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Objective. We aim to explore the clinical therapeutic effect of alternative wave electroacupuncture combined with Lee's naprapathy therapy on knee osteoarthritis (KOA) (blood stasis due to qi stagnation). Method. 122 patients with KOA treated in our hospital from January 2018 to October 2021 were randomly grouped into a combined group (n = 61) and a control group (n = 61). The combined group was treated with alternative wave electroacupuncture combined with Lee's naprapathy, while the control group was treated with alternative wave electroacupuncture alone. Clinical efficacy of the two groups was observed. The Visual Analogue Scale (VAS), Lysholm Scale, Indexes of Severity for Osteoarthritis (ISOA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared before and after treatment, followed up for 3 months and 6 months. The adverse reactions of the two groups were observed. Result. The overall response rate of the combined group (96.72%) was higher than that of the control group (81.97%), and the difference was statistically significant (P < 0.05). After treatment and follow-up for 3 months and 6 months, the Lysholm score of the combined group was higher than that of the control group, while the VAS, ISOA, and WOMAC scores were lower than those of the control group, and the difference between the two was statistically significant (P < 0.05). There were no serious adverse reactions in both groups (P > 0.05). Conclusion. The alternative wave electroacupuncture combined with Lee's naprapathy is effective and safe in treating KOA (blood stasis due to qi stagnation). [ABSTRACT FROM AUTHOR]

Marathon performance is influenced by factors such as aerobic capacity and those related to neuromuscular function. Complex training (CPX) is a multicomponent training method, wherein heavy strength and plyometric exercises alternate within a single session and is an effective method to improve neuromuscular adaptations. This study compared the effects of CPX, heavy strength training (HST) and endurance-strength (EST) combined with running endurance training on neuromuscular adaptations and running performance in 38 recreational marathoners (age:31.4 ± 3.8 years, VO2max:57.6 ± 6.8 ml·kg−1·min−1). Athletes were allocated in 3 groups: CPX, HST and EST and were tested for one maximum repetition strength (1RM), squat jump and countermovement jumps (SJ, CMJ), leg press (LP) concentric and eccentric strength, running economy (RE) and velocity at VO2max (vVO2max) before and after the 6-week intervention. CPX and HST were performed 2 times per week in conjunction with the running endurance training. RE and vVO2max improved in CPX and HST groups (p < 0.01, RE: −5% to −6.4%, vVO2max: 5.7% and 4.2%, respectively) with no change in EST. Similarly, all neuromuscular performance indicators improved in CPX and HST (p < 0.0167, 1RM strength:19.7% to 25.1%, SJ and CMJ: 5.3% to 11.6%, LP concentric and eccentric strength: 5.5% to 18.0%). In summary, 6-week of concurrent CPX or HST and endurance training resulted in similar improvement in maximum strength, RE, and vVO2max. Importantly, both CPX and HST training resulted in greater improvements in eccentric strength and RE compared to EST that performed concurrent endurance-strength and endurance training. [ABSTRACT FROM AUTHOR]

Study Question: Is a maternal history of spontaneous abortion (SA) associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring?Summary Answer: Our results suggest an association between maternal history of SA and ADHD in offspring, with the risk increasing with the number of maternal SA and highest in the firstborn children whose mothers had had recurrent SAs after adjusting for a number of potential confounders.What Is Known Already: A history of SA has been associated with more complications in next pregnancies and adverse childbirth outcomes, which are risk factors for ADHD in the offspring. However, no previous study has investigated whether maternal SA increases risk of ADHD in the offspring.Study Design, Size, Duration: This population-based study included all live-born children in Denmark from 1 January 1995 to 31 December 2012 (n = 1 062 667). All children were followed from 3 years of age until the day of ADHD diagnosis, death, emigration or 31 December 2016, whichever came first.Participants/materials, Setting, Methods: There were 130 206 (12.2%) children born to mothers who had at least one SA. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Main Results and the Role Of Chance: During a median follow-up of 9.4 years (interquartile range, 5.4-14.3), 25 747 children were diagnosed with ADHD. Overall, children of mothers with a history of SA had an increased rate of ADHD (HR, 1.11; 95% CI, 1.07 to 1.15). The HRs increased with the number of maternal SA, 1.09 (95% CI, 1.05 to 1.13) for one SA and 1.22 (95% CI, 1.12 to 1.33) for at least two SAs, respectively. These findings were consistent when we took into consideration a number of factors, such as maternal socioeconomic status, type of SA, birth order, parental history of psychiatric disorders, pregnancy characteristics and adverse birth outcomes.Limitations, Reasons For Caution: Misclassification of SA was possible as we used population-based register data to capture maternal history of SA. However, any misclassification of maternal history of SA would be non-differential with regard to the diagnosis of ADHD in offspring, which generally leads to underestimation of the associations. Furthermore, probabilistic sensitivity analysis suggested that only 1% of change in the estimate may have been due to misclassification of SA.Wider Implications Of the Findings: SA is quite frequent (varying from 15 to 20%), and a small increase of neurodevelopmental problems in offspring could have major public health implications.Study Funding/competing Interest(s): This work was supported by grants from the National Natural Science Foundation of China (No. 81703237, No. 81530086 and No. 81761128035), National Key Research and Development Program (2018YFC1002801, 2016YFC1000505), Shanghai Municipal Commission of Health and Family Planning (No. 2017ZZ02026, No. 2017EKHWYX-02), the Novo Nordisk Foundation (NNF18OC0052029), the Danish Council for Independent Research (DFF-6110-00019), the Nordic Cancer Union (176673, 186200 and R217-A13234-18-S65), Karen Elise Jensens Fond (2016) and Xinhua Hospital of Shanghai Jiao Tong University School of Medicine (2018YJRC03). All authors report no conflict of interest.Trial Registration Number: NA. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • The NOx conversion of the MnO x /CePO 4 catalyst was above 80% even at 180 °C. • The MnO x /CePO 4 catalyst exhibits an excellent water tolerance and N 2 selectivity. • The process of NO oxidation to NO 2 over the catalyst plays a key role during the NH 3 -SCR process. • Monodentate nitrates were the major active species for the NO removal. • The reaction process of the MnO x /CePO 4 catalyst was majorly conducted via the Langmuir–Hinshelwood mechanism. Abstract The MO x (M = Cu, Mn, Co)/CePO 4 support was firstly prepared via the hydrothermal and impregnated method. Selective catalytic reduction of NO with NH 3 (NH 3 -SCR) results showed that the MnO x modifications greatly improved the SCR activities at low temperatures. The NOx conversion of the MnO x /CePO 4 catalyst was above 80% even at 180 °C. In-situ DRIFTS results suggest that the SCR reaction is majorly conducted between the absorbed monodentate nitrate and NH 3 species (i.e., the Langmuir–Hinshelwood mechanism). MOx (M = Cu, Mn, Co) exists in the formation of nano-size particles obtained by SEM and TEM directly. These nano-size particles can provide active surface adsorbed oxygen and thus improve the NO oxidation ability as indicated by the O 2 -TPD and NO oxidation tests. The process of NO oxidation to NO 2 plays a key role to produce the absorbed monodentate nitrate as indicated by the In-situ DRIFTS. The support CePO 4 acts as the acid sites to form highly active NH 4 + species. The synergic effect between the MnO x and CePO 4 contributed to the high SCR activity over the MnO x /CePO 4 catalyst. Additionally, the MOx/CePO 4 catalyst exhibits an excellent water tolerance and N 2 selectivity. Consequently, the MnO x /CePO 4 catalyst becomes the potential catalyst for the practical process. [ABSTRACT FROM AUTHOR]

• New ignition delay times of 1,2,4-trimethylbenzene are measured. • Comparisons of the ignition characteristics of three C9H12 fuels are performed. • Dominant reactions affecting ignition of three C9H12 fuels are different. • The reaction path of trimethylbenzene is different from n-propyl benzene. • Trimethylbenzene undergoes complicated reactions compared with n-propyl benzene. Alkyl aromatics comprise a significant portion of real fuels. Among various alkyl aromatics, the C 9 H 12 aromatic fuels including n-propylbenzene and trimethylbenzenes are representative alkyl aromatics, which are widely detected in real fuels, and they are widely employed as surrogate compounds in modeling real fuels. Thus, the combustion kinetic study of C 9 H 12 fuels is necessary and urgent for fuel combustion. In this work, comparative experimental and kinetic modeling study of the high-temperature ignition of three C 9 H 12 fuels is performed. New ignition delay time (IDT) measurements are carried out in a high-pressure shock tube (HPST) for 1,2,4-trimethylbenzene and 1,3,5-trimethylbenzene. The studied pressure is 2, 5 and 10 bar, the equivalence ratios are 0.5, 1.0 and 2.0, and the temperature range is from 1090 K to 1600 K for IDT in HPST. The experimental results are simulated using an updated detailed kinetic mechanism. Reaction path analysis and sensitivity analysis are performed to provide insight into the chemical kinetics controlling the ignition of the three C 9 H 12 fuels. The present experimental data set and kinetic model results should be valuable to improve our understanding of the combustion chemistry of alkyl aromatics and to offer practical guidance for the surrogate model development of real fuels. [ABSTRACT FROM AUTHOR]

In this study, comparative analyses of highway runoff samples obtained from seventeen storm events have been conducted between the traditional water quality assessment method and biotoxicity tests, using zebrafish ( Danio rerio ) embryos and luminous bacteria ( Vibrio qinghaiensis. Q67 ) to provide useful information for ecotoxicity assessment of urban highway runoff. The study results showed that the Nemerow pollution index based on US EPA recommended Criteria Maximum Concentrations (CMC) (as traditional water quality assessment method) had no significant correlation with luminous bacteria acute toxicity test results, while significant correlation has been observed with two indicators of 72 hpf (hours post fertilization) hour hatching rate and 96 hpf abnormality rate from the toxicity test with zebrafish embryos. It is therefore concluded that the level of mixture toxicity of highway runoff could not be adequately measured by the Nemerow assessment method. Moreover, the key pollutants identified from the water quality assessment and from the biotoxicity evaluation were not consistent. For biotoxic effect evaluation of highway runoff, three indexes were found to be sensitive, i.e. 24 hpf lethality and 96 hpf abnormality of zebrafish embryos, as well as the inhibition rate for luminous bacteria Q67 . It is therefore recommended that these indexes could be incorporated into the traditional Nemerow method to provide a more reasonable evaluation of the highway runoff quality and ecotoxicity. [ABSTRACT FROM AUTHOR]

Objective. Primary bladder tumors have a high degree of malignancy. To investigate the expression of human papillomavirus type 16 (HPV-16) in primary bladder tumors and the loss of cell differentiation and to explore the significance of HPV-16 detection, it is expected to be a disease. Treatment provides a theoretical basis. Methods. Fifty-seven patients with primary bladder tumors admitted to our hospital from January 2019 to January 2022 were selected as the research subjects, and they were divided into HPV-related groups according to the human papillomavirus (HPV) infection status (n = 28) and HPV unrelated group (n = 29). The general data of patients were collected, the expression of HPV-16 in bladder tissue samples was detected, and the correlation between pathological parameters and HPV-16 expression was analyzed. Results. Among HPV subtypes, HPV 16 subtype accounted for the highest proportion, followed by HPV-18 and HPV-6 subtypes; there was no significant difference in tumor stage (stage 1, stage a, stage 2a) between the HPV-related group and the HPV-unrelated group (stage 1, stage a, and stage 2a). P > 0.05); there was no significant difference in postoperative pathological expression (high expression and low expression) of patients (P > 0.05); there was no statistical difference in age and gender between HPV-related and HPV-unrelated groups (P > 0.05), HPV-related group and HPV-unrelated group compared daily regular drinking and smoking status, the difference was statistically significant (P < 0.05); HPV-16 expression was not correlated with tumor differentiation degree and age of patients (P > 0.05); the area under the curve (AUC) of HPV-16 for judging primary bladder tumor expression and cellular molecular deletion was 0.891, with a sensitivity of 83.94% and a specificity of 88.57%. Conclusion. HPV-16 is an upper, expressed in primary bladder tumors and will participate in the differentiation and loss of cells, which can provide effective guidance and basis for the diagnosis of primary bladder tumors, which is an important factor for judging the pathological stage and prognosis of patients and can provide a theoretical reference for the formulation of therapeutic measures. [ABSTRACT FROM AUTHOR]

Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects individuals across their lifespan. Early diagnosis and intervention are crucial for improving outcomes. However, current diagnostic methods are often time-consuming, and costly, making them inaccessible to many families. In the current study, we aim to test caregiver-child interaction as a potential tool for screening children with ASD in clinic. Methods: We enrolled 85 preschool children (Mean age: 4.90 ± 0.65 years, 70.6% male), including ASD children with or without developmental delay (DD), and typical development (TD) children, along with their caregivers. ASD core symptoms were evaluated by Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule-Calibrated Severity Scores (ADOS-CSS). Behavioral indicators were derived from video encoding of caregiver-child interaction, including social involvement of children (SIC), interaction time (IT), response of children to social cues (RSC), time for caregiver initiated social interactions (GIS) and time for children initiated social interactions (CIS)). Power spectral density (PSD) values were calculated by EEG signals simultaneously recorded. Partial Pearson correlation analysis was used in both ASD groups to investigate the correlation among behavioral indicators scores and ASD symptom severity and PSD values. Receiver operating characteristic (ROC) analysis was used to describe the discrimination accuracy of behavioral indicators. Results: Compared to TD group, both ASD groups demonstrated significant lower scores of SIC, IT, RSC, CIS (all p values < 0.05), and significant higher time for GIS (all p values < 0.01). SIC scores negatively correlated with CARS (p = 0.006) and ADOS-CSS (p = 0.023) in the ASD with DD group. Compared to TD group, PSD values elevated in ASD groups (all p values < 0.05), and was associated with SIC (theta band: p = 0.005; alpha band: p = 0.003) but not IQ levels. SIC was effective in identifying both ASD groups (sensitivity/specificity: ASD children with DD, 76.5%/66.7%; ASD children without DD, 82.6%/82.2%). Conclusion: Our results verified the behavioral paradigm of caregiver-child interaction as an efficient tool for early ASD screening. [ABSTRACT FROM AUTHOR]

Background: The orthopedic treatment of the stiff clubfoot is challenging for clinicians, and the purpose of this study was to explore the preliminary findings of 3D printing-assisted patient-specific instrument (PSI) osteotomy guide for use in the orthopedic treatment of the stiff clubfoot. Material and methods: There were 20 patients (25 feet) with stiff clubfoot admitted from December 2018 to June 2022, including 13 males (16 feet) and 7 females (9 feet), aged 24–52 years, mean 40.15 years; 8 left feet, 7 right feet, 5 bipedal. All patients underwent triple arthrodesis and were divided into 10 cases (12 feet) in the PSI group (n = 12) and 10 cases (13 feet) in the conventional surgery group (n = 13) according to the surgical approach. The duration of surgery and the number of radiation exposures were recorded in all cases, and the American Orthopedic Foot and Ankle Society (AOFAS), and International Congenital Clubfoot Study Group (ICFSG) scoring systems were applied postoperatively to assess the effect of corrective treatment. All measurement data were expressed as mean ± standard deviation, and differences between groups were determined by Student's t test. All count data between the two groups were compared using the chi-square test or Fisher's exact test analysis. Results: All 20 patients (25 feet) were followed up for 1 year. No major complications related to osteotomy, such as overcorrection, incomplete correction, or bone nonunion, were observed in the PSI and conventional surgery groups at the final follow-up, and the PSI group had the advantage of shorter operative time (P < 0.01), less radiation exposure (P < 0.01), and higher excellent rate compared with the conventional surgery group. The AOFAS score (P > 0.05) and ICFSG score (P > 0.05) at the last follow-up were not statistically significant in both groups, but the excellent rate at the last follow-up was 91.7% in the PSI group which was significantly higher than that of the conventional surgery group at 76.9%. Conclusions: The utilization of 3D printing-assisted PSI osteotomy guide in orthopedic surgery for stiff clubfoot offers a safe and effective surgical tool for triple joint fusion treatment. This technology simplifies surgical procedures, minimizes intraoperative radiation exposures, reduces surgical time, and enables precise and personalized treatment. [ABSTRACT FROM AUTHOR]

In order to address the problem of the underlying mechanism of mathematics learning disability (MLD), in the current research, we investigated the visual and auditory perceptions of elementary school children with visual and auditory MLD from the first to fourth grade. We found that children with visual mathematics learning disability (VMLD) and those with auditory mathematics learning disability (AMLD) all had problems in both visual and auditory perceptions. After further analysis, we found that children with VMLD suffered from more serious problems with visual perception than with auditory perception while it was the other way around for children with AMLD. Children with visual and auditory mathematics learning disability (V-AMLD) had both serious problems with visual and auditory perceptions. It thus can be seen that the visual Arabic code of number was more closely tied with the visual perception while the auditory-verbal code of number more closely associated with the auditory perception. The results shed light on the subtypes of MLD and contributed to the intervention. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a clinically heterogeneous neurodevelopmental disorder defined by characteristic behavioral and cognitive features. Abnormal brain dynamic functional connectivity (dFC) has been associated with the disorder. The full spectrum of ADHD-related variation of brain dynamics and its association with behavioral and cognitive features remain to be established. Methods: We sought to identify patterns of brain dynamics linked to specific behavioral and cognitive dimensions using sparse canonical correlation analysis across a cohort of children with and without ADHD (122 children in total, 63 with ADHD). Then, using mediation analysis, we tested the hypothesis that cognitive deficits mediate the relationship between brain dynamics and ADHD-associated behaviors. Results: We identified four distinct patterns of dFC, each corresponding to a specific dimension of behavioral or cognitive function (r = 0.811–0.879). Specifically, the inattention/hyperactivity dimension was positively associated with dFC within the default mode network (DMN) and negatively associated with dFC between DMN and the sensorimotor network (SMN); the somatization dimension was positively associated with dFC within DMN and SMN; the inhibition and flexibility dimension and fluency and memory dimensions were both positively associated with dFC within DMN and between DMN and SMN, and negatively associated with dFC between DMN and the fronto-parietal network. Furthermore, we observed that cognitive functions of inhibition and flexibility mediated the relationship between brain dynamics and behavioral manifestations of inattention and hyperactivity. Conclusions: These findings document the importance of distinct patterns of dynamic functional brain activity for different cardinal behavioral and cognitive features related to ADHD. [ABSTRACT FROM AUTHOR]

Introduction: Acute myeloid leukemia (AML) patients with CEBPA double mutation (CEBPAdm) were associated with distinct immunophenotypes and prognosis. Recently, both International Consensus Classification (ICC) and World Health Organization (WHO) classifications incorporated BZIP single mutations (CEBPAsmBZIP) into the favorable risk group. However, the immunophenotypes of CEBPAsmBZIP mutations have not been characterized, especially when compared with the immunophenotypes of CEBPAdm. Methods: Retrospectively, we investigated and compared the immunophenotypes of AML with CEBPA mutations. Randomforest model and XGBoost algorithm were used to set up a scoring system based on the immunophenotypes of those patients. Results: In a total of 967 AML patients: 218 were CEBPAdm (198 consisted of mutations in the BZIP region [CEBPAdmBZIP], 20 were double mutations outside BZIP region [CEBPAdm‐woBZIP]), 117 were CEBPAsm (54 CEBPAsmBZIP and 63 were single mutations outside BZIP region [CEBPAsm‐woBZIP]) and the others were wildtype CEBPA (CEBPAwt). Patients with CEBPAdmBZIP, CEBPAdm‐woBZIP and CEBPAsmBZIP shared the distinct immunophenotype of CD7+ CD34+ MPO+ HLA‐DR+ CD19−, in contrast to patients with CEBPAsm‐woBZIP and CEBPAwt who showed reduced expression of CD7, HLA‐DR, MPO, CD34 and a higher expression of CD19. Based on these immunophenotypes, we developed a scoring system to preemptively identify AML with CEBPAsmBZIP and CEBPAdm and validated it internally and externally. Conclusions: AML with CEBPAdmBZIP, CEBPAdm‐woBZIP, and CEBPAsmBZIP shared similar immunophenotypic profiles, whereas profoundly differed from the CEBPAsm‐woBZIP and CEBPAwt AML. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study is to explore the application of a very important person (VIP) intervention mode in patients with advanced tumors in the western region of China. Methods. One hundred and sixty-three patients were randomly divided into a control and experimental groups. The control group received routine care, and the experimental group received VIP future care. The willingness to end-of-life treatment, decision-making certainty, and quality of life were compared between the two groups before intervention (T0), after intervention (T1), and 1 month after intervention (T2). Results. There were no significant differences in the basic data of the two groups. Unlike the control group, the experimental group preferred palliative care at the end of T1 (P < 0.05), and the acceptance rate of cardiopulmonary resuscitation and mechanical treatment decreased significantly. After the VIP intervention, the patient was transferred to the intensive care unit (ICU) (P < 0.05). After 1 month of intervention (T2), the results showed that the overall quality of life, physical discomfort, negative emotions, care and support, survival predicament, and lifetime value of the patients were significantly higher than those before the intervention (all P < 0.05). Decision certainty results showed that the differences between the T0, T1, and T2 time points and the interaction between groups and time were statistically significant, and the interaction was more significant at T2 (P < 0.05). Conclusion. VIP future care can change patients' wishes for end-of-life care, improve patients' and quality of life, and increase patient decision-making certainty. [ABSTRACT FROM AUTHOR]

Cistanche tubulosa (CT) is the dried fleshy stem with scaly leaves of Cistanche tubiflora (Schenk) Wight, which has the effects of tonifying the kidney-yang, benefiting the vital essence and blood, and moisturizing the intestines and laxatives. There are differences in the activity of CT before and after processing, but the mechanism of processing is not clear. The study aimed to compare the strength of action of CT before and after yellow-wine processing in the treatment of constipation and kidney yang deficiency and to identify the active ingredients responsible for the differences in activity before and after yellow-wine processing. This study established the fingerprints of CT and PCT using HPLC to identify their shared components. Then efficacy of KYDS and FC were carried out to compare the differences between CT and PCT in terms of efficacy. Next, this study established the spectrum-effect relationship between the shared chemical components and the medical effects of CT and PCT using the gray correlation analysis and entropy methods. Ultimately, the activity of the analyzed chemical components was verified using the zebrafish model. CT was more effective than PCT in promoting intestinal peristalsis, regulating gastrointestinal hormone levels, and thus treating FC. PCT was more effective than CT in improving the level of hormone indexes of the hypothalamus-pituitary-target gland axis, replenishing blood, and enhancing immunity. Through the analysis of the spectrum-effect relationship, it was finally found that 5, 6, 12 (tubuloside A), and 13 (isoacteoside) might be more closely related to the activity of tonifying kidney yang, and peaks 9, 10, and 11 (acteoside) are more closely associated with the treatment of constipation, and peaks 3 (salidroside), 4, 1, 2 (geniposidic acid), and 8 (echinacoside) were associated with both kidney yang tonic and treatment of constipation. At the same time, an activity verification experiment showed that echinacoside, geniposidic acid, and salidroside were effective in the treatment of FC and KYDS, while acteoside was very effective in the treatment of FC, and tubuloside A was significant in supplementing the blood, which validated the spectrum-effect relationship analysis. This study proved that the raw CT had a better laxative effect, while the yellow-wine processed CT had a better kidney-yang tonic effect; moreover, spectrum-effect relationships were established to analyze the chemical components leading to changes in the activity of CT before and after yellow-wine processing. [Display omitted] • The activity of Cistanche tubulosa before and after processing was compared. • The active ingredients of Cistanche tubulosa related to toning kidney Yang, treating constipation were analyzed by spectrum-effect relationship. • The validation of the active ingredients regarding kidney yang tonic activity and constipation treatment activity was carried out through zebrafish models. [ABSTRACT FROM AUTHOR]

Polygala tenuifilia Willd (Polygalaceae), a traditional Chinese medicine, has been used for a long time to treat various illnesses with serious adverse reactions. Glycyrrhizae radix et rhizoma processing is generally used to reduce the adverse reactions. The aim of this study was to validate the irritation caused by raw Polygalaceae (RPA), to investigate whether processed Polygalaceae (PGA) was less irritating, and to screen and validate irritant properties of virgaureagenin G (polygala acid, PA), 3,6′-disinapoylsucrose (DSS), Tenuifolia (TEN) and polygalaxanthone III (POL), which had pharmacologically active in Polygalaceae. Zebrafish model, Draize test and High-Performance Liquid Chromatography (HPLC) were utilized to achieve the aim. Scanning Electron Microscopy (SEM) and optical microscope were used to determine the presence of calcium oxalate needle crystal in RPA and PGA. Zebrafish egg spinning changes and zebrafish embryo behavior were used for irritation validation, irritation comparison and irritant screening. For additional evidence, the Draize test, HE staining of rabbit eyes and ELISA kit were used. Finally, changes in the composition of RPA and PGA were investigated using HPLC. SEM and optical microscopy revealed no calcium oxalate needle crystals in Polygalaceae. RPA, PGA, PA and DSS were able to accelerate the spinning of zebrafish eggs and the movement of embryos, while TEN and POL were not. RPA, PGA, DSS and PA may cause rabbit eyes to become hyperemic and swollen, resulting in damage to the iris, cornea and conjunctiva and increased levels of interleukin-6 (IL-6) and interleukin-10 (IL-10). Comparatively, the effects caused by PGA were less severe than those caused by RPA. In addition, compared to RPA, PGA had lower levels of DSS and PA. RPA, PGA, DSS, and PA were irritating. However, processing and curing could reduce the irritation by reducing the levels of DSS and PA. DSS and PA could be two potential irritants of Polygalaceae. [Display omitted] • Polygala tenuifilia Willd is irritating. • Polygala tenuifilia Willd processed by Glycyrrhizae Radix et Rhizoma is less irritating. • 3,6′-disinapoylsucrose and virgaureagenin G are two of the irritating ingredients of Polygala tenuifilia Willd. • Processed Polygala tenuifilia Willd has lower content of 3,6′-disinapoylsucrose and virgaureagenin G. [ABSTRACT FROM AUTHOR]

Background. Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients. Methods. We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI. Results. In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, and 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n = 11) for patients without AKI, 72.7% (n = 8) for patients with transient AKI, and 86.5% (n = 32) for patients with persistent AKI (P < 0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P < 0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (h a z a r d r a t i o H R = 2.582 ; 95% CI: 1.025–6.505; P = 0.044 ; and H R = 6.974 ; 95% CI: 3.334–14.588; P < 0.001). Conclusions. AKI duration can be an important predictive parameter in elder patients suffering from COVID-19 and are admitted to ICU. Among these patients, those exhibiting persistent AKI have a lower in-hospital survival rate than those with transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention. [ABSTRACT FROM AUTHOR]

The spread of multidrug-resistant Klebsiella pneumoniae (MDR-KP) has become an emerging threat as a result of the overuse of antibiotics. Bacteriophage (phage) therapy is considered to be a promising alternative treatment for MDR-KP infection compared with antibiotic therapy. In this research, a lytic phage BUCT610 was isolated from hospital sewage. The assembled genome of BUCT610 was 46,774 bp in length, with a GC content of 48%. A total of 83 open reading frames (ORFs) and no virulence or antimicrobial resistance genes were annotated in the BUCT610 genome. Comparative genomics and phylogenetic analyses showed that BUCT610 was most closely linked with the Vibrio phage pYD38-A and shared 69% homology. In addition, bacteriophage BUCT610 exhibited excellent thermal stability (4–75 °C) and broad pH tolerance (pH 3–12) in the stability test. In vivo investigation results showed that BUCT610 significantly increased the survival rate of Klebsiella pneumonia-infected Galleria mellonella larvae from 13.33% to 83.33% within 72 h. In conclusion, these findings indicate that phage BUCT610 holds great promise as an alternative agent with excellent stability for the treatment of MDR-KP infection. [ABSTRACT FROM AUTHOR]

Background and Objectives: To assess the general and nutritional health of children with attention deficit/ hyperactivity disorder (ADHD).Methods and Study Design: The National Multicenter Sleep Research Database for 23791 school-age children in grades 1-6 from 9 cities in China was accessed. Children with a specialist diagnosis of ADHD or not (non-ADHD) in 2005 were studied. National anthropometric growth standards for children aged 2-18 years classified children as underweight, wasted, stunted (short stature presumed nutritional), or overweight/obesity. Independent variables were preterm birth, sleep quality and prior disease and ADHD was the dependent variable. Binary logistic regression models were developed along with interaction analyses for associated disorder or disease on overweight/obesity, and stunted.Results: Some 18731 records were analyzed for 808 children with ADHD. The comparative prevalences for ADHD with non-ADHD children were stunted 9.8% vs 5.9% (p<0.001) and overweight/ obesity (32.6% vs 29.6%, p=0.002) respectively. ADHD boys were more often underweight (7.5% vs 5.3%, p=0.027), but not in girls. ADHD likelihood Odds Ratios, ORs (with 95%CI) were for premature birth 1.838, (1.393-2.423), allergic diseases 1.915 (1.526-2.399), otitis media 1.54 (1.118- 2.146), tonsillar or adenoid hypertrophy1.662 (1.348-2.050), gastroesophageal reflux 3.008(1.792-1.792-5.049), and sleep disorder 2.201(1.847-2.623) were ADHD risk factors. Only poor sleep quality and ADHD exhibited an interaction for stunted with OR=0.409 (0.233-0.719).Conclusions: Compromised and complex nutritional health in ADHD children challenges clinical nutrition with a range of health problems, albeit coherent with the needed nutritional emphasis in the 'first 1000 days'. [ABSTRACT FROM AUTHOR]

Background: An increasing number of neuroimaging studies report alterations of cortical thickness (CT) related to the neuropathology of bipolar disorder (BD). We provide here a whole-brain vertex-wise meta-analysis, which may help improve the spatial precision of these identifications.Methods: A comprehensive meta-analysis was performed to investigate the differences in CT between patients with BD and healthy controls (HCs) by using a newly developed mask for CT analysis in seed-based d mapping (SDM) meta-analytic software. We used meta-regression to explore the effects of demographics and clinical characteristics on CT. This meta-review was conducted in accordance with PRISMA guideline.Results: We identified 21 studies meeting criteria for the systematic review, of which 11 were eligible for meta-analysis. The meta-analysis comprising 649 BD patients and 818 HCs showed significant cortical thinning in the left insula extending to left Rolandic operculum and Heschl gyrus, the orbital part of left inferior frontal gyrus (IFG), the medial part of left superior frontal gyrus (SFG) as well as bilateral anterior cingulate cortex (ACC) in BD. In meta-regression analyses, mean patient age was negatively correlated with reduced CT in the left insula.Limitations: All enrolled studies were cross-sectional; we could not explore the potential effects of medication and mood states due to the limited data.Conclusions: Our results suggest that BD patients have significantly thinner frontoinsular cortex than HCs, and the results may be helpful in revealing specific neuroimaging biomarkers of BD patients. [ABSTRACT FROM AUTHOR]

Objectives: To compare the prevalence of chronic periodontitis between men who had semen abnormalities and those who had normozoospermia through a case–control study. Materials and Methods: Male patients who visited the assisted reproduction clinic of a large general hospital and were diagnosed with semen abnormalities were included in the case group. The control group was composed of patients of the same clinic with normozoospermia. The semen analysis included sperm concentration, count and progressive and total motility, which were measured in the laboratory. A questionnaire and clinical periodontal examination were conducted for all participants. Logistic regression was performed to explore the relationship between chronic periodontitis and male infertility. Results: A total of 192 participants were included: 63 participants (32.8%) had some type of semen abnormality (case group), while 129 participants (67.2%) had normozoospermia (control group). The case group had a significantly higher prevalence of moderate/severe periodontitis than the control group (33.3% vs. 17.8%, p =.012). The logistic regression showed that participants who had moderate/severe periodontitis had a greater chance of having semen abnormalities after adjusting for other confounding factors (OR = 3.377, p =.005). Conclusions: Periodontitis is associated with semen abnormalities and sperm motility in men. [ABSTRACT FROM AUTHOR]

Background: Whether extended lymphadenectomy for right colon cancer leads to increased perioperative complications or improves survival is still controversial. This trial aimed to compare the efficacy and safety of complete mesocolic excision (CME) versus D2 dissection in laparoscopic right hemicolectomy for patients with right colon cancer. This article reports the early safety results from the trial.Methods: This randomised, controlled, phase 3, superiority, trial was done at 17 hospitals in nine provinces of China. Eligible patients were aged 18-75 years with histologically confirmed primary adenocarcinoma located between the caecum and the right third of the transverse colon, without evidence of distant metastases. Central randomisation was done by means of the Clinical Information Management-Central Randomisation System via block randomisation (block size of four). Patients were randomly assigned (1:1) to CME or D2 dissection during laparoscopic right colectomy. Central lymph nodes were dissected in the CME but not in the D2 procedure. Neither investigators nor patients were masked to their group assignment but the quality control committee were masked to group assignment. The primary endpoint was 3-year disease-free survival, but the data for this endpoint are not yet mature; thus, only the secondary outcomes-intraoperative surgical complications and postoperative complications within 30 days of surgery, graded according to the Clavien-Dindo classification, mortality (death from any cause within 30 days of surgery), and central lymph node metastasis rate in the CME group only-are reported in this Article. This early analysis of safety was preplanned. The outcomes were analysed according to a modified intention-to-treat principle (excluding patients who no longer met inclusion criteria after surgery or who did not have surgery). This study is registered with ClinicalTrials.gov, NCT02619942. Study recruitment is complete, and follow-up is ongoing.Findings: Between Jan 11, 2016, and Dec 26, 2019, 1072 patients were enrolled and randomly assigned. After exclusion of 77 patients, 995 patients were included in the modified intention-to-treat population (495 in the CME group and 500 in the D2 dissection group). The postoperative surgical complication rate was 20% (97 of 495 patients) in the CME group versus 22% (109 of 500 patients) in the D2 group (difference, -2·2% [95% CI -7·2 to 2·8]; p=0·39); the frequency of Clavien-Dindo grade I-II complications were similar between groups (91 [18%] vs 92 [18%], difference, -0·0% [95% CI -4·8 to 4·8]; p=1·0) but Clavien-Dindo grade III-IV complications were significantly less frequent in the CME group than in the D2 group (six [1%] vs 17 [3%], -2·2% [-4·1 to -0·3]; p=0·022); no deaths occurred in either group. Of the intraoperative complications, vascular injury was significantly more common in the CME group than in the D2 group (15 [3%] vs six [1%], difference, 1·8 [95% CI 0·04 to 3·6]; p=0·045). Metastases in the central lymph nodes were detected in 13 (3%) of 394 patients who underwent central lymph node biopsy in the CME group; no patient had isolated metastases to central lymph nodes.Interpretation: Although the CME procedure might increase the risk of intraoperative vascular injury, it generally seems to be safe and feasible for experienced surgeons.Funding: The Capital Characteristic Clinical Project of Beijing and the Chinese Academy of Medical Sciences. [ABSTRACT FROM AUTHOR]

Background: Obesity may impact surgical outcomes of gastrectomy. Whether visceral fat area (VFA) is a better obesity parameter than body mass index (BMI) is still controversial. The aim of this study is to compare the accuracy and effectiveness of VFA and BMI in predicting the short-term surgical outcomes of gastrectomy.Methods: Patients who were diagnosed with gastric cancer were measured for BMI and VFA preoperatively and then divided into a VFA-H (VFA-high) group and VFA-L (VFA-low) group, at the cutoff point of 100 cm2, and a BMI-H (BMI-high) group and BMI-L (BMI-low) group, at the cutoff point of 25 kg/m2. The short-term surgical outcomes were compared between the different groups.Results: In total, 276 patients were enrolled in this study; 55 (19.9%) patients were classified into the BMI-H group, and 122 (44.2%) patients were classified into the VFA-H group. There was a significant correlation between BMI and VFA (r = 0.652, p < 0.001). Compared with the VFA-L group, the VFA-H group had a higher incidence of postoperative complications (31.1% vs. 13.0%; p < 0.001), longer operation duration (270.0 (235.0-305.0) vs. 255.0 (223.8-295.0), p = 0.046), and more blood loss (100.0 (100.0-150.0) vs. 80.0 (80.0-100.0), p < 0.001), while the BMI-H group had more blood loss than the BMI-L group (100.0 (100.0-120.0) vs. 100.0(80.0-100.0), p = 0.006). Logistic regression showed that VFA was an independent risk factor for postoperative complications (odds ratio 2.813, 95% CI 1.523-5.194; p = 0.001).Conclusion: For gastric cancer patients, VFA is superior to BMI in accurately and effectively illuminating the impact of obesity on short-term surgical outcomes.Trial Registration: Clinicaltrials.gov: NCT02800005. [ABSTRACT FROM AUTHOR]

Donor lymphocyte infusion (DLI) might be used prophylactically to reduce relapse after allogeneic hematopoietic stem cell transplantation for very high-risk leukemia/lymphoma without effective targeted therapy. To compare the safety and efficacy of prophylactic DLI for prevention of relapse after allogeneic peripheral blood stem cell transplantation from haploidentical donors (HID-SCT) and matched-sibling donors (MSD-SCT) in patients with very high-risk acute myeloid leukemia (AML), we performed a retrospective analysis in a cohort of 21 HID-SCT and 13 MSD-SCT recipients, displaying similar baseline characteristics except for donor's gender distribution. Grade 2-4 acute graft-versus-host disease (GVHD) at 100-day post-DLI was higher in HID-SCT group than that in MSD-SCT group (59.5% vs. 30.8%, p = 0.05). The grade 3-4 acute GVHD (17.5% vs. 7.7%), 1-year chronic GVHD (36.6% vs. 33.2%), and severe chronic GVHD (15.3% vs. 27.3%) were not statistically significant different between groups. One-year non-relapse mortality was higher in HID-SCT group than that in MSD-SCT group with marginal significance (27.9% vs. 0.0%, p = 0.061). One-year relapse rate was not statistically significant different between HID-SCT group and MSD-SCT group (21.6% vs. 36.5%, p = 0.543). For HID-SCT recipients, 1-year relapse rate was lower in patients receiving prophylactic DLI than that in a control cohort of eight patients with same very high-risk features but not receiving prophylactic DLI (62.5% vs. 28.3%, p = 0.037). No statistically significant difference was observed in 1-year overall survival (OS, 55.1% vs. 83.9%, p = 0.325) and relapse-free survival (RFS, 50.1% vs. 74.0%, p = 0.419) rates between HID-SCT group and MSD-SCT group. In multivariate analyses, non-remission status prior to transplant, poor-risk gene mutations, and donor's age ≥ 48 years predicted a higher risk of relapse after DLI. Non-remission status prior to transplant predicted inferior OS and RFS. Patient's age ≥ 40 years also predicted an inferior OS. In conclusion, prophylactic DLI was very safe and efficient for reducing relapse in patients with very high-risk AML receiving MSD-SCT. In the recipients of HID-SCT, the application of prophylactic DLI could reduce the risk of relapse, although with a higher incidence of DLI-associated acute GVHD than those of MSD-SCT. [ABSTRACT FROM AUTHOR]

There was limited information about the efficacy of myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT) in non-complete remission (non-CR) patients with relapsed/refractory peripheral T cell lymphomas (PTCLs). We conducted a retrospective study of 21 consecutive non-CR patients with relapsed/refractory PTCLs who received myeloablative allo-PBSCT between January 2008 and June 2016. The median follow-up of survivors was 46.5 months (range, 14-105 months). The estimated 3-year relapse rate was 24% (95% CI, 9 to 43%). The 3-year non-relapsed mortality rate was 24% (95% CI, 9 to 44%). Overall, the estimated 3-year overall survival was 47% (95% CI, 25 to 66%). And the estimated 3-year progression-free survival was 46% (95% CI, 24 to 66%). Specifically, eight patients failed to achieve a CR at the first evaluation 3 months after allo-PBSCT and received withdraw of immunosuppression. Five patients also received donor lymphocytes infusions. Five (5/8, 62.5%) patients responded subsequently to these interventions (complete = 4, partial = 1). Overall, ten patients were alive at our last follow-ups, and durable CR were achieved in nine patients without further therapy. Five (50%) of these ten alive patients experienced chronic graft-versus-host disease (GVHD). Our favorable clinical outcomes suggested myeloablative allo-PBSCT was a valid therapeutic option for non-CR patients with relapsed/refractory PTCLs. The sustained CR after immunotherapeutic intervention and high prevalence of chronic GVHD in alive patients provided evidence of graft versus T cell lymphoma effects. [ABSTRACT FROM AUTHOR]

Background: The preoperative work-up has limitations on finding peritoneal dissemination (PD) in gastric cancer patients. Laparoscopic exploration (LE) can discover radiographically occult PD, obtain accurate stage and avert futile laparotomy. The aim of our study was to introduce "Four-Step Procedure" LE in West China Hospital and further evaluate its safety and feasibility.Methods: We conducted a retrospective analysis on 165 patients from July 2016 to December 2017 who underwent "Four-Step Procedure" LE in gastrointestinal surgery department of West China Hospital. All the patients were diagnosed with gastric adenocarcinoma without explicit distant metastasis through Computed Tomography and/or Gastrointestinal Ultrasonography. Peritoneal lavage cytological examination (CY) was routinely performed during LE in our research. The "Four-Step" technical process of LE was introduced comprehensively. The clinicopathologic features and the presence of PD or CY at LE were analyzed, and the stratified analysis by cT and cN stages on the proportion of P1 and/or CY1 was also reported in this study.Results: Total of 165 patients accepted LE in our study, among these patients: 27 (16.4%) patients with P1 and/or CY1: 19 (11.5%) patients were found PD (P1), 17 (10.3%) patients with positive cytological examination (CY1) and 9 (3.6%) patients with P1Cy1. The stratified analysis by cT stage indicated that there was no P1 and/or Cy1 in cT1-cT2 stages, 1 (2.7%) patient with P1 and 1 (2.7%) with Cy1 in cT3 stage, 18 (20.0%) patients with P1 and 16 (17.8%) with Cy1 in cT4 stage. After LE, there were 74 (44.8%) patients underwent laparoscopic assistant gastrectomy, 25 (15.2%) patients with open gastrectomy, 50 (30.3%) patients with neoadjuvant chemotherapy and 16 (9.7%) patients with palliative chemotherapy and/or conversion therapy.Conclusion: "Four-Step Procedure" LE is reliable and feasible for gastric cancer. From our study, LE has unique superiority on ascertaining PD and cytological examination and LE should be recommended in cT4 stage gastric cancer before resection. [ABSTRACT FROM AUTHOR]

Unmanipulated haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) has been an established treatment to cure high-risk leukemia/lymphoma. Relapse is the main cause of treatment failure for patients with relapsed/refractory disease or with very high-risk gene mutations such as TP53, TET2, and DNMT3a. In this study, we aimed to establish the tolerance and efficacy of prophylactic donor lymphocyte infusion (DLI) with G-CSF-primed peripheral blood progenitors for prevention of relapse in these very high-risk patients after haplo-PBSCT. The prophylactic DLI was given at a median of 77 days after transplantation in 31 of 45 consecutive patients with very high-risk leukemia/lymphoma. The median dose of CD3+ cells for infusion was 1.8 × 107/kg. The 100-day incidences of acute graft-versus-host disease (GVHD) grades 2-4 and 3-4 after DLI were 55.3% and 10.2%. The 2-year incidences of chronic GVHD and severe chronic GVHD were 52.0% and 18.2%. The 2-year incidences of non-relapse mortality and relapse were 33.1% and 32.5%. The 2-year probabilities of overall survival and relapse-free survival were 40.1% and 31.9%. Poor-risk gene mutations (p = 0.029), disease in non-remission status prior to transplantation (p = 0.005), and donors older than 40 years of age (p = 0.043) were associated with relapse after DLI. In multivariate analysis, disease in non-remission status prior to transplantation was an independent risk factor of relapse (hazard ratio = 4.079; p = 0.035). These data showed the feasibility of the prophylactic DLI in the haplo-PBSCT setting and the anti-leukemic efficacy in very high-risk leukemia/lymphoma. [ABSTRACT FROM AUTHOR]

Background: Staging laparoscopy(SL) is a recommended technique for the staging of Gastric Cancer(GC) and provides the indication for a radical surgery. Considering the medical practice in China, the standardized and regular usage of SL is yet to be spread. However, existing guidelines vary and make an ambiguity of indication for SL. Besides, the specific indication for Chinese patients remains a niche. This study aims to the essential, missing information of Chinese patients and tries to normalize the indication of LS in medical practice in China.Methods: The study is a prospective, multicenter cohort study being conducted in China with a total of 450 patients, all diagnosed with locally advanced gastric cancer (cT2-4 N0-3 M0, no evidence of intra-abdominal dissemination) through Computed Tomography(CT) and/or Endoscopic Ultrasonography(EUS). Peritoneal lavage is regularly performed during the SL. Multivariate Cox regression model and receiver-operator characteristic(ROC) analysis will be used to analyze the significant risk factors of intra-abdominal metastasis(including peritoneal dissemination and a positive cytological result).Discussion: This confirmatory study will provide us with the specific positive rate of intraabdominal metastasis of GC in China, compared with empirical evidence of 20%. We expect this trial will contribute to our discovery of the specific risk factors of intra-abdominal metastasis of Chinese patients and to the stimulating and performing of minimally invasive surgical procedures.Trial Registration: ClinicalTrials.gov : registration number NCT02172690 . [ABSTRACT FROM AUTHOR]

Background: Phelan-McDermid syndrome (PMS) or 22q13 deletion syndrome is a rare developmental disorder characterized by hypotonia, developmental delay (DD), intellectual disability (ID), autism spectrum disorder (ASD) and dysmorphic features. Most cases are caused by 22q13 deletions encompassing many genes including SHANK3. Phenotype comparisons between patients with SHANK3 mutations (or deletions only disrupt SHANK3) and 22q13 deletions encompassing more than SHANK3 gene are lacking.Methods: A total of 29 Mainland China patients were clinically and genetically evaluated. Data were obtained from medical record review and a standardized medical history questionnaire, and dysmorphology evaluation was conducted via photographic evaluation. We analyzed 22q13 deletions and SHANK3 small mutations and performed genotype-phenotype analysis to determine whether neurological features and other important clinical features are responsible for haploinsufficiency of SHANK3.Results: Nineteen patients with 22q13.3 deletions ranging in size from 34 kb to 8.7 Mb, one patient with terminal deletions and duplications, and nine patients with SHANK3 mutations were included. All mutations would cause loss-of function effect and six novel heterozygous variants, c.3838_3839insGG, c.3088delC, c.3526G > T, c.3372dupC, c.3120delC and c.3942delC, were firstly reported. Besides, we demonstrated speech delay (100%), DD/ID (88%), ASD (80%), hypotonia (83%) and hyperactivity (83%) were prominent clinical features. Finally, 100% of cases with monogenic SHANK3 deletion had hypotonia and there was no significant difference between loss of SHANK3 alone and deletions encompassing more than SHANK3 gene in the prevalence of hypotonia, DD/ID, ASD, increased pain tolerance, gait abnormalities, impulsiveness, repetitive behaviors, regression and nonstop crying which were high in loss of SHANK3 alone group.Conclusions: This is the first work describing a cohort of Mainland China patients broaden the clinical and molecular spectrum of PMS. Our findings support the effect of 22q13 deletions and SHANK3 point mutations on language impairment and several clinical manifestations, such as DD/ID. We also demonstrated SHANK3 haploinsufficiency was a major contributor to the neurological phenotypes of PMS and also responsible for other important phenotypes such as hypotonia, increased pain tolerance, impulsiveness, repetitive behaviors, regression and nonstop crying. [ABSTRACT FROM AUTHOR]

We hope to establish a new readmission prediction score for patients with head and neck cancer (HNC) after major cancer surgery. A retrospective cohort study was conducted from the clinical and cancer registry data at Kaohsiung Veterans General Hospital. We included the data of patients with newly diagnosed HNC who underwent surgical treatment between Nov 2010 and Dec 2017. Multivariate logistic regression was performed to determine independent factors for 30-day readmission rate and establish a new prediction score. We compared the discriminatory ability of our new prediction score, HOSPTIAL score, and LACE index using linear trend chi-square test, the Akaike information criterion (AIC), and c-statistic. The 487 patients with HNC who underwent major surgery were discharged from the medical center. Of these patients, 40 (8.2%) were readmitted to the same hospital within 30 days. Our prediction score, namely LIST (representing leukocytosis, Charlson comorbidity index score of > 0, length of stay of top 33% for the total population, and advanced tumor stage) was derived through multivariate logistic regression. Compared with the HOSPITAL score and LACE index, LIST had a higher linear trend chi-square value (27.8 vs 4.3 and 6.3), higher prediction accuracy (0.743 vs 0.586 and 0.589), and lower AIC value (251 vs 274 and 272). The LIST can estimate 30-day readmission rates in patients with HNC. More intensive discharge planning and transition of care along with patient education can be applied to this high-risk group before discharge. [ABSTRACT FROM AUTHOR]