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Introduction Pancreatic portal hypertension (PPH) is a rare complication of acute pancreatitis (AP) that can lead to severe gastrointestinal bleeding. The risk factors associated with PPH, as well as the overall prognosis, warrant further investigation. This study aims to develop and validate a nomogram to predict PPH in patients with AP.Methods Consecutive patients with AP from 2015 to 2023 were retrospectively included in the study. Demographic data, clinical manifestations within the first week of AP onset, and initial contrast-enhanced CT findings were used to develop the predictive model. Univariate and multivariate Cox regression analyses were performed to identify risk factors for PPH. Based on the results of the multivariate analysis, a nomogram was developed. The patients were randomly divided into training and validation sets at a 7:3 ratio. The accuracy and discriminative power of the predictive model were assessed using the area under the curve (AUC) from the receiver operating characteristic curve and the calibration curve.Results Of the 1473 patients with AP, 107 (7.3%) developed PPH within 6 months (range: 2–22 months) during follow-up. Multivariate regression analysis showed that body mass index (BMI) (HR, 1.10; 95% CI 1.04 to 1.16; p=0.001), moderately severe grade (HR, 9.36; 95% CI 4.58 to 19.13; p

Abstract In recent years, the environmental health issue of microplastics has aroused an increasingly significant concern. Some studies suggested that exposure to polystyrene microplastics (PS-MPs) may lead to renal inflammation and oxidative stress in animals. However, little is known about the essential effects of PS-MPs with high-fat diet (HFD) on renal development and microenvironment. In this study, we provided the single-cell transcriptomic landscape of the kidney microenvironment induced by PS-MPs and HFD in mouse models by unbiased single-cell RNA sequencing (scRNA-seq). The kidney injury cell atlases in mice were evaluated after continued PS-MPs exposure, or HFD treated for 35 days. Results showed that PS-MPs plus HFD treatment aggravated the kidney injury and profibrotic microenvironment, reshaping mouse kidney cellular components. First, we found that PS-MPs plus HFD treatment acted on extracellular matrix organization of renal epithelial cells, specifically the proximal and distal convoluted tubule cells, to inhibit renal development and induce ROS-driven carcinogenesis. Second, PS-MPs plus HFD treatment induced activated PI3K-Akt, MAPK, and IL-17 signaling pathways in endothelial cells. Besides, PS-MPs plus HFD treatment markedly increased the proportions of CD8+ effector T cells and proliferating T cells. Notably, mononuclear phagocytes exhibited substantial remodeling and enriched in oxidative phosphorylation and chemical carcinogenesis pathways after PS-MPs plus HFD treatment, typified by alterations tissue-resident M2-like PF4+ macrophages. Multispectral immunofluorescence and immunohistochemistry identified PF4+ macrophages in clear cell renal cell carcinoma (ccRCC) and adjacent normal tissues, indicating that activate PF4+ macrophages might regulate the profibrotic and pro-tumorigenic microenvironment after renal injury. In conclusion, this study first systematically revealed molecular variation of renal cells and immune cells in mice kidney microenvironment induced by PS-MPs and HFD with the scRNA-seq approach, which provided a molecular basis for decoding the effects of PS-MPs on genitourinary injury and understanding their potential profibrotic and carcinogenesis in mammals. Graphical Abstract

As a “medicine food homology” plant, the Piper betle L. has the characteristics of spicy, slightly sweet, and warm in nature, which can be used for treating cold, cough, stomachache, and eczema. The leaves have a strong and spicy aromatic smell and are widely used in chewables in Asia. Chemical analysis showed that the Piper betle L. contains nutrients and other chemical ingredients, including protein, starch, fat, essential oils, phenols, alcohols, ketones and alkaloids, etc. Modern pharmacological studies suggest that Piper betle L. is qualified with antimicrobial, antioxidant, anticancer, insect-resistant, anti-inflammatory, anti-malaria, and anti-glycosylation effect and so on. This article systematically reviews the material foundation and biological activity of Piper betle L., providing a reference for the further research and rational development.

PurposesWe aimed to clarify the real-world status of breast cancer surgery and the cost in China.MethodsThis cross-sectional survey relied on data obtained from the hospitalization summary reports (HSRs) in 77 top-ranked (grade 3A) hospitals in China to analyze breast cancer patients who underwent surgery between January 2015 and December 2015. The surgery and cost were mainly evaluated.ResultsOverall, 31,900 breast cancer patients underwent surgeries in 77 hospitals. The mean age in our study was 51.5 years (SD, 11.7 years). The primary types of surgical procedures were mastectomy (n = 24,629, 77.2%) and breast-conserving surgery (6,210, 19.5%). The rate of mastectomy was the highest at age band 50–65 years (n = 10,861, 82.1%) and in non-first-tier cities (n = 7,651, 88.4%) as well as in Northeast China (n = 3,107, 93.2%). The rate of breast-conserving surgery was less than 10% in non-first-tier cities (9.8%), Southwest China (6.1%), and Northeast China (5.8%). The median cost was $3,352.4 (interquartile range (IQR), $2,492.6–4,588.0). Mastectomy cost was significantly higher than breast-conserving surgery cost in both different city tiers and regional distribution except Northeast China (p < 0.001).ConclusionsThis study demonstrated that the main breast cancer surgery in Chinese 3A hospitals was mastectomy and that the cost varied both across and within geographic regions and city tiers. This information helps describe the real-world status of breast surgery and the cost in China.

BackgroundGestational diabetes mellitus (GDM) is a common endocrine metabolic disease, involving a carbohydrate intolerance of variable severity during pregnancy. The incidence of GDM-related complications and adverse pregnancy outcomes has declined, in part, due to early screening. Machine learning (ML) models are increasingly used to identify risk factors and enable the early prediction of GDM. ObjectiveThe aim of this study was to perform a meta-analysis and comparison of published prognostic models for predicting the risk of GDM and identify predictors applicable to the models. MethodsFour reliable electronic databases were searched for studies that developed ML prediction models for GDM in the general population instead of among high-risk groups only. The novel Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias of the ML models. The Meta-DiSc software program (version 1.4) was used to perform the meta-analysis and determination of heterogeneity. To limit the influence of heterogeneity, we also performed sensitivity analyses, a meta-regression, and subgroup analysis. ResultsA total of 25 studies that included women older than 18 years without a history of vital disease were analyzed. The pooled area under the receiver operating characteristic curve (AUROC) for ML models predicting GDM was 0.8492; the pooled sensitivity was 0.69 (95% CI 0.68-0.69; P

In this study, the complete chloroplast genome of Loropetalum chinense var. rubrum Yieh was sequenced and characterized. The chloroplast genome is 159,427 bp in length, and contains a large single-copy (LSC) region of 88,185 bp and a small single-copy (SSC) region of 18,772 bp separated by a pair of inverted repeat (IR) regions of 26,235 bp. There are 128 genes in the genome including 83 protein-coding, 37 tRNA, and eight rRNA genes. The overall GC is 38.0% and the LSC, SSC, and IR regions are 36.1, 32.7, and 43.1%, respectively. Phylogenetic analysis of L. chinense var. rubrum fully resolved it in a clade with L. subcordatum. This complete chloroplast genome will provide valuable insight into evolution, molecular breeding, and phylogenetic analysis of Loropetalum species.

Here, we report the complete chloroplast genome of Pittosporum brevicalyx. The genome is 153,388 bp in size, which is comprised of a large single-copy (LSC) region of 84,724 bp, a small single-copy (SSC) region of 18,716 bp, and two inverted repeat (IR) regions of 24,974 bp. The overall GC content of the plastome was 38.3%. The new sequence comprised 127 unique genes, including 82 protein-coding genes, 8 rRNA genes, and 37 tRNA genes. Phylogenetic analysis showed that P.brevicalyx was close to Pittosporum kerrii and Pittosporum eugenioides. These data may providing useful information for phyletic evolution of P.brevicalyx within the Pittosporaceae family.

In this study, trifold CdTe nanorods and CdTe nanospheres were prepared by the environmentally benign solvothermal process where K _2 TeO _3 and CdCl _2 acting as the raw materials, L-ascorbic acid as the reducing agent, ethylene glycol as the solvent and polyvinylpyrrolidone as the surfactant, respectively. The morphology of the products can be regulated by the amount of KOH. Specifically, trifold CdTe nanorods could be prepared with 0.1 g of KOH before the reaction; while CdTe nanospheres were obtained with 0.5 g of KOH. The higher the amount of KOH added, the stronger the reducibility of L-ascorbic acid. For higher reducibility, CdTe crystal nuclei which was continuously generated will first nucleate and grow in the gaps between the rods of the trifold nanorods because of the special morphology and structure of the trifold nanorods. Therefore, with the increasing of the number of CdTe crystal nuclei caused by the accelerated reaction rate, the trifold nanorods will gradually evolve into nanospheres.

Tungsten fibre nets reinforced tungsten composites (Wf/W) containing four net layers were fabricated by spark plasma sintering (SPS), hot pressing (HP) and cold rolling after HP (HPCR), with the weight fraction of fibres being 17.4%, 10.5% and 10.5%, respectively. The relative density of the HPCRed samples is the highest (99.8%) while that of the HPed composites is the lowest (95.1%). Optical and scanning electron microscopy and electron back scattering diffraction were exploited to characterize the microstructure, while tensile and hardness tests were used to evaluate the mechanical properties of the samples. It was found that partial recrystallization of fibres occurred after the sintering at 1800 °C. The SPSed and HPed Wf/W composites begin to exhibit plastic deformation at 600 °C with tensile strength (TS) of 536 and 425 MPa and total elongation at break (TE) of 11.6% and 23.0%, respectively, while the HPCRed Wf/W composites exhibit plastic deformation at around 400 °C. The TS and TE of the HPCRed Wf/W composites at 400 °C are 784 MPa and 8.4%, respectively. The enhanced mechanical performance of the Wf/W composites over the pure tungsten can be attributed to the necking, cracking, and debonding of the tungsten fibres.

Background: Plastic and covered metal stents need to be removed or exchanged within appropriate time in case of undesirable complications. However, it is not uncommon that patients do not follow the recommendation for further stent management after Endoscopic Retrograde Cholangiopancreatography (ERCP). The effect of short message service (SMS) intervention monthly on the stent removal/exchange adherence in patients after ERCP is unknown at this time. Methods: A prospective, randomized controlled study was conducted. After receiving regular instructions, patients were randomly assigned to receive SMS reminding monthly (SMS group) for stent removal/exchange or not (control group). The primary outcome was stent removal/exchange adherence within appropriate time (4 months for plastic stent or 7 months for covered stent). Multivariate analysis was performed to assess factors associated with stent removal/exchange adherence within appropriate time. Intention-to-treat analysis was used. Results: A total of 48 patients were randomized, 23 to the SMS group and 25 to the control. Adherence to stent removal/exchange was reported in 78.2 % (18/23) of patients receiving the SMS intervention compared with 40 % (10/25) in the control group (RR 1.98, 95 % CI 1.16-3.31; p = 0 · 010). Among patients with plastic stent insertion, the median interval time from stent implantation to stent removal/exchange were 90 days in the SMS group and 136 days in the control respectively (HR 0.36, 95 % CI 0.16-0.84, p = 0.018). No difference was found between the two groups regarding late-stage stent-related complications. The rate of recurrent abdominal pain tended to be lower in SMS group without significant difference (8.7 vs 28 %, p = 0.144). Multivariate logistic regression analyses revealed that SMS reminding was the only factor associated with adherence of stent removal/exchange (OR 6.73, 95 % CI 1.64-27.54, p = 0.008). Conclusion: This first effectiveness trial demonstrated that SMS reminding monthly could significantly increase the patient adherence to stent removal/exchange after ERCP. Trial Registration: The study was respectively registered on July 10 in 2016 at ClinicalTrials.gov ( NCT02831127 ). [ABSTRACT FROM AUTHOR]

Background: Many factors have been found to affect the difficulty of colonoscope insertion, such as age, gender, body mass index (BMI), history of abdominal surgery and operator etc. However, a scoring system may be more useful to predict the difficulty during colonoscopy. Methods: The individual and procedure-related data of 616 patients undergoing colonoscopy were prospectively collected from December 2013 through February 2014 in Xijing Hospital of Digestive Diseases. Cox regression analysis was used to identify high-risk factors associated with difficulty of colonoscopy. A predicting model with the difficult colonoscopy score (DCS) was developed. Results: Total cecum intubation rate was 98.9% (609/616). Advanced age, lower BMI, inexperienced operator and fair or poor sleep quality were identified as independent factors of prolonged insertion time (all p < 0.05), which were used to develop the DCS. Based on the score, patients could be divided into high-risk and low-risk groups with distinct incomplete rates within 10 min (42.0% vs. 16.5%, p < 0.001). Compared with those with DCS ≤ 1, patients with DCS > 1 had increased insertion time (10.6 ± 0.7 min vs. 6.9 ± 0.2 min, p < 0.001) and pain score (1.9 ± 1.5 vs. 1.4 ± 1.4, p = 0.002). More abdominal compression (36.9% vs. 16.8%, p < 0.001) and position change (51.4% vs. 22.6%, p < 0.001) were needed in this group of patients. Conclusion: Patients with DCS > 1 had longer insertion time, higher pain score and needed more abdominal compression and position changes. DCS was useful for predicting the difficulty of colonoscope intubation. (ClinicalTrials.gov NCT02105025 05/05/2014). [ABSTRACT FROM AUTHOR]

This paper provides asymptotic full crack-tip stress field solutions for an in-plane mixed-mode stationary crack in an anisotropic functionally graded material. A monoclinic graded material that has a material symmetry plane is considered. The complex variable approach and the asymptotic scaling factor are used to solve the governing fourth-order partial differential equation for exponentially graded anisotropic materials with gradation either parallel or perpendicular to the crack. Full crack-tip stress fields under mode-I and mode-II loading are visualized and discussed for homogeneous and exponentially graded anisotropic materials. We observe that higher-order terms are affected by material gradation and play an important role on crack-tip stress fields in functionally graded materials. [ABSTRACT FROM AUTHOR]

This paper provides full asymptotic crack-tip field solutions for an antiplane (mode-III) stationary crack in a functionally graded material. We use the complex variable approach and an asymptotic scaling factor to provide an efficient procedure for solving standard and perturbed Laplace equations associated with antiplane fracture in a graded material. We present the out-of-plane displacement and the shear stress solutions for a crack in exponentially and linearly graded materials by considering the gradation of the shear modulus either parallel or perpendicular to the crack. We discuss the characteristics of the asymptotic solutions for a graded material in comparison with the homogeneous solutions. We address the effects of the made-Ill stress intensity factor and the antiplane T-stress onto crack-tip field solutions. Finally, engineering significance of the present work is discussed. [ABSTRACT FROM AUTHOR]