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Objective This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. Design This is a cross-sectional study. Setting The study was conducted in a tertiary medical center. Participants The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. Main Outcome Measure(s) Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann–Whitney U test was used to evaluate the patients’ sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. Results In the univariate analysis, patients’ age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. Conclusions By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.

Octogenarians with esophageal cancer typically have a poor physical condition, reduced physiological reserves, and high postoperative mortality (POM). Extensive lymph node dissection increases surgical trauma and postoperative complications. The purpose of this study was to examine the associations between the number of dissected lymph nodes and short-term and long-term postoperative outcomes in octogenarians with thoracic esophageal cancer.We examined the data of patients from the Surveillance, Epidemiology, and End Results database. We divided the patients into two groups in accordance with the number of lymph nodes dissected: patients with15 examined lymph nodes (eLNs) and patients with ≥15 eLNs. Mortality was quantified at 30, 60, and 90 d after surgery. Univariable and multivariable logistic regression analyses were performed to identify predictors of 90-day mortality. Kaplan-Meier analysis and the log-rank test were used to analyze the overall survival and cause-specific survival of the patients.A total of 208 octogenarians with thoracic esophageal cancer were included in the analysis. The 30-day POM rates were 10.3% and 6.9%, the 60-day POM rates were 16.9% and 13.9%, and the 90-day POM rates were 21.3% and 19.4% for patients with15 eLNs and ≥15 eLNs, respectively. However, the differences in POM between the two groups were statistically nonsignificant (all P 0.05). In accordance with the multivariable logistic regression analysis, age and marital status were significantly associated with 90-day POM. Furthermore, no significant difference was found between the groups in terms of long-term survival. The 5-year overall survival rates were 29% and 26.8% (P = 0.719) and the 5-year cause-specific survival rates were 43.2% and 34.1% (P = 0.446) in patients with15 eLNs and ≥15 eLNs, respectively.We have demonstrated that octogenarians undergoing esophagectomy are associated with an unacceptably high POM, and less extensive lymph node resection does not decrease POM. Octogenarians may not benefit from esophagectomy with lymphadenectomy. Additional studies need to be conducted to further guide clinicians performing highly selective esophagectomy.

Objective: The expression and function of platinum transporters affect drug tissue concentration and therapeutic effects. We had previously characterized functional variant of platinum intake transporter SLC31A1 gene. We aimed to investigate the association of platinum efflux transporter gene ABCG2 polymorphism and combined ABCG2 and SLC31A1 polymorphisms with clinical outcomes of NSCLC patients receiving platinum-based chemotherapy. Methods: We genotyped thirteen tagging and functional SNPs of ABCG2 in 1004 patients, and assessed their association with response, toxicity and survival using unconditional logistic regression and Cox proportional hazards regression analyses respectively. Results: Nonsynonymous rs2231142 (odds ratio [OR] 2.07; 95 % confidence interval [CI] 1.26-3.63), rs1871744 (OR 0.60; 95 % CI 0.42-0.87) and their haplotype and diplotype were associated with objective response. Rs4148157 was associated with shorter overall survival (Log-rank P = 0.002; hazard ratio [HR] 1.22; 95 % CI 1.05-1.42). Furthermore, the combined SLC31A1 rs2233914 and ABCG2 rs1871744 genotype was significantly associated with poor response (OR 0.31; 95 % CI 0.17-0.56; P interaction = 0.003). And the combined genotypes of the functional rs10759637 of SLC31A1 and the nonsynonymous rs2231142 (Log-rank P = 5.20×10-5; HR 1.47; 95 % CI 1.19-1.81; P interaction = 0.007) or linked rs4148157 of ABCG2 were significantly associated with poor survival. Conclusion: This study reveals divergent association of ABCG2 polymorphism with response and survival of NSCLC patients receiving platinum-based chemotherapy, demonstrates the combined effects of functional variants of ABCG2 and SLC31A1 on clinical outcomes, and highlights pharmacogenetic relevance of platinum transporter genes interaction.

Background: To explore the safety and efficacy of laparoscopic extralevator abdominoperineal excision (La-ELAPE) and open extralevator abdominoperineal excision (Op-ELAPE) for patients with lower r...

Purpose To determine the efficacy and safety of the combination of bronchial arterial infusion (BAI) chemotherapy and transarterial chemoembolization with the use of drug-eluting embolic (DEE) particles in the treatment of unresectable advanced lung cancer. Materials and Methods A retrospective review was performed of 23 patients with unresectable lung cancer (stage III/IV) who received BAI chemotherapy and DEE chemoembolization. Treatment response was assessed by enhanced CT and evaluated on the basis of Response Evaluation Criteria In Solid Tumors at 30 d after the last combination treatment. Patients were followed up until death or March 15, 2020, whichever was first. Overall survival (OS) was estimated by Kaplan–Meier analysis, and factors associated with OS were evaluated by Cox proportional-hazards test. Results Complete response, partial response, stable disease, and progressive disease were seen in 2, 16, 5, and 0 patients at 30 d after the last combination treatment, respectively; therefore, the overall response rate was 78.3% and the disease control rate was 100%. Preprocedure symptoms (hemoptysis in 7 patients and dyspnea in 10) resolved in all cases after combination therapy. Nineteen patients died during follow-up, and 4 survived. Median OS was 15.6 mo (95% confidence interval, 10.1–21.1 mo). On univariate analysis and multivariate analysis, tumor/node/metastasis staging was an independent risk factor for prognosis. There were no serious adverse events during the procedures. Conclusions The combination of BAI chemotherapy plus DEE chemoembolization appears to be a promising method for treatment of advanced lung cancer.

Background The purpose of this study was to evaluate the impact of statins (HMG-CoA reductase inhibitors) on the prognosis of patients undergoing esophagectomy in a high incidence area. Methods This study retrospectively analyzed the database of patients underwent esophagectomy in the First Affiliated Hospital of Zhengzhou University. Preoperative application of statins for more than one year as the grouping factor. A propensity score matching (PSM) analyses was conducted to reduce heterogeneity and increase the comparability of the two groups, then compared the survival time of the matched groups through the Kaplan-Meier method. All P values were 2-sided and P

Objectives: In this study, we aimed to explore the influence of right-to-left shunt (RLS) presence on the clinical features of migraine and to follow-up on the post-operative curative effec...

A tracheal stent implantation is an effective treatment for benign or malignant tracheal stenosis and tracheal fistula (1-6). Currently, covered self-expanding metal stents (SEMS) are generally used in benign cases and uncovered SEMS for treating malignant tracheal stenosis. However, the radial force of the stent on the trachea and the friction between the stent and the tracheal wall during coughing often provoke granulation tissue hyperplasia (7,8). This hyperplasia, which appears at the ends of covered stents or over the entire stented area in the case of uncovered stents, results in incarceration of the stent and tracheal restenosis (9,10). Removal of the stent is then necessary (11,12). Tracheal stent removal can result in complications such as a tracheal mucosal tear, tracheal perforation, mediastinal abscess, massive hemorrhage, and asphyxia (13-15). When the SEMS is embedded in hyperplastic granulation tissue, tracheal perforation and hemorrhage risks are especially high (16-18). Despite advances in interventional techniques and bronchoscopy, both stent removal and treatment of related complications remain difficult. Inspired by the success of the stent-in-stent (SIS) technique for esophageal stent removal (19,20), we applied it to the removal of tracheal SEMS in four patients with severe proliferative stenosis. We describe our technique and report the outcomes.

Background: Lung transplantation is recognized as the only therapeutic option for patients who develop irreversible pulmonary fibrosis after herbicide intoxication.Methods: We have collected and presented clinical course and outcome of four patients who received lung transplantation due to paraquat and diquat intoxication from 2018 to 2021. Another patient who received initial lung transplantation due to paraquat intoxication and re-transplantation due to chronic lung allograft dysfunction in 2019, was further reported. Patients were admitted in lung transplantation centers, including the 1st affiliated hospital of Zhengzhou University and Wuxi Lung transplantation center. Previous reported cases from Europe, Canada and China were also summarized as benchmark.Results: During the period from the year of 2018 to 2021, there have been four patients in China, who received lung transplantation due to herbicide intoxication. Median age of the four patients was 37 (IQR 34.5, 39.75) years old. Median time from intoxication to lung transplantation was 27.5 (IQR 27, 30.5) days. Bilateral lung transplantation was performed in three patients, while one single lung transplantation was performed in an urgent listed patient. Extracorporeal Membrane Oxygenation (ECMO) and hemopurification support were used in all patients (100%). Details of the cases with follow-ups were further presented and analyzed.Conclusions: Late timing of bilateral lung transplantation can be performed successfully for pulmonary fibrosis after paraquat or diquat intoxication. The survival of patients with complex perioperative conditions can be achieved with a multidisciplinary team to manage the irreversible effects of intoxication.

Key Points Question Could esophageal cancer be detected by testing breathomics using high-pressure photon ionization time-of-flight mass spectrometry (HPPI-TOFMS)? Findings In this diagnostic study of 675 patients with and without cancer, esophageal cancer was accurately detected by testing breathomics with a sensitivity of 97.83% and specificity of 83.72% in the validation data set. Meaning These findings suggest that testing breathomics could help to improve the diagnosis of esophageal cancer., This diagnostic study investigates whether breathomics can detect esophageal cancer among patients without a previous diagnosis of cancer using high-pressure photon ionization time-of-flight mass spectrometry., Importance A triage test is needed to increase the detection rate for esophageal cancer. Objective To investigate whether breathomics can detect esophageal cancer among patients without a previous diagnosis of cancer using high-pressure photon ionization time-of-flight mass spectrometry (HPPI-TOFMS). Design, Setting, and Participants This diagnostic study included participants who planned to receive an upper endoscopy or surgery of the esophagus at a single center in China. Exhaled breath was collected with a self-designed collector and air bags before participants underwent these procedures. Sample collection and analyses were performed by trained researchers following a standardized protocol. Participants were randomly divided into a discovery data set and a validation data set. Data were collected from December 2020 to March 2021. Exposures Breath samples were analyzed by HPPI-TOFMS, and the support vector machine algorithm was used to construct a detection model. Main Outcomes and Measures The accuracy of breathomics was measured by the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Results Exhaled breath samples were obtained from 675 patients (216 [32%] with esophageal cancer; 459 [68%] with noncancer diseases). Of all patients, 206 (31%) were women, and the mean (SD) age was 64.0 (11.9) years. In the validation data set, esophageal cancer was detected with an accuracy of 93.33%, sensitivity of 97.83%, specificity of 83.72%, positive predictive value of 94.74%, negative predictive value of 92.78%, and area under the receiver operating characteristic curve of 0.89. Notably, for 16 patients with high-grade intraepithelial neoplasia, 12 (75%) were predicted to have esophageal cancer. Conclusions and Relevance In this diagnostic study, testing breathomics using HPPI-TOFMS was feasible for esophageal cancer detection and totally noninvasive, which could help to improve the diagnosis of esophageal cancer.

The left and right recurrent laryngeal nerve(RLN) are asymmetrical, and the precise differences and metastasis risk stratifications based on preoperative CT scan between the left and right RLN lymph nodes have not yet been analyzed. In this study, we compared the anatomical characteristics and generated prediction models to predict the probability of left and right RLN lymph node metastasis using preoperative clinical data in patients undergoing thoracolaparoscopic esophagectomy with cervical anastomosis to guide clinical treatment. Methods We retrospectively reviewed the clinical data of 1660 consecutive patients with thoracic esophageal cancer who underwent esophagectomy with cervical anastomosis at the Department of Thoracic Surgery at our center between January 2015 and December 2020 and investigated the anatomical characteristics and risks of bilateral RLN lymph nodes according to preoperative CT scan and pathological examination findings. Results A total of 299 and 343 patients who underwent left(right) RLN lymph node dissection were included in the final analysis. By plotting ROC curves, we concluded that the cutoff values of the long and short axis to predict metastasis of the left (right) RLN lymph nodes were 10 (8 mm) and 7.5 (6.5 mm), respectively. The short axis rather than the long axis was significantly associated with left RLN lymph node metastasis. Correspondingly, the long axis was much more important than the short axis in regard to the right RLN lymph nodes. Conclusion There were different anatomical characteristics and precise metastasis risk stratifications between the left and right RLN lymph node metastases.

Enchondromas originating in the epiphyses of long bones are rare and epiphyseal osteoid osteomas are also uncommon. Diagnosis can become elusive when enchondromas or osteoid osteomas occur in atypical locations and present with nonspecific clinical and imaging characteristics.We report a case of epiphyseal enchondroma of the left proximal femur in a 15-year-old girl with a 2-month history of left lower extremity pain. Preoperative CT displayed thickened cortex in the anterior surface of the left proximal femur with specks of calcification and inhomogeneity of the adjacent bone marrow cavity. She was diagnosed with osteoid osteoma. Postoperative pathological examination of surgically excised specimens revealed a diagnosis of enchondromas.Our case highlights that enchondroma should be considered in lesions of the epiphysis.

BACKGROUND: There are no effective preoperative diagnostic measures to predict the probability of left and right recurrent laryngeal nerve (RLN) lymph node (LN) metastasis using preoperative clinical data in patients undergoing thoracolaparoscopic esophagectomy with cervical anastomosis. METHODS: We retrospectively reviewed the clinical data of 1,660 consecutive patients with thoracic esophageal cancer who underwent esophagectomy with cervical anastomosis at the Department of Thoracic Surgery at the First Affiliated Hospital of Zhengzhou University between January 2015 and December 2020. RESULTS: A total of 299 and 343 patients who underwent left (Cohort 1) and right (Cohort 2) RLN LN dissection were included in the final analyses. The analyses were conducted within each cohort. Among the 299 patients in Cohort 1, left RLN LN involvement was found in 41 patients (13.7%). A multivariable analysis showed that age, tumor location, and short axis were significantly associated with RLN LN metastasis (all P

Background Enchondromas originating in the epiphyses of long bones are rare and epiphyseal osteoid osteomas are also uncommon. Diagnosis can become elusive when enchondromas or osteoid osteomas occur in atypical locations and present with nonspecific clinical and imaging characteristics. Case presentation We report a case of epiphyseal enchondroma of the left proximal femur in a 15-year-old girl with a 2-month history of left lower extremity pain. Preoperative CT displayed thickened cortex in the anterior surface of the left proximal femur with specks of calcification and inhomogeneity of the adjacent bone marrow cavity. She was diagnosed with osteoid osteoma. Postoperative pathological examination of surgically excised specimens revealed a diagnosis of enchondromas. Conclusions Our case highlights that enchondroma should be considered in lesions of the epiphysis.

EGFR fusions are rare genomic events in non-small cell lung cancer (NSCLC), and a total of nine types have been previously reported in lung adenocarcinoma: EGFR-RAD51, EGFR-PURB, EGFR-ANXA2, EGFR-ZNF713, EGFR-YAP1, USP42-EGFR, EGFR-SEPTIN14, EGFR-TNS3, and EGFR-ZCCHC6. EGFR fusion mutations combined with EGFR amplification are even rarer in NSCLC. The EGFR-intergenic region (IGR) fusion mutation is unreported, and thus, there are no studies targeting this fusion together with EGFR amplification in lung adenocarcinoma. Our brief study provides clinical evidence that combined targeted therapy with gefitinib and cetuximab could result in a significant antitumor response in patients with the EGFR-IGR fusion and EGFR amplification. KEY POINTS: EGFR fusion mutations are rare, and EGFR fusion mutations combined with EGFR amplification are even rarer in non-small cell lung cancer (NSCLC). To the authors' knowledge, there is no previous report on the coexistence of the EGFR-intergenic region (IGR) fusion and EGFR amplification. This is the first report of a patient with NSCLC with the EGFR-IGR fusion and EGFR amplification who achieved a significant antitumor response from treatment with gefitinib combined with cetuximab.

Design and control of a lower-limb exoskeleton rehabilitation of the elderly are the main challenge for health care in the past decades. In order to satisfy the requirements of the elderly or disabled users, this paper presents a novel design and adaptive fuzzy control of lower-limb empowered rehabilitation, namely MOVING UP. Different from other rehabilitation devices, this article considers active rehabilitation training devices. Firstly, a novel product design method based on user experience is proposed for the lower-limb elderly exoskeleton rehabilitation. At the same time, in order to achieve a stable operation control for the assistant rehabilitation system, an adaptive fuzzy control scheme is discussed. Finally, the feasibility of the design and control method is validated with a detailed simulation study and the human-interaction test. With the booming demand in the global market for the assistive lower-limb exoskeleton, the methodology developed in this paper will bring more research and manufacturing interests.

Soybean seed hardness is an important quality character in soybean food processing. Both vegetable soybean and natto require soft seeds to achieve a desirable sensory experience and for effective processing. In this study, we used a texture analyzer to measure the seed hardness of Chinese mini core collection via two indexes over 4 years and found significant correlations among the seed hardness, seed oil content, and germplasm eco-region. Based on 1514 SNPs, genome-wide association studies (GWAS) were conducted using a mixed linear model (MLM). Seventeen SNPs were identified to be associated with seed hardness in at least two environments. Among them, one locus, designated Q-15-0087770, was associated with two indexes, and 13 putative genes were confirmed based on their annotations in SoyBase. This research provides new insights into advanced marker-assisted selections for breeding soybeans for seed hardness and oil content.

Non-small-cell lung cancer (NSCLC), the most common type of lung cancer accounting for 85% of the cases, is often diagnosed at advanced stages owing to the lack of efficient early diagnostic tools. 5-Hydroxymethylcytosine (5hmC) signatures in circulating cell-free DNA (cfDNA) that carries the cancer-specific epigenetic patterns may represent the valuable biomarkers for discriminating tumor and healthy individuals, and thus could be potentially useful for NSCLC diagnosis. Here, we employed a sensitive and reliable method to map genome-wide 5hmC in the cfDNA of Chinese NSCLC patients and detected a significant 5hmC gain in both the gene bodies and promoter regions in the blood samples from tumor patients compared with healthy controls. Specifically, we identified six potential biomarkers from 66 patients and 67 healthy controls (mean decrease accuracy >3.2, P

Although great efforts have been devoted to enhancing the efficiency and stability of perovskite solar cells (PSCs), the performance of PSCs has been far lower than anticipated. Interface engineering is helpful for obtaining high efficiency and stability through control of the interfacial charge transfer in PSCs. This paper demonstrates that the efficiency and stability of PSCs can be enhanced by introducing stable α-CsPbI3 quantum dots (QDs) as an interface layer between the perovskite film and the hole transport material (HTM) layer. By synergistically controlling the valence band position (VBP) of the perovskite and the interface layer, an interface engineering strategy was successfully used to increase the efficiency of hole transfer from the perovskite to the HTM layer, resulting in the power conversion efficiency increasing from 15.17 to 18.56%. In addition, the enhancement of the stability of PSCs can be attributed to coating inorganic CsPbI3 QDs onto the perovskite layer, which have a high moisture stability and result in long-term stability of the PSCs in ambient air.

Bronchopleural fistula after pulmonary resection is a serious complication, with major impact on the quality of life and survival. This study aims to evaluate the efficacy and safety of customized airway stenting in the treatment of bronchopleural fistula. A series of airway stents for dedicated bronchopleural fistula occlusion were designed after taking into account the anatomical and pathophysiological features of post-pulmonary resection fistulas and the shortcomings of airway stents currently available. The fistulas were occluded with the bullet head or a special part of the covered airway stent. Successful stenting was defined as immediate cessation of air leak from the residual cavity after stenting. The results were retrospectively analyzed. Airway occlusion stenting was successful on the first attempt in 143/148 (96.6%) patients with bronchopleural fistulas. In the remaining 5 patients, occlusion was successful only on the second try. At follow-up 30 days after stenting, 141 patients reported relief in symptoms. No choking, laryngeal edema, or airway rupture occurred in any patient during stent insertion or removal; 2 patients developed hemorrhage during stent removal. Airway occlusion stenting appears to be a feasible and effective technique for treatment of bronchopleural fistula.

AIM To review the removal of Y-shaped airway self-expanding covered metallic stents using the interventional technique under fluoroscopy. MATERIALS AND METHODS The clinical data of 33 patients who underwent removal of Y-shaped airway self-expanding covered metallic stents from March 2011 to August 2019 were analysed retrospectively. RESULTS A total of 35 Y-shaped stents were removed. The average indwelling duration of the tracheal stents was 101.7 ± 105.4 days. Four cases were removed via the conventional method (grasping the upper tip of the stent to collapse and adduct the proximal end of the stent), whereas 31 cases were removed using the reversal method (grasping the distal end of the stent to invert and strip out the stent). The duration of stent removal was 24.3 ± 12.4 minutes (median time, 20 minutes). CONCLUSION The interventional radiology technique is a feasible, safe, and effective method for removing Y-shaped airway self-expanding covered metallic stents, and can be considered for use in the clinical setting.

The rarity of primary small cell carcinoma of the esophagus (PSCE) has limited the clinical feature and survival analysis with large sample size. Tissue chromogranin A (CgA) protein expression has been reported to be a useful biomarker for diagnosing PSCE. Interestingly, recent studies have indicated tissue CgA as a significant prognostic marker in multiple human cancers, but without PSCE. The present study, thus, was undertaken to characterize the clinicopathological changes and to evaluate the associations of tissue CgA expression with clinical response on Chinese PSCE patients. All the 125 PSCE patients were enrolled from our 500,000 esophageal and gastric cardia carcinoma databases (1973-2015), constructed by the cooperative team from more than 700 hospitals in China and established by Henan Key Laboratory for Esophageal Cancer Research in Henan, China. Immunostaining for CgA showed that CgA was mainly located in cytoplasm of tumor cells with a positive detection rate of 44.6%. The CgA positive expression rate in PSCE at lower segment of the esophagus (72.2%) was higher than that at middle segment (41.5%) (P = 0.001). However, CgA protein expression did not correlated with lymph node metastasis (P = 0.767), TNM staging (P = 0.740), tumor invasion (P = 0.253), gender (P = 0.262), and age (P = 0.250). Multivariate survival analysis showed that the patients with higher CgA protein expression had a superior long survival than those without CgA expression (P = 0.037). The clinicopathological analysis showed that PSCE occurred predominantly in male (M:F = 1.9:1) at the middle segment (68%) of the esophagus. Histologically, 89.6% were pure PSCE and 10.4% were mixed type with either squamous cell carcinoma (8%) or adenocarcinoma (2.4%). It was noteworthy that, with the in-depth invasion from T1 to T2 and T3, the positive lymph node metastasis rate increased dramatically from 38%, 56% to 74%, respectively. The survival rates of 1-, 2-, 3-, and 5-year were 64%, 35%, 18%, and 7%, respectively. The Kaplan-Meier survival analysis showed that the young patients (≤60 years) had longer survival than the elderly (P = 0.011). Interestingly, multivariate survival analysis revealed that the patients with mixed PSCE had a significantly better survival than those with pure PSCE (P = 0.015). Furthermore, the median survival time for the patients with and without lymph node metastasis was 1.16 and 2.03 years, respectively. But, the difference was not significant (P = 0.143). Univariate analysis did not show any survival influence by gender, tumor location, tumor invasion depth, and TNM staging. It was noteworthy that, of the 13 early PSCE patients (T1N0M0), only one patient had more than 5 year survival, the others died with less than one or two year (65%). The present study indicates that the PSCE is of badly worsen prognosis, even in the pathological early stage. Tissue CgA protein expression is a promising maker not only for diagnosis and also for prognosis. Further assessment is needed to establish specific PSCE pathological staging system and to clarify the mechanisms of CgA protein in PSCE progression and prognosis.

// Kang Cui 1,* , Xiangnan Li 2,* , Yabing Du 1,* , Xiance Tang 3 , Seiji Arai 4,5 , Yiwei Geng 1 , Ying Xi 1 , Han Xu 6 , Yue Zhou 7 , Wang Ma 1 and Tengfei Zhang 1 1 Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 3 Department of Medical Affairs, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China 4 Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States 5 Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan 6 Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China 7 Deparmtent of B-Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China * These authors have contributed equally to this work Correspondence to: Tengfei Zhang, email: // Wang Ma, email: // Keywords : HGPIN, prostate cancer, chemoprevention, adjusted indirect meta-analysis, green tea catechins Received : February 12, 2017 Accepted : March 06, 2017 Published : March 15, 2017 Abstract Background: High-grade prostatic intraepithelial neoplasia (HGPIN) is the precursor or premalignant form of prostate cancer. At least 30% patients with a confirmed HGPIN will develop prostate cancer within 1 year after repeated biopsy. HGPIN patients are the appropriate at-risk population for chemoprevention strategies investigation against prostate cancer. However the commonly used chemoprevention agents that targeted on hormonal imbalance or lifestyle-related factors showed varied results in HGPIN patients. Methods: Literature searches were conducted in PubMed, EMBASE and Cochrane library according to Cochrane guidelines before January 31 st , 2017. Direct meta-analysis were performed to summarize the efficacy of candidate chemopreventative agents Dutasteride, Flutamide, Toremifene, Selenium, Green tea components, Lycopene and natural food products combination. Adjusted indirect meta-analyses were employed to compare the relative efficacy of these candidate chemoprevention agents head-to-head. Results: The overall incidence of prostate cancer in HGPIN was slightly decreased by chemoprevention agents (25.7% vs 31.5%, RR = 0.92, 95% CI: 0.83-1.03, P = 0.183), with minor heterogeneity (I 2 = 22.3%, 𝟀 2 = 15.08, P = 0.237), but without statistical significance. Subgroup analysis showed that green tea catechins significantly decreased prostate cancer in HGPIN patients (7.60% vs 23.1%, RR = 0.39, 95% CI: 0.16-10.97, P P = 0.044), with moderate heterogeneity (I 2 = 47.9%, 𝟀 2 = 1.92, P = 0.166). The adjusted indirect meta-analysis favored green tea catechins over other chemoprevention agents, and significantly when compared to natural food products combination (RR = 0.355, 95% CI: 0.134-0.934). Conclusion: The overall efficacy of chemoprevention agents in HGPIN patients is limited. But Green tea catechins showed the superiority to decrease prostate cancer in HGPIN patients.

Background Increasing evidence suggests the potential involvement of metalloproteinase family proteins in the pathogenesis of neuropathic pain, although the underlying mechanisms remain elusive. Methods Using the spinal nerve ligation model, we investigated whether ADAM10 proteins participate in pain regulation. By implementing invitro methods, we produced a purified culture of satellite glial cells to study the underlying mechanisms of ADAM10 in regulating neuropathic pain. Results Results showed that the ADAM10 protein was expressed in calcitonin gene-related peptide (CGRP)-containing neurons of the dorsal root ganglia, and expression was upregulated following spinal nerve ligation surgery invivo. Intrathecal administration of GI254023X, an ADAM10 selective inhibitor, to the rats one to three days after spinal nerve ligation surgery attenuated the spinal nerve ligation-induced mechanical allodynia and thermal hyperalgesia. Intrathecal injection of ADAM10 recombinant protein simulated pain behavior in normal rats to a similar extent as those treated by spinal nerve ligation surgery. These results raised a question about the relative contribution of ADAM10 in pain regulation. Further results showed that ADAM10 might act by cleaving E-cadherin, which is mainly expressed in satellite glial cells. GI254023X reversed spinal nerve ligation-induced downregulation of E-cadherin and activation of cyclooxygenase 2 after spinal nerve ligation. β-catenin, which creates a complex with E-cadherin in the membranes of satellite glial cells, was also downregulated by spinal nerve ligation surgery in satellite glial cells. Finally, knockdown expression of β-catenin by lentiviral infection in purified satellite glial cells increased expression of inducible nitric oxide synthase and cyclooxygenase 2. Conclusion Our findings indicate that neuron-derived ADAM10 production stimulates peripheral nerve injury-induced neuropathic pain by cleaving E-cadherin in satellite glial cells.

Interleukin-6 (IL-6) is produced by a variety of cells involved in inflammation and acts as local intensification signals in pathological processes associated with chronic eye inflammation. This meta-analysis was performed to provide a better understanding of the relationship between IL-6 and diabetic retinopathy.The study was started with systematic search for literatures by using the PubMed, Web of Science and Embase online databases. The standard mean difference (SMD) and its 95% confidence intervals (CIs) were was included and then pooled with a random effects model.Thirty-one articles, containing1099 DR patients and 1010 controls, were included in this meta-analysis. The level of IL-6 in the DR group was found to be higher than that in the control group (SMD: 2.12, 95% CI: 1.53-2.70, p 0.00001).Obvious heterogeneity existed between the studies (p 0.00001, I

With industrial internet increasingly used in manufacturing industry, the traditional manufacturing industry can no longer meet the needs of the development of manufacturing and producing, which brought both an opportunity and a huge challenge for small and medium-sized manufacturing enterprises. After investigations and consultations with many small and medium-sized enterprise, developed a set of production management systems for small and medium-sized enterprises. The system includes three layers: physical layer, network layer and system layer. At the physical layer, field data is collected through photoelectric sensors and a model is established to found high-precision sensor node method. At the network layer, ZigBee wireless transmission network protocol is used to develop a wireless transmission module with strong anti-interference ability and data confidentiality. At the system layer, a production management system is developed according to characteristics of mobile terminals and PC in order to achieve equipment failure repair, alarm message push and other functions in the mobile terminal and to realize visual board and other functions. The system and technologies proposed is important for information-based manufacturing industries.

The purpose of this study was to determine whether the number of lymph nodes dissected predicts prognosis in surgically treated elderly patients with pN0 thoracic esophageal cancer. We searched the Surveillance, Epidemiology, and End Results database and identified the records of younger (

AIM To investigate the feasibility and safety of a fluoroscopy-assisted interventional technique for removal of bullet-shaped self-expanding covered metallic stents from bronchopleural fistulas (BPFs). MATERIALS AND METHODS Clinical data for 49 consecutive patients who underwent removal of bullet-shaped self-expanding covered metal stents from October 2010 to November 2019 were analysed retrospectively. Fifty-one stents were removed in all, including 29 large Y-shaped bullet stents, 10 small Y-shaped bullet stents, and 12 branched bullet-shaped stents. The average duration for which tracheal stents were in place was 99.4±8.5 days. RESULTS Fifty-one stents were removed successfully, of which 49 were directly removed on the first attempt. The time required for stent removal ranged from 7–60 minutes (median time, 22 minutes). In eight cases, the stent was removed by the conventional method (i.e., grasping the upper tip of the stent to collapse and adduct the proximal end), and in 43 by the eversion method (i.e., grasping the distal end of the stent to invert and peel out). CONCLUSIONS Interventional radiology is a simple, safe, and effective method to extract self-expanding covered metallic bullet-shaped stents, with no need for general anaesthesia and tracheal intubation. It has a short operation time, is well tolerated by patients, and is worthy of clinical application.

Microglia are critical in the pathogenesis of neuropathic pain. In this study, we investigated the role of microvesicles (MVs) in neuropathic pain induced by spinal nerve ligation (SNL) in rats. First, we found that MVs shed from microglia were increased in the cerebrospinal fluid and dorsal horn of the spinal cord after SNL. Next, MVs significantly reduced paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). In addition, the P2X7-p38 pathway was related to the bleb of MVs after SNL. Interleukin (IL)-1β was found to be significantly upregulated in the package of MVs, and PWT and PWL increased following inhibition with shRNA-IL-1β. Finally, the amplitude and frequency of spontaneous excitatory postsynaptic currents increased following stimulation with MVs. Our results indicate that the P2X7-p38 pathway is closely correlated with the shedding of MVs from microglia in neuropathic pain, and MVs had a significant effect on neuropathic pain by participating in the interaction between microglia and neurons.

Background and Objectives Perforated esophageal carcinoma with mediastinal abscess is a clinically life-threatening emergency. Herein, we summarize our experience with placement of transnasal drainage catheters and covered esophageal stents for the treatment of this condition. Methods We retrospectively assessed the medical records of 20 patients who were treated using our intervention protocol. Patients received local anesthesia and sedation prior to transnasal drainage catheter placement into the mediastinal abscess, which was followed by esophageal stent placement. Once the fluid was completely drained and the abscess was completely closed, the drainage catheter was removed. Results The placement of the drainage catheter and stent was successful in all patients. The drainage catheter was successfully removed from the mediastinum after 7–60 days in 14 patients. During the follow-up of 1–18 months, six patients died from hemorrhage, eight from cancer progression or pulmonary infection, one from atrial fibrillation, and one from asphyxia caused by tracheal compression. The remaining four patients can eat normally. Conclusions Placement of transnasal drainage catheters and covered esophageal stents may be an appropriate palliative therapy for patients with perforated esophageal carcinoma with mediastinal abscess who are not candidates for surgery or have a high postoperative risk. J. Surg. Oncol. 2016;114:725–730. © 2016 Wiley Periodicals, Inc.

Purpose MicroRNA-454 has been proven dysregulated in some human malignancies and correlated with tumor progression. However, its expression and function in non-small cell lung cancer (NSCLC) is still unclear. Thus, the aim of this study was to explore the effects of miR-454 in NSCLC tumorigenesis and development. Methods Using quantitative RT-PCR, we detected miR-454 expression in NSCLC cell lines and primary tumor tissues. The association of miR-454 expression with clinicopathological factors and prognosis was also analyzed. Then, the effects of miR-454 on the biological behavior of NSCLC cells were investigated. At last, the potential regulatory function of miR-454 on PTEN expression was confirmed. Results miR-454 was found to be up-regulated in NSCLC tissues and cell lines. High miR-454 expression was closely correlated with lymph node metastasis, advanced TNM stage, and shorter overall survival. Multivariate regression analysis corroborated that miR-454 overexpression was an independent unfavourable prognostic factor for patients with NSCLC. Down-regulation of miR-454 could significantly reduce NSCLC cell proliferation, enhance cell apoptosis, and impair cell invasion and migration in vitro, while up-regulation of miR-454 showed opposite effects. Further, PTEN was confirmed as a direct target of miR-454 by using Luciferase Reporter Assay. Conclusions These findings indicate that miR-454 may act as an oncogene in NSCLC and would serve as a potential therapy target for this disease.

The increase in global mean air temperature is likely to affect the soil temperatures in agricultural areas. This study aims to study the effects of winter soil warming on the responses of wheat to low temperature stress in spring. Wheat plants were grown under either normal or increased soil temperature by 2.5 °C for 82 days in winter. The physiological and yield responses of the plants to a 2-day low temperature stress (4/2 °C in the day/night) at jointing stage were investigated. After exposing to low spring temperature, the plants that had experienced winter soil warming showed lower leaf and root water potential, lower oxygen scavenging capacity and poor photosynthetic performance as compared with the plants grown under normal soil temperature during winter. WL plants had significantly lower sugar content in shoot than the CL plants, which might have contributed to their higher susceptibility to low temperature. In addition, winter soil warming exacerbated the negative effects of low spring temperature on grain yield.

The Penning discharge structure was designed to produce plasma anode used in a high current pulsed electron beams source. The cylindrical anode of diameter 80 mm and height 30 mm was powered by a pulse voltage of ∼5 kV. The plasma discharge characteristics were investigated by means of oscilloscope, current sensor and digital camera. The results show that the plasma discharge goes through two main stages, a high-voltage, low-current stage and a high current discharge stage. There exists an anode voltage threshold to ignite the high current discharge. With the higher working pressure and magnetic field intensity, the Penning discharge operates more quickly and steadily. The time accuracy can be controlled under ±0.5 μs The peak discharge current increases proportionally with the anode voltage. The HCPEB emissions were realized with the optimized parameters including working pressure 7 × 10 −2 Pa, anode voltage 5 kV, magnetic field 2000 Gauss and ballast resistor 200 Ω.

1.5-1.6 eV bandgap Pb-based perovskite solar cells (PSCs) with 30-31% theoretical efficiency limit by the Shockley-Queisser model achieve 21-24% power conversion efficiencies (PCEs). However, the best PCEs of reported ideal-bandgap (1.3-1.4 eV) Sn-Pb PSCs with a higher 33% theoretical efficiency limit are 0.4 V). Herein, it is found that the addition of guanidinium bromide (GABr) can significantly improve the structural and photoelectric characteristics of ideal-bandgap (≈1.34 eV) Sn-Pb perovskite films. GABr introduced in the perovskite films can efficiently reduce the high defect density caused by Sn2+ oxidation in the perovskite, which is favorable for facilitating hole transport, decreasing charge-carrier recombination, and reducing the Voc deficit. Therefore, the best PCE of 20.63% with a certificated efficiency of 19.8% is achieved in 1.35 eV PSCs, along with a record small Voc deficit of 0.33 V, which is the highest PCE among all values reported to date for ideal-bandgap Sn-Pb PSCs. Moreover, the GABr-modified PSCs exhibit significantly improved environmental and thermal stability. This work represents a noteworthy step toward the fabrication of efficient and stable ideal-bandgap PSCs.

Background Tumor necrosis factor-alpha (TNF-α) is produced by multinuclear giant cells and acts as local intensification signals in pathological processes associated with chronic eye inflammation. This meta-analysis was performed to provide a better understanding of the relationship between TNF-α and diabetic retinopathy (DR). Method Online electric databases were searched to retrieve all relevant articles published before October 2017. The standard mean difference (SMD) and their 95% confidence intervals (CI) were included and then pooled with a random effects model. Results A total of 16 articles with 1286 participants were included in this meta-analysis. No difference in the level of TNF-α was found between DR patients and healthy controls (SMD = 0.39, 95% CI = −0.09 to 0.68, P = 0.01). Subgroup analysis showed that with respect to the level of TNF-α, the association was significant for studies conducted in Europe (SMD: 0.57, 95% CI: 0.11–1.02, P = 0.01), patients with type 1 DM (SMD: 1.06, 95% CI: 0.09–2.04, P = 0.03), studies based on serum samples (SMD: 0.57, 95% CI: 0.12–1.02, P = 0.01) and studies with a sample size >50 (SMD: 0.39, 95% CI: 0.03–0.75, P = 0.04). Conclusion The results this meta-analysis indicated that the level of TNF-α in DR patients was significantly different from that in the healthy controls, so TNF-α represents a candidate biomarker for DR.

A 46-year-old male patient was admitted into the hospital due to repeated hemoptysis for more than seven months. Bronchiectasis of the left upper lobe was considered based on the symptoms, signs, and imaging findings. Thoracoscopic resection of lingual segment of the left upper pulmonary lobe was finally performed in the order of the lingual segmental vein, the lingual segmental bronchus, the lingual segmental artery, and the pulmonary tissues of the lingual segment. Total surgery time was 60 min and blood loss was 40 mL. The chest tube was removed on the 4th postoperative day. The patient was discharged home on the 8(th) postoperative day.

Although neuropathic pain is one of the most intractable diseases, recent studies indicate that systemic or local injection of bone marrow stromal cells (BMSCs) decreases pro-inflammatory cytokines release and alleviates neuropathic pain. However, it is still not clear whether pre-treated BMSCs have a strong anti-inflammatory and/or analgesia effect. Using the spinal nerve ligation model of neuropathic pain, IL-1β pre-treated BMSCs (IL-1β-BMSCs) were injected into rats followed by SNL in order to determine possible effects. Results indicated that IL-1β-BMSCs were more efficacious in both amelioration of neuropathic pain and inhibition of microglia activation. Specifically, microglia inhibition was found to be mediated by chemokine C-C motif ligand 7 (CCL7) but not CCL2. Results also showed that IL-1β-BMSCs had a stronger inhibitory effect on astrocyte activation as well as CCL7 release, which was found to be mediated by IL-10 not transforming growth factor-β1. In addition, we also found directional migration of IL-1β-BMSCs was mediated by inceased C-X-C motif chemokine ligand (CXCL) 13 expression following SNL. In conclusion, our results indicated IL-1β-BMSCs could inhibit microglia activation and neuropathic pain by decreasing CCL7 level in spinal cord.

This study aims to evaluate the effectiveness and clinical performance of a panel of urinary biomarkers to diagnose prostate cancer (PCa) in Chinese men with PSA levels between 4 and 10 ng/mL. A total of 122 patients with PSA levels between 4 and 10 ng/mL who underwent consecutive prostate biopsy at three hospitals in China were recruited. First-catch urine samples were collected after an attentive prostate massage. Urinary mRNA levels were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The predictive accuracy of these biomarkers and prediction models was assessed by the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve. The diagnostic accuracy of PCA3, PSGR, and MALAT-1 was superior to that of PSA. PCA3 performed best, with an AUC of 0.734 (95% CI: 0.641, 0.828) followed by MALAT-1 with an AUC of 0.727 (95% CI: 0.625, 0.829) and PSGR with an AUC of 0.666 (95% CI: 0.575, 0.749). The diagnostic panel with age, prostate volume, % fPSA, PCA3 score, PSGR score, and MALAT-1 score yielded an AUC of 0.857 (95% CI: 0.780, 0.933). At a threshold probability of 20%, 47.2% of unnecessary biopsies may be avoided whereas only 6.2% of PCa cases may be missed. This urinary panel may improve the current diagnostic modality in Chinese men with PSA levels between 4 and 10 ng/mL.

Spontaneous rupture of the esophagus is a rare but life-threatening thoracic emergency, with high rates of clinical misdiagnosis and mortality. This article summarizes our experience in the treatment of spontaneous esophageal rupture with transnasal thoracic drainage and temporary esophageal stent and jejunal feeding tube placement.We retrospectively assessed the medical records of 19 patients with spontaneous esophageal rupture treated using our intervention protocol. Patients received local anesthesia and sedation prior to undergoing transnasal drainage catheter placement into the thoracic abscess cavity, followed by temporary esophageal stent and jejunal feeding tube placement. After the operation, abscess lavage, nutritional support, and anti-inflammatory treatment were given. The transnasal thoracic drainage catheter, esophageal stent, and feeding tube were removed after the healing of the abscess cavity.In all, 19 covered esophageal stents were placed in 19 patients with spontaneous esophageal rupture. All operations were technically successful. After an average of 84.06 days, the stents were successfully removed from 17 patients. No cases of massive hemorrhage, esophageal rupture, or other complications occurred during stent removal. An 82-year-old patient died of heart failure 2 months after the operation. One patient died of sudden massive hematemesis and hematochezia 55 days after the operation. In one patient, the esophageal injury failed to heal completely.Our treatment protocol is simple, minimally invasive, and efficacious and may be an alternative for patients who are not candidates for surgery, have a high risk of postoperative complications, or wish to undergo minimally invasive surgery.Therapeutic study, level V.

Prognostics of the remaining useful life (RUL) of lithium-ion batteries is a crucial role in the battery management systems (BMS). An artificial neural network (ANN) does not require much knowledge from the lithium-ion battery systems, thus it is a prospective data-driven prognostic method of lithium-ion batteries. Though the ANN has been applied in prognostics of lithium-ion batteries in some references, no one has compared the prognostics of the lithium-ion batteries based on different ANN. The ANN generally can be classified to two categories: the shallow ANN, such as the back propagation (BP) ANN and the nonlinear autoregressive (NAR) ANN, and the deep ANN, such as the long short-term memory (LSTM) NN. An improved LSTM NN is proposed in order to achieve higher prediction accuracy and make the construction of the model simpler. According to the lithium-ion data from the NASA Ames, the prognostics comparison of lithium-ion battery based on the BP ANN, the NAR ANN, and the LSTM ANN was studied in detail. The experimental results show: (1) The improved LSTM ANN has the best prognostic accuracy and is more suitable for the prediction of the RUL of lithium-ion batteries compared to the BP ANN and the NAR ANN, (2) the NAR ANN has better prognostic accuracy compared to the BP ANN.

This letter presents an amplitude adaptive notch filtering (AANF) as a tool for grid signal processing and synchronization of distributed generation systems that provide improvement solutions for both grid-connected and stand-alone mode of microgrids. The proposed technique is simple and offers a high degree of immunity and insensitivity to power disturbances, especially when the signal amplitude varies. Since the powerful technique can reduce impact of the amplitude variation of signal, it has a wider range of application and can take the place of the traditional ANF in the microgrids. This technique can also be used in the detection of symmetrical components, harmonics, active power, and reactive power. Theoretical analysis is presented and the performance of the method is evaluated by simulation.

Drought is one of the major environmental factors limiting plant growth and development. Drought stress tolerance in plants involves diverse and multiple physiological and molecular mechanisms. Priming and drought stress memory are key processes, by which plant may increase the tolerance to subsequent drought events. Stress memory involves multiple modifications at physiological, proteomic, transcriptional levels and epigenetic mechanisms. In this chapter, we summarized recent advancements in physiological, biochemical, and molecular studies related to drought priming and its effect on drought tolerance in plants. The mechanisms of drought stress memory and the possible priming-induced cross-tolerance to other abiotic stresses are discussed.

Objectives: To investigate whether preprocedural high-dose atorvastatin decreases the incidence of contrast-induced nephropathy (CIN) and protects the renal function after emergency percutaneous coronary intervention (PCI). Methods: Statin-naive patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency PCI (n = 161) randomly received atorvastatin (80 mg, n = 78, ATOR group) or placebo [n = 83, control (CON) group] followed by long-term atorvastatin (40 mg/day). The primary end point was incidence of CIN. Results: In the ATOR group, 2.6% of the patients developed CIN versus 15.7% in the CON group (p = 0.01). In the ATOR group, postprocedural serum creatinine was significantly lower (93.4 ± 17.1 vs. 112.6 ± 23.3 µmol/l at 48 h and 84.2 ± 14.2 vs. 95.3 ± 17.7 µmol/l at 72 h, both p < 0.0001) and in the CON group, peak serum cystatin C was lower (0.51 ± 0.14 vs. 0.61 ± 0.13 mg/l, p < 0.0001). Atorvastatin pretreatment was independently associated with a decreased risk of CIN (OR 0.084, 95% CI 0.015–0.462, p = 0.004). The proportion of alanine aminotransferase >3 × upper limit of the normal value within 1 month was 3.85 versus 1.20% (ATOR vs. CON group, p = 0.57). Conclusion: Preprocedural high-dose atorvastatin prevents CIN and protects the renal function in patients with acute STEMI undergoing emergency PCI.

We aimed to screen possible biomarkers associated with the molecular mechanism of breast cancer using microRNA (miRNA) microarray. The miRNAs expression profile GSE45666 was downloaded from Gene Expression Omnibus database, which included 101 genechips from breast tumor samples and 15 from adjacent breast normal tissue samples. Limma package in R language was used to screen and identify differentially expressed miRNAs (DE-miRNAs) which were classified as up-regulated and down-regulated groups. Then, target genes regulated by the two groups of DE-miRNA were predicted, followed by the functional and pathway enrichment analysis using the DAVID system. Totally, 130 DE-miRNAs were screened out, including 59 up-regulated DE-miRNAs and 71 down-regulated DE-miRNAs. The functional enrichment indicated that target genes of up- and down-regulated DE-miRNA may be most highly associated with positive regulation of gene expression and regulation of cellular metabolic process, respectively. Target genes regulated by the up- and down-regulated DE-miRNAs were mainly enriched in 13 and 14 pathways, respectively, and both were most significant in subcategories in cancer. In addition, we identified three important miRNAs (miR-142-3p, miR-483-5p and miR-483-3p) pivotal for the initiation and progression of this malignant tumor. MiR-142-3p, miR-483-5p and miR-483-3p are potential key factors for further understanding the molecular mechanism of breast cancer by affecting the normal physiological function of cell.

A variety of dopant-free hole-transporting materials (HTMs) is effectively applied in perovskite solar cells (PSCs); however, HTMs with the additional function of HTM/perovskite interfacial optimization that is crucial to their photovoltaic performance are really limited. In this work, the design of an HTM bearing an intensive exposure of its functional aromatic rings to perovskite layer via side-chain engineering is attempted. With an edge-on orientation and a short distance to perovskite, this HTM was expected to display an excellent ability to extract holes from and passivate defects in the perovskite layer. To demonstrate this strategy, an alternating copolymer was constructed with a 2,5-di-2-ethylhexyloxy-1,4-phenylene unit and a bithiophene unit, and the PSC based on this polymer showed an ultrahigh short-circuit current density of 25.50 mA cm-2 , which was the highest so far presented by dopant-free organic HTMs. A comparable power conversion efficiency of 19.68% (certified: 19.5%) to that of a control 2,2',7,7'-tetrakis(N,N-di-p-methoxyphenylamine)-9,9'-spirobifluorene (spiro-OMeTAD) device (19.81%) was thus obtained, which is the highest value ever reported for mesoporous PSCs based on dopant-free polymeric HTMs.