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The purpose of this study was to evaluate the feasibility of the combination of point-shear wave elastography (p-SWE) and estimated glomerular filtration rate (eGFR) for assessing different stages of interstitial fibrosis and tubular atrophy (IF/TA) in patients with chronic renal allograft dysfunction (CAD). From September 2020 to August 2021, 47 patients who underwent renal biopsy and p-SWE examinations were consecutively enrolled in this study. The areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate overall accuracy and to identify the optimal cutoff values for different IF/TA stages. A total of 43 patients were enrolled in this study. The renal cortical stiffness and eGFR showed a significant difference between IF/TA Grade 0–1 and Grade 2–3 (p < 0.001). Additionally, renal stiffness and eGFR were independent predictors for moderate-to-severe IF/TA (Grade ≥ 2) according to multiple logistic regression analysis. The combination of p-SWE and eGFR, with an optimal cutoff value of −1.63, was superior to eGFR alone in assessing moderate-to-severe interstitial fibrosis (AUC, 0.86 vs. 0.72, p = 0.02) or tubular atrophy (AUC, 0.88 vs. 0.74, p = 0.02). There was no difference between p-SWE and eGFR in assessing moderate-to-severe IF/TA (AUC, 0.85 vs. 0.79, p = 0.61). Therefore, combining p-SWE and eGFR is worthy of clinical popularization and application. [ABSTRACT FROM AUTHOR]

Abstract: It has been reported that low-dose of tacrolimus (Tac) is advantageous for the long-term allograft function and survival when compared with standard-dose of tacrolimus. However, the underlying mechanism is not known and remains to be elucidated. CD4+CD25+FoxP3+ regulatory T cells (Tregs) play a key role in the induction and maintenance of transplantation tolerance. We studied whether low-dose of Tac would favor the induction of donor-specific Tregs. We found that in all transplant recipients treated with low-dose of Tac (target trough level of 3 to 7 ng/ml), CD4+CD25+FoxP3+ Tregs were induced and expanded in the periphery and accumulated in the allograft after transplantation, and they retained their suppressive efficacy in vitro. When studied in vitro, we found that high concentration of Tac significantly decreased the induction of FoxP3 expression in mixed lymphocyte reactions (MLR) when compared with low concentration of Tac. Taken together, these data imply that in solid-organ transplantation the minimization of Tac might be beneficial and favors the induction of donor-specific Tregs maintaining transplantation tolerance to alloantigen. [Copyright &y& Elsevier]

Introduction: Parkinson's disease is one of the most common neurodegenerative diseases. Deep brain stimulation (DBS) can improve motor symptoms in patients with middle and late Parkinson's disease, reduce the use of levodopa, and thus reduce drug-related side effects. Postoperative delirium can significantly reduce the short-term and long-term quality of life in elderly patients, which can be alleviated by dexmedetomidine (DEX). However, whether prophylactic DEX could reduce the incidence of postoperative delirium in patients with Parkinson's disease was still unknown., Methods and Analysis: This is a single-centre, randomised, double-blinded, placebo-controlled group trial. A total of 292 patients aged 60 years and above elected for DBS will be stratified according to DBS procedure, subthalamic nucleus or globus pallidus interna, then randomly allocated to the DEX group or the placebo control group with a 1:1 ratio, respectively. In the DEX group, patients will be injected with the DEX continuously with an electronic pump at a rate of 0.1 µg/kg/hour for 48 hours at the beginning of general anaesthesia induction. In the control group, normal saline will be administered at the same rate for patients as in the DEX group. The primary endpoint is the incidence of postoperative delirium within 5 days after surgery. Postoperative delirium is assessed by the combination of the Richmond Anxiety Scale and the Confusion Assessment Method (CAM) for the intensive care unit or the 3-minute diagnostic interview for CAM as applicable. The secondary endpoints include the incidence of adverse events and non-delirium complications, the length of stay in the intensive care unit and hospital and all-cause 30-day mortality after the operation., Ethics and Dissemination: The protocol has been approved by the Ethics Committee of Beijing Tiantan Hospital of Capital Medical University (KY2022-003-03). The results of this study will be disseminated through presentation at scientific conferences and publication in scientific journals., Trial Registration Number: NCT05197439., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Serum fibroblast growth factor 23 (FGF23) is associated with acute kidney injury (AKI) and mortality in patients with critical illnesses. However, the accurate predictive performance of FGF23 on AKI remains inconclusive., Methods: Meta-analysis was performed using data sources including PubMed, Web of Science, EMBASE, and Cochrane (until June 1, 2021). Cohort or observational studies including patients with AKI and serum FGF23 level as the index test were included. The primary outcome was the AKI detective accuracy. This study has been registered in PROSPERO (CRD42021249930)., Results: Eleven studies with 1946 patients in seven countries were included. Across all settings, the sensitivity and specificity for serum FGF23 levels to predict AKI were 82% (95% CI, 66-91%) and 77% (95% CI, 67-85%), respectively. The diagnostic odds ratio of FGF23 was 15.51 (95% CI, 4.89-49.19), with the pooled positive likelihood ratio of 3.62 (95% CI, 2.25-5.83) and a negative likelihood ratio of 0.23 (95% CI, 0.11-0.50). The area under the receiver operating characteristic curve to detect AKI was 0.86 (95% CI, 0.82-0.88). C-terminal FGF23 had a better performance than intact FGF23., Conclusions: Plasma FGF23 is a valuable biomarker for incident AKI in critically ill patients. Comparisons of FGF23 with other biomarkers in AKI still need more studies to prove., Competing Interests: None., (AJTR Copyright © 2021.)

Background: American Joint Committee on Cancer (AJCC) recently had published 8th edition staging system, in which a separate staging system was proposed for gastric cancers those received preoperative therapy (ypStage), however ypT0 was not included. The aim of this study was to propose the inclusion of ypT0 into the new staging classification., Methods: We collected data of gastric cancer patients who underwent gastrectomy after preoperative chemotherapy in the First Affiliated Hospital of Zhejiang University (2004-2015). Kaplan-Meier survival estimations and log-rank tests were performed to compare survival., Results: 314 patients were enrolled in this study according to inclusion and exclusion criteria. The 5-year overall survival (OS) rate of all patients was 53.5% and the survival estimation was well discriminated by ypstage (P<0.001). Twenty-five patients were identified achieving pathological complete regression in primary lesion (ypT0), in which there were 16 pCR patients and 9 ypT0N+ patients. The 5-year OS of pCR patients was 93.8%, which was not better than ypstage I with 5-year OS of 97.5% (P=0.507). Meanwhile, ypT0N+ patients' 5-year OS was 66.7%, which was significantly shorter than those with ypstage I (P=0.002), but no statistical difference from ypstage II with 5-year OS of 71.6% (P=0.583)., Conclusions: Complete pathological regression of primary lesion (ypT0) was a predictor for long-term outcomes. pCR and ypT0N+ patients might be considered for inclusion in the ypstage I and ypstage II group respectively., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr-20-2426). The authors have no conflicts of interest to declare., (2020 Translational Cancer Research. All rights reserved.)

Objectives: As the demand for kidney transplant allografts has increased, many centers are expanding the upper limit of acceptable body mass index for kidney donors. However, obesity is a risk factor for developing renal disease. Our goal was to quantify body mass index trends in donor nephrectomy patients and to institute nutrition counseling to promote sustainable weight loss to reduce the risk of metabolic syndrome-derived renal dysfunction., Materials and Methods: Ninety patients who underwent donor nephrectomy between 2007 and 2012 consented to having height and weight data collected at multiple time points. After data collection, each patient underwent a standardized nutrition counseling session. One year later, body mass index was reassessed., Results: Preoperatively, 52% of the patients were overweight or obese. The percentage of overweight and obese patients remained stable for 2 years after surgery. However, at 3, 4, and 5 years after surgery, these rates increased to 59%, 69%, and 91%. Each patient was counseled about obesity-related comorbidities and provided information about lifestyle modification. One year later, 94% of previously overweight patients and 82% of previously obese patients had a decrease in mean body mass index from 27.2 ± 4.0 kg/m2 to 25.1 ± 3.6 kg/m2., Conclusions: Living-donor nephrectomy patients are at risk of developing obesity, similar to the adult population. Nutrition counseling may be beneficial to help normalize body mass index in patients who have become overweight or obese to potentially prevent obesity-related comorbidities. All patients were evaluated by a nutrition specialist after surgery to review our donor nephrectomy nutrition brochure. Body mass index monitoring and primary care follow-up appear to be appropriate surveillance methods.

Aim: The role of neutrophil-lymphocyte ratio (NLR) and derived neutrophil-lymphocyte ratio (d-NLR) in outcome prediction is assessed in patients with advanced gastric cancer receiving preoperative chemotherapy in a 5-year follow-up cohort., Patients and Methods: Patients undergoing preoperative chemotherapy and sequential R0 resection for advanced gastric cancer were enrolled from July 2004 to November 2011. Wilcoxon matched-pairs signed-rank test was used to evaluate the change of peripheral blood parameters. Receiver operating curve was used to identify the optimal cutoff values of NLR and d-NLR. Survival function was analyzed using Kaplan-Meier curves and Cox proportional hazard model., Results: Significant difference was found between baseline and post-chemotherapy blood parameters, including leukocytes, neutrophils, lymphocytes, NLR and d-NLR (all P <0.05). High baseline NLR group (NLR ≥2.230) had a significant shorter recurrence-free survival (RFS) (hazard ratio [HR] =1.814, 95% confidence interval [95% CI]: 1.112-2.960, P =0.015) and shorter overall survival (OS) (HR =1.867, 95% CI: 1.129-3.089, P =0.013) than those of the low baseline NLR group (NLR <2.230). High baseline d-NLR group (d-NLR ≥1.885) also had a shorter RFS (HR =1.805, 95% CI: 1.116-2.919, P =0.014) and shorter OS (HR =1.783, 95% CI: 1.091-2.916, P =0.019) than those of the low baseline d-NLR group (d-NLR <1.885). However, post-chemotherapy NLR and d-NLR showed no prognostic significance on RFS and OS (all P >0.05). Multivariate analysis showed that higher baseline NLR but not d-NLR was identified as an independent factor associated with worse RFS (HR =1.707, 95% CI: 1.042-2.797, P =0.034) and worse OS (HR =1.758, 95% CI: 1.058-2.919, P =0.029)., Conclusion: Baseline NLR and d-NLR may serve as convenient, easily measured prognostic indicators in advanced gastric cancer treated with preoperative chemotherapy and sequential R0 resection, especially to baseline NLR, which showed independent prognostic significance on RFS and OS, while post-chemotherapy NLR and d-NLR lost their usefulness due to the inhibition of bone marrow hematopoietic function. Patients with high baseline NLR and d-NLR values need multimodal therapy., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Cancer-associated inflammation is a key determinant of disease progression and survival in most cancers. The aim of our study was to assess the predictive value of preoperative inflammatory markers, such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, red cell distribution width (RDW), and mean platelet volume, for survival in breast cancer patients. In total, 608 breast cancer patients operated on between January 2009 and December 2011 were included in this observational study. The association between preoperative inflammatory markers and survival outcomes was analyzed. Patients with high NLR (>2.57) or high RDW (>13.45%) showed a significantly lower overall survival rate than those with lower NLR (≤2.57) or lower RDW (≤13.45%). NLR and RDW, along with node stage and molecular subtypes, were independent prognostic factors. There was a significant survival difference according to NLR in the luminal A and triple-negative subtypes (93.3% versus 99.3%, P=0.001; 68.8% versus 95.1%, P=0.000, respectively). The triple-negative subtype was the only subtype in which higher RDW patients showed significantly poor prognosis (81.3% versus 95.5%, P=0.025). Pre-operation NLR and RDW is a convenient, easily measured prognostic indicator for patients with breast cancer, especially in patients with the triple-negative subtype.

This paper introduces the characteristics of the Hilbert-Huang transform (HHT), and studies the classification of movement imagery EEG based on the HHT method and BP neural network. After preprocessed, the movement imagery EEG data were descomposed with empirical mode decomposition (EMD) into a series of intrinsic mode functions (IMFs). Then the low frequency IMFs were removed, and the rest of IMFs were conducted by Hilbert transform to get Hilbert marginal spectrum. The marginal spectrum subtracted values between the channal C3 and channal C4 were selected as the original features which were then decreased the dimension by the principal components analysis so as to be jointed with EEG complexity to construct the feature vector. The BP neural network was utilized to classify the EEG pattern of left and right hand motor imagery. The brain computer interface (BCI) competition II data set III was selected to carry out the discrimination, and the classification accuracy rate is up to 87.14%, which is a comparably good result and proves HHT to be a feasible and effective method on EEG analysis.

This article introduces some commonly used methods of ozone concentration detection, including chemical method, UV absorption method, and electrochemical method etc., introduces the latest four ozone concentration sensors, and summarizes the advantages and disadvantages of each method. In addition, the article emphatically introduces the ozone's applications and development in the medical aspects. Prospects for the use of ozone concentration detection, ozone treatment and ozone therapy instrument are also demonstrated in it. The literature collected and reviewed on ozone concentration detection and ozone therapy includes 37 papers in English, and 50 papers in Chinese, but only 30 articles among them are included in this review (19 in Chinese and 11 in English), according to the principle of eliminating the old information and repetitive contents. The present paper selects only those on ozone, ozone concentration, ozone therapy and ozone therapy instrument.

With the development of economy, the incidence of diabetes is keeping on rising. It has been a larger chief offender endangering human health. Glucose monitoring in time, accurately and continuously can provide the basis for the adjustment of diet, exercise and drug treatment project, and can control disease at the level of satisfaction degree. Noninvasive measurement of glucose avoids blood collection with high frequency, alleviates pain caused by blood sampling, and prevents infection. It comes with hope for the diabetic. In this article, we compare the kinds of techniques, introduce the theory, the problems of polarization rotation, the solving methods and the advantages, thus providing references for the noninvasive measurement of glucose.

Objective: To investigate the histological and keratinous variation of prefabricated urethra in the capsule with micro-mucosa and gelatin sponge compound graft., Methods: Five 8-week-old Guizhou miniature pigs (2 females and 3 males) weighing 20-25 kg were used. Eight tissue expanders were bilaterally inserted into subcutaneous position on the dorsal thorax of each pig. Forty inserted expanders were randomized into two groups (n=20 per group). For the experimental group, the free buccal mucosa was cut into particles less than 1 mm in diameter, spread onto the gelatin sponge (3 cm x 2 cm) and then transplanted to the capsule; the area expansion ratio of autogenous micro-mucosa was 8 : 1. For the control group, soft tissue expander without mucosa graft was implanted. The pressure in inserted expander was about 40 mm Hg (1 mm Hg=0.133 kPa). Inflation should be stopped when the injected saline volume reached 15 mL. The animals were killed 1 and 2 weeks and 1, 2, and 4 months after the implant to receive examination. Microscope, histology, and immunohistochemistry changes were observed., Results: All the animals survived to the end of the experiment and the wounds healed by first intention. There was no obvious degeneration of gelatin sponge, and some of the mucosa survived 1 week after implant. The gelatin sponge was partly absorbed, most of the mucosa survived 2 weeks after implant. Visual examination showed complete epithelialization of the entire cavity 1 month after implant. The experimental group at 2 and 4 months were similar to that of at 1 month in gross observations. The neo-mucosa was not found in the control group at different time points after implant. Histology examination revealed that compound implant was mainly infiltrated by inflammatory cells and the micro-mucosa survived well 1 week after implant in the experimental group. The stratified squamous epithelium presented obvious polarity and the submucous neovascularization was abundant 2 weeks after implant. The compound implant achieved complete epithelialization 1 month after implant. The epithelium degeneration occurred 2 months after implant. The stratified squamous epithelium presented no abovious polarity 4 months after implant. No neo-mucosa was evident in control group at different time points. The experimental group was positive for the pan-cytokeratin staining at 1, 2 weeks, and 1, 2 months after implant, but negative at 4 months after implant. The pan-cytokeratin staining was negative in the control group at different time points., Conclusion: The buccal micromucosa and gelatin sponge compound graft can grow well on the expanded capsule 1 month after implant and the epithelium degeneration is evident 2 months after implant. Environment of implanted mucosa has great influence on epithelium mucosa.

Objective: To investigate the feasibility of prefabricating urethra in the expander capsule with gelatin sponge and micro-mucosa compound transplantation., Methods: Eight 8-week-old Guizhou miniature pigs (male and/or female) weighing 20-25 kg were used. Six expanders (15 mL) were placed subcutaneously on the dorsal thorax of each miniature pig. Autologous oral mucosa of every pig was harvested 2 weeks later to prepare micro-mucosa with a diameter less than 1 mm. Gelatin sponge 3 cm x 2 cm in size was transplanted to the expander capsule after being coated by the autologous micro-mucosa at the area expansion ratio of 4 : 1 (group A), 8 : 1 (group B), and 16 : 1 (group C), respectively (n = 2 per group). The implantation of gelatin sponge served as the blank control (group D, n = 2). Physiological saline was injected into the expander immediately after operation, and the pressure in the expander was 40 mm Hg (1 mm Hg = 0.133 kPa). The postoperative general condition of the animals was observed. At 1, 2, and 3 weeks after operation, the animals were killed to receive general, HE staining, and immunohistochemistry staining observations., Results: All animals survived till the end of the experiment. The wounds healed well. General observation: in groups A, B, and C at 1 week after operation, there was no obvious degeneration of gelatin, the mucous was survived partially, and there were significant differences among three groups in terms of mucosa healing rate (P < 0.05), groups A and B were better than group C, and group A was better than group B; at 2 weeks, the gelatin sponge was partly absorbed, most of the mucosa survived, and the mucosa healing rate of groups A and B was better than that of group C (P < 0.05); at 3 weeks, the gelatin sponge was still not absorbed completely, the wound reached epithelialization approximately, and there were no significant differences among three groups in terms of mucosa healing rate (P > 0.05). No neo-mucosa was evident in group D at each time point. Histology and immunohistochemistry staining observation: at each time point, the mucosa epithelium survival, inflammatory cell infiltration, and pan-cytokeratin were evident in groups A, B, and C; at 3 weeks after operation, the stratified squamous epithelium presented obvious polarity and the submucous neovascularization was abundant in groups A, B, and C. There was no mucosa epithelium and positive stained pan-cytokeratin in group D. For the percentage of positive pan-cytokeratin stained area, there were significant differences among groups A, B, and C 1 week after operation (P < 0.05); at 2 and 3 weeks after operation, there was significant difference between group A and group C, and between group B and group C (P < 0.05); but no significant difference was evident between group A and group B (P > 0.05)., Conclusion: Micro-mucosa and gelatin spongy compound transplantation on the expander capsule can form mucosal lining, achieve complete epithelialization in 2 weeks, and contribute to maintain the normal function of prefabricated urethra.