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The treatment of huge hepatocellular carcinoma (HCC) is still challengeable due to its deteriorative heterogeneity, for which conventional transarterial chemoembolization (TACE) is proposed as an efficient therapy; however, drug-eluting beads TACE (DEB-TACE) is rarely reported in these patients. Thus, the current study aimed to explore the efficacy, prognostic factors, and safety of DEB-TACE using CalliSpheres in huge HCC patients.Ninety-nine huge HCC patients treated by DEB-TACE using CalliSpheres were retrospectively reviewed. Treatment response, change of tumor markers, liver function indexes, progression-free survival (PFS), and adverse events were retrieved.Objective response rate (ORR) was 66.1%, 48.6%, and 23.8%, then disease control rate (DCR) was 85.5%, 67.6%, and 33.3% at month (M) 1, M3, and M6, respectively; furthermore, carcinoembryonic antigen (CEA) (p = 0.037), alpha fetoprotein (AFP) (p 0.001), and protein induced by vitamin K absence or antagonist-II (PIVKA-II) (p 0.001) were all declined at 1 month after DEB-TACE. The median PFS was 8.3 (95% confidence interval: 6.0-10.6) months with 1-year and 2-year PFS rates of 38.5% and 15.5%, accordingly. Moreover, elevated China liver cancer (CNLC) stage (p = 0.036, hazard ratio (HR): 1.937) and abnormal cancer antigen 199 (p = 0.019, HR: 2.465) were correlated with unfavorable PFS. Besides, liver function indexes were not deteriorated after DEB-TACE. Lastly, main adverse events included pain (20.2%), fever (17.2%), nausea (14.1%), and vomit (9.1%), which were mild and manageable.DEB-TACE using CalliSpheres presents satisfying efficacy and tolerable safety in huge HCC patients, suggesting that it might be a good treatment option for these patients.

Background: Self-medication behavior has great adverse effects on children. The aims of this study were to assess the prevalence of self-medication with antibiotics (SMA) among children aged 0–5 ye...

Objectives Sleep status can affect the body's immune status and mental health. This study aims to investigate the sleep status of Chinese residents during the outbreak of Coronavirus Disease 2019 (COVID-19) and to evaluate its related risk factors. Methods This research carried out a cross-sectional survey in February 2020 (during the COVID-19 outbreak) to investigate the sleep status of residents nationwide in the form of an online questionnaire. Of the 8151 respondents, 6437 were eventually included in the analysis. Logistic regression is applied to analyze the associated factors affecting residents' sleep quality. Results During the COVID-19 outbreak, the incidence of sleep disturbances in residents was 17.65%. Increased risk of sleep disturbances was found to be associated with older age, female gender, and poor self-reported health status. Moreover, the odds ratios (ORs) were 1.42 (95% CI: 1.1–2.64), 1.35 (95% CI: 1.16–1.59), 5.59 (95% CI: 4.32–7.23), respectively. Those residents who believed COVID-19 had caused a high number of deaths or who thought COVID-19 was not easy to cure were more likely to experience sleep disorders, and the ORs were 1.73 (95% CI: 1.43–2.09), 1.57 (95% CI: 1.29–1.91), respectively. Regular exercise was a protective factor for sleep disturbances, OR = 0.77 (95% CI: 0.63–0.93). Conclusions During the outbreak of COVID-19, nearly one-fifth of participants had sleep disorders. It is necessary to pay more attention to people at high risk for sleep disturbances during the outbreak, adopt effective risk communication methods, enhance residents' rational understanding of COVID-19, and develop practical indoor exercise programs for general public to improve sleep quality., Highlights • Nearly one-fifth of participants had sleep disorders during the COVID-19 outbreak. • People's perceptions of the death toll affect their sleep. • People's perceptions of treatment difficulty of COVID-19 affect their sleep. • It is necessary to pay attention to the elderly and those in poor health.

Background Self-medication is one of the most common forms of inappropriate use of antibiotics. This study aimed to assess the prevalence of self-medication with antibiotics (SMA) in China and evaluate the related factors. Methods A cross-sectional survey was conducted in Wuhan, Hubei, China from July 1, 2019 to July 31, 2019. Participants were recruited in public places to answer a structured questionnaire. The information of participants’ social demographic characteristics, antibiotic knowledge and health beliefs were collected. Binary Logistics regression analysis was used to examine the associated factors of SMA. Results Of the 3206 participants, 10.32% reported SMA in the past 6 months. Participants who with middle or high perceived barriers to seek health care services showed a higher likelihood of SMA (P P Conclusions Compared with developed countries, the prevalence of SMA in China is still higher. Measures to conduct public health education and improve the accessibility of health services are crucial to decrease the overall self-medication rate in China.

Background Effort-reward imbalance is an adverse psychological response to working conditions that has several negative effects on nurses. However, there is little research on effort-reward imbalance and its influencing factors among nurses in emergency departments. This study aimed to understand the current situation of effort-reward imbalance and explore its influencing factors among emergency department nurses in China. Methods From July to August 2018, a structured online questionnaire survey was conducted among emergency department nurses in China. Data were collected from emergency department nurses employed in hospitals providing pre-hospital care in China. The questionnaire consisted of sociodemographic characteristics, work-related factors and effort-reward imbalance. A descriptive analysis and a binary logistic regression were conducted to explore the effort-reward imbalance and its influencing factors among emergency department nurses. Results The study involved 17,582 emergency department nurses; notably, the prevalence of effort-reward imbalance was 59.66%. The participating nurses who were males, aged 25 to 34 years, whose educational level was a bachelor degree or above, who had a junior or above title, who had longer years of service, and who had suffered verbal or physical violence in the past year had a higher risk of effort-reward imbalance. Furthermore, the nurses with a high monthly income, who believed that the number of nurses met the department’s demand had a lower risk of effort-reward imbalance. Conclusions Effort-reward imbalance was prevalent among emergency department nurses in China. Measures such as adjusting the night shift frequency, increasing the number of nurses, raising salaries and reducing workplace violence should be considered to reduce the level of effort-reward imbalance.

To discuss postoperative thrombocytopenia in the treatment of hepatocellular carcinoma (HCC) through transcatheter arterial chemoembolization (TACE) with single application of Lobaplatin as chemotherapy drug.The study retrospectively analyzed 1,945 HCC patients treated with TACE in our hospital from May 2013 to May 2018. The number of first-time users of lobaplatin reached 128, the second-time users reached 417, the third-time and above users 239. The analysis examined various items of patients, including gender, age, multiple preoperative examination indicators (platelet level, liver function tests, AFP level), ascites, preoperative presence of peptic ulcer at the initial (3-7 days) and long-term (21-90 days) postoperative stages. Platelet levels were evaluated according to the WHO Grading System for Hematologic Toxicity for side effects of anticancer drugs.For HCC patients with normal pre-intervention platelet level, the incidences of mild decrease, moderate decrease and severe decrease after intervention were 16.50%, 10.47% and 4.88% respectively, the incidences of long-term platelet reduction after intervention were 13.25%, 4.73% and 1.65% respectively. The level of post-intervention thrombocytopenia was not correlated with the cycles of lobaplatin use. The initial thrombocytopenia was more obvious in female patients after intervention. The presence or absence of peptic ulcer and ascites before the intervention had an effect on the initial thrombocytopenia after the intervention. Platelet level before intervention was correlated with that after intervention. The liver function grading before intervention had no effect on the two levels of thrombocytopenia after intervention. There was a correlation between AFP level grouping before intervention and initial thrombocytopenia after intervention.The long-term incidence of thrombocytopenia after interventional therapy was not high in TACE patients with HCC treated with LPT alone, which was relatively safe. Besides, the occurrence of thrombocytopenia after intervention had certain characteristics, which can be used to guide clinical practice, so as to reduce the incidence of thrombocytopenia or provide targeted symptomatic support treatment.

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness. Magnetic resonance imaging (MRI) studies report an association between POAG and nonvisual pathway alterations. Locus coeruleus (LC) is a major source of norepinephrine released in the brain, and norepinephrine can reduce intraocular pressure via increasing aqueous outflow. This study aimed to investigate the relationship between glaucoma and the LC in patients with POAG and animal models. Resting-state functional MRI was performed using a 3-Tesla MR scanner with an eight-channel phased-array head coil, and MRI data were analyzed. A rat model of chronic glaucoma was generated by episcleral vein ligation and cauterization. DBA/2J mice that develop glaucoma with age were also acquired. Immunohistochemistry and immunofluorescence staining were used to investigate LC tyrosine hydroxylase (TH) and dopamine β-hydroxylase (DβH) expression, as well as cell apoptosis by terminal deoxynucleotidyl transferase dUTP Nick-End Labeling staining. Patients with POAG showed significantly increased amplitude of low-frequency fluctuation (ALFF) in the LC compared with controls. LC ALFF values showed significant correlations with cup-to-disk ratio, retinal nerve fiber layer thickness, and visual function (P 0.05). Functional connectivity (FC) between the LC and frontal and insular lobes was reduced, but elevated between the LC and parahippocampal gyrus, compared with controls. Glaucoma animal models revealed reduced expression of TH and DβH in the LC, and increased cell apoptosis. In this study, we provide novel evidence for the relationship between the LC and glaucoma. The LC may act as a network in POAG pathogenesis and intraocular pressure regulation.

The purpose of this study was to explore the central mechanism of transauricular vagus nerve stimulation (taVNS) to human by fMRI and to find a suitable taVNS site for potential tinnitus treatment. 24 healthy subjects aged between 28 and 38 years were enrolled in the experiment. 8 subjects were stimulated in the auricular acupoints Kindey (CO10), Yidan (CO11), Liver (CO12) and Shenmen (TF4) in the left ear, 8 subjects were stimulated at the anterior wall of the auditory canal and left lower limb as an anterior stimulation group; 8 persons who were arranged in a sham group received taVNS at the left ear lobe and tail of the helix. Functional magnetic resonance imaging (fMRI) data from the cortices was collected and an Alphasim analysis was performed. We found that taVNS at auricular acupoints CO10-12, TF4 can instantly and effectively generate blood oxygenation level dependent (BOLD) signal changes in the prefrontal, auditory and limbic cortices of healthy subjects by fMRI. When comparing the acupoints group and the sham group in the left brain, the signals from the prefrontal cortex, the auditory ascending pathway including superior temporal gyrus, middle temporal gyrus, thalamus and limbic system regions such as putamen, caudate, posterior cingulate cortex, amygdala and parahippocampal gyrus were increased under our stimulation. The difference of the BOLD signal in the left brain between acupoints group and anterior group was in the superior temporal gyrus. We could also find signal differences in several regions of right brain among the groups. In conclusion, taVNS at acupoints CO10-12, TF4 could activate the prefrontal, auditory and limbic cortices of healthy brain and this scheme could be a promising tool for tinnitus treatment.

The purpose of this study is to evaluate the magnetic susceptibility of normal-appearing white matter (NAWM) in patients with multiple sclerosis (MS) using quantitative susceptibility mapping.Ninety-four patients with relapse-remitting MS (RRMS) (37 with gadolinium-enhancing lesions and 57 with only gadolinium-nonenhancing lesions) and 55 healthy control subjects were included in this retrospective study. The susceptibility values of NAWM relative to CSF in patients with MS were compared with those of white matter (WM) in healthy control subjects and were correlated with the patient status of gadolinium-enhancing lesions, disease duration, and expanded disability status scale scores.All 37 patients with RRMS and gadolinium-enhancing lesions also had gadolinium-nonenhancing lesions. Susceptibility values of NAWM in patients with MS and only gadolinium-nonenhancing lesions (-18.29 ± 8.03 parts per billion [ppb]) were higher than those for WM in healthy control subjects (-25.81 ± 6.02 ppb; p0.001) and NAWM in patients with gadolinium-enhancing lesions (-25.64 ± 6.55 ppb; p0.001). Susceptibility values of NAWM in patients with MS with gadolinium-enhancing lesions were similar to those for WM in healthy control subjects (p = 0.91). This trend was dependent on neither NAWM region nor disease duration when the data were controlled for age. NAWM susceptibility was not correlated with either disease duration or expanded disability status scale (p0.05).In patients with RRMS and gadolinium-nonenhancing lesions, the susceptibility values of NAWM decrease when gadolinium-enhancing lesions appear, approaching values similar to those of WM in healthy control subjects, suggesting that NAWM may contribute to the iron accumulation observed in early active MS lesions.

To investigate the relationship between morphological changes in the lateral geniculate nucleus (LGN), as measured by magnetic resonance imaging (MRI), and damage to the optic disc in primary open-angle glaucoma (POAG) patients.A total of 23 patients with POAG and 23 age- and gender-matched non-glaucomatous subjects were enrolled. Every patient had structural damage to the optic disc. Cup-to-disc ratio (CDR) and retinal nerve fiber layer thickness (RNFLT) were measured, and 3.0-Tesla MRI examinations performed. Bilateral LGNs were identified and manually extracted, and their maximum heights and volumes compared with the clinical damage to the optic disc.In POAG patients, morphological changes in LGNs and RNFLT were consistently varied (P0.05), while a negative correlation between LGN measurements and CDR was observed (P0.05). LGN height was more significantly correlated with damage to the optic disc than was LGN volume. In contrast, no significant correlation was found between morphological changes in LGNs and age or optic disc parameters in the non-glaucomatous controls (P0.05).LGN atrophy in POAG patients was altered in a manner consistent with damage to the optic disc. Morphological changes in LGNs as measured by MRI and especially LGN maximum height may be useful ways to detect optic nerve neuropathy in glaucoma.

The intravenous methylprednisolone (iv MP) strategy for Graves' ophthalmopathy (GO) and evaluation of its activity against the disease warrants further exploration. A prospective randomized controlled trial for 3 months was performed in a tertiary referral teaching hospital to compare the efficacy and safety of two different regimens of iv MP, and determine the value of clinical activity score (CAS) and T2 relaxation time (T2RTs) and areas of extraocular muscles (EOMs) by magnetic resonance imaging for diagnosis of active GO. Forty patients with moderate to severe GO and CAS ≥ 3 or 1 ≤ CAS3 with prolonged T2RTs on EOMs were randomly assigned to a monthly (MR: 1.5 g iv MP monthly for 3 months) or weekly (WR: 0.5 g iv MP weekly for 6 weeks, followed by 0.25 g weekly for 6 weeks) regimen. Overall response based on ophthalmic symptoms, T2RTs, areas of EOMs and adverse effects were recorded at each visit. The total rate of response was 71.9%. Rates of improved, unchanged, deteriorated were similar between the MR and WR groups (p0.05). The maximum T2RTs and areas significantly decreased at the end of intervention in both groups (p0.05). Results show that both MR and WR are effective and safe in treatment of GO. T2RTs combined with CAS can sensitively detect active GO and predict the response to iv MP.

Quantitative susceptibility mapping (QSM) has shown its potential for anatomical and functional MRI, as it can quantify, for in vivo tissues, magnetic biomarkers and contrast agents which have differential susceptibilities to the surroundings substances. For reconstructing the QSM with a single orientation, various methods have been proposed to identify a unique solution for the susceptibility map. Bayesian QSM approach is the major type which uses various regularization terms, such as a piece-wise constant, a smooth, a sparse, or a morphological prior. Six QSM algorithms with or without structure prior are systematically discussed to address the structure prior effects. The methods are evaluated using simulations, phantom experiments with the given susceptibility, and human brain data. The accuracy and image quality of QSM were increased when using structure prior in the simulation and phantom compared to same regularization term without it, respectively. The image quality of QSM method using the structure prior is better comparing, respectively, to the method without it by either sharpening the image or reducing streaking artifacts in vivo. The structure priors improve the performance of the various QSMs using regularized minimization including L1, L2, and TV norm.

A high-performance imaging probe with NIR luminescence and synergistically enhanced T1−T2 relaxivity was synthesized. This nanoprobe exhibits a relatively high tumor-targeting efficacy and enables NIR optical and T1-/T2-weighted MR imaging of hepatic tumor cells in vivo.

The objective of this study was to successfully synthesize epidermal growth factor receptor monoclonal antibody–conjugated superparamagnetic iron oxide nanoparticles (EGFRmAb-SPIONs) and explore their biocompatibility and potential applications as a targeted magnetic resonance imaging (MRI) contrast agent for the EGFR-specific detection of brain glioma in vivo. After conjugation of EGFRmAb with SPIONs, the magnetic characteristics of EGFRmAb-SPIONs were investigated. Thereafter, the targeting abilities of EGFRmAb-SPIONs with MRI were qualitatively and quantitatively assessed in EGFR-positive C6 glioma cells in vitro and in a Wistar rat model bearing C6 glioma in vivo. Furthermore, the preliminary biocompatibility and toxicity of EGFRmAb-SPIONs were evaluated in normal rats through hematology assays and histopathologic analyses. Statistical analysis was performed using one-way analysis of variance and Student t -test, with a significance level of p < .05. From the results of EGFRmAb-SPION characterizations, the average particle size was 10.21 nm and the hydrodynamic diameter was 161.5 ± 2.12 nm. The saturation magnetization was 55 emu/g·Fe, and T 2 relaxivity was 92.73 s −1 mM −1 in distilled water. The preferential accumulation of the EGFRmAb-SPIONs within glioma and subsequent MRI contrast enhancement were demonstrated both in vitro in C6 cells and in vivo in rats bearing C6 glioma. After intravenous administration of EGFRmAb-SPIONs, T 2 -weighted MRI of the rat model with brain glioma exhibited an apparent hypointense region within glioma from 2 to 48 hours. The maximal image contrast was reached at 24 hours, where the signal intensity decreased and the R 2 value increased by 30% compared to baseline. However, T 2 -weighted imaging of the rat model administered with SPIONs showed no visible signal changes within the tumor over the same time period. Moreover, no evident toxicities in vitro and in vivo with EGFRmAb-SPIONs were clearly identified based on the laboratory examinations. EGFRmAb-SPIONs could potentially be employed as a targeted contrast agent in the molecule-specific diagnosis of brain glioma in MRI.

Background Previous studies demonstrated that primary open angle glaucoma (POAG) is associated with abnormal brain structure; however, little is known about the changes in the local synchronization of spontaneous activity. The main objective of this study was to investigate spontaneous brain activity in patients with POAG using regional homogeneity (ReHo) analysis based on resting state functional magnetic resonance imaging (rs-fMRI). Methodology/Principal Findings Thirty-nine POAG patients and forty-one age- and gender- matched healthy controls were finally included in the study. ReHo values were used to evaluate spontaneous brain activity and whole brain voxel-wise analysis of ReHo was carried out to detect differences by region in spontaneous brain activity between groups. Compared to controls, POAG patients showed increased ReHo in the right dorsal anterior cingulated cortex, the bilateral medial frontal gyrus and the right cerebellar anterior lobe, and decreased ReHo in the bilateral calcarine, bilateral precuneus gryus, bilateral pre/postcentral gyrus, left inferior parietal lobule and left cerebellum posterior lobe. A multiple linear regression analysis was performed to explore the relationships between clinical measures and ReHo by region showed significant group differences in the POAG group. Negative correlations were found between age and the ReHo values of the superior frontal gyrus (r = −0.323, p = 0.045), left calcarine (r = −0.357, p = 0.026) and inferior parietal lobule (r = −0.362, p = 0.024). A negative correlation was found between the ReHo values of the left precuneus and the cumulative mean defect (r = −0.400, p = 0.012). Conclusions POAG was associated with abnormal brain spontaneous activity in some brain regions and such changed regional activity may be associated with clinical parameters. Spontaneous brain activity may play a role in POAG initiation and progression.

To investigate nerve fibre damage of the visual pathway in patients with primary open-angle glaucoma using tract-based spatial statistical analysis of diffusion tensor imaging and correlate these measures with the clinical severity of glaucoma.Cross-sectional study.Twenty-five individuals with primary open-angle glaucoma and 24 healthy controls were recruited.All subjects underwent detailed ophthalmological examinations, including the cup-to-disc ratio, retinal nerve fibre layer thickness and visual fields test. Diffusion tensor imaging of the visual pathway was performed using a 3.0-T magnetic resonance scanner.Diffusivity changes of the nerve fibres in the visual pathway were calculated through tract-based spatial statistical analysis. The mean diffusivity and fractional anisotropy were assessed and compared with ophthalmological measurements.Compared with controls, bilateral optic tracts and optic radiations in primary open-angle glaucoma patients showed significantly decreased fractional anisotropy and increased mean diffusivity (P0.05). In the glaucoma group, the fractional anisotropy of the optic tracts and optic radiations varied consistently with the cup-to-disc ratio, retinal nerve fibre layer thickness and visual function analysis, respectively (P0.05). The mean diffusivity of the optic tracts correlated with these ophthalmological measurements (P0.05). However, no significant correlation was observed between the mean diffusivity of the optic radiations and the ophthalmological measurements (P0.05).The optic tracts and optic radiations of primary open-angle glaucoma patients demonstrated radiological evidence of neurodegeneration. This varied with damage to the optic disc and with the loss of visual function. Tract-based spatial statistical analysis of diffusion tensor imaging is an objective and effective tool for detecting the loss of cortical nerve fibres in primary open-angle glaucoma.