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Abstract The advent of immunotherapy has greatly improved the prognosis of non-small cell lung (NSCLC) patients. However, given its low response rate and high cost of treatment, the search for valuable predictive markers of treatment efficacy is necessary. Considering the complexity and heterogeneity of the tumour and tumour microenvironment, the construction of a multi-dimensional prediction model is necessary. Therefore, we aimed to integrate clinical parameters, radiomic features, and immune signature data from NSCLC patients receiving immunotherapy to construct a multi-dimensional prediction model to better predict the efficacy of immunotherapy. The current study enrolled 137 NSCLC patients who received immunotherapy. We collected baseline clinical information, CT images, and tumour tissue specimens. Using 3D-Slicer software, radiomic features were extracted from patient CT images, and tumor tissue samples obtained before immunotherapy were subjected to immunohistochemical staining. Then, the least absolute shrinkage and selection operator (LASSO) Cox regression analysis was applied to downscale the data, and the radiomic features and immune signatures associated with the prognosis of immunotherapy patients were identified. The modified lung immune predictive index (mLIPI), radiomics score (Radioscore), immune score and multi-dimensional model nomogram were constructed. The C-index and area under the curve (AUC) were applied to evaluate the predictive efficacy of the models. Three radiomic features and three immune signatures that could predict the efficacy of immunotherapy were eventually screened. Multivariate analysis showed that the mLIPI, Radioscore, and immune score were independent predictive factors for PFS and OS (P

Abstract Background The prevalence of multiple nosocomial infections (MNIs) is on the rise, however, there remains a limited comprehension regarding the associated risk factors, cumulative risk, probability of occurrence, and impact on length of stay (LOS). Method This multicenter study includes all hospitalized patients from 2020 to July 2023 in two sub-hospitals of a tertiary hospital in Guangming District, Shenzhen. The semi-Markov multi-state model (MSM) was utilized to analyze risk factors and cumulative risk of MNI, predict its occurrence probability, and calculate the extra LOS of nosocomial infection (NI). Results The risk factors for MNI include age, community infection at admission, surgery, and combined use of antibiotics. However, the cumulative risk of MNI is lower than that of single nosocomial infection (SNI). MNI is most likely to occur within 14 days after admission. Additionally, SNI prolongs LOS by an average of 7.48 days (95% Confidence Interval, CI: 6.06–8.68 days), while MNI prolongs LOS by an average of 15.94 days (95% CI: 14.03–18.17 days). Furthermore, the more sites of infection there are, the longer the extra LOS will be. Conclusion The longer LOS and increased treatment difficulty of MNI result in a heavier disease burden for patients, necessitating targeted prevention and control measures.

IntroductionAgronomic traits are key components of wheat yield. Exploitation of the major underlying quantitative trait loci (QTLs) can improve the yield potential in wheat breeding.MethodsIn this study, we constructed a recombinant inbred line (RIL) population from Mingxian 169 (MX169) and Pindong 34 (PD34) to determine the QTLs for grain length (GL), grain width (GW), grain length-to-width ratio (LWR), plant height (PH), spike length (SL), grain number per spike (GNS), and the thousand grain weight (TGW) across four environments using wheat 90K SNP array.ResultsA QTL associated with TGW, i.e., QTGWpd.swust-6BS, was identified on chromosome 6B, which explained approximately 14.1%–16.2% of the phenotypic variation. In addition, eight QTLs associated with GL were detected across six chromosomes in four different test environments. These were QGLpd.swust-1BL, QGLpd.swust-2BL, QGLpd.swust-3BL.1, QGLpd.swust-3BL.2, QGLpd.swust-5DL, QGLpd.swust-6AL, QGLpd.swust-6DL.1, and QGLpd.swust-6DL.2. They accounted for 9.0%–21.3% of the phenotypic variation. Two QTLs, namely, QGWpd.swust-3BS and QGWpd.swust-6DL, were detected for GW on chromosomes 3B and 6D, respectively. These QTLs explained 12.8%–14.6% and 10.8%–15.2% of the phenotypic variation, respectively. In addition, two QTLs, i.e., QLWRpd.swust-7AS.1 and QLWRpd.swust-7AS.2, were detected on chromosome 7A for the grain LWR, which explained 10.9%–11.6% and 11.6%–11.2% of the phenotypic variation, respectively. Another QTL, named QGNSpd-swust-6DS, was discovered on chromosome 6D, which determines the GNS and which accounted for 11.4%–13.8% of the phenotypic variation. Furthermore, five QTLs associated with PH were mapped on chromosomes 2D, 3A, 5A, 6B, and 7B. These QTLs were QPHpd.swust-2DL, QPHpd.swust-3AL, QPHpd.swust-5AL, QPHpd.swust-6BL, and QPHpd.swust-7BS, which accounted for 11.3%–19.3% of the phenotypic variation. Lastly, a QTL named QSLpd.swust-3AL, conferring SL, was detected on chromosome 3A and explained 16.1%–17.6% of the phenotypic variation. All of these QTLs were defined within the physical interval of the Chinese spring reference genome.DiscussionThe findings of this study have significant implications for the development of fine genetic maps, for genomic breeding, and for marker-assisted selection to enhance wheat grain yield.

Background Information about orthopedics diseases on the Internet has not been extensively assessed. Our purpose was to evaluate the quality of online information of osteosarcoma on current video-sharing platforms in mainland China. Method TikTok and Bilibili were independently queried from June to July 2023 by four independent researchers using the Microsoft Edge web browser. Information about the videos and creators was recorded, and descriptive analyses were conducted. Results After data extraction, a total of 95 videos were included, in which 43 videos were uploaded by certified doctors (45.3%), with 35 videos (36.8%) uploaded by certified orthopedic surgeons. Of the content of these videos, 78.9% were introduction ( n = 75), 64.2% were on professional knowledge ( n = 61), 28.4% were on treatment ( n = 27), while 5.3% were on surgical techniques ( n = 5). The mean DISCERN total score was 43.8 ± 13.4, and the mean JAMA score was 3.8 ± 0.3. Conclusions Videos about osteosarcoma on current video-sharing platforms were extensive, but were not comprehensive and professional. Although current online videos have the potential to improve public awareness on osteosarcoma, due to their quality and content, were not assessed to be good sources for medical education.

Objective To screen the prognostic influencing factors of patients with endovascular treatment for acute basilar artery occlusion (ABAO⁃EVT). Methods The baseline, clinical and follow⁃up data of 215 patients with ABAO⁃EVT from October 2017 to August 2022 in The First Affiliated Hospital of University of Science and Technology of China, Linyi People's Hospital of Shandong and Maoming People's Hospital of Guangdong were retrospectively collected, including sex, age, stroke or transient ischemic attack (TIA), hypertension, diabetes, coronary heart disease, atrial fibrillation, smoking and drinking history, National Institutes of Health Stroke Scale (NIHSS) score, intravenous thrombolysis, first pass effect, times of embolectomy, extended Thrombolysis in Cerebral Infarction (eTICI), and modified Rankin Scale (mRS) score 90 d after operation. According to the 90 d mRS score, the patients were divided into 2 groups: good prognosis group (mRS score 0-3, n = 93) and poor prognosis group (mRS score 4-6, n = 122). Univariate and multivariate stepwise Logistic regression analyses were used to screen the neurological prognostic influencing factors of ABAO ⁃ EVT patients 90 d after operation. Results Logistic regression analysis showed that the baseline NIHSS score increased was a risk factor for poor prognosis of ABAO⁃EVT patients (aOR = 0.936, 95%CI: 0.907-0.965, P = 0.000; aOR = 0.940, 95%CI: 0.910-0.970, P = 0.000), with the first pass effect (aOR = 5.752, 95%CI: 2.875-11.508; P = 0.000), eTICI grade 2c-3 (aOR = 7.113, 95%CI: 3.665-13.805; P = 0.000) were protective factors for good prognosis. Conclusions Low baseline NIHSS score, first pass effect and reperfusion level of eTICI 2c-3 are all protective factors for good neurological prognosis of ABAO⁃EVT patients.

Background It remains unclear whether intensification of the chemotherapy backbone in tandem with an anti-EGFR can confer superior clinical outcomes in a cohort of RAS/BRAF wild-type colorectal cancer (CRC) patients with initially unresectable colorectal liver metastases (CRLM). To that end, we sought to comparatively evaluate the efficacy and safety of cetuximab plus FOLFOXIRI (triplet arm) versus cetuximab plus FOLFOX (doublet arm) as a conversion regimen (i.e., unresectable to resectable) in CRC patients with unresectable CRLM. Methods and findings This open-label, randomized clinical trial was conducted from April 2018 to December 2022 in 7 medical centers across China, enrolling 146 RAS/BRAF wild-type CRC patients with initially unresectable CRLM. A stratified blocked randomization method was utilized to assign patients (1:1) to either the cetuximab plus FOLFOXIRI (n = 72) or cetuximab plus FOLFOX (n = 74) treatment arms. Stratification factors were tumor location (left versus right) and resectability (technically unresectable versus [greater than or equal to]5 metastases). The primary outcome was the objective response rate (ORR). Secondary outcomes included the median depth of tumor response (DpR), early tumor shrinkage (ETS), R0 resection rate, progression-free survival (PFS), overall survival (not mature at the time of analysis), and safety profile. Radiological tumor evaluations were conducted by radiologists blinded to the group allocation. Primary efficacy analyses were conducted based on the intention-to-treat population, while safety analyses were performed on patients who received at least 1 line of chemotherapy. A total of 14 patients (9.6%) were lost to follow-up (9 in the doublet arm and 5 in the triplet arm). The ORR was comparable following adjustment for stratification factors, with 84.7% versus 79.7% in the triplet and doublet arms, respectively (odds ratio [OR] 0.70; 95% confidence intervals [CI] [0.30, 1.67], Chi-square p = 0.42). Moreover, the ETS rate showed no significant difference between the triplet and doublet arms (80.6% (58/72) versus 77.0% (57/74), OR 0.82, 95% CI [0.37, 1.83], Chi-square p = 0.63). Although median DpR was higher in the triplet therapy group (59.6%, interquartile range [IQR], [50.0, 69.7] versus 55.0%, IQR [42.8, 63.8], Mann-Whitney p = 0.039), the R0/R1 resection rate with or without radiofrequency ablation/stereotactic body radiation therapy was comparable with 54.2% (39/72) of patients in the triplet arm versus 52.7% (39/74) in the doublet arm. At a median follow-up of 26.2 months (IQR [12.8, 40.5]), the median PFS was 11.8 months in the triplet arm versus 13.4 months in the doublet arm (hazard ratio [HR] 0.74, 95% CI [0.50, 1.11], Log-rank p = 0.14). Grade [greater than or equal to] 3 events were reported in 47.2% (35/74) of patients in the doublet arm and 55.9% (38/68) of patients in the triplet arm. The triplet arm was associated with a higher incidence of grade [greater than or equal to] 3 neutropenia (44.1% versus 27.0%, p = 0.03) and diarrhea (5.9% versus 0%, p = 0.03). The primary limitations of the study encompass the inherent bias in subjective surgical decisions regarding resection feasibility, as well as the lack of a centralized assessment for ORR and resection. Conclusions The combination of cetuximab with FOLFOXIRI did not significantly improve ORR compared to cetuximab plus FOLFOX. Despite achieving an enhanced DpR, this improvement did not translate into improved R0 resection rates or PFS. Moreover, the triplet arm was associated with an increase in treatment-related toxicity. Trial Registration ClinicalTrials.gov Identifier: NCT03493048., Author(s): De-Shen Wang 1, Chao Ren 1, Shan-Shan Li 2, William Pat Fong 1, Xiao-Jun Wu 3, Jian Xiao 2,4, Bin-Kui Li 5, Yun Zheng 5, Pei-Rong Ding 3, Gong [...]

Chloride ion erosion in seawater is a major cause of durability damage to reinforced concrete structures. Most of the currently used anti-corrosion coatings are organic polymer coatings, which are prone to aging and peeling off and polluting the environment. Inspired by the underwater adhesion behavior of mussels, a green substance-tannic acid (TA) is found and used as the main material of anti-chloride coatings. Three assembly methods of green concrete chloride-resistant coatings fabricated by the oxidative self-polymerization of tannic acid, coordination-driven one-step assembly and multistep assembly of tannic acid (TA), and trivalent iron cation (Fe(III)) on a concrete surface are proposed. Compared to the other two assembly methods and existing coatings, the one-step assembly of the TA and Fe(III) coating was recommended to be the first choice because of its good continuity; shortest time-consumption (just 10 min); lowest price (only one-third of epoxy coating); and the best chloride-resistant effectiveness per unit thickness reaching 52.17%, far better the multistep assembly method and the oxidative self-polymerization method by 12.67% and 2.42%, which is 79-times higher than that of epoxy resin A. This study offers a TA-based concrete coating fabricated by the one-step assembly method with an excellent anti-chloride performance and cheap price, which is promising for a wide range of applications for the chloride-resistant corrosion protection of steel-reinforced concrete in seawater environments. [ABSTRACT FROM AUTHOR]

BACKGROUND: The flow reaching the vocal folds may be lower than that at the output of high-flow nasal cannula (HFNC) system. This could be due to upper-respiratory obstruction, oxygen leakage, or other factors. The objective of this study was to observe the effect of flow through a nasopharyngeal airway on intrapharyngeal pressure (IPP) in subjects undergoing fiberoptic bronchoscopy (FOB). METHODS: Patients scheduled for FOB were invited to participate. Measurements were performed at flows of 0-60 L/min; the subjects wore WN-N95 folding medical protective masks (N95) and either underwent FOB or not. IPP at each flow was recorded following 15 s of ventilation, and the cross-sectional area (CSA) of the gastric sinus was measured before and after FOB. Hypoxemia, reflux aspiration, and other pertinent events were recorded. RESULTS: Sixty subjects undergoing FOB at the Affiliated Hospital of Jiaxing University participated in this trial from October 2022-September 2023. IPP increased significantly with an increase in flow and also increased after placing the N95 mask with the same flow (P < .001). When results from before to after FOB were compared, the difference in CSA was statistically significant 263.6 (220.7-300.5) mm² vs 305.5 (275.4-329.5) mm², P < .001, but the difference in the risk of reflux aspiration was not statistically significant (0% vs 6.7%, P = .13). Complication rates during treatment were 8.3% for hypoxemia, 0% for reflux aspiration, 1.7% for hypertension, 1.7% for hypotension, 6.7% for tachycardia, 5% for bradycardia, and 10% for postoperative nausea and vomiting. CONCLUSIONS: HFNC can provide effective oxygen therapy for people undergoing FOB, and increases in IPP with flow in the range of 0-60 L/min may not increase the risk of reflux aspiration. [ABSTRACT FROM AUTHOR]

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Fully ceramic microencapsulated (FCM) fuel is a five-layer intercalation system material consisting of a UO2 core, a sparse pyrolytic carbon layer (Buffer), an inner dense pyrolytic carbon layer (IPyC), an outer dense pyrolytic carbon layer (OPyC), and a silicon carbide matrix (SiC). At first, this paper researched the thermodynamic models of the materials, including heat conduction coefficient, Young's modulus, thermal expansion coefficient, etc. Then DIGIMAT, the finite element software, was used to establish the equivalent volume element (RVE) for the equivalent analysis of the thermodynamic properties of the FCM fuel pellet. Finally, the thermodynamic equivalent performance model of FCM fuel was obtained by multi-factor fitting analysis. The results show that among these thermodynamic properties of FCM fuel pellets, the Young's modulus, thermal expansion coefficient and plastic performance are mainly affected by temperature, fast neutron fluence, and UO2 volume fraction; the specific heat capacity is mainly affected by UO2 volume fraction and temperature; the heat conduction coefficient is mainly affected by temperature and UO2 volume fraction. The thermal conductivity is mainly affected by temperature, burnup and UO2 volume fraction. In this study, the equivalent models obtained through the fitting analysis of RVE model parameters can well describe the thermodynamic behavior of FCM fuel particles. [ABSTRACT FROM AUTHOR]