Co-foliar application of zinc and nano-silicon to rice helps in reducing cadmium exposure risk: Investigations through in-vitro digestion with human cell line bioavailability assay

Foliar application of zinc (Zn) or silicon nanoparticles (Si-NPs) may exert regulatory effects on cadmium (Cd) accumulation in rice grains, however, their impact on Cd bioavailability during human rice consumption remains elusive. This study comprehensively investigated the application of Zn with or without Si-NPs in reducing Cd accumulation in rice grains as well to exactly evaluate the potential risk of Cd exposure resulting from the rice consumption by employing field experiment as well laboratory bioaccessibility and bioavailability assay. Sole Zn (ZnSO4) or in combination with Si (ZnSO4 +Si and ZnO+Si) efficiently lowered the Cd concentration in rice grains. However, the impact of bioaccessible (0.1215-0.1623 mg kg-1) and bioavailable Cd (0.0245-0.0393 mg kg-1) during simulated human rice consumption depicted inconsistent trend. The straw HCl-extractable fraction of Cd (FHCl-Cd) exhibited a significant correlation with total, bioaccessible, and bioavailable Cd in grains, indicating the critical role of FHCl-Cd in Cd accumulation and translocation from grains to human. Additionally, foliar spraying of Zn+Si raised the nutritional value of rice grains, leading to increased protein content and reduced phytic acid concentration. Overall, this study demonstrates the potential of foliar application of ZnSO4 +Si in mitigating the Cd levels in rice grains and associated health risks upon consumption.

Association Between Cancer and Cardiovascular Toxicity: A Nationwide Cross-Sectional Study on NHANES 1999-2018

There is a dearth of evidence pertaining to the relationship of cardiovascular disease (CVD) and its subtype with adjudicated cancer, thereby limiting our understanding of the heightened risk of CVD resulting from long-term complications of cancer and its therapies. The aim of this study was to quantify the risks of CVD and its subtypes in adult cancer survivors compared with cancer-free controls in a nationwide cross-sectional study on Continuous National Health and Nutrition Examination Survey (NHANES). We included 44,442 participants ranging in age from 20 to 85 years. Cancer and CVD diagnoses were ascertained via the household questionnaires. The association of cancer status with the risk of CVD and CVD subtype was examined using weighted logistic regression. Stratification analyses were also performed by age, sex, race, marital status, income status, educational level, and hyperlipidemia. The Wald test was used to calculate P-value for interaction. A total of 4178 participants have cancer, while 4829 participants had CVD, respectively. In the multivariable-adjusted model, the cancer was consistently linked to an elevated risk of CVD. Stratification analyses showed that stronger association between cancer status and CVD risk was found in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. Our study confirmed that cancer participants were strongly linked to living with CVD, independent of traditional cardiovascular risk factors, especially in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. There exists a pressing requirement to establish effective strategies for the prevention of CVD within this population characterized by a heightened risk.

Vaginal delivery of triplets after emergency transvaginal cerclage: A case report and literature review

RATIONALE

To report a peculiar case of vaginal delivery of a triplet after emergency transvaginal cerclage and to find a way to optimize some extreme situations encountered in clinical practice after evaluating feasibility.

PATIENT CONCERNS

A 33-year-old gravida 6, para 0050 woman at 21 + 6 weeks of gestation was referred to the obstetric department for opening of the cervical canal. An emergency McDonald cerclage was performed at 22 weeks of gestation after a comprehensive assessment, and the pregnancy ended with vaginal delivery at 24 + 6 weeks of gestation. The postpartum period was normal, and the newborns were discharged to home care after treatment in the neonatal intensive care unit.

INTERVENTIONS

After discussing the risks, the patient requested emergency transvaginal McDonald cerclage at 22 weeks of gestation.

OUTCOMES

Emergency McDonald cerclage was performed at 22 weeks of gestation, and the pregnancy ended with vaginal delivery at 24 + 6/25 weeks of gestation, successfully prolonging gestation by 20/21 days. The postpartum period had no exceptional circumstances, and newborns were discharged to home care after treatment in the neonatal intensive care unit for 104/98/104 days.

LESSONS

Emergency cerclage seems to be impossible in multiple pregnancies. However, in this case, after a comprehensive assessment, it was feasible to extend the gestational age by emergency cerclage, and prompt and accurate evaluation is important to avoid complications and individualize the following management. In this case, we may find a way to optimize some extreme situations encountered in clinical practice and offer a glimmer of hope for families challenged with multiple pregnancies at risk of preterm delivery. However, more high-quality studies are needed to prove the effectiveness and safety of emergency cerclages in triplets.

Foliar application of plant growth regulators for enhancing heavy metal phytoextraction efficiency by Sedum alfredii Hance in contaminated soils: Lab to field experiments

The phytoremediation efficiency of plants in removing the heavy metals (HMs) might be influenced by their growth status and accumulation capacity of plants. Herein, we conducted a lab-scale experiment and a field try out to assess the optimal plant growth regulators (PGRs) including indole-3-acetic acid (IAA)/brassinolide (BR)/abscisic acid (ABA) in improving the phytoextraction potential of Sedum alfredii Hance (S. alfredii). The results of pot experiment revealed that application of IAA at 0.2 mg/L, BR at 0.4 mg/L, and ABA at 0.2 mg/L demonstrated notable potential as optimal dosage for Cd/Pb/Zn phytoextraction in S. alfredii. The findings of subcellular level of Cd/Pb/Zn in leaves showed that IAA (0.2 mg/L), BR (0.4 mg/L) or ABA (0.2 mg/L) promoted the HMs storage in the soluble and cell wall fraction, therefore contributing HMs subcellular compartmentation. In addition, application of PGRs notably enhanced the antioxidant system (SOD, CAT, POD, APX activities) while reducing lipid peroxidation (MDA content) in S. alfredii, consequently improving HMs tolerance and growth of S. alfredii. Moreover, the results of field trial showed that application of BR, IAA, or ABA+BR substantially improved the growth of S. alfredii by inducing plants biomass and augmenting the levels of photosynthetic pigment contents. Notably, ABA+BR noticed the highest theoretical biomass by 42.9 %, followed by IAA (41.6 %), and BR (36.4 %), as compared with CK. Additionally, ABA+BR treatment showed effectiveness in removing the Cd by 103.4 %, while BR and IAA led to a significant increase of Pb and Zn removal by 239 % and 116 %, respectively, when compared with CK. Overall, the results of this study highlights that the foliar application of IAA, BR, or ABA+BR can serve as viable strategy to boosting phytoremediation efficiency of S. alfredii in contaminated soil by improving the biomass and metal accumulation in harvestable parts.

Auxin synthesis promotes N metabolism and optimizes root structure enhancing N acquirement in maize (Zea mays L.)

MAIN CONCLUSION

Foliar NAA increases photosynthate supplied by enhancing photosynthesis, to strengthen root activity and provide a large sink for root carbohydrate accumulation, which is beneficial to acquire more nitrogen. The improvement of grain yield is an effective component in the food security. Auxin acts as a well-known plant hormone, plays an important role in maize growth and nutrient uptake. In this study, with maize variety Zhengdan 958 (ZD958) as material, the effects of auxin on nitrogen (N) uptake and assimilation of seedling maize were studied by hydroponic experiments. With water as the control, naphthalene acetic acid (NAA, 0.1 mmol/L) and aminoethoxyvinylglycine (AVG, 0.1 mmol/L, an auxin synthesis inhibitor) were used for foliar spraying. The results showed that NAA significantly improved photosynthetic rate and plant biomass by 58.6% and 91.7%, respectively, while the effect of AVG was opposite to that of NAA. At the same time, key enzymes activities related N assimilation in NAA leaves were significantly increased, and the activities of nitrate reductase (NR), glutamine synthetase (GS) and glutamate synthase (GOGAT) were increased by 32.3%, 22.9%, and 16.2% in new leaves. Furthermore, NAA treatment promoted underground growth. When compared with control, total root length, root surface area, root tip number, branch number and root activity were significantly increased by 37.8%, 22.2%, 35.1%, 28.8% and 21.2%. Root growth is beneficial to N capture in maize. Ultimately, the total N accumulation of NAA treatment was significantly increased by 74.5%, as compared to the control. In conclusion, NAA foliar spraying increased endogenous IAA content, and enhanced the activity of N assimilation-related enzymes and photosynthesis rate, in order to build a large sink for carbohydrate accumulation. In addition, NAA strengthened root activity and regulated root morphology and architecture, which facilitated further N uptake and plant growth.

Sodium, potassium intake, and all-cause mortality: confusion and new findings

BACKGROUND

The World Health Organization (WHO) has established recommended daily intakes for sodium and potassium. However, there is currently some controversy regarding the association between sodium intake, potassium intake, the sodium-to-potassium ratio, and overall mortality. To assess the correlations between sodium intake, potassium intake, the sodium-to-potassium ratio, and overall mortality, as well as the potential differences in sodium and potassium intake thresholds among different population groups, we analyzed data from NHANES 2003-2018.

METHODS

NHANES is an observational cohort study that estimates sodium and potassium intake through one or two 24-h dietary recalls. Hazard ratios (HR) for overall mortality were calculated using multivariable adjusted Cox models accounting for sampling design. A total of 13855 out of 26288 participants were included in the final analysis. Restricted cubic spline analyses were used to examine the relationship between sodium intake, potassium intake, and overall mortality. If non-linearity was detected, we employed a recursive algorithm to calculate inflection points.

RESULTS

Based on one or two 24-h dietary recalls, the sample consisted of 13,855 participants, representing a non-institutionalized population aged 40-80 years, totaling 11,348,771 person-months of mean follow-up 99.395 months. Daily sodium intake and daily potassium intake were inversely associated with all-cause mortality. Restrictive cubic spline analysis showed non-linear relationships between daily sodium intake, potassium intake, sodium-potassium ratio, and total mortality. The inflection point for daily sodium intake was 3133 mg/d, and the inflection point for daily potassium intake was 3501 mg/d, and the inflection point for daily sodium-potassium ratio intake was 1.203 mg/mg/d. In subgroup analyses, a significant interaction was found between age and high sodium intake, which was further confirmed by the smooth curves that showed a U-shaped relationship between sodium intake and all-cause mortality in the elderly population, with a inflection point of 3634 mg/d.

CONCLUSION

Nonlinear associations of daily sodium intake, daily potassium intake and daily sodium-potassium ratio intake with all-cause mortality were observed in American individuals. The inflection point for daily sodium intake was 3133 mg/d. And the inflection point for daily sodium intake was 3634 mg/d in elderly population. The inflection point for daily potassium intake was 3501 mg/d. The inflection point for daily sodium-potassium ratio intake was 1.203 mg/mg/d, respectively, A healthy diet should be based on reasonable sodium intake and include an appropriate sodium-to-potassium ratio.

The association between cardiovascular health and depression: Results from the 2007-2020 NHANES

BACKGROUND

Limited research has been conducted on the correlation between Life's Essential 8 (LE8), the recently updated algorithm for evaluating cardiovascular health (CVH), and depression.

METHODS

A total of 21,942 individuals were chosen from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2020. The depression was determined using the Patient Health Questionnaire (PHQ-9), with a score of 10 or higher indicating diagnosis. The LE8 score consists of 8 metrics: sleep health, diet, physical activity, nicotine exposure, body mass index, blood lipids, blood glucose, and blood pressure. Each LE8 metric was scored from 0 to 100 points. The summation of all metrics divided by 8 generated the total LE8 score and was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Weighted logistic regression and restricted cubic splines (RCS) were used to assess the association between LE8 score and depression.

RESULTS

A significant inversely nonlinear relationship was observed between LE8 score and depression. When compared to participants with high CVH, those with moderate CVH had multivariable adjusted odds ratios (ORs) for depression of 2.36 (95 % CI, 1.79-3.10), while those with low CVH had ORs of 4.71 (95 % CI, 3.44-6.47). Moreover, the effect size of the LE8 score on depression remained stable in all pre-specified subgroups, with all P-values for interaction being more than 0.05.

CONCLUSIONS

The results indicate a significant inversely nonlinear relationship between LE8 score and depression, particularly among males. These findings emphasize the importance of maintaining higher CVH as a preventive measure against depression.

Reply to Siyu Tan: Associations of cardiovascular health assessed by life's essential 8 with diabetic retinopathy and mortality in type 2 diabetes. The author's reply

The present study is a reply of authors regarding the commentary from Siyu Tan. In this study, we paid specific attention to (1) highlight the inclusion criterion and diagnosis of Type 2 diabetes mellitus; (2) explain the assessments of cardiovascular health and diabetic retinopathy.

Association of Cardiovascular Health with Cognitive Function in US Older Adults: A Population-Based Cross-Sectional Study

INTRODUCTION

Promoting cardiovascular health (CVH) by Life's Simple 7 is associated with better cognitive function. In 2022, the American Heart Association (AHA) prompted Life's Essential 8 (LE8) to strengthen CVH assessment. This study investigated the association between the new CVH metrics assessed by LE8 and cognitive function, thus providing evidence for implementing LE8 in the primordial prevention of cognitive impairment.

METHODS

2,050 participants aged 60 and older from National Health and Nutrition Examination Survey 2011-2014 were included. Cognitive function was measured by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). The overall and domain-specific cognitive function z-score was created. CVH score was calculated following AHA's advisory. The multivariable linear regression model estimated the associations.

RESULTS

The CVH score assessed by LE8 was independently, positively, and linearly associated with the overall cognitive function. A per-10 point increase in CVH was associated with higher overall cognitive z-scores (β, 0.06; 95% confidence interval [CI], 0.03, 0.09), and participants with moderate (β, -0.14; 95% CI, -0.22, -0.05) and low CVH (β, -0.27; 95% CI, -0.37, -0.16) had lower overall cognitive z-scores compared to participants with high CVH. Similar patterns of associations were observed between CVH of AFT and DSST. Components of CVH were further associated with different domain-specific cognitive functions.

CONCLUSION

Maintaining an ideal CVH improves cognitive function in older adults. Ideal adherence to individual components of LE8 was associated with improved overall and domain-specific cognitive functions. Therefore, promoting CVH according to LE8 might benefit cognitive function in the elderly.

Short-term transplantation effect of a tissue-engineered meniscus constructed using drilled allogeneic acellular meniscus and BMSCs

During the construction of tissue-engineered meniscus, the low porosity of extracellular matrix restricts the flow of nutrient solution and the migration and proliferation of cells, thus affecting the tissue remodeling after transplantation. In this study, the canine allogeneic meniscus was drilled first and then decellularized. The drilled tissue-engineered menisci (Drilled Allogeneic Acellular Meniscus + Bone Marrow Mesenchymal Stem Cells, BMSCs) were transplanted into the knee joints of model dogs. On the basis of ensuring the mechanical properties, the number of the porosity and the cells implanted in allogeneic acellular meniscus was significantly increased. The expression levels of glycosaminoglycans and type II collagen in the drilled tissue-engineered meniscus were also improved. It was determined that the animals in the experimental group recovered well-compared with those in the control group. The graft surface was covered with new cartilage, the retraction degree was small, and the tissue remodeling was good. The surface wear of the femoral condyle and tibial plateau cartilage was light. The results of this study showed that increasing the porosity of allogeneic meniscus by drilling could not only maintain the mechanical properties of the meniscus and increase the number of implanted cells but also promote cell proliferation and differentiation. After transplantation, the drilled tissue-engineered meniscus provided a good remodeling effect in vivo and played a positive role in repairing meniscal injury, protecting articular cartilage and restoring knee joint function.

The Role of Cancer in the Risk of Cardiovascular and All-Cause Mortality: A Nationwide Prospective Cohort Study

Objectives: Evidence on cardiovascular-related and all-cause mortality risks in a wide range of cancer survivors is scarce but needed to inform prevention and management. Methods: We performed a nationwide prospective cohort study using information from the Continuous National Health and Nutrition Examination Survey (NHANES) in the United States and the linked mortality follow-up files, available for public access. A propensity score-matched analysis with a 1:1 ratio was conducted to reduce the baseline differences between participants with and without cancer. The relationship between cancer status and the cardiovascular-related and all-cause mortality risk was examined using weighted Cox proportional hazards regression. Independent stratification analysis and cancer-specific analyses were also performed. Results: The study sample included 44,342 participants, aged 20-85, interviewed between 1999 and 2018. Of these, 4,149 participants had cancer. All-cause death occurred in 6,655 participants, of whom 2,053 died from cardiovascular causes. Propensity-score matching identified 4,149 matched pairs of patients. A fully adjusted Cox proportional hazards regression showed that cancer was linked to an elevated risk of cardiovascular-related and all-cause mortality both before and after propensity score matching. Stratification analysis and cancer-specific analyses confirmed robustness of results. Conclusion: Our study confirmed that cancer was strongly linked to cardiovascular-related and all-cause mortality, even after adjusting for other factors that could impact a risk, including the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score, age, sex, ethnicity, marital status, income, and education level.

Comparison of Survival Outcomes between Adults and Pediatrics with Non-Metastatic Head and Neck Rhabdomyosarcoma: A SEER Database Analysis of 550 Patients

PURPOSE/OBJECTIVE(S)

Despite the long-term survival rate for children with head and neck rhabdomyosarcoma (HNRMS) has improved to over 70-80% due to advancements in therapeutic approaches, the survival outcomes for adult HNRMS have not been thoroughly investigated. Our study aims to compare and analyze the survival outcomes of adult and pediatric patients with non-metastatic HNRMS, with a focus on the effect of different local treatment methods on disease outcomes.

MATERIALS/METHODS

We conducted a retrospective analysis of data from the Surveillance, Epidemiology, and End Results (SEER) database covering the period from 2004 to 2018. Our study population consisted of patients with Head and Neck Rhabdomyosarcoma (HNRMS) who had not developed distant metastases and received at least one local treatment, either radiotherapy or surgery. The comparison of overall survival (OS) and cancer-specific survival (CSS) was performed between the adult and pediatric patient groups, and between patients who received surgery (with or without radiotherapy) and those who received radiotherapy only (non-surgery).

RESULTS

In the study of 550 patients diagnosed with Head and Neck Rhabdomyosarcoma (HNRMS), data was collected from 181 (32.9%) adult and 369 (67.1%) pediatric patients. The results showed that the adult patient group had a significantly worse outcome compared to the pediatric group in terms of 5-year overall survival (OS) rate (34.9% vs 81.6%, P<0.001) and 5-year cancer specific survival (CSS) rate (59.96% vs 87.48%, P<0.001). Of these patients, 308(56%) underwent radical surgery, with 228 (41.5%) receiving a combination of radiation and surgery and the remaining 242 (44%) receiving radiation therapy alone. No significant differences were found in 5-year OS and CSS rates between the surgery and non-surgery (radiation only) groups in adult patients (34.9% vs 35.0%, P = 0.900; 60.2% vs 59.6%, P = 0.988). However, there were slight differences observed in the pediatric patient group, with the 5-year OS and CSS rates being higher for the surgery group compared to the non-surgery group (86.9% vs 75.9%, P = 0.001 and 90.6% vs 84.2%, P = 0.054, respectively).

CONCLUSION

The results of this cohort study indicate that age plays a crucial role in predicting survival outcomes in patients diagnosed with Head and Neck Rhabdomyosarcoma (HNRMS). The findings highlight the need for age-specific treatment strategies for HNRMS patients. While the data suggests that radiotherapy may be a viable first-line option for non-metastatic adult HNRMS patients, additional research is required to validate these trends.

Associations of cardiovascular health assessed by life's essential 8 with diabetic retinopathy and mortality in type 2 diabetes

BACKGROUND

Vascular complications are the leading causes of reduced life quality and mortality in type 2 diabetes mellitus (T2DM). Life's Essential 8 (LE8) is a newly modified measurement of cardiovascular health (CVH) by American Heart Association (AHA). Promoting CVH has been previously shown to improve the prognosis of T2DM. However, studies regarding the effects of CVH by LE8 on diabetic retinopathy (DR), a major microvascular complication, and death from the cardiovascular and overall causes in T2DM are currently lacking. This study aimed to investigate these associations thus providing preliminary evidence.

METHODS

A total of 3192 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the final analysis. Records of mortality during follow-up were obtained by linking to the National Death Index. The multivariable logistic regression and Cox proportional hazard regression with restricted cubic splines were used to estimate the associations. Subgroup analyses were performed to examine the effects of gender, age, and duration of T2DM.

RESULTS

648 individuals had DR at baseline. During a median follow-up of 76 months, 645 overall deaths (incidence per 1000 person-years, 26.53%; 95% confidence interval (CI), 26.50-26.56) were ascertained, including 216 from cardiovascular causes (incidence per 1000 person-years, 8.96%; 95% CI, 8.94-8.98). The multivariable-adjusted odds ratio (OR) per 100-point increase of LE8 was 0.80 (95% CI, 0.71-0.90) for DR, and participants with high levels of LE8 were associated with 47% risk reduction (OR, 0.53; 95% CI, 0.40-0.70). The multivariable-adjusted hazard ratio (HR) per 100-point increase of LE8 was 0.71 (95% CI, 0.62-0.81) and 0.68 (95% CI, 0.58-0.85) for all-cause mortality and cardiovascular mortality, respectively. Similar patterns of inverse associations were observed in participants with moderate and high levels of LE8 for all-cause and cardiovascular mortality. Notably, stronger associations between LE8 and mortality were discovered in participants below 60 years (P < 0.05 for interaction). Moreover, LE8 was correlated with all-cause mortality in a linear way (P for nonlinear=0.32).

CONCLUSION

The AHA's newly prompted LE8 was strongly and inversely associated with the risk of DR, all-cause mortality, and cardiovascular-specific mortality in T2DM. LE8 may be a feasible and effective approach in the tertiary prevention of T2DM.

Prospective Efficacy of Two Cycles Toripalimab Plus Induction Chemotherapy in T4 or N3 Locoregionally Advanced Nasopharyngeal Carcinoma: A Retrospective and Mechanistic Study

PURPOSE/OBJECTIVE(S)

Gemcitabine-cisplatin (GP) as the most commonly used induction chemotherapy is the standard first-line systemic treatment for advanced nasopharyngeal carcinoma. However, the toxicity of three cycles induction chemotherapy following on chemoradiotherapy remains a pertinent issue. Additional monoclonal antibody against human programmed death-1 (PD-1) has shown promising efficacy in recurrent or metastatic nasopharyngeal carcinoma.

MATERIALS/METHODS

In this study, we compared three cycles of gemcitabine and cisplatin as classical induction chemotherapy with two cycles of induction chemotherapy plus toripalimab, and then both groups treated with the similar concurrent chemoradiotherapy. Patients with locoregionally advanced nasopharyngeal carcinoma staging T4 or N3 were randomly assigned in a 1:1 ratio to receive gemcitabine (at a dose of 1 g per square meter of body-surface area on days 1 and 8) plus cisplatin (80 mg per square meter on day 1-3), administered every 3 weeks for three cycles, or GP combined with toripalimab (at a dose of 240mg) for two cycles. The primary end point was recurrence-free survival (i.e., freedom from disease recurrence [distant metastasis or locoregional recurrence] or death from any cause) in the intention-to-treat population. Secondary end points included overall survival, treatment adherence, and safety.

RESULTS

A total of 60 patients were included in the trial (30 patients in the toripalimab combined induction chemotherapy group and another 30 in the standard-therapy group). Among 60 patients evaluable for response assessment after induction therapy, all patients had overall response in combined group, including 10 patients (30%) with complete response (CR) in the primary tumor site. 21 patients (70%) were evaluated as partial response (PR) in the standard induction chemotherapy, and another 9 patients were assessed as SDa. At a median follow-up of 27.6 months, the 6-months, 1-, 2-year recurrence-free survival was 100% vs 86.7%, 100% vs 80%, 93% vs 70% in the toripalimab combined induction chemotherapy group and standard-therapy group (stratified hazard ratio for recurrence or death, 0.62; 95% confidence interval [CI], 0.38 to 0.87; P = 0.001). Overall survival at 2 years was 93.3% and 100%, respectively (stratified hazard ratio for death, 0.53; 95% CI, 0.29 to 0.79). The incidence of acute adverse events of grade 3 or 4 was 76.8% in the standard-induction chemotherapy group and 56% in the standard-therapy group, with a higher incidence of neutropenia, thrombocytopenia, anemia, nausea, and vomiting in the induction chemotherapy group. The incidence of grade 3 or 4 late toxic effects was 10.2% in the induction chemotherapy group and 10.4% in the combined-therapy group.

CONCLUSION

Two cycles of toripalimab combined with induction chemotherapy of and CCRT shows excellent distant metastatic control with acceptable safety, which is a new promising and effective systemic therapy regimen for high-risk of metastatic NPC patients.

Combining Radiotherapy with Chemotherapy and Immunotherapy as First-Line Treatment for De Novo Metastatic Nasopharyngeal Carcinoma: A Dual-Center Retrospective Analysis

PURPOSE/OBJECTIVE(S)

Local regional radiotherapy combined with systemic chemotherapy significantly improves the prognosis of patients with metastatic nasopharyngeal carcinoma (NPC). Immunochemotherapy has become the first-line treatment for initial metastatic NPC. This study evaluated the safety and efficacy of local regional radiotherapy combined with immunochemotherapy as the first-line treatment of metastatic NPC.

MATERIALS/METHODS

Patients with histologically proven de novo metastatic NPC who received immunotherapy and chemotherapy followed by local-regional radiotherapy were included from 2 cancer centers. Toxicity and treatment response were assessed using CTCAE 5.0 and RECIST 1.1, respectively. Overall survival (OS) and progression free survival (PFS) were analyzed using the Kaplan-Meier method.

RESULTS

From 2019 to 2021, a total of 16 patients were retrospectively analyzed. The median age was 44.5-year-old (range 16-76). Patients with ≥3 metastatic lesions accounts for 58.8%. Bone metastasis was the most common metastatic site. The chemotherapy regimens were paclitaxel/gemcitabine and cisplatin. Toripalimab, camrelizumab and sintilimab were used for immunotherapy. All patients completed the local regional radiotherapy with 69.96Gy for primary nasopharyngeal tumor and positive lymph nodes, 60.06Gy for high-risk region and 50ཞ54.45Gy for low-risk region. Seven patients underwent radiotherapy for metastatic lesions. The median follow-up was 20.5 months (range 6-38 months). Two-year OS was 100%. Three patients experienced distant progression. One-year and 2-year PFS rate was 93.8% and 76.7%, respectively. After combination of chemotherapy and immunotherapy, the overall response rate (ORR) was 93.7% with a complete response (CR) of 6.3%. At the end of radiotherapy, the ORR was 100%. Nine patients (56.3%) achieved CR. Radiotherapy related acute severe (grade 3 or higher) toxicity was dermatitis (1/16, 6.3%) and mucositis (2/16, 12.5%). Immunotherapy related hypophysitis and capillary hyperplasia was 6.3% and 6.3%, respectively. No long-term toxicity was observed.

CONCLUSION

Loco-regional radiotherapy provided a promising efficacy with modest toxicity for patients with metastatic nasopharyngeal carcinoma who received immunochemotherapy.

Bacterial Community Modifies Host Genetics Effect on Early Childhood Caries

By age 5, approximately one-fifth of children have early childhood caries (ECC). Both the oral microbiome and host genetics are thought to influence susceptibility. Whether the oral microbiome modifies genetic susceptibility to ECC has not been tested. We test whether the salivary bacteriome modifies the association of a polygenic score (PGS, a score derived from genomic data that summarizes genetic susceptibility to disease) for primary tooth decay on ECC in the Center for Oral Health Research in Appalachia 2 longitudinal birth cohort. Children were genotyped using the Illumina Multi-Ethnic Genotyping Array and underwent annual dental examinations. We constructed a PGS for primary tooth decay using weights from an independent, genome-wide association meta-analysis. Using Poisson regression, we tested for associations between the PGS (high versus low) and ECC incidence, adjusting for demographic characteristics (n = 783). An incidence-density sampled subset of the cohort (n = 138) had salivary bacteriome data at 24 mo of age. We tested for effect modification of the PGS on ECC case status by salivary bacterial community state type (CST). By 60 mo, 20.69% of children had ECC. High PGS was not associated with an increased rate of ECC (incidence rate ratio, 1.09; 95% confidence interval [CI], 0.83-1.42). However, having a cariogenic salivary bacterial CST at 24 mo was associated with ECC (odds ratio [OR], 7.48; 95% CI, 3.06-18.26), which was robust to PGS adjustment. An interaction existed between the salivary bacterial CST and the PGS on the multiplicative scale (P = 0.04). The PGS was associated with ECC (OR, 4.83; 95% CI, 1.29-18.17) only among individuals with a noncariogenic salivary bacterial CST (n = 70). Genetic causes of caries may be harder to detect when not accounting for cariogenic oral microbiomes. As certain salivary bacterial CSTs increased ECC risk across genetic risk strata, preventing colonization of cariogenic microbiomes would be universally beneficial.

Spatio-temporal evolution and influencing factors of China's ICT service industry

The ICT service industry has become a burgeoning industry at a high and stable speed. Their equitable distribution can improve national and global positive peace. This paper aimed to verify the characteristics of spatio-temporal evolution and its influencing factors in the ICT service industry. Based on the data from 31 Provinces in China from 2015 to 2019, this paper uses location quotient, spatial autocorrelation methods and spatial econometric analysis to explore the development characteristics, evolution and influencing factors of the ICT service industry, respectively. The main results are shown as follows: (1) China's ICT service industry is mainly concentrated in Beijing, Shanghai, Zhejiang, Tibet, and Guangdong, with a trend of specialisation development. They are not only distributed in cities with relatively superior overall development but also those with superior industrial and development carrier elements. Technological relevance, aggregation, and political difference might have an impact on promoting the emergence and development of these industries. (2) ICT service industry is characterised by stable and highly concentrated development. Numbers between three to five significant provinces and types with high-high (HH) and high-low (HL) clusters of local spatio-temporal association kept stable in the period. The HH was in eastern coastal areas, including Zhejiang, Shanghai, Jiangsu, and Shandong, and the HL was in Guangdong in 2015. There is a definite spatial correlation in spatial distribution with constant strengthening. (3) TUR, NDN, MIAT and the area were shown to have a significant role in promoting the ICT service industry, while NW, GDP and ICT Employment were shown to have a significant negative impact on this industry. Correspondingly, two strategies were put forward here: (1) accelerating the inter-provincial networking development of the ICT service industry, and (2) strengthening government policy guidance for the ICT service industry. These outcomes can not only provide a scientific basis and theoretical support for the distribution of strategies and resources for these industries at the theoretical level but also improve resource integration from the national perspective and the efficiency of resource use at the practical level.

Association between hysterectomy status and stroke risk and cause-specific and all-cause mortality: evidence from the 2005-2018 National Health and Nutrition Examination Survey

Background

Prior research on women who had hysterectomies has shown mixed results on whether or not hysterectomies increased the incidence of stroke and cause-specific or all-cause mortality.

Methods

Using information from the Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including linked mortality follow-up files available for public access, a multicycle cross-sectional design mortality linkage study was performed.

Results

Conducted during the years 2005-2018, the study sample included 14,214 female participants ranging in age from 20 to 85 years. The relationship between the hysterectomy status and the risk of stroke and cause-specific and all-cause mortality was examined using a series of weighted logistic regressions and Cox proportional hazards regressions, respectively. The presence of a hysterectomy was consistently linked to an elevated risk of stroke using weighted logistic regression models. The hysterectomy status, however, consistently showed no effect on survival by adjusted weighted Cox regression analysis.

Conclusion

Our study found a significant association between hysterectomy and stroke, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, ethnicity, marital status, income, education, and depression severity.

Systemic juvenile xanthogranuloma: A systematic review

OBJECTIVE

To perform a systematic review to investigate the available literature regarding systemic juvenile xanthogranuloma (SJXG) and report the population characteristics, clinical manifestation, therapy, and outcome.

REVIEW METHODS

A search of PubMed, Embase, and Cochrane Library for all articles published between 1981 and 2022 was performed with variations and combinations of the following search terms: extracutaneous, visceral, systemic, and juvenile xanthogranuloma (JXG). Data extracted included demographics, organ involvement, treatment, outcome, and permanent sequelae.

RESULTS

A total of 103 articles encompassing 159 patients met the inclusion criteria. The median onset age was 9 months, with a male predominance (61%). The distribution of major involved organs varied by age, and younger onset age was associated with more organ involvement. The most commonly involved site was the central nervous system (CNS) (40.9%), followed by the liver (31.4%), the lung (18.9%), and the eye (18.2%). At the termination of follow-up, 93 patients (58.5%) were alive with no disease, 56 (35.2%) were alive with disease, and 10 (6.3%) were dead of disease. There was a significant difference in outcome between patients with and without spleen involvement (p = .0003), and patients with spleen involvement suffered a higher risk of death. Permanent sequelae mainly comprised CNS symptoms and ocular manifestations.

CONCLUSIONS

SJXG can involve varying numbers and combinations of extracutaneous sites. There is no standard therapy for SJXG and clinicians should choose individualized therapy modalities.

Applying an entropy-weighted TOPSIS method to evaluate energy green consumption revolution progressing of China

The energy green consumption revolution (EGCR) is the highest priority in the Chinese government's energy revolution agenda. The purpose of this study is to provide a comprehensive and objective evaluation of the China's EGCR progressing from 2011 to 2019. In this study, an integrated economic-social-energy-environmental EGCR evaluation framework is built, and the entropy-weighted TOPSIS method with four customized equations is used to calculate and analyze the EGCR index. The study finds that the EGCR index at the national level fluctuates between 0.290 and 0.302, showing a stagnant and regressive trend. At the regional and provincial levels, the EGCR index for eastern China remains at high level, floating above 0.4 and no further growing trend has been indicated. As for the eastern China, Beijing is the only city has high-level EGCR index and is able to maintain positive growth trend. The EGCR index in central, western, and northeastern China is at a low level, fluctuating below 0.4. This result is mainly caused by the fact that the majority of these regions are still constrained by the fossil fuel-dominated social, economy, energy, and environment structures. Therefore, the research findings not only provide supportive evidence for the Chinese government to recognize the progressing of EGCR, but also offer statistical basis over formulating and updating EGCR policies at a timely manner.

Space and social distancing in managing and preventing COVID-19 community spread: An overview

The spread of COVID-19 at a large scale and at a rapid pace indicates the lack of social distancing measures at multiple levels. The individuals are not to be blamed, nor should we assume the early measures were ineffective or not implemented. It is all down to the multiplicity of transmission factors that made the situation more complicated than initially anticipated. Therefore, in facing the COVID-19 pandemic, this overview paper discusses the importance of space in social distancing measures. The methods used to investigate this study are literature review and case study. Many scholarly works have already provided us with evidence-based models that suggest the influential role of social distancing measures in preventing COVID-19 community spread. To further elaborate on this important topic, the aim here is to look at the role of space not only at the individual level but at larger scales of communities, cities, regions, etc. The analysis helps better management of cities during the pandemics such as COVID-19. By reflecting on some of the ongoing research on social distancing, the study concludes with the role of space at multiple scales and how it is central to the practice of social distancing. We need to be more reflective and responsive to achieve earlier control and containment of the disease and the outbreak at the macro level.

ICT applications and the COVID-19 pandemic: Impacts on the individual's digital data, digital privacy, and data protection

A prominent move amid the COVID-19 pandemic is related to the wide use of ICT applications for various reasons. Such services are context-specific and sector-specific, but we see transformative directions leading to digital data collection, monitory, and management platforms. For now, these have been beneficial to evaluate trends and issues related to the pandemic. Some aggregated data could also help decision-making processes, which are helpful to contain such disruptive events. However, the main concern is the use of the individual's data and information, which means we may shift to micro-management and eventual controlling tools that could harm data protection processes. Undoubtedly, the use of ICTs during the COVID-19 pandemic has been primarily positive at multiple scales, but we have to evaluate the pros and cons before accepting all data collection processes. Such ICT-mediated platforms and/or applications must remain beneficial to all and avoid breaching the individual's data protection. This short communication paper first introduces ICT applications during the COVID-19 before providing an overview and further analysis of the situation of the ICT applications. Afterward, it discusses issues of data privacy, data collection, and data use, which are the backbone of ICT applications. The discussions highlight that future research in this area could look into associated issues related to digital privacy, data-driven approaches, and data protection regulations.

Is a classical incision the only way to perform a near-term conjoined twins' cesarean section? Thoracopagus conjoined twin delivery by a low-segment transverse incision

Conjoined twin pregnancies are rare, usually occurring in cases of monochorionic monoamniotic twin pregnancies. The most common type of conjoined twins, thoracopagus (42%), is difficult to deliver via a low-segment transverse incision hysterotomy after 35 weeks of gestation. Therefore, conjoined twin cesarean deliveries are typically performed using the classical incision method. However, this often leads to an increased risk of postoperative maternal morbidity and uterine rupture during a subsequent pregnancy. Because of the low survival rate of conjoined twins, subsequent pregnancies are often desired. Hence, minimizing trauma to the uterus is a primary concern. A technique for delivering conjoined twins at 35 weeks of gestation by cesarean delivery with a low-segment transverse incision hysterotomy is proposed here. A video is included to explain and demonstrate these procedures. This method can minimize uterine trauma and maximize the chances of a successful subsequent pregnancy.

Immune infiltration and immunophenotyping in atrial fibrillation

Atrial fibrillation (AF) is a relatively common arrhythmia in clinical practice. Although significant progress has been achieved in the treatment of AF and its associated complications, research on AF prevention lags behind, mainly due to the lack of a deep understanding of AF pathogenesis. In recent years, as our knowledge has grown, the role of the inflammatory/immune response in the occurrence and progression of AF has gradually gained attention. In this paper, based on existing gene expression data in the Gene Expression Omnibus database, a detailed description of immune infiltration status in AF is presented using a series of analytical methods, including differential analysis, Gene Ontology categorization, Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and weighted gene coexpression network analysis, and analysis tools such as CIBERSORTx and Cytoscape. Several new AF/immune infiltrations-related signature genes were identified, and the AF/immune infiltration pathology was classified based on these immune signature genes, thus providing novel insights into the pathogenesis of AF based on the inflammatory response.

Diversified Shifts in the Cross Talk between Members of the Gut Microbiota and Development of Coronary Artery Diseases

Coronary artery disease (CAD) is one of leading causes of mortality worldwide. Studies on roles that the gut microbiota plays in development of atherosclerosis or acute myocardial infarction (AMI) have been widely reported. However, the gut microbiota is affected by many factors, including age, body mass index (BMI), and hypertension, that lead to high CAD risk. However, the associations between gut microbiota and CAD development or other CAD risk factors remain unexplored. Here, we performed a 16S RNA gene sequencing analysis of 306 fecal samples collected from patients with mild coronary stenosis (MCS; n = 36), stable angina (SA; n = 91), unstable angina (UA; n = 48), and acute myocardial infarction (AMI; n = 66) and 65 non-CAD controls. Using a noise-corrected method based on principal-component analysis (PCA) and the random forest algorithm, we identified the interference with gut microbial profiling of multiple factors (including age, gender, BMI, and hypertension) that potentially contributed significantly to the development of CAD. After correction of noise interference from certain interfering factors, we found consistent indicator microbiota organisms (such as Vampirovibrio, Ruminococcus, and Eisenbergiella) associated with the presence of MCS, SA, and AMI. Establishment of a diagnostic model revealed better performance in early CAD than clinical indexes with indicator microbes. Furthermore, indicator microbes can improve the accuracy of clinical indexes for the diagnosis of AMI. Additionally, we found that the microbial indicators of AMI Sporobacter and Eisenbergiella showed consistent positive and negative correlations to the clinical indexes creatine kinase (CK) and hemoglobin (Hb), respectively. As a control indicator of AMI, Dorea was negatively correlated with CK but positively correlated with Hb. IMPORTANCE Our study discovered the effect of confounding factors on gut microbial variations and identified gut microbial indicators possibly associated with the CAD development after noise correction. Our discovered indicator microbes may have potential for diagnosis or therapy of cardiovascular disorders.

Zirconium-modified attapulgite was used for removing of Cr(vi) in aqueous solution

This work fabricated the zirconium-modified attapulgite (Zr@ATP) for removing Cr(vi) ions in aqueous solutions. According to X-ray diffraction, scanning electron microscopy, TEM, Fourier transform infrared, and X-ray photoelectron spectroscopy analyses, Zr was successfully grafted onto the attapulgite rod surface. Cr(vi) adsorption onto Zr@ATP surface fitted well with the Langmuir isotherm and pseudo-second-order kinetic models, which suggested that the adsorption is primarily chemisorption. When the pH of the aqueous solution is 3, Zr@ATP achieved the highest Cr(vi) absorption, of about 32.84 mg/g. Density functional theory studies revealed that the hydroxyl functional group introduced through the modification process supplies more active sites to form the hydrogen bond with CrO 4 2 − {\text{CrO}}_{4}^{2-} and HCrO 4 − {\text{HCrO}}_{4}^{-} .

Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey

Background

Morbidity and mortality of arteriosclerotic cardiovascular disease (ASCVD) varied according to socioeconomic status (SES), and evidence on the association between SES and ASCVD risk, and cause-specific and all-cause mortality was nevertheless lacking in large-scale or population-based studies.

Methods

A multicycle cross-sectional design and mortality linkage study was conducted using data from Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including public use linked mortality follow-up files through December 31, 2019. Poverty income ratio (PIR) served as a SES index. A series of weighted Logistic regressions and Cox proportional hazards regressions were used to investigate the association between the SES and the risk of ASCVD and mortality, respectively.

Results

The study sample was comprised of 30,040 participants aged 20-85 years old during the 2005-2018 period. Weighted Logistic regression models consistently indicated significant relationship between people experiencing poverty and increased risk of ASCVD, and linear trend tests were all statistically significant (all P for trend < 0.001). Additionally, weighted Cox regression analysis consistently demonstrated that the hazards of cause-specific and all-cause mortality increased, with the decrease of each additional income level, and trend analyses indicated similar results (all P for trend < 0.001).

Conclusions

Our study confirmed that the SES was strongly linked to living with ASCVD, and cause-specific and all-cause mortality, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, sex, marital status, education, and depression severity.

Association between level of depression and coronary heart disease, stroke risk and all-cause and cardiovascular mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey

Research on the association between level of depression and coronary heart disease (CHD), stroke risk, and all-cause and cardiovascular mortality is lacking in large-scale or population-based studies incorporating cardiovascular disease (CVD) endpoints. We aim to assess the relationship between the level of a person's depression and their risk of CHD, stroke, and all-cause and cardiovascular mortality. Utilizing data from the United States National Health and Nutrition Examination Survey (NHANES), multicycle cross-sectional design and mortality linkage studies were conducted. The study sample included 30918 participants aged 20-85 years old during the 2005-2018 period. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9), with scores of 5, 10, 15, and 20 being the cut-off points for mild, moderate, moderately severe, and severe depression, respectively. A series of weighted logistic regression analyses and Cox proportional hazards models were utilized to examine the relationship between the level of depression with the risk of CHD, stroke, all-cause, and cardiovascular mortality. Trend analyses were conducted by entering the level of depression as a continuous variable and rerunning the corresponding regression models. Weighted logistic regression models consistently indicated a statistically significant association between the level of depression and increased risk of CHD and stroke, and those linear trend tests were statistically significant (P for trend < 0.001). Furthermore, weighted Cox regression analyses consistently indicated that participants who had a more severe degree of depression were at a higher risk of all-cause death, and trend analyses suggested similar results (P for trend < 0.001). Another weighted Cox regression analysis also consistently indicated that except for severe depression, the hazard of cardiovascular death was increased with each additional level increase of depression. Our study confirmed that the level of depression was strongly associated with CHD, stroke, and all-cause and cardiovascular mortality, even after accounting for other factors that could impact risk, including variables of age, gender, ethnicity, income, education, body mass index (BMI), marital, and smoking status.

The DEMATEL method explores the interdependent relationship structure and weights for diagnosis-related groups system

Purpose

This study constructs a structure of interaction between dimensions and criteria within the diagnosis-related groups (DRGs) system from a quantitative system and identifies key factors affecting the overall performance of medical services.

Method

From September to December 2020, the influence relation structure diagram (IRSD) of the dimensions and corresponding criteria was developed from the practical experience of a group of domain experts, based on the DEMATEL method. Subsequently, all dimensions and criteria construct influential weights from a systems perspective. Finally, the main influential factors were identified based on the analysis results.

Results

The IRSD results showed that, in the overall performance of medical services, “Medical service capacity (C₁)” was the main influential dimension, influencing both “Medical service efficiency (C₂)” and “Medical service safety (C₃).” At the criteria level, “Case-mix index (CMI) (C₁₂),” “Time efficiency index (C₂₁),” and “Inpatient mortality of medium-to-low group (C₃₂)” were the main influential criteria in the corresponding dimensions. The influential weight results showed that “Medical service capacity (C₁)” was also a key dimension. “Case-mix index (CMI) (C₁₂),” “Cost efficiency index (C₂₂),” and “Inpatient mortality of medium-to-low group (C₃₂)” were the key criteria in their respective dimensions.

Conclusion

Patients and managers should first focus on the capacity of medical service providers when making a choice or deciding using the results of the DRGs system. Furthermore, they should pay more attention to medical safety even if it is not as weighted as medical efficiency.

CXCR4 and TYROBP mediate the development of atrial fibrillation via inflammation

Atrial fibrillation (AF) is a rapid supraventricular arrhythmia. However, the pathogenesis of atrial fibrillation remains controversial. We obtained transcriptome expression profiles GSE41177, GSE115574 and GSE79768 from GEO database. WGCNA was performed, DEGs were screened, PPI network was constructed using STRING database. CTD database was used to identify the reference score of hub genes associated with cardiovascular diseases. Prediction of miRNAs of hub genes was performed by TargetScan. DIANA‐miRPath v3.0 was applied to make functional annotation of miRNA. The animal model of atrial fibrillation was constructed, RT‐PCR was used to verify the expression of hub genes. Immunofluorescence assay for THBS2 and VCAN was made to identify molecular. Design of BP neural network was made to explore the prediction relationship of CXCR4 and TYROBP on AF. The merged datasets contained 104 up‐regulated and 34 down‐regulated genes. GO and KEGG enrichment analysis results of DEGs showed they were mainly enriched in ‘regulation of release of sequestered calcium ion into cytosol’, ‘actin cytoskeleton organization’ and ‘focal adhesion’. The hub genes were CXCR4, SNAI2, S100A4, IGFBP3, CSNK2A1, CHGB, VCAN, APOE, C1QC and TYROBP, which were up‐regulated expression in the AF compared with control tissues. There was strong correlation among the CXCR4, TYROBP and AF based on the BP neural network. Through training, best training performance is 9.6474e‐05 at epoch 14, and the relativity was 0.99998. CXCR4 and TYROBP might be involved in the development of atrial fibrillation by affecting inflammation‐related signalling pathways and may serve as targets for early diagnosis and preventive treatment.

The digital divide impacts on mental health during the COVID-19 pandemic

One of the most daunting unintended consequences of the digital revolution is the digital divide (DD), a pervasive social and information inequality. It negatively affects all sectors of society, and exerts compounding influences on other social inequities. To further complicate the situation, the COVID-19 pandemic has been intensifying the scale of DD and deepening the scope of DD barriers with the increasing but imbalanced applications of digital technologies. For instance, while digital technologies can provide support to fulfill people's mental health needs, recurring evidence shows that DD-prone people are more likely to be excluded from critical services, activities, and resources to support their health concerns and challenges. So far, studies about the mental health consequences of DD amid COVID-19 are limited. Available evidence suggests that the general mental health impacts of COVID-19 include anxiety, depression, and suicidal behaviors, while the mental health consequences of DD due to COVID-19 are mainly stress, distress, and anxiety. To shed light on the research gap, based on the social inequality roots of DD and the nexus between DD barriers and factors of social inequalities, this study highlights the alarming overlap between DD-prone communities and vulnerable populations. Furthermore, we underscore the future research directions that could help society better serve both underserved communities.

A fully automated noncontrast CT 3-D reconstruction algorithm enabled accurate anatomical demonstration for lung segmentectomy

Background

Three‐dimensional reconstruction of chest computerized tomography (CT) excels in intuitively demonstrating anatomical patterns for pulmonary segmentectomy. However, current methods are labor‐intensive and rely on contrast CT. We hereby present a novel fully automated reconstruction algorithm based on noncontrast CT and assess its performance both independently and in combination with surgeons.

Methods

A retrospective pilot study was performed. Patients between May 2020 to August 2020 who underwent segmentectomy in our single institution were enrolled. Noncontrast CTs were used for reconstruction. In the first part of the study, the accuracy of the demonstration of anatomical variants by either automated or manual reconstruction algorithm were compared to surgical observation, respectively. In the second part of the study, we tested the accuracy of the identification of anatomical variants by four independent attendees who reviewed 3‐D reconstruction in combination with CT scans.

Results

A total of 20 cases were enrolled in this study. All segments were represented in this study with two left S1‐3, two left S4 + 5, one left S6, five left basal segmentectomies, one right S1, three right S2, 1 right S2b + 3a, one right S3, two right S6 and two right basal segmentectomies. The median time consumption for the automated reconstruction was 280 (205–324) s. Accurate vessel and bronchial detection were achieved in 85% by the AI approach and 80% by Mimics, p = 1.00. The accuracy of vessel classification was 80 and 95% by AI and manual approaches, respectively, p = 0.34. In real‐world application, the accuracy of the identification of anatomical variant by thoracic surgeons was 85% by AI+CT, and the median time consumption was 2 (1–3) min.

Conclusions

The AI reconstruction algorithm overcame defects of traditional methods and is valuable in surgical planning for segmentectomy. With the AI reconstruction, surgeons may achieve high identification accuracy of anatomical patterns in a short time frame.

How does the COVID-19 fuel insomnia?

One of the leading health consequences of the pandemic is the prevalence of sleep-related issues, such as insomnia. Hence, this study highlights the relationship between COVID-19 and insomnia and how insomnia is increasing due to the pandemic. The study's findings summarise that the COVID-19 pandemic has produced ubiquitous mental challenges, including loneliness, anxiety, fear, stress, extreme tiredness, and health concerns. It is also associated with physical issues such as social isolation, juggling work or study, parenting challenges, and significant behavior changes stemming from mass home confinement. There are also economic hardships, financial insecurity, risk, and infection. These factors lead to undoing routines and broken circadian rhythms amid the pandemic, affecting three sleep regulatory processes of the homeostatic sleep drive, the circadian rhythm, and the arousal system. Furthermore, we suggest future research directions to explore (1) long-term health impacts of the pandemic, (2) therapeutic strategies and the implementation of social policies to support people with sleep difficulties, (3) prevention programs and clinical interventions, and (4) nationwide or cross-regional online and practical psychological and sleep management intervention systems and platforms to address the psychological strain of isolation and traumatic experiences of the pandemic.

Hyperuricemia induces lipid disturbances by upregulating the CXCL-13 pathway

The molecular mechanism underlying hyperuricemia-induced lipid metabolism disorders is not clear. The purpose of the current study was to investigate the mechanism of lipid disturbances in a hyperuricemia mice model. RNA-Seq showed that differentially expressed genes (DEGs) in the fatty acid synthesis signaling pathway were mainly enriched and CXCL-13 was significantly enriched in protein-protein interaction networks. Western blotting, Q-PCR, and immunofluorescence results further showed that hyperuricemia upregulated CXCL-13 and disturbed lipid metabolism in vivo and in vitro. Furthermore, CXCL-13 alone also promoted the accumulation of lipid droplets and upregulated the expression of FAS and SREBP1, blocking AMPK signaling and activating the PKC and P38 signaling pathways. Silencing CXCL-13 reversed uric-acid-induced lipid droplet accumulation, which further downregulated FAS and SREBP1 expression, inhibited the p38 and PKC signaling, and activated AMPK signaling. In conclusion, hyperuricemia induces lipid metabolism disorders via the CXCL-13 pathway, making CXCL-13 a key regulatory factor linking hyperuricemia and lipid metabolism disorders. These results may provide novel insights for the treatment of hyperuricemia.NEW & NOTEWORTHY The underlying molecular mechanism of hyperuricemia-induced lipid metabolism disorders is still unclear. The study aimed to investigate the mechanism of lipid disturbance in hyperuricemia mice model. To our knowledge, we proposed for the first time that CXCL-13 may be a key regulator of hyperuricemia and lipid metabolism disorders. These results may provide new insights for the clinical treatment of hyperuricemia.

"Carpe Diem?": Disjunction Effect of Incidental Affect on Intertemporal Choice

Incidental affect has an important impact on intertemporal choice (IC). This research aimed to test how positive incidental affect influences IC and its underlying mechanisms. We assumed that positive incidental affect may have a disjunction effect on IC that includes or excludes immediate time. Moreover, we examined the role of time perception for the effect of affect on IC. In Study 1, after undergoing affect priming by video clips, participants completed the IC task using a multiple staircase paradigm. Using Hierarchical Bayesian Modeling, we estimated the discount rate parameter by distinguishing “immediate” and “non-immediate” conditions of IC. The participants’ time perception was also measured. In Study 2, apart from the choice preference of IC, we additionally investigated the differences in the participants’ attention to delay and reward attributes before decision making. The results of the two studies indicated that positive incidental affect leads to longer time perception (Study 1) and prior and more attention to the delay attribute of IC (Study 2), which leads individuals to prefer immediate options in the IC (Studies 1 and 2). Moreover, there is a disjunction effect of affect; in other words, the incidental affect did not influence IC excluding immediate time (Studies 1 and 2). This study improves our understanding of the disjunctive effect and its mechanism of inducing a positive incidental affect on IC and thus provides a new perspective on how related decision making can be improved.

Risk Stratifying and Prognostic Analysis of Subclinical Cardiac Implantable Electronic Devices Infection: Insight From Traditional Bacterial Culture

Background

Subclinical infection of cardiac implantable electronic devices (CIEDs) is a common condition and increases the risk of clinical infection. However, there are limited studies focused on risk stratifying and prognostic analysis of subclinical CIED infection.

Methods and Results

Data from 418 consecutive patients undergoing CIED replacement or upgrade between January 2011 and December 2019 were used in the analysis. Among the patients included, 50 (12.0%) were detected as positive by bacterial culture of pocket tissues. The most frequently isolated bacteria were coagulase‐negative staphylococci (76.9%). Compared with the noninfection group, more patients in the subclinical infection group were taking immunosuppressive agents, received electrode replacement, or received CIED upgrade and temporary pacing. Patients in the subclinical infection group had a higher PADIT (Prevention of Arrhythmia Device Infection Trial) score. Univariable and multivariable logistic regression analysis found that use of immunosuppressive agents (odds ratio [OR], 6.95 [95% CI, 1.44–33.51]; P=0.02) and electrode replacement or CIED upgrade (OR, 6.73 [95% CI, 2.23–20.38]; P=0.001) were significantly associated with subclinical CIED infection. Meanwhile, compared with the low‐risk group, patients in the intermediate/high‐risk group had a higher risk of subclinical CIED infection (OR, 3.43 [95% CI, 1.58–7.41]; P=0.002). After a median follow‐up time of 36.5 months, the end points between the subclinical infection group and noninfection group were as follows: composite events (58.0% versus 41.8%, P=0.03), rehospitalization (54.0% versus 32.1%, P=0.002), cardiovascular rehospitalization (32.0% versus 13.9%, P=0.001), CIED infection (2.0% versus 0.5%, P=0.32), all‐cause mortality (28.0% versus 21.5%, P=0.30), and cardiovascular mortality (10.0% versus 7.6%, P=0.57).

Conclusions

Subclinical CIED infection was a common phenomenon. The PADIT score had significant value for stratifying patients at high risk of subclinical CIED infection. Subclinical CIED infection was associated with increased risks of composite events, rehospitalization, and cardiovascular rehospitalization.

A current collect-free Li1.2Ni0.13Co0.13Mn0.54O2flexible film for high-performance lithium-ion batteries

Due to the high demand for more convenient flexible devices, there are more requirements for higher performance of flexible batteries. The layered lithium-rich manganese-based Li_1.2Ni_0.13Co_0.13Mn_0.54O₂cathode material has the advantages of higher energy density, higher discharge capacity and environmentally friendly, so it can be used for high-performance flexible electrode cathode material. Its theoretical capacity can reach more than 250 mAh g^-1, which is higher than most cathode materials currently used in commercialization. Here we synthesize Li_1.2Ni_0.13Co_0.13Mn_0.54O₂(LNCM) cathode, and then use a simple method to make a current collect-free LNCM flexible film. This film has excellent flexibility and electrochemical performance. At 25 mA g^-1, its initial discharge capacity reaches 314.0 mAh g^-1. After 200 cycles of 500 mA g^-1, its capacity retention rate is 82.1%, the attenuation is about 0.08% per cycle. Moreover, by bending at any position of the flexible film, it can still remain intact, and the soft-packaged battery made by the flexible film can still be used under the bending condition and keep the brightness of the LED lamp unchanged. This shows that using Li_1.2Ni_0.13Co_0.13Mn_0.54O₂to make high-performance flexible electrodes is a simple and effective method, which is expected to be practically applied to flexible electronic devices.