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Background: Targeted therapy for intrahepatic cholangiocarcinoma (ICC) shows superior survival outcomes but patients with certain targetable alterations are no more than 20%. Genetic alteration screening for all ICC patients is of high cost and not routinely performed. This study intends to develop a histopathology-based artificial intelligence (AI)-assisted system for predicting genetic alteration of ICC. Methods: We constructed a Genetic Alteration Prediction (GAP) system based on multi-instance learning and self-supervised learning to predict genetic alterations using whole-slide images (WSIs) of H&E-stained slides. A total of 2069 WSIs from 232 ICC patients underwent surgery of the FAH-SYSU dataset were used for model construction and adjustment by five-fold cross-validation. Another 150 patients from three medical centres were used as independent external validations. We also compared the cost-effectiveness of GAP-assisted precise treatment and all-sequencing strategy to non-sequencing strategy. Results: The GAP was able to predict actionable genetic alterations of ICC, including FGFR2 and IDH. The area under the receiver operating characteristic curves (AUC) for FGFR2 and IDH were 0.754 and 0.713 in the internal dataset, and 0.724 and 0.656 in the external dataset, respectively. Furthermore, compared to giving chemotherapy without sequencing for every patient, GAP-assisted precise treatment could increase 1 progression-free quality-adjusted life month with a cost of $13871.72, the co-responding figure for all-sequencing strategy is $44538.93. Decision curve analysis showed that AI-assisted strategy provides better clinical benefits. Conclusions: We constructed an AI-assisted genetic alteration screening system which is predictable to ICC actionable targets and has potential to assist precise targeted treatment of advanced ICC. [ABSTRACT FROM AUTHOR]

To explore the advantages in the flexibility of ternary pumped storage units (T-PSUs) compared with fixed-speed pumped storage units (FS-PSUs) and variable-speed pumped storage units (VS-PSUs) in the day-ahead optimal scheduling of power systems, this paper firstly establishes the mathematical model of T-PSUs which is suitable for the target application, and establishes a new hybrid pumped storage model combining both FS-PSUs and T-PSUs for the purpose of improving existing FS-PSUs. Secondly, a day-ahead optimal scheduling model used for a wind-thermal-pumped storage bundled transmission system with the goal of obtaining the lowest operating cost is established. Additionally, various indicators are proposed to comprehensively evaluate the flexibility of different pumped storage unit types on day-ahead optimal scheduling. Finally, a sensitivity analysis is conducted from three aspects: covering the wind power capacity, load rate, and pumped storage capacity. The results indicate that T-PSUs are superior to FS-PSUs and VS-PSUs in maintaining the smooth, economic, and robust operation of thermal power units, as well as in promoting wind power consumption. This provides a significant reference for evaluating the technical and economic benefits of the different types of pumped storage units in applications of future power grids. [ABSTRACT FROM AUTHOR]

Background: Accurate estimation of the long-term risk of recurrence in patients with non-metastatic colorectal cancer (CRC) is crucial for clinical management. Histology-based deep learning is expected to provide more abundant information for risk stratification. Methods: We developed and validated a weakly supervised deep-learning model for predicting 5-year relapse-free survival (RFS) to stratify patients with different risks based on histological images from three hospitals of 614 cases with non-metastatic CRC. A deep prognostic factor (DL-RRS) was established to stratify patients into high and low-risk group. The areas under the curve (AUCs) were calculated to evaluate the performances of models. Results: Our proposed model achieves the AUCs of 0.833 (95% CI: 0.736–0.905) and 0.715 (95% CI: 0.647–0.776) on validation cohort and external test cohort, respectively. The 5-year RFS rate was 45.7% for high DL-RRS patients, and 82.5% for low DL-RRS patients respectively in the external test cohort (HR: 3.89, 95% CI: 2.51–6.03, P < 0.001). Adjuvant chemotherapy was associated with improved RFS in Stage II patients with high DL-RRS (HR: 0.15, 95% CI: 0.06–0.38, P < 0.001). Conclusions: DL-RRS has a good predictive performance of 5-year recurrence risk in CRC, and will better serve the clinical decision-making. [ABSTRACT FROM AUTHOR]

The modular multilevel converter based high voltage direct current (MMC-HVDC) is a dynamic power balancing system. The control system of MMC generally adopts a dual closed-loop vector control strategy based on the traditional instantaneous power model under asymmetric grid state, which has complex control structure and low control accuracy. This paper introduces a flexible instantaneous power model and establishes a general power equation with active power and new reactive power as control objects. Based on this, an improved sliding-mode MMC-HVDC direct power control strategy based on the new instantaneous power model is proposed which combines the flexible instantaneous power model and the improved sliding-mode control method to eliminate the twice grid-frequency ripples in both active and reactive power under asymmetric grid states. Furthermore, it omits the inner-loop controller and power compensation terms while optimizing the control structure. Simulation results show that the proposed method has better dynamic responsiveness, control accuracy and robustness under operating conditions such as asymmetric grid state and parameter perturbation which can better exploit the advantages of the flexible instantaneous power model. [ABSTRACT FROM AUTHOR]

The Fractional Frequency Transmission System (FFTS) operates with low frequency to decrease the electrical length of AC transmission lines, consequently enhancing transmission capacity. The integration of renewable energy sources via FFTS will significantly impact power system planning. This paper presents a Fractional Frequency Transmission Expansion Planning (FF‐TEP) model, which considers the interaction between FFTS and the industrial‐frequency power grid. This model addresses the challenges posed by the integration of offshore wind power through FFTS, and takes several key factors into account, including the active power coupling of Modular Multilevel Matrix Converter (M3C), inverter capacity, and converter transformer capacity. To address the non‐convexity caused by AC power flow, this paper introduces a Genetic‐Particle Swarm Optimization algorithm (G‐PSO) with dynamic penalties tailored to the M3C structure. This approach incorporates both crossover and mutation operators from Genetic Algorithms (GA) into Particle Swarm Optimization (PSO). The penalty function dynamically adapts according to the M3C structure, resulting in improved global optimization while maintaining computational efficiency. The results of two case studies demonstrate that FFTS can significantly enhance transmission capacity while reducing cable charging power. This reduces investment costs and decreases voltage offset issues. [ABSTRACT FROM AUTHOR]

There is still controversy about whether severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination at different times of day will induce a stronger immune response. Therefore, a randomized controlled trial (ChiCTR2100045109) is conducted to investigate the impact of vaccination time on the antibody response to the inactivated vaccine against SARS‐CoV‐2 from April 15 to 28, 2021. Participants are randomly assigned in a 1:1 ratio to receive inactivated SARS‐CoV‐2 vaccine in the morning or afternoon. The primary endpoint is the change of neutralizing antibody between baseline and 28 days after the second dose. In total, 503 participants are randomized, and 469 participants (238 in the morning group and 231 in the afternoon group) complete the follow‐up. There is no significant difference in the change of neutralizing antibody between baseline and 28 days after the second dose between the morning and afternoon groups (22.2 [13.2, 45.0] AU mL−1 vs 22.0 [14.4, 40.7] AU mL−1, P = 0.873). In prespecified age and sex subgroup analyses, there is also no significant difference in the morning and afternoon group (all P > 0.05). This study demonstrates that the vaccination time does not affect the antibody response of two doses of inactivated SARS‐CoV‐2 vaccine. [ABSTRACT FROM AUTHOR]

Introduction: Organic agriculture is highly regarded by people for its commitment to health, ecology, care, and fairness. The soil microbial community responds quickly to environmental changes and is a good indicator for evaluating soil microecology. Therefore, from the perspective of soil microbial communities, elucidating the impact of organic management on soil microecology in tea plantations has great significance for improving local tea plantation systems. Methods: The study collected bulk soil from organic management (OM) and conventional management (CM) tea plantations in Pu’er City, a major tea-producing area in China, and analyzed their species diversity, structural composition, and co-occurrence networks using metagenomics technology. Results: Compared with CM, the diversity index (Shannon) and evenness index (Heip) of soil fungi increased by 7.38% and 84.2% in OM tea plantations, respectively. The relative abundance of microorganisms related to the nitrogen cycle increased. Specifically, there was a significant increase in Rhodobiales, a 2-fold increase in Nitrospirae, and approximately 1.95 and 2.03 times increases in unclassified genera within Betaproteobacteria and Deltaproteobacteria, respectively. The relative abundance of plant residue degradation species, Gemmatimonadetes, Ascomycota, and Basidiomycota, increased by 2.8, 1, and 1.4 times, respectively. The OM was conducive to the establishment of collaborative relationships among bacterial species and increased the diversity and complexity of species relationships in fungal communities. The network stability of soil ecosystems was promoted. The organic tea plantations’ keystone taxa contained mycorrhizal fungi (Pezoloma_ericae, Rhizophagus_irregularis, Rhizophagus_clarus), as well as species involved in soil nitrogen metabolism (Acidobacteria_bacterium, Acidobacteriia_bacterium_AA117, Sphingomonas_sp._URHD0007, Enhydrobacter_aerosaccus), pathogen (Erysiphe_pulchra), and parasites (Paramycosporidium saccamoeba). The partial least squares method (PLS-SEM) indicated that OM affected N-NH+4negatively, increasing the abundance of fungi, and thereby positively affecting the Shannon index. Conclusion: In brief, reasonable organic management can improve the diversity of soil microorganisms, increase the relative abundance of beneficial bacteria in tea plantation soil, and promote the stability of the soil microbial ecological network. [ABSTRACT FROM AUTHOR]

Background: Liver resection is the mainstay of curative treatment for intrahepatic cholangiocarcinoma (ICC) while the postoperative prognosis varies greatly, with no recognized biomarker. We aimed to identify the plasma metabolomic biomarkers that could be used for preoperative risk stratification of ICC patients. Methods: 108 eligible ICC patients who underwent radical surgical resection between August 2012 and October 2020 were enrolled. Patients were randomly divided into a discovery cohort (n = 76) and a validation cohort (n = 32) by 7:3. Metabolomics profiling of preoperative plasma was performed and clinical data were collected. The least absolute shrinkage and selection operator (LASSO) regression, Cox regression, and receiver operating characteristic (ROC) analyses were used to screen and validate the survival-related metabolic biomarker panel and construct a LASSO-Cox prediction model. Results: 10 survival-related metabolic biomarkers were used for construction of a LASSO-Cox prediction model. In the discovery and validation cohorts, the LASSO-Cox prediction model achieved an AUC of 0.876 (95%CI: 0.777–0.974) and 0.860 (95%CI: 0.711–1.000) in evaluating 1-year OS of ICC patients, respectively. The OS of ICC patients in the high-risk group was significantly worse than that in the low-risk group (discovery cohort, p < 0.0001; validation cohort: p = 0.041). Also, the LASSO-Cox risk score (HR 2.43, 95%CI: 1.81–3.26, p < 0.0001) was a significant independent risk factor associated with OS. Conclusions: The LASSO-Cox prediction model has potential as an important tool in evaluating the OS of ICC patients after surgical resection and can be used as prediction tools to implement the best treatment options that could result in better outcomes. [ABSTRACT FROM AUTHOR]

The research on terahertz wave manipulation based on metasurfaces has gradually deepened, and the number of functions or electromagnetic control dimensions in a single device is constantly increasing. For the spatial dimension of terahertz field regulation, its design degrees of freedom have been expanded from a single transverse plane to the propagation path. In this paper, we propose a novel circularly polarization multiplexed metasurface for dual channel terahertz wave transmission control. Based on the spatial integration of two heterogeneous meta-atoms, which are spin-decoupled and isotropic, respectively, there are four phase channels that can be used at the same time, thus achieving different switching between vector and scalar beams in different circularly polarization channels along the optical path. For linearly polarized wave incidence, the device exhibits conversion between different vector beams longitudinally. To control more electric field components, we combine focused wavefront design with vector or scalar fields and utilize the focusing induced spin–orbit coupling effect, then complex amplitude switching of longitudinal electric field components is obtained. This article extends the manipulation of terahertz waves along the propagation trajectory based on metasurface from single to dual channel for the first time, providing a reference for the design of multifunctional meta-device in terahertz band. [ABSTRACT FROM AUTHOR]

Background: Negative conversion of nucleic acid was a key factor in deciding discharge or the end of isolation of asymptomatic or mild COVID-19 patients. We aimed to explore the effect of vaccination on the time to negative conversion after Omicron infection. Methods: This retrospective cohort study included asymptomatic or mild patients with COVID-19 admitted to Fangcang shelter Hospital from November 10, 2022 to December 2, 2022. The relationship between vaccination status and the time to negative conversion was analyzed by multiple linear regression. Results: A total of 2,104 asymptomatic or mild COVID-19 patients were included in the analysis, of whom 1,963 were vaccinated. The mean time to negative conversion of no vaccination, one dose, two doses, and three doses were 12.57 (5.05), 12.18 (3.46), 11.67 (4.86) and 11.22 (4.02) days, respectively (p = 0.002). Compared with no vaccination, two doses (β=-0.88, 95% CI: -1.74, -0.02, p = 0.045), and three doses (β=-1.51, 95% CI: -2.33, -0.70, p < 0.001) were both associated with shorter time to negative conversion. Comparing with two doses, booster dose was associated significantly with shorter time to negative conversion (β=-0.63, 95% CI: -1.07, -0.20, p = 0.004). Age was positively correlated with the time to negative conversion (β = 0.04, 95% CI: 0.02, 0.05, p < 0.001). Conclusion: Vaccination with inactivated vaccine and booster dose can shorten the time to negative conversion of asymptomatic or mild COVID-19 patients. The significant prolongation of time to negative conversion with increasing age suggests the promotion of vaccination, especially booster dose, particularly in the elderly. [ABSTRACT FROM AUTHOR]

Background: Both dysregulation of mechanistic target of rapamycin (mTOR) signalling and DNA methylation patterns have been shown to be closely associated with tumor progression and serve as promising targets for hepatocellular carcinoma (HCC) therapy. Although their respective roles in HCC have been extensively revealed, the existence of molecular interactions between them remains largely unknown. Methods: The association of DNA methylation and mTOR signalling in HCC tissues and cell lines was assessed. A Kaplan‒Meier analysis was applied to estimate the overall survival (OS) and recurrence-free survival (RFS) of HCC patients. The modulation of DNMT1 by mTOR in HCC cell lines was determined. The effect of the drug combination in cell lines and mouse models was examined. Results: The results showed that the DNA methylation level was positively associated with the activation of mTOR signalling in HCC tissues and cell lines. Moreover, HCC patients with higher DNA methylation levels and enhanced activation of mTOR signalling exhibited the worst prognosis. Then, we screened methylation-related enzymes and found that the activation of mTOR signalling increased DNMT1 expression and activity. In addition, mTOR enhanced the translational efficiency of DNMT1 in a 4E-BP1-dependent manner, which is based on the pyrimidine rich translational element (PRTE)-containing 5′UTR of DNMT1. Moreover, we demonstrated that the combined inhibition of mTOR and DNMT synergistically inhibited HCC growth in vitro and in vivo. Conclusions: In addition to some already identified pro-cancer downstream molecules, the activation of mTOR signalling was found to promote DNA methylation by increasing the translation of DNMT1. Furthermore, combined targeting of mTOR and DNMT1 has been demonstrated to have a more effective tumor suppressive function in HCC. [ABSTRACT FROM AUTHOR]

With the sharp increase in fluctuant sources in power systems, the deterministic power flow (DPF) calculation has been unable to meet the demands of practical applications; thus, the probabilistic method becomes indispensable for the reliable and stable operation of power systems. This paper adopts the probabilistic power flow (PPF) method, which is a Monte Carlo simulation (MCS) based on the Latin hypercube sampling (LHS) method, to analyze the uncertainties of power systems. Specifically, the available load supply capability (ALSC) based on the branch loading rate is used to analyze the safety margin of the whole system, while the improved power flow entropy is introduced to quantify the equilibrium of power flow distribution. The repeated power flow (RPF) calculation is combined with the PPF method, and, hence, the probabilistic repeated power flow (PRPF) method is proposed to calculate the power flow entropy at the initial state and the probabilistic ALSC. To flexibly control the power flow, the unified power flow controller (UPFC) is added to the AC power system. The different control coefficients of UPFC are set to reveal the relationship between power flow entropy and available load supply capability under the stochastic scenarios. Finally, the modified IEEE14 test system is used to study the adjustment abilities of UPFC. With consideration of uncertainties in the test case, the positive effect of UPFC on the power flow entropy and the probabilistic ALSC under stochastic scenarios is deeply studied. [ABSTRACT FROM AUTHOR]

Dectin-1 (gene Clec7a), a receptor for β-glucans, plays important roles in the host defense against fungi and immune homeostasis of the intestine. Although this molecule is also suggested to be involved in the regulation of tumorigenesis, the role in intestinal tumor development remains to be elucidated. In this study, we find that azoxymethane-dextran-sodium-sulfate-induced and ApcMin-induced intestinal tumorigenesis are suppressed in Clec7a−/− mice independently from commensal microbiota. Dectin-1 is preferentially expressed on myeloid-derived suppressor cells (MDSCs). In the Clec7a−/− mouse colon, the proportion of MDSCs and MDSC-derived prostaglandin E2 (PGE2) levels are reduced, while the expression of IL-22 binding protein (IL-22BP; gene Il22ra2) is upregulated. Dectin-1 signaling induces PGE2-synthesizing enzymes and PGE2 suppresses Il22ra2 expression in vitro and in vivo. Administration of short chain β-glucan laminarin, an antagonist of Dectin-1, suppresses the development of mouse colorectal tumors. Furthermore, in patients with colorectal cancer (CRC), the expression of CLEC7A is also observed in MDSCs and correlated with the death rate and tumor severity. Dectin-1 signaling upregulates PGE2-synthesizing enzyme expression and PGE2 suppresses IL22RA2 expression in human CRC-infiltrating cells. These observations indicate a role of the Dectin-1-PGE2-IL-22BP axis in regulating intestinal tumorigenesis, suggesting Dectin-1 as a potential target for CRC therapy. The effect of β-glucans and their receptor Dectin-1 in tumor development remains controversial. Here the authors show that Dectin-1 signaling promotes the development of colorectal cancer (CRC) by inducing prostaglandin E2 production in myeloid-derived suppressor cells and by suppressing IL-22BP expression, suggesting dectin-1 blockade as a potential therapeutic target for CRC. [ABSTRACT FROM AUTHOR]

Emerging chromium (Cr) species have attracted increasing concern. A majority of Cr species, especially hexavalent chromium (Cr(VI)), could lead to lethal effects on human beings, animals, and aquatic lives even at low concentrations. One of the conventional water-treatment methodologies, adsorption, could remove these toxic Cr species efficiently. Additionally, adsorption possesses many advantages, such as being cost-saving, easy to implement, highly efficient and facile to design. Previous research has shown that the application of different adsorbents, such as carbon nanotubes (carbon nanotubes (CNTs) and graphene oxide (GO) and its derivatives), activated carbons (ACs), biochars (BCs), metal-based composites, polymers and others, is being used for Cr species removal from contaminated water and wastewater. The research progress and application of adsorption for Cr removal in recent years are reviewed, the mechanisms of adsorption are also discussed and the development trend of Cr treatment by adsorption is proposed. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection causes coronavirus disease 2019 (COVID‐19), which is still devastating economies and communities globally. The increasing infections of variants of concern (VOCs) in vaccinated population have raised concerns about the effectiveness of current vaccines. Patients with autoimmune diseases (PAD) under immunosuppressant treatments are facing higher risk of infection and potentially lower immune responses to SARS‐CoV‐2 vaccination. Methods: Blood samples were collected from PAD or healthy controls (HC) who finished two or three doses of inactivated vaccines. Spike peptides derived from wild‐type strain, delta, omicron BA.1 were utilised to evaluate T cell responses and their cross‐recognition of delta and omicron in HC and PAD by flow cytometry and ex vivo IFNγ‐ELISpot. Results: We found that inactivated vaccine‐induced spike‐specific memory T cells were long‐lasting in both PAD and HC. These spike‐specific T cells were highly conserved and cross‐recognized delta and omicron. Moreover, a third inactivated vaccine expanded spike‐specific T cells that responded to delta and omicron spike peptides substantially in both PAD and HC. Importantly, the polyfunctionality of spike‐specific memory T cells was preserved in terms of cytokine and cytotoxic responses. Although the extent of T cell responses was lower in PAD after two‐dose, T cell responses were boosted to a greater magnitude in PAD by the third dose, bringing comparable spike‐specific T cell immunity after the third dose. Conclusion: Inactivated vaccine‐induced spike‐specific T cells remain largely intact against delta and omicron variants. This study expands our understanding of inactivated vaccine‐induced T cell responses in PAD and HC, which could have important indications for vaccination strategy. [ABSTRACT FROM AUTHOR]

In this paper, we theoretically consider the magneto-optical spin Hall effect of light (MOSHEL) in a graphene–gold heterojunction structure at terahertz frequencies, and determine the maximum value of the transverse shift of the spin Hall effect of light (SHEL) in the designed structure by varying the terahertz frequency, the thickness of the metal layer, the Fermi energy level of the graphene, and the magnetic induction density. When the terahertz frequency was 1.2 THz, the metal layer thickness 50 nm, the Fermi level 0.2 eV, and the magnetic induction density B was 10 T, the SHEL shifts of left-handed circularly polarized (LHCP) and right-handed circularly polarized (RHCP) components was greatest at the critical angle (58°), with as value of 498 μm, 1000 times larger than the visible light. At this point, graphene exhibited a significant magneto-optical effect, dramatically enhancing the splitting extrema of LHCP and RHCP. This structure will provide possibilities for enhancement of the transverse shift and efficient regulation of the optical spin Hall effect within the terahertz range. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, elective surgery has to undergo longer wait times, including nephrectomy for T1 renal cell carcinoma (RCC). This study aimed to investigate the time-to-surgery (TTS) of Chinese T1 RCC patients and its influencing factors, and to illustrate the impact of TTS on the prognosis of T1 RCC. Methods: We retrospectively enrolled 762 Chinese patients with pathological T1 RCC that underwent nephrectomy. To discover the impact of TTS on survival outcomes, we explored the possible delay intervals by week using the Kaplan-Meier method and Log-rank test. Cox proportional hazard models with inverse probability-treatment weighting (IPTW) were used to assess the association between TTS and disease-free survival (DFS) and overall survival (OS). Results: The median TTS of T1 RCC patients was 15 days. The Charlson comorbidity index, the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score, and the maximal tumor diameter on presentation were independent influencing factors for TTS. The cut-off point of TTS was selected as 5 weeks according to the Log-rank analysis. For T1a RCC, patients with TTS > 5 weeks had similar DFS (HR = 2.39; 95% CI, 0.82–6.94; p = 0.109) and OS (HR = 1.28; 95% CI, 0.23–7.16; p = 0.779) compared to patients with TTS ≤ 5 weeks. For T1b RCC, patients with TTS > 5 weeks had shorter DFS (HR = 2.90; 95% CI = 1.46–5.75; p = 0.002) and OS (HR = 2.49, 95% CI = 1.09–5.70; p = 0.030) than patients with TTS ≤ 5 weeks. Conclusions: Prolonged TTS had no impact on the prognosis of T1a RCC while surgery delayed for over 5 weeks may lead to worse survival in T1b RCC. [ABSTRACT FROM AUTHOR]

Background and aim: Preoperative evaluation of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) is important for surgical strategy determination. We aimed to develop and establish a preoperative predictive model for MVI status based on DNA methylation markers. Methods: A total of 35 HCC tissues and the matched peritumoral normal liver tissues as well as 35 corresponding HCC patients' plasma samples and 24 healthy plasma samples were used for genome-wide methylation sequencing and subsequent methylation haplotype block (MHB) analysis. Predictive models were constructed based on selected MHB markers and 3-cross validation was used. Results: We grouped 35 HCC patients into 2 categories, including the MVI− group with 17 tissue and plasma samples, and MVI + group with 18 tissue and plasma samples. We identified a tissue DNA methylation signature with an AUC of 98.0% and a circulating free DNA (cfDNA) methylation signature with an AUC of 96.0% for HCC detection. Furthermore, we established a tissue DNA methylation signature for MVI status prediction, and achieved an AUC of 85.9%. Based on the MVI status predicted by the DNA methylation signature, the recurrence-free survival (RFS) and overall survival (OS) were significantly better in the predicted MVI− group than that in the predicted MVI + group. Conclusions: In this study, we identified a cfDNA methylation signature for HCC detection and a tissue DNA methylation signature for MVI status prediction with high accuracy. [ABSTRACT FROM AUTHOR]

Intercropping often substantially increases phosphorus (P) availability to plants compared with monocropping, which could be an effective strategy for soil legacy P recovery and agricultural production. However, the biogeochemical interactions among plants, microbes, and soil that mobilize P remain largely unknown in intercropping systems. Pot experiments with maize-soybean intercropping in a calcareous soil were conducted to investigate the potential chemical and biological transformation mechanisms of inorganic P (Pi) and organic P (Po) using sequential extraction and Illumina MiSeq sequencing. Compared to monocropping of each crop, maize-soybean intercropping significantly enhanced total P uptake of the two crops by mobilizing Ca2-Pi [extracted by bicarbonate (NaHCO3)], Al-Pi/Po [extracted by ammonium fluoride (NH4F)] and Fe-Pi [extracted by sodium hydroxide and sodium carbonate (NaOH-Na2CO3)] fractions. Furthermore, there were significant increases in the organic carbon content and alkaline phosphomonoesterase (ALP) and phosphodiesterase (PDE) activities as well as the abundances of Microvirga, Lysobacter, Microlunatus and Sphingomonas under maize-soybean intercropping relative to monocropping. In contrast, compared to monocroppping, no significant change in the soil pH was observed under maize-soybean intercropping. Therefore, the enhanced P uptake of the maize-soybean intercropping probably resulted from a synergistic effect of rhizosphere organic carbon deposit, increased activities of ALP and PDE, together with the bacteria (Microvirga, Lysobacter, Microlunatus and Sphingomonas) which showed correlation with soil P forms, while the generally recognized rhizosphere acidification was excluded in this investigated calcareous soil. Moreover, the selected bacterial genera exhibited a closer network in the rhizosphere of soybean compared to maize, suggesting enhanced interactions among bacteria in the soybean rhizosphere. These results provide theoretical bases for the recovery of soil legacy P by maize-soybean intercropping. [ABSTRACT FROM AUTHOR]

The effectiveness of a 3rd dose of SARS-CoV-2 vaccines waned quickly in the Omicron-predominant period. In response to fast-waning immunity and the threat of Omicron variant of concern (VOC) to healthcare workers (HCWs), we conduct a non-randomized trial (ChiCTR2200055564) in which 38 HCWs volunteer to receive a homologous booster of inactivated vaccines (BBIBP-CorV) 6 months after the 3rd dose. The primary and secondary outcomes are neutralizing antibodies (NAbs) and the receptor-binding domain (RBD)-directed antibodies, respectively. The 4th dose recalls waned immunity while having distinct effects on humoral responses to different antigens. The peak antibody response to the RBD induced by the 4th dose is inferior to that after the 3rd dose, whereas responses to the N-terminal domain (NTD) of spike protein are further strengthened significantly. Accordingly, the 4th dose further elevates the peak level of NAbs against ancestral SARS-CoV-2 and Omicron BA.2, but not BA.1 which has more NTD mutations. No severe adverse events related to vaccination are recorded during the trial. Here, we show that redistribution of immune focus after repeated vaccinations may modulate cross-protective immune responses against different VOCs. Despite the availability of booster doses against SARS-CoV-2, variants of concern are capable of escaping immune responses established by vaccination or natural infection. In this work, the authors detail the immune responses elicited in a cohort of healthcare workers, receiving a fourth dose of inactivated vaccine. [ABSTRACT FROM AUTHOR]

Power systems face adequacy risks because of the high integration of renewable energy. It is urgent to develop efficient methods for power system operational reliability assessment. Conventional power system reliability assessment methods cannot achieve real-time assessment of system risk because of the high computational complexity and long calculation time. The high computational complexity is mainly caused by a large number of optimal power flow (OPF) calculations. To reduce the computational complexity, this paper transfers the optimal power flow model as a multiparameter linear programming model. Then, the optimal power flow can be obtained by linear calculations. Furthermore, this paper proposes a state reduction method considering the importance index of transmission lines for further improving the calculation efficiency. Case studies are carried out on IEEE standard systems and a provincial power grid in China. Compared with the conventional reliability assessment method, the reliability assessment efficiency of the proposed method increases by 10–40 times, and the assessment error is less than 1%. [ABSTRACT FROM AUTHOR]

Background: Vaccination is important in influenza prevention but the immune response wanes with age. The circadian nature of the immune system suggests that adjusting the time of vaccination may provide an opportunity to improve immunogenicity. Our previous cluster trial in Birmingham suggested differences between morning and afternoon vaccination for some strains in the influenza vaccine in older adults. Whether this effect is also seen in a younger age group with less likelihood of compromised immunity is unknown. We therefore conducted an individual-based randomized controlled trial in Guangzhou to test the hypothesis that influenza vaccination in the morning induces a stronger immune response in older adults than afternoon vaccination. We included adults in middle age to determine if the effect was also seen in younger age groups. Results: Of the 418 participants randomised, 389 (93.1%, 191 middle-aged adults aged 50–60 years and 198 older adults aged 65–75 years) were followed up. Overall, there was no significant difference between the antibody titers (geometric mean /95% CI) after morning vs afternoon vaccination (A/H1N1: 39.9 (32.4, 49.1) vs. 33.0 (26.7, 40.7), p = 0.178; A/H3N2: 92.2 (82.8, 102.7) vs. 82.0 (73.8, 91.2), p = 0.091; B: 15.8 (13.9, 17.9) vs. 14.4 (12.8, 16.3), p = 0.092), respectively. However, in pre-specified subgroup analyses, post-vaccination titers for morning versus afternoon vaccination in the 65–75 years subgroup were (A/H1N1): 49.5 (36.7, 66.6) vs. 32.9 (24.7, 43.9), p = 0.050; (A/H3N2): 93.5 (80.6, 108.5) vs. 73.1 (62.9, 84.9), p = 0.021; (B): 16.6 (13.8, 20.1) vs. 14.4 (12.3, 17.0), p = 0.095, respectively. Among females, antibody titers for morning versus afternoon vaccination were (A/H1N1): 46.9 (35.6, 61.8) vs. 31.1 (23.8, 40.7), p = 0.030; (A/H3N2): 96.0 (83.5, 110.3) vs. 84.7 (74.4, 96.5), p = 0.176; (B): 14.8 (12.7, 17.3) vs. 13.0 (11.3, 14.9), p = 0.061, respectively. In the 50–60 years old subgroup and males, there were no significant differences between morning and afternoon vaccination. Conclusions: Morning vaccination may enhance the immunogenicity to influenza vaccine in adults aged over 65 and women. An intervention to modify vaccination programs to vaccinate older individuals in the morning is simple, cost free and feasible in most health systems. [ABSTRACT FROM AUTHOR]

There are two situations of transmission redundancy and transmission congestion when large-scale offshore wind farms send power out. The energy storage system can store the power blocked by wind power due to insufficient transmission capacity and release it in the period when the wind power output level is low. In this paper, a full-life-cycle cost model is established for energy storage, and a joint planning model for offshore wind power storage and transmission considering carbon emission reduction benefits is established, which integrates power grid transmission benefits, carbon emission reduction benefits, energy storage construction costs, transmission project construction costs and wind abandonment penalty costs. The channel construction and energy storage configuration scheme with the greatest net benefit can be obtained. The relationship between the transmission channel capacity setting and the energy storage parameter configuration under this model is studied, and the combined effect of transmission channel and energy storage system in improving the level of wind power transmission is analyzed. The sensitivity analysis of the influence of the optimal storage and transmission planning scheme of the offshore wind farms is carried out from the perspectives of transmission line engineering cost and transmission channel curve type. [ABSTRACT FROM AUTHOR]

Introduction: Advanced biliary tract carcinoma (BTC) has a poor prognosis and few treatment options. We compared the efficacy of the PD-1 monoclonal antibody (PD-1-mAb) combined regimens with the standard chemotherapy in the first-line and second-line treatment of advanced BTC. Methods: We retrospectively assessed the patients with advanced BTC, who received treatment at the First Affiliated Hospital of Sun Yat-Sen University and the Sun Yat-Sen University Cancer Center. The patients were treated with PD-1-mAb combined regimens or standard chemotherapy at the first line or treated with PD-1-mAb combined regimens or systematic therapy at the second line. Further subgroup analyses were assessed to identify superior regimens. Results: This study included 210 patients. The first-line PD-1-mAb combination group (n = 83) achieved longer median PFS (mPFS) (7.3 vs 5.3 months, p=0.001) and median OS (mOS) (15.6 vs 11.4 months, p=0.002) than the first-line standard chemotherapy group (n=76). Similarly, the second-line PD-1-mAb combination group (n=50) yielded longer mPFS (6.1 vs 2.6 months, p< 0.001) and mOS (11.7 vs 7.2 months, p=0.008) than the second-line systematic therapy group (n=51). Subgroup analyses showed that the PD-1-mAb combined with TKI group achieved better mPFS than the chemotherapy group whether in the first-line (HR = 0.468, p=0.005) or the second-line setting (HR = 0.45, p=0.009), but did not achieve superiority in mOS (both p 0.05). Compared with the chemotherapy group, the PD-1-mAb combined with chemotherapy group achieved longer mOS (HR = 0.53, p=0.023) in the first-line setting and longer mPFS in the second-line setting (HR = 0.54, p=0.044). Conclusion: The PD-1-mAb combination therapy is superior to the standard chemotherapy in advanced or unresectable BTC, whether as a first-line or second-line treatment. Among the combination therapy, both the PD-1-mAb combined with TKI and combined with standard chemotherapy were promising options for advanced BTC patients. [ABSTRACT FROM AUTHOR]

Background: The safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines is widely appreciated. However, there is limited knowledge regarding the potential impact of SARS-CoV-2 vaccines on the thyroid. Methods: We performed two prospective clinical trials between April and June, 2021, enrolling recipients of the inactivated SARS-CoV-2 vaccine (BBIBP-CorV and CoronaVac). Thyroid function, antithyroid antibody levels, and SARS-CoV-2 neutralizing antibody levels were detected for each participant before receiving the first vaccine dose and 28 days after receiving the second vaccine dose. Results: A total of 657 recipients participated in the study. The overall median thyroid function and levels of antithyroid antibodies before and after SARS-CoV-2 vaccination were within the normal range. Among the 564 participants with normal thyroid function at baseline, 36 (6.38% [confidence interval; CI 4.51–8.73]) developed thyroid dysfunction. Of the 545 recipients with negative antithyroid antibodies at baseline, none developed abnormal antibodies after vaccination. Notably, 75.27% (70/93 [CI 65.24–83.63]) of the 93 recipients with thyroid dysfunction returned to normal function after vaccination. The levels of antithyroid peroxidase antibody (96.20% [CI 89.30–99.21]) and antithyroglobulin antibody (TgAb; 88.31% [CI 78.97–94.51]) remained positive after vaccination in most patients with abnormal values at baseline. However, the TgAb levels in more than half of the patients (48/77) decreased. All of 11 abnormal thyrotropin receptor antibody levels at baseline decreased postvaccination. Conclusions: Vaccination with an inactivated SARS-CoV-2 vaccine had no significant adverse impact on thyroid function or antithyroid antibodies within the first 28 days after the second dose. Clinical Trial Registration: ChiCTR2100045109 and ChiCTR2100042222. [ABSTRACT FROM AUTHOR]

In practical AC/DC hybrid grids, the uncertainty sources such as wind speeds and loads are massive and bounded intrinsically, the latter feature of which is neglected in most probabilistic power flow (PPF) analyses unfortunately. In this paper, a scaled unscented transformation (SUT)-based PPF on the large AC/DC hybrid grids, in particular for addressing the boundary issue of these high-dimensional random input variables under Pearson correlation, is proposed and investigated. The empirical formula used for determining the scaling parameter of the SUT method is designed to obtain the sample points, with a purpose of capturing sufficient probability information from the preliminary standard normal distributions. Boundary inverse transformation (BIT) is developed to transform these samples into the original probability space via handling each dimensional boundary value, and to guarantee that all the sample points of SUT fall into a reasonable, physical interval. The effectiveness and advantage of the proposed method are validated by using a set of test results on the modified IEEE 1354-bus (PEGASE) system. [ABSTRACT FROM AUTHOR]

Aims: With prevalence of hepatocellular carcinoma (HCC) in low-risk population (LRP), establishing a non-invasive diagnostic strategy becomes increasingly urgent to spare unnecessary biopsies in this population. The purposes of this study were to find characterisics of HCC and to establish a proper non-invasive method to diagnose HCC in LRP.Methods: A total of 681 patients in LRP (defined as the population without cirrhosis, chronic HBV infection or HCC history) were collected from 2 institutions. The images of computed tomography (CT) and magnetic resonance imaging (MRI) were manually analysed. We divided the patients into the training cohort (n = 324) and the internal validating cohort (n = 139) by admission time in the first institution. The cohort in the second institution was viewed as the external validation (n = 218). A multivariate logistic regression model incorporating both imaging and clinical independent risk predictors was developed. C-statistics was used to evaluate the diagnostic performance.Results: Besides the major imaging features of HCC (non-rim enhancement, washout and enhancing capsule), tumor necrosis or severe ischemia (TNSI) on imaging and two clinical characteristics (gender and alpha fetoprotein) were also independently associated with HCC diagnosis (all P < 0.01). A clinical model (including 3 major features, TNSI, gender and AFP) was built to diagnose HCC and achieved good diagnostic performance (area under curve values were 0.954 in the training cohort, 0.931 in the internal validation cohort and 0.902 in the external cohort).Conclusions: The clinical model in this study developed a satisfied non-invasive diagnostic performance for HCC in LRP. [ABSTRACT FROM AUTHOR]

Background: The past decade has witnessed a dramatic increase in the number of patients with inflammatory bowel disease (IBD) in China. The nationwide burden of hospitalization remains unclear, however. We aimed to address this gap by conducting analysis using a nationwide database. Methods: Population-based hospitalization rates from 2013 to 2018 were calculated by extrapolating the number of patients in the database to the national level. Surgical rates, annual hospital charges, and length of stay were also used for quantification of hospitalization burden. The Poisson regression analysis and the Cochran–Armitage trend test were conducted to analyze temporal trends as expressed as annual percentage of change (APC) with 95% confidential intervals (CIs). Results: From 2013 to 2018, the hospitalization rates for Crohn's disease (CD) and ulcerative colitis (UC) in China increased from 2.20 (95% CI = 2.17–2.22) to 3.62 (3.59–3.65) per 100,000 inhabitants (p < 0.0001) with an APC of 10.68% (6.00–15.36%) and from 6.24 (6.20–6.28) to 8.29 (8.23–8.33) per 100,000 inhabitants (p < 0.0001) with an APC of 5.73% (2.32–9.15%), respectively. Surgical rates decreased from 7.96% (7.29–8.63%) to 5.56% (5.11–6.00%) for CD patients (p < 0.0001) with APC of −6.30% (−11.33 to −1.27%) and from 3.54% (3.26–3.82%) to 2.52% (2.32–2.72%) for UC patients (p < 0.0001) with APC of −6.35% (−16.21 to 3.51). In 2018, there were estimated 166,000 IBD patients hospitalized costing a total of $426.37 million ($149.91 + $276.46 million) across the entire China. Conclusion: The population-based hospitalization rate of IBD increased, whereas the surgical rate decreased from 2013 to 2018 in China. [ABSTRACT FROM AUTHOR]

Background: Microvascular invasion (MVI) is essential for the management of hepatocellular carcinoma (HCC). However, MVI is hard to evaluate in patients without sufficient peri-tumoral tissue samples, which account for over a half of HCC patients. Methods: We established an MVI deep-learning (MVI-DL) model with a weakly supervised multiple-instance learning framework, to evaluate MVI status using only tumor tissues from the histological whole slide images (WSIs). A total of 350 HCC patients (2917 WSIs) from the First Affiliated Hospital of Sun Yat-sen University (FAHSYSU cohort) were divided into a training and test set. One hundred and twenty patients (504 WSIs) from Dongguan People's Hospital and Shunde Hospital of Southern Medical University (DG-SD cohort) formed an external test set. Unsupervised clustering and class activation mapping were applied to visualize the key histological features. Results: In the FAHSYSU and DG-SD test set, the MVI-DL model achieved an AUC of 0.904 (95% CI 0.888–0.920) and 0.871 (95% CI 0.837–0.905), respectively. Visualization results showed that macrotrabecular architecture with rich blood sinus, rich tumor stroma and high intratumor heterogeneity were identified as the key features associated with MVI (+), whereas severe immune infiltration and highly differentiated tumor cells were associated with MVI (−). In the simulation of patients with only one WSI or biopsies only, the AUC of the MVI-DL model reached 0.875 (95% CI 0.855–0.895) and 0.879 (95% CI 0.853–0.906), respectively. Conclusion: The effective, interpretable MVI-DL model has potential as an important tool with practical clinical applicability in evaluating MVI status from the tumor areas on the histological slides. [ABSTRACT FROM AUTHOR]

Background and Aims: Radiological prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) is essential but few models were clinically implemented because of limited interpretability and generalizability. Methods: Based on 2096 patients in three independent HCC cohorts, we established and validated an MVI predicting model. First, we used data from the primary cohort to train a 3D‐ResNet network for MVI prediction and then optimised the model with "expert‐inspired training" for model construction. Second, we implemented the model to the other two cohorts using three implementation strategies, the original model implementation, data sharing model implementation and skeleton sharing model implementation, the latter two of which used part of the cohorts' data for fine‐tuning. The areas under the receiver operating characteristic curve (AUCs) were calculated to compare the performances of different models. Results: For the MVI predicting model, the AUC of the expert‐inspired model was 0.83 (95% CI: 0.77–0.88) compared to 0.54 (95% CI: 0.46–0.62) of model before expert‐inspiring. Taking this model as an original model, AUC on the second cohort was 0.76 (95% CI: 0.67–0.84). The AUC was improved to 0.83 (95% CI: 0.77–0.90) with the data‐sharing model, and further improved to 0.85 (95% CI: 0.79–0.92) with the skeleton sharing model. The trend that the skeleton sharing model had an advantage in performance was similar in the third cohort. Conclusions: We established an expert‐inspired model with better predictive performance and interpretability than the traditional constructed model. Skeleton sharing process is superior to data sharing and direct model implementation in model implementation. [ABSTRACT FROM AUTHOR]

Emerging SARS-CoV-2 variants of concern (VOCs) harboring multiple mutations in the spike protein raise concerns on effectiveness of current vaccines that rely on the ancestral spike protein. Here, we design a quadrivalent mosaic nanoparticle vaccine displaying spike proteins from the SARS-CoV-2 prototype and 3 different VOCs. The mosaic nanoparticle elicits equivalent or superior neutralizing antibodies against variant strains in mice and non-human primates with only small reduction in neutralization titers against the ancestral strain. Notably, it provides protection against infection with prototype and B.1.351 strains in mice. These results provide a proof of principle for the development of multivalent vaccines against pandemic and potential pre-emergent SARS-CoV-2 variants. Emerging SARS-CoV-2 variants with multiple mutations raise concerns on vaccine effectiveness. Here, Kang et al. report that a quadrivalent mosaic nanoparticle vaccine displaying spike proteins from the SARS-CoV-2 prototype and three different VOCs confer protection against SARS-CoV-2 variants in mice. [ABSTRACT FROM AUTHOR]

A new method to enhance the beam shift of Goos–Hänchen (GH) effect in a 1D photonic crystal based on Larmor resonance in terahertz (THz) region is proposed. Larmor resonance can enhance the surface plasmon resonance (SPR) effect, which enhances the GH effect. A 1D photonic crystal with a graphene–VO2 periodic structure is designed. As a result of different states at different temperatures, the SPR effect of graphene–VO2 periodic structure photonic crystals will change. In this structure, Larmor resonance caused by a strong magnetic field perpendicular to the incident surface will resonate with surface plasmons. It is found that the strength of the magnetic field required to enhance SPR is relative to the frequency of electromagnetic waves and the Fermi level. The enhancement of the GH effect by the Larmor resonance theory provides a new way for us to measure strong magnetic fields. [ABSTRACT FROM AUTHOR]

The oil chromatography online monitoring system can monitor the insulation status of power transformers continuously and real‐time. The accuracy of its detection data directly affects the stable operation of the transformers. Aiming at the problem of abnormal data in the current transformer online monitoring data set, this paper proposes an online oil chromatographic data processing method based on association rules and support vector regression (SVR) analysis. First, using piecewise linearization to convert numerical variables into Boolean variables, and then exploring gas indicators with strong correlations in oil chromatogram. Then, using the improved box plot method to detect the abnormal value points in it, and distinguish the data of different abnormal patterns based on the association rules. Finally, the advanced particle swarm optimization support vector regression (APSO‐SVR) algorithm is used to repair the data to improve the credibility of the data set. Using actual transformer oil chromatographic monitoring data for testing, the results show that the proposed data processing method can effectively improve the accuracy of oil chromatographic online monitoring data. © 2021 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 inactivated vaccines have shown remarkable efficacy in clinical trials, especially in reducing severe illness and casualty. However, the waning of humoral immunity over time has raised concern over the durability of immune memory following vaccination. Thus, we conducted a nonrandomized trial among the healthcare workers (HCWs) to investigate the long-term sustainability of SARS-CoV-2-specific B cells and T cells stimulated by inactivated vaccines and the potential need for a third booster dose. Although neutralizing antibodies elicited by the standard two-dose vaccination schedule dropped from a peak of 29.3 arbitrary units (AU)/mL to 8.8 AU/mL 5 months after the second vaccination, spike-specific memory B and T cells were still detectable, forming the basis for a quick recall response. As expected, the faded humoral immune response was vigorously elevated to 63.6 AU/mL by 7.2 folds 1 week after the third dose along with abundant spike-specific circulating follicular helper T cells in parallel. Meanwhile, spike-specific CD4+ and CD8+ T cells were also robustly elevated by 5.9 and 2.7 folds respectively. Robust expansion of memory pools by the third dose potentiated greater durability of protective immune responses. Another key finding in this trial was that HCWs with low serological response to two doses were not truly "non-responders" but fully equipped with immune memory that could be quickly recalled by a third dose even 5 months after the second vaccination. Collectively, these data provide insights into the generation of long-term immunological memory by the inactivated vaccine, which could be rapidly recalled and further boosted by a third dose. [ABSTRACT FROM AUTHOR]

Background: The quality of randomized crossover studies on digestive diseases is unclear. We aimed to review crossover trials in digestive disease journals and evaluate their reporting quality and risk of bias. Methods: We searched the PubMed, Web of Science, and Scopus databases for all crossover trials in 39 digestive journals between January 2011 and September 2021. Reporting adherence was based on the CONSORT 2010 statement: extension to randomized crossover trials published in July 2019. A newly released Cochrane risk of bias tool 2.0 extension for crossover trials was applied to assess the risk of bias. Results: In total, 173 studies were included in the analysis, and 16.2% were published following the CONSORT statement extension. The crossover design was not only widely used in drug efficacy trials (48.6%) but also in endoscopic ultrasound trials (23.7%) and dietary studies (17.9%) in the field of digestive diseases. The overall reporting adherence was 37.6% for full texts and 43.4% for abstracts. The proportions of trials with low, some concerns, and high risk of bias were 13.9%, 15.6%, and 70.5%, respectively. The difference in reporting adherence and high risk of bias between pre- and post-CONSORT was not significant. Having a sample size plan, defining primary end points, and pre-registration showed higher reporting adherence and lower risk of bias than those who did not. Conclusion: These findings demonstrated the inadequate quality of randomized crossover trials for digestive diseases. Compliance with the CONSORT extension for crossover trials must be strengthened and improved (PROSPERO CRD: 42021248723). [ABSTRACT FROM AUTHOR]

Background This study explored the diagnostic performance of visceral adiposity to predict the degree of intestinal inflammation and fibrosis. Methods The patients with Crohn's disease (CD) who underwent surgical small bowel resection at the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between January 2007 and December 2017 were enrolled. We evaluated the intestinal imaging features of computed tomography enterography (CTE), including mesenteric inflammatory fat stranding, the target sign, mesenteric hypervascularity, bowel wall thickening, lymphadenopathy, stricture diameter, and maximal upstream diameter. We used A.K. software (Artificial Intelligence Kit, version 1.1) to calculate the visceral fat (VF) and subcutaneous fat (SF) volumes at the third lumbar vertebra level. Pathological tissue information was recorded. Diagnostic models were established based on the multivariate regression analysis results, and their effectiveness was evaluated by area under the curve (AUC) and decision curve analyses. Results Overall, 48 patients with CD were included in this study. The abdominal VF/SF volume ratio (odds ratio, 1.20; 95% confidence interval, 1.05–1.38; P  =   0.009) and the stenosis diameter/upstream intestinal dilatation diameter (ND) ratio (odds ratio, 0.90; 95% confidence interval, 0.82–0.99; P  =   0.034) were independent risk factors for the severe fibrosis of the small intestine. The AUC values of the VF/SF ratio, the ND ratio, and their combination were 0.760, 0.673, and 0.804, respectively. The combination of the VS/SF volume ratio and ND ratio achieved the highest net benefit on the decision curve. Conclusion The VF volume on CTE can reflect intestinal fibrosis. The combination of the VF/SF volume ratio and ND ratio of CD patients assessed using CTE can help predict severe fibrosis stenosis of the small intestine. [ABSTRACT FROM AUTHOR]

Pathological MVI diagnosis could help to determine the prognosis and need for adjuvant therapy in hepatocellular carcinoma (HCC). However, narrative reporting (NR) would miss relevant clinical information and non-standardized sampling would underestimate MVI detection. Our objective was to explore the impact of innovative synoptic reporting (SR) and seven-point sampling (SPRING) protocol on microvascular invasion (MVI) rate and patient outcomes. In retrospective cohort, we extracted MVI status from NR in three centers and re-reviewed specimen sections by SR recommended by the College of American Pathologists (CAP) in our center. In prospective cohort, our center implemented the SPRING protocol, and external centers remained traditional pathological examination. MVI rate was compared between our center and external centers in both cohorts. Recurrence-free survival (RFS) before and after implementation was calculated by Kaplan-Meier method and compared by the log-rank test. In retrospective study, we found there was no significant difference in MVI rate between our center and external centers [10.3% (115/1112) vs. 12.4% (35/282), P=0.316]. In our center, SR recommended by CAP improved the MVI detection rate from 10.3 to 38.6% (P<0.001). In prospective study, the MVI rate in our center under SPRING was significantly higher than external centers (53.2 vs. 17%, P<0.001). RFS of MVI (−) patients improved after SPRING in our center (P=0.010), but it remained unchanged in MVI (+) patients (P=0.200). We conclude that the SR recommended by CAP could help to improve MVI detection rate. Our SPRING protocol could help to further improve the MVI rate and optimize prognostic stratification for HCC patients. [ABSTRACT FROM AUTHOR]

Objectives: Pretreatment evaluation of tumor biology and microenvironment is important to predict prognosis and plan treatment. We aimed to develop nomograms based on gadoxetic acid-enhanced MRI to predict microvascular invasion (MVI), tumor differentiation, and immunoscore. Methods: This retrospective study included 273 patients with HCC who underwent preoperative gadoxetic acid-enhanced MRI. Patients were assigned to two groups: training (N = 191) and validation (N = 82). Univariable and multivariable logistic regression analyses were performed to investigate clinical variables and MRI features' associations with MVI, tumor differentiation, and immunoscore. Nomograms were developed based on features associated with these three histopathological features in the training cohort, then validated, and evaluated. Results: Predictors of MVI included tumor size, rim enhancement, capsule, percent decrease in T1 images (T1D%), standard deviation of apparent diffusion coefficient, and alanine aminotransferase levels, while capsule, peritumoral enhancement, mean relaxation time on the hepatobiliary phase (T1E), and alpha-fetoprotein levels predicted tumor differentiation. Predictors of immunoscore included the radiologic score constructed by tumor number, intratumoral vessel, margin, capsule, rim enhancement, T1D%, relaxation time on plain scan (T1P), and alpha-fetoprotein and alanine aminotransferase levels. Three nomograms achieved good concordance indexes in predicting MVI (0.754, 0.746), tumor differentiation (0.758, 0.699), and immunoscore (0.737, 0.726) in the training and validation cohorts, respectively. Conclusion: MRI-based nomograms effectively predict tumor behaviors in HCC and may assist clinicians in prognosis prediction and pretreatment decisions. Key Points: • This study developed and validated three nomograms based on gadoxetic acid-enhanced MRI to predict MVI, tumor differentiation, and immunoscore in patients with HCC. • The pretreatment prediction of tumor microenvironment may be useful to guide accurate prognosis and planning of surgical and immunological therapies for individual patients with HCC. [ABSTRACT FROM AUTHOR]

The evidence of the impact of traditional statistical (TS) and artificial intelligence (AI) tool interventions in clinical practice was limited. This study aimed to investigate the clinical impact and quality of randomized controlled trials (RCTs) involving interventions evaluating TS, machine learning (ML), and deep learning (DL) prediction tools. A systematic review on PubMed was conducted to identify RCTs involving TS/ML/DL tool interventions in the past decade. A total of 65 RCTs from 26,082 records were included. A majority of them had model development studies and generally good performance was achieved. The function of TS and ML tools in the RCTs mainly included assistive treatment decisions, assistive diagnosis, and risk stratification, but DL trials were only conducted for assistive diagnosis. Nearly two-fifths of the trial interventions showed no clinical benefit compared to standard care. Though DL and ML interventions achieved higher rates of positive results than TS in the RCTs, in trials with low risk of bias (17/65) the advantage of DL to TS was reduced while the advantage of ML to TS disappeared. The current applications of DL were not yet fully spread performed in medicine. It is predictable that DL will integrate more complex clinical problems than ML and TS tools in the future. Therefore, rigorous studies are required before the clinical application of these tools. [ABSTRACT FROM AUTHOR]

Background: The aim of this work is to explore the impact of the number of sampling sites (NuSS) and sampling location on microvascular invasion (MVI) detection rate and long-term survival of hepatocellular carcinoma (HCC), and determine the minimum NuSS for sufficient MVI detection. Patients and Methods: From January 2008 to March 2017, 1144 HCC patients who underwent hepatectomy were retrospectively enrolled. Associations between NuSS and MVI positive rates and overall survival were investigated. NuSS thresholds were determined by Chow test and confirmed prospectively in 305 patients from April 2017 to February 2019. In the prospective cohort, the distribution of MVI in different sampling locations and its prognostic effect was evaluated. Results: MVI positive rates increased as NuSS increased, steadily reaching a plateau when NuSS reached a threshold. A threshold of four, six, eight, and eight sampling sites within paracancerous parenchyma ≤ 1 cm from tumor was required for detecting MVI in solitary tumors measuring 1.0–3.0, 3.1–4.9, and ≥ 5.0 cm and multiple tumors. Patients with adequate NuSS achieved longer survival than those with inadequate NuSS [hazard ratio (HR) = 0.75, P = 0.043]. For all MVI-positive patients, MVI could be detected positive in paracancerous parenchyma ≤ 1 cm from tumor. Patients with MVI positive in paracancerous parenchyma > 1 cm had higher recurrence risk than those with MVI positive only in parenchyma ≤ 1 cm (HR = 6.05, P < 0.001). Conclusions: Adequate NuSS is associated with higher MVI detection rate and better survival of HCC patients. We recommend four, six, eight, and eight as the cut-points for evaluating MVI sampling quality and patients' prognostic stratification in the subgroups of solitary tumors measuring 1.0–3.0 cm, 3.1–4.9 cm and ≥ 5.0 cm and multiple tumors, respectively. [ABSTRACT FROM AUTHOR]

Background and Aim: The evidences for use of postoperative antibiotics (POA) in hepatocellular carcinoma (HCC) patients who underwent hepatectomy are controversial. We aimed to explore the relationship between POA and hepatectomy‐related infection in a hepatitis B virus (HBV)‐related HCC population. Methods: We retrospectively collected 934 HCC patients who underwent hepatectomy for curative intent from three tertiary hospitals in China. The incidences of postoperative infection including surgical site infection and remote site infection were recorded and calculated. Univariable and multivariable logistic regression analyses were performed to explore related factors of postoperative infection and POA. And the relationship between infection rates with different durations of POA was investigated. Results: The overall infection rate was 8.2% (77/934), including 6.5% (61/934) of surgical site infection and 2.0% (19/934) of remote site infection. Multivariable analysis revealed that the administration of POA was negatively related with the incidence of postoperative infection significantly (odds ratio = 0.50, 95% confidence interval = 0.30 to 0.83; P = 0.008). Albumin‐bilirubin score, Barcelona Clinic Liver Cancer (BCLC) stage and extent of hepatectomy were independently related to the POA. And 3‐day regimen seemed to be the shortest duration of POA to gain the lowest incidence of postoperative infection. Conclusions: Postoperative antibiotic is necessary for HBV‐related HCC patients to prevent postoperative infection, especially for those with higher albumin‐bilirubin score, at BCLC stage B–C, or who underwent major hepatectomy. For HBV‐related HCC patients, postoperative second‐generation cephalosporins, or ceftriaxone for 3 days after surgery might be proper. [ABSTRACT FROM AUTHOR]