing PD and MSA patients from HC subjects. Results: The average age of HC subjects was (70±8) years old, the average age of PD patients was (64±9) years old, including 115 (38.9%) cases with tremor dominant PD (TD-PD), 132 cases (44.6%) of postural instability disorder predominant PD (PIGD-PD), and 142 cases (48.0%) of patients with H-Y stage 2. UPDRS Ⅲ score was 31.2±17.8. The mean age of MSA patients was (64±9) years, with the mean UMSARS Ⅱ score of 18.9±10.3. The non-motor symptoms of PD and MSA patients were significantly different from those of HC subjects (P<0.001). The levels of RBC-O-α-Syn in PD [(50±17) ng/mg] and MSA [(52±19) ng/mg] were significantly higher than those in HC subjects [(21±10) ng/mg] (P<0.001). The sensitivity and specificity of RBC-O-α-Syn in distinguishing PD patients and HC subjects were 87.16% (95%CI: 82.87%-90.50%) and 86.10% (95%CI: 82.38%-89.14%), with an AUC of 0.933 (95%CI: 0.914-0.951), and the sensitivity and specificity in distinguishing MSA patients and HC subjects were 85.88% (95%CI: 76.93%-91.74%) and 81.39% (95%CI: 77.30%-84.89%), with an AUC of 0.921 (95%CI: 0.884-0.957). The levels of RBC-O-α-Syn in PD patients with rapid eye movement sleep behavior disorder (RBD) were higher than that in PD patients without RBD [(53±16) ng/mg vs (48±17) ng/mg, P=0.029].The content of RBC-O-α-Syn in female PD patients and HC subjects was higher than that in male, but there was no significant difference between subjects of different ages and disease duration (P>0.05). In addition, RBC-O-α-Syn content was positively correlated with UPDRS Ⅲ (r=0.18, P=0.002) and the score of rapid eye movement sleep behavior disorder questionnaire(Hong Kong) (RBDQ-HK)(r=0.19, P<0.001). But there was no correlation with H-Y stage, non-motor symptoms scale (NMSS), MMSE, Moca, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) scores (all P>0.05). There was no correlation between RBC-O-α-Syn content and UMSARS Ⅱ, NMSS, MMSE, MoCA, HAMD, HAMA in patients with MSA (all P>0.05). Conclusions: Levels of RBC-O-α-Syn are significantly increased in PD and MSA patients. There are positive correlations between levels of RBC-O-α-Syn and scores of UPDRS Ⅲ and RBDQ-HK.

Observation of high-energy neutrinos from the Galactic plane

The origin of high-energy cosmic rays, atomic nuclei that continuously impact Earth's atmosphere, is unknown. Because of deflection by interstellar magnetic fields, cosmic rays produced within the Milky Way arrive at Earth from random directions. However, cosmic rays interact with matter near their sources and during propagation, which produces high-energy neutrinos. We searched for neutrino emission using machine learning techniques applied to 10 years of data from the IceCube Neutrino Observatory. By comparing diffuse emission models to a background-only hypothesis, we identified neutrino emission from the Galactic plane at the 4.5σ level of significance. The signal is consistent with diffuse emission of neutrinos from the Milky Way but could also arise from a population of unresolved point sources.

[Effect of Liraglutide on platelet distribution width and carotid intima-media thickness in type 2 diabetic mellitus patients with obesity]

Objective: To investigate the effect of Liraglutide on platelet distribution width(PDW) and carotid intima-media thickness(cIMT) in type 2 diabetic mellitus patients with obesity. Methods: Randomized controlled trial. A total of 80 type 2 diabetes mellitus (T2DM) obese patients with unsatisfactory glucose control were prospectively enrolled in this study from the Department of Endocrinology of Yuhuangding Hospital Affiliated to Qingdao University from January to December 2021. All the participants were treated with metformin or sulfonylureas. They were randomly divided into two groups: Liraglutide treatment group (Li group, n=40) and Control group (Con group, n=40).The Li group started the treatment with Liraglutide on the basis of the original hypoglycemic agents and the Con group was treated with metformin and sulfonylurea. After 16 weeks of treatment, the changes of PDW, cIMT and body mass index (BMI) in the two groups were observed, multiple linear regression was uesd to analyze the influencing factors of cIMT variation, and the effect of liraglutide on PDW and cIMT in obese patients with type 2 diabetes was analyzed. Results: Finally, 38 patients completed the study in Li group, including 23 males and 15 females, aged 30-69(56±11) years. All 40 patients in Con group completed the study, including 18 males and 22 females, aged 39-67(59±7) years. After 16 weeks of treatment, the levels of PDW and cIMT in Li group were (12.8±1.6) fl and (0.85±0.08) mm, respectively, lower than those before treatment (15.0±1.6) fl and (1.14±0.10) mm (t=18.61 and 20.37, respectively, both P<0.001); The PDW and cIMT in Con group were (13.6±1.5) fl and (1.05±0.10) mm, respectively, lower than those before treatment (15.0±1.5) fl and (1.13±0.13) mm (t=17.42 and 9.65, respectively, both P<0.001). The levels of fasting plasma glucose (FPG) and total cholesterol (TC) in both groups were lower than those before treatment(all P<0.001). After the treatment, the levels of PDW, cIMT, FPG and TC in Li group were lower than those in Con group (all P<0.05). The changes of PDW and cIMT before and after the treatment in Li group were (2.2±0.7) fl and (0.30±0.09) mm, respectively, higher than those in the Con group [(1.4±0.5) fl and (0.09±0.06) mm], with a statistically significant difference (both P<0.001). The changes of FPG and TC in Li group were significantly higher than those in Con group (all P<0.05). Multiple linear regression analysis showed that liraglutide, the changes of TC and systolic blood pressure (SBP) were the influencing factors for the changes of cIMT [β (95%CI) were 0.20 (0.17-0.23), 0.03 (0.01-0.06), 0.01 (0.00-0.01), respectively, all P<0.05] Conclusion: Liraglutide treatment could reduce PDW and cIMT, thus contributing to cardiovascular benefits.

Hand Posture and Force Estimation Using Surface Electromyography and an Artificial Neural Network

OBJECTIVE

The purpose of this study was to develop an approach to predict hand posture (pinch versus grip) and grasp force using forearm surface electromyography (sEMG) and artificial neural networks (ANNs) during tasks that varied repetition rate and duty cycle.

BACKGROUND

Prior studies have used electromyography with machine learning models to predict grip force but relatively few studies have assessed whether both hand posture and force can be predicted, particularly at varying levels of duty cycle and repetition rate.

METHOD

Fourteen individuals participated in this experiment. sEMG data for five forearm muscles and force output data were collected. Calibration data (25, 50, 75, 100% of maximum voluntary contraction (MVC)) were used to train ANN models to predict hand posture (pinch versus grip) and force magnitude while performing tasks that varied load, repetition rate, and duty cycle.

RESULTS

Across all participants, overall hand posture prediction accuracy was 79% (0.79 ± .08), whereas overall hand force prediction accuracy was 73% (0.73 ± .09). Accuracy ranged between 0.65 and 0.93 based on varying repetition rate and duty cycle.

CONCLUSION

Hand posture and force prediction were possible using sEMG and ANNs, though there were important differences in the accuracy of predictions based on task characteristics including duty cycle and repetition rate.

APPLICATION

The results of this study could be applied to the development of a dosimeter used for distal upper extremity biomechanical exposure measurement, risk assessment, job (re)design, and return to work programs.

Integrating EM and Patch-seq data: Synaptic connectivity and target specificity of predicted Sst transcriptomic types

Neural circuit function is shaped both by the cell types that comprise the circuit and the connections between those cell types ¹ . Neural cell types have previously been defined by morphology ^{2, 3} , electrophysiology ^{4, 5} , transcriptomic expression ^6-8 , connectivity ^9-13 , or even a combination of such modalities ^14-16 . More recently, the Patch-seq technique has enabled the characterization of morphology (M), electrophysiology (E), and transcriptomic (T) properties from individual cells ^17-20 . Using this technique, these properties were integrated to define 28, inhibitory multimodal, MET-types in mouse primary visual cortex ²¹ . It is unknown how these MET-types connect within the broader cortical circuitry however. Here we show that we can predict the MET-type identity of inhibitory cells within a large-scale electron microscopy (EM) dataset and these MET-types have distinct ultrastructural features and synapse connectivity patterns. We found that EM Martinotti cells, a well defined morphological cell type ^{22, 23} known to be Somatostatin positive (Sst+) ^{24, 25} , were successfully predicted to belong to Sst+ MET-types. Each identified MET-type had distinct axon myelination patterns and synapsed onto specific excitatory targets. Our results demonstrate that morphological features can be used to link cell type identities across imaging modalities, which enables further comparison of connectivity in relation to transcriptomic or electrophysiological properties. Furthermore, our results show that MET-types have distinct connectivity patterns, supporting the use of MET-types and connectivity to meaningfully define cell types.

Evidence of Antineutrinos from Distant Reactors Using Pure Water at SNO

The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.

[Research progress in pH-responsive antibacterial nanomaterials for inhibiting oral plaque biofilms]

pH-responsive antibacterial nanomaterials are a new type of nanomaterials that can selectively undergo structural changes and trigger drug release according to significant pH differences produced by the body under physiological and pathological conditions. The formation of acidic microenvironment in plaque is the key to the pathogenicity of oral plaque biofilm, which also creates conditions for the oral application of pH-responsive antibacterial nanomaterials. pH-responsive antibacterial nanomaterials can respond to changes in pH of plaque microenvironment and accurately control the release of antibacterial drugs, providing a new direction for improving drug efficacy and targeted antibacterial. The present article reviews the classification, mechanism and application of pH-responsive antibacterial nanomaterials in oral plaque inhibition.

Measurement of the ν_{e}-Nucleus Charged-Current Double-Differential Cross Section at ⟨E_{ν}⟩=2.4 GeV Using NOvA

The inclusive electron neutrino charged-current cross section is measured in the NOvA near detector using 8.02×10^{20} protons-on-target in the NuMI beam. The sample of GeV electron neutrino interactions is the largest analyzed to date and is limited by ≃17% systematic rather than the ≃7.4% statistical uncertainties. The double-differential cross section in final-state electron energy and angle is presented for the first time, together with the single-differential dependence on Q^{2} (squared four-momentum transfer) and energy, in the range 1  GeV≤E_{ν}<6  GeV. Detailed comparisons are made to the predictions of the GENIE, GiBUU, NEUT, and NuWro neutrino event generators. The data do not strongly favor a model over the others consistently across all three cross sections measured, though some models have especially good or poor agreement in the single differential cross section vs Q^{2}.

Integrated analysis of long non-coding RNAs and mRNA expression profiles identified potential interactions regulating melanogenesis in chicken skin

1. Long non-coding RNAs (lncRNAs) play important roles in various physiological functions. However, the mechanisms underlying the regulation of lncRNAs in melanogenesis remain unclear. To determine the molecular mechanisms involved in skin melanogenesis, the present study depicted the expression profiles of lncRNAs and messenger RNAs (mRNAs) in black- (B group) and white- (W group) skinned chickens using RNA sequencing.2. In total, 373 differentially expressed lncRNAs (DELs; 203 up-regulated and 170 down-regulated) and 253 differentially expressed genes (DEGs; 152 up-regulated and 101 down-regulated) were identified between the B and W groups. A total of eight known melanogenesis-related genes were identified (KIT, TYRP1, DCT (TYRP2), SLC45A2, OCA2, EDNRB2, TRPM1 and RAB38).3. Functional annotation of the co-expressed DEGs and DELs was performed using Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway analyses. The co-expressed DEGs were mainly involved in melanogenesis and the co-expressed genes of 117 and 108 DELs were significantly enriched in the melanogenesis and tyrosine metabolism pathways, respectively.4. The DEL-DEG interaction network revealed that three lncRNAs (XR_003072387.1, XR_003075112.1, and XR_003077033.1) and DCT genes may have key roles in regulating melanogenesis in chicken skin. This data provides the groundwork for studying the lncRNA regulatory mechanisms of skin melanogenesis and suggested a new perspective on the modulation of melanogenesis in chicken skin based on a lncRNA-mRNA causal regulatory network.

Design knowledge graph-aided conceptual product design approach based on joint entity and relation extraction

Design knowledge is critical to creating ideas in the conceptual design stage of product development for innovation. Fragmentary design data, massive multidisciplinary knowledge call for the development of a novel knowledge acquisition approach for conceptual product design. This study proposes a Design Knowledge Graph-aided (DKG-aided) conceptual product design approach for knowledge acquisition and design process improvement. The DKG framework uses a deep-learning algorithm to discover design-related knowledge from massive fragmentary data and constructs a knowledge graph for conceptual product design. The joint entity and relation extraction model is proposed to automatically extract design knowledge from massive unstructured data. The feasibility and high accuracy of the proposed design knowledge extraction model were demonstrated with experimental comparisons and the validation of the DKG in the case study of conceptual product design inspired by massive real data of porcelain.

Effects of aircraft tray table height and neck posture on passenger comfort: A study of the economy class cabin

BACKGROUND

The tray table in economy class air travel may cause excessive neck flexion and discomfort in passengers.

OBJECTIVE

The purpose of this study is to examine the influence of different tray table heights on the neck posture and discomfort perception of passengers.

METHODS

A passenger experience survey was used to determine the passengers' view that the tray table was not high enough, and that most passengers were dissatisfied with the overall comfort evaluation of the tray table, especially passengers with obesity. Three head-neck angles and discomfort perceptions of six body parts in 58 participants were recorded by neck posture 3D scanning and perceived level of discomfort assessment, respectively.

RESULTS

Tray tables at the original height (68 cm) caused unnatural neck posture and discomfort in participants. Raising the tray table can improve the neck posture of participants and reduce discomfort. However, raising the tray table too high will cause more shoulder discomfort in participants. Based on the results, 78 (±2) cm is suggested as the suitable thresholds range of tray tables for economy class air travel.

CONCLUSION

The results and findings of this study could provide a theoretical base for the optimization of tray table design.

[Risk factors and characteristics of gut microbiota and metabolites in inflammatory bowel diseases patients with urolithiasis]

Objective: To identify the related factors and characteristics of gut microbiota and metabolites in inflammatory bowel disease (IBD) patients with urolithiasis. Methods: A total of 68 IBD patients with urolithiasis and 136 gender-and age-matched IBD patients without urolithiasis in the Department of Gastroenterology, Peking Union Medical College Hospital from January 2014 to December 2019 were recruited. The diagnosis of urolithiasis was confirmed by plain films, ultrasonography, abdominal computed tomography or intravenous urography. The clinical data of patients were collected, and the association between the clinical characteristics and urolithiasis was further analyzed. The fecal samples were collected from 10 patients with urolithiasis and 18 patients without urolithiasis, and the gut microbiota and metabolites composition were analyzed. Results: There were 49 male and 19 female IBD patients with urolithiasis, with a mean age of (36.0±12.4) years, and 98 male and 38 female patients without urolithiasis, with a mean age of (36.1±12.5) years. Univariate analysis revealed that the rate of ileostomy and the resection of small intestine in Crohn's disease (CD) patients with urolithiasis (n=34) was significantly higher than CD patients without urolithiasis (n=68) (26.5% vs 7.4%, P=0.019). And the erythrocyte sedimentation rate was also higher [26.5 (12.0, 40.8) vs 13.0 (7.2, 32.5) mm/1 h, P=0.022] in CD patients with urolithiasis. There were no significant differences in clinical characteristics and biochemical parameters between the ulcerative colitis (UC) patients with urolithiasis (n=34) and without urolithiasis (n=68) (all P>0.05). The multivariate logistic regression analysis indicated that ileostomy and the resection of small intestine were the independent related factors for urolithiasis in CD patients (OR=4.619, 95%CI: 1.178-18.111, P=0.028). There was no significant difference in α and β diversity between the two groups (all P>0.05). At the phylum level, there was no significant difference in the abundance of microbiota (all P>0.05). At the genus level, the abundance of Enterococcus (P=0.049), Eubacterium_eligens (P=0.036) was significantly decreased. At the species level, the abundance of Bacteroides_coprocola was increased in urolithiasis group (P=0.035), while the abundance of Blautia_caecimuris was significantly decreased (P=0.042). No significant difference was found in fecal metabolites between the two groups (all P>0.05). According to LDA effect size (Lefse) analysis, taxa including Sphingomonadales, Fenollaria, Bacteroides_coprocola contributed greatly to the difference between the two groups. Conclusions: Ileostomy and the resection of small intestine are related factors for urolithiasis in patients with CD. Gut microbiota may be involved in the occurrence of urolithiasis in patients with IBD.

Evidence for neutrino emission from the nearby active galaxy NGC 1068

A supermassive black hole, obscured by cosmic dust, powers the nearby active galaxy NGC 1068. Neutrinos, which rarely interact with matter, could provide information on the galaxy’s active core. We searched for neutrino emission from astrophysical objects using data recorded with the IceCube neutrino detector between 2011 and 2020. The positions of 110 known gamma-ray sources were individually searched for neutrino detections above atmospheric and cosmic backgrounds. We found that NGC 1068 has an excess of 79 − 20 + 22 neutrinos at tera–electron volt energies, with a global significance of 4.2σ, which we interpret as associated with the active galaxy. The flux of high-energy neutrinos that we measured from NGC 1068 is more than an order of magnitude higher than the upper limit on emissions of tera–electron volt gamma rays from this source.

Investigating the Overall Experience of Wearable Robots during Prototype-Stage Testing

Wearable robots (WRs) might interact with humans in a similar manner to teammates to accomplish specific tasks together. However, the available data on WR user experience (UX) studies are limited, especially during the prototyping phase. Therefore, this study aims to examine the overall experience of WRs during the prototyping phase based on an exploratory research model. This theoretical model considered usability, hedonic quality, and attitude toward using WRs as key factors in explaining and predicting overall experience. To test the hypotheses inherent in the research model, quantitative empirical research was conducted and the data were analyzed by partial least squares structural equation modeling (PLS-SEM). The results from the PLS-SEM analysis revealed the significance level of correlations between the latent variables in the research model. The exploratory research model was able to explain up to 53.2% of the variance in the overall experience of using WRs, indicating medium predictive power. This research develops a new quantitative empirical research model that can be used to explain and predict the overall experience of interactive products such as WRs. Meanwhile, the model is needed during WR testing in the prototype phase.

A Telecommuting Experience Service Design Decision Model Based on BP Neural Network

Introduction

The telecommuting experience and job performance have been significantly impacted by the COVID-19 pandemic, and job performance stability of telecommuting employees has become a critical concern.

Objective

A decision model for telecommuting experience service design was constructed based on a backpropagation (BP) neural network to provide a theoretical basis for enterprises to evaluate telework performance and the psychological health of employees.

Methods

The analytic hierarchy process (AHP) was used to determine the core stakeholders. The grey relational analysis (GRA) method and the NASA Task Load Index (NASA-TLX) scale were used to measure the factors affecting employees’ telecommuting experience and job performance. A BP neural network relationship model of employees’ telecommuting experience was established to predict its impact on employees’ job performance.

Results

Based on the model prediction results, a service system map was created, and the potential to enhance the telework performance of employees was evaluated.

Discussion

It was concluded that the factors affecting the telecommuting experience were diverse, but emotions had the dominant influence. Significant positive correlations were found between emotional impact and temporal perception, execution difficulty, and communication barriers.

Conclusion

The proposed decision model for telecommuting experience service design accurately predicted the impact of telecommuting efficiency, providing an effective approach for innovative remote management.

A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul

 

South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea.

Key messages

• Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed.

• By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.

Search for Unstable Sterile Neutrinos with the IceCube Neutrino Observatory

We present a search for an unstable sterile neutrino by looking for a resonant signal in eight years of atmospheric ν_{μ} data collected from 2011 to 2019 at the IceCube Neutrino Observatory. Both the (stable) three-neutrino and the 3+1 sterile neutrino models are disfavored relative to the unstable sterile neutrino model, though with p values of 2.8% and 0.81%, respectively, we do not observe evidence for 3+1 neutrinos with neutrino decay. The best-fit parameters for the sterile neutrino with decay model from this study are Δm_{41}^{2}=6.7_{-2.5}^{+3.9}  eV^{2}, sin^{2}2θ_{24}=0.33_{-0.17}^{+0.20}, and g^{2}=2.5π±1.5π, where g is the decay-mediating coupling. The preferred regions of the 3+1+decay model from short-baseline oscillation searches are excluded at 90% C.L.

Comparative analysis of R2R3-MYB transcription factors in the flower of Iris laevigata identifies a novel gene regulating tobacco cold tolerance

Breeding for flower cold resistance is a priority for flower breeding research in northern China. The identification of cold resistance genes will not only provide genetic resources for cold resistance breeding, but also form a basis for the study of plant cold resistance mechanisms. Based on the flower transcriptome of Iris laevigata, 20 R2R3-MYBs were identified and comprehensive analysis, including conservative domain, phylogenetic analyses and functional distribution, were performed for R2R3-MYBs. Expression patterns of the abiotic stress genes under cold stress were detected, the upregulated gene was genetically transformed into tobacco, and the related physiological indicators of the transgenic tobacco were measured. A novel cold resistance gene, IlMYB306, was obtained. qRT-PCR indicated that IlMYB306 was dramatically induced by cold stress and was significantly upregulated in roots. The free proline content, MDA, SOD and POD activity of the transgenic tobacco improved after cold stress, and the chlorophyll content decreased slowly. In addition, overexpression of IlMYB306 improved cold resistance of the seeds. SEM results showed leaves of transgenic tobacco had obvious folds, more grooves and bulges on the lower leaf surface. Overall, we report a novel cold resistance R2R3-MYB gene, IlMYB306, in the flower of I. laevigata, which could improve tobacco cold stress tolerance by thickening the waxy layer, increasing antioxidant activity and the content of proline.

Effects of variations in the tragus expansion angle on physical comfort for in-ear wearables

Tragus expansion angle (TEA) is an angular variable that quantifies the outward degree of expansion of the tragus cartilage induced by in-ear wearables (designed with hard materials) fitted into the external ear. It is a physical factor that directly influence user's comfort experience during interaction with in-ear wearables. This study was aimed at quantifying the effects of variations in TEA on physical comfort. TEA was measured and normalised employing a measuring device and Tragus Expansion Index (TEI) proposed in this study. Physical (dis)comfort was assessed using a rating scale designed based on the 5-point Likert and Borg-CR10 scales. Comparatively, the comfort range of variations in TEA was similar for both genders. Males could endure a higher level of variations in TEA compared to females. A quantitative relationship between variations in TEA and (dis)comfort ratings was established using TEI values and GaussAmp function, which can be employed for ergonomic design purposes. Practitioner summary: This study provides an empirical and available source for quantifying the effects of variations in the tragus expansion angle on physical comfort, including quantitative tools and (dis)comfort rating models, which could be used as a reference for improving the fit, comfort and functional capacity of in-ear wearable devices.

Analysis of the auricles and auricular shape types for ear-related wearables: A study of mainland Chinese sample aged 15–79

BACKGROUND: Comprehension of the complex shape of the auricle and how it differs in terms of factors such as sex, age, and side have become an imperative aspect of the fabrication and service delivery of products that are natural, functional, and healthy for users. OBJECTIVE: This study was aimed at providing a clear understanding of the anthropometric characteristics based on age, sex, size, and side and shape type of the auricles of mainland Chinese samples. METHODS: Casting and 3D scanning were employed to obtain eighteen auricular measurement variables from 1120 subjects (aged 15–79). Examination of sex-related and bilateral differences were conducted. Furthermore, factor analysis was employed to establish the factors associated with the variations in auricular shape. Also, hierarchical cluster analysis was performed to classify the auricular shapes of individuals. RESULTS: The auricular inclination angle, conchal depth and tragal height did not exhibit any specific trend across the age groups. No significant bilateral difference was observed in both genders. The auricular shapes were classified into five types according to six major factors. CONCLUSIONS: It was observed that measurement variables of the Chinese auricles changed continuously with age, with most of the linear variables exhibiting a steady increase. The apparent strong association between the auricular types and age groups indicate that a person’s auricular shape may change with age.

P12.04.A Exosomes from glioma associated sphere forming cells induce a transition of invasive phenotype via transfer of EMP2 and CA9

Background

Glioblastoma multiforme (GBM) mostly occurs local recurrence at normal parenchyme adjacent tumor despite of conventional treatment. Glioma stem like cells (GSC) forming intratumoral heterogeneity within the GBM acquired the microenvironmental adaptation by inter-exosomal contents exchange between heterogenic cells. In addition, GSC has an invasive potential as like human GBM. Therefore, we investigate whether exosomal proteins of GSC affect the normal tissue invasion in GBM.

Material and Methods

Exosomes were isolated by Size-Exclusion method from conditioned media and validated by Electron microscope and Immunoblot assay. Exosomal proteomics were examined with Liquid Chromatography-Mass Spectrometry (LC/MS). To produce the fluorescent exosome, bi-cistron vectors were cloned with shRNA and CD63-GFP. To identify the effect of tranfected exosome, the isolated exosomes were treated to recipient cells and examined the invasion by 3D invasion assay and mouse intracranial model.

Results

Firstly, we dichotomized two groups following tumor invasion at matrigel assay and GSC derived orthotopic mouse model. CSC2 and X01 GSCs revealed highly invasive phenotype whereas 83NS and 528NS GSCs did not. Exosome was isolated in each group and identified by CD63 expression or electron microscopy. In proteomics analysis, hypoxia, extracellular matrix organization, GTPase cycle related proteins were enriched in highly invasive cell’s exosome. Among them, we focused the carbonic anhydrase IX (CA9) and the epithelial membrane protein 2 (EMP2) on its permissive role to glioblastoma invasion respectively. CA9 and EMP2 mRNA and protein levels were verified in GSCs and their exosomes and the high expression levels were detected in CSC2 and X01 compared to the low one in 83NS and 528NS GSCs. To evaluate the effects of CA9 and EMP2 on exosome mediated invasion potential, viral bi-cistron vectors was composed with the target gene knockdown and the CD63 fluorescence was used to detect intracellular exosome transfer. Interestingly, the decreased expression of phosphorylated FAK, a key invasive marker, was observed after Lentiviral mediated CA9- and EMP2-knockdown in highly invasive CSC2. To identify whether CA9 and EMP2 proteins are the intracellular effector protein responsible for exosome mediated glioma invasion, the donor exosomes (Exo-CSC2-sh-CA9 and Exo-CSC2-EMP2, after Lentiviral transfection to CSC2s) were isolated and treated to the non invasive 528NS cells as recipient cells. In 3D invasion assay, Exo-CSC2-shCA9 or Exo-CSC2-shEMP2 mediated tumor invasion was significantly decreased at 528NS GSCs compared to Exo-CSC2-shEV. These features were found at mouse intracranial model as well.

Conclusion

Together with these, we conclude that exosome derived from GSCs induces a transition of invasive phenotype via transfer of EMP2 and CA9 proteins.

Color Design Decisions for Ceramic Products Based on Quantification of Perceptual Characteristics

The appearance characteristics of ceramic color are an important factor in determining the user's aesthetic perception of the product. Given the problem that ceramic color varies and the user's visual sensory evaluation of color is highly subjective and uncertain, a method of quantifying ceramic color characteristics based on the Back Propagation (BP) neural network algorithm is proposed. The semantic difference method and statistical method were used to obtain quantified data from ceramic color perceptual semantic features and were combined with a neural network to study the association between ceramic color features and user perceptual-cognitive evaluation. A BP neural network was used to build a ceramic color perceptual semantic mapping model, using color semantic quantified values as the input layer, color L, A, and B component values as the output layer, and model training to predict the sample. The output color L, A, and B components are used as the input layer and the color scheme was designed. The above method can effectively solve the mapping problem between the appearance characteristics of ceramic color and perceptual semantics and provide a decision basis for ceramic product color design. The case application of color design of daily-use ceramic products was conducted to verify the effectiveness and feasibility of the quantitative research method of ceramic color imagery.

Strong Constraints on Neutrino Nonstandard Interactions from TeV-Scale ν_{μ} Disappearance at IceCube

We report a search for nonstandard neutrino interactions (NSI) using eight years of TeV-scale atmospheric muon neutrino data from the IceCube Neutrino Observatory. By reconstructing incident energies and zenith angles for atmospheric neutrino events, this analysis presents unified confidence intervals for the NSI parameter ε_{μτ}. The best-fit value is consistent with no NSI at a p value of 25.2%. With a 90% confidence interval of -0.0041≤ε_{μτ}≤0.0031 along the real axis and similar strength in the complex plane, this result is the strongest constraint on any NSI parameter from any oscillation channel to date.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Assessing the Influencing Factors of Electronic Word-of-Mouth on CSR Issues. A Case of Hospotality Service Industry of China

Corporate social responsibility (CSR) information can be effectively disseminated via social media in a variety of industries, including the hospitality sector. In the same way, the media has a significant impact on CSR because the news media helps companies achieve their CSR goals. Prior research has not examined the main factors that influence electronic word of mouth (eWOM) on media coverage of CSR issues via social networking websites. For the purpose of examining the most significant predictors of intention to share or comment on negative CSR news reported by one media outlet on a specific social networking site (SNS). 677 Wechat users in China were surveyed in order to test the proposed model empirically. According to the findings of the study, eWOM intentions are positively influenced by environmental CSR content, and advertisement related CSR content. It also confirmed that the value of information is positively influenced by the credibility of the source. The variables interpersonal influencer impact and privacy concerns had no significant relationship, nor did they have any significant relationship with the intentions to share and comment on Wechat. Further the study findings suggest the theoretical and managerial policy recommendation for decision makers.

[Multimodal Magnetic Resonance and Fluorescence Imaging of the Induced Pluripotent Stem Cell Transplantation in the Brain]

The understanding of the engrafted cell behaviors such as the survival, growth and distribution is the prerequisite to optimize cell therapy, and a multimodal imaging at both anatomical and molecular levels is designed to achieve this goal. We constructed a lentiviral vector carrying genes of ferritin heavy chain 1 (FTH1), near-infrared fluorescent protein (iRFP) and enhanced green fluorescent protein (egfp), and established the induced pluripotent stem cells (iPSCs) culture stably expressing these three reporter genes. These iPSCs showed green and near-infrared fluorescence as well as the iron uptake capacity in vitro. After transplanted the labeled iPSCs into the rat brain, the engrafted cells could be in vivo imaged using magnetic resonance imaging (MRI) and near-infrared fluorescent imaging (NIF) up to 60 days at the anatomical level. Moreover, these cells could be detected using EGFP immunostaining and Prussian blue stain at the cellular level. The developed approach provides a novel tool to study behaviors of the transplanted cells in a multi-modal way, which will be valuable for the effectiveness and safety evaluation of cell therapy.

[Methylation of p16 gene and reduced expression of p16 protein in insulinoma associated with clinicopathological features]

Objective: To study the alterations of p16 gene and its expression in insulinoma and to correlate the findings with clinicopathological characteristics. Methods: Expression of p16 protein was detected in 72 insulinomas and 49 para-tumoral or normal pancreatic tissues by immunohistochemical staining. Genomic DNA was isolated from 32 tumor tissue and 17 paired pancreatic tissues and bisulfite-modified. Promoter methylation status of p16 gene was detected in 32 tumor tissue and 17 paired pancreatic tissues by methylation specific PCR. The findings were correlated with the clinicopathological features. Results: There were 30 males and 42 females in all 72 patients, aged (46.5±14.0) years. Loss or reduced expression of p16 protein was found in 42 of 72 insulinomas (58.3%) while loss or reduced expression of p16 was seen in only 34.7% (17/49) of para-tumoral or normal pancreatic tissues (χ²=6.52, P=0.011). Promoter methylation of p16 gene was found in 13 of 32 insulinomas (40.6%) and only 2 of 17 (11.8%) para-tumoral tissues (χ²=4.35, P=0.037). The expression of p16 protein in insulinoma was not associated with clinicopathological features such as gender, age, tumor size and tumor grade. Conclusions: Loss or reduced expression of p16 protein was found in insulinomas, and associated with p16 gene promoter methylation.