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Yang Xie, Xiangyang Sun, Fubo Xie, Wencheng Jian, Qingliang Wang, Xiaochen Ma, Caixia Li, Kai Zhang Department of Radiology, Qilu Hospital of Shandong University, Shandong, People’s Republic of ChinaCorrespondence: Kai Zhang, Department of Radiology, Qilu Hospital of Shandong University, Shandong, People’s Republic of China, Tel +8618560081593, Email fifa6107@126.comPurpose: To examine the relationship between lactate dehydrogenase (LDH) levels and soluble programmed cell death-ligand 1 (sPD-L1) levels in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).Methods: A total of 83 hCC patients participated in this study. Patients were categorized into subgroups based on their alpha-fetoprotein (AFP) levels, presence or absence of extrahepatic metastasis, vascular invasion, Barcelona Clinic Liver Cancer (BCLC) stage, tumor response, tumor size, and number LDH and sPD-L1 levels were compared before and after TACE (3, 7, and 30 days post-TACE).Results: LDH and sPD-L1 levels were significantly higher at 3 and 7 days post-TACE than at baseline. Positive correlations were observed between changes in LDH levels and sPD-L1 levels at 3 and 7 days post-TACE. LDH levels were higher in patients with elevated AFP compared to those in the normal AFP group at 3 and 7 days post-TACE, in the stable disease (SD) group compared to complete response (CR) and partial response (PR) groups at 7 days post-TACE, and in those with tumor > 5 cm compared with those with tumor ≤ 5 cm at 3 and 7 days after TACE (all P < 0.05). sPD-L1 levels were higher in patients with vascular invasion than those without vascular invasion at 3 and 7 days post-TACE, in the SD group compared to CR and PR groups at 3 and 7 days post-TACE, and in those with tumor > 5 cm compared to those with tumor < 5 cm at 3 and 7 days after TACE (all P < 0.05).Conclusion: A positive correlation was found between LDH expression and sPD-L1 levels, suggesting LDH as a potential biomarker for assessing immune status in HCC patients following TACE.Keywords: hepatocellular carcinoma, immunotherapy, lactate dehydrogenase, soluble programmed cell death ligand-1, transarterial chemoembolization

Xiaochen Ma, Xiangyang Sun, Fubo Xie, Wencheng Jian, Qingliang Wang, Yang Xie, Caixia Li, Kai Zhang Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of ChinaCorrespondence: Kai Zhang, Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, People’s Republic of China, Email zhangkai@qiluhospital.comAim: This study aims to explore the role of soluble programmed cell death protein 1 (sPD-1) in individuals with hepatocellular carcinoma (HCC) undergoing treatment with drug-eluting beads transarterial chemoembolization (D-TACE). Additionally, we aim to assess the potential utility of sPD-1 for determining the optimal timing for combining D-TACE with immune checkpoint inhibitors (ICIs).Materials and Methods: A total of 44 HCC patients eligible for D-TACE and 55 healthy volunteers were enrolled in this study. Three milliliters of peripheral venous blood from the patients were collected on the day before D-TACE and 3, 7, and 30 days after D-TACE, respectively, for the assay of sPD-1. The relationships between sPD-1 levels, clinical features, outcomes, and the fluctuation of sPD-1 during treatment were analyzed.Results: The initial sPD-1 levels in patients were found to be significantly higher than those in the control group. Although the initial sPD-1 levels displayed a decreasing trend with an increase in BCLC stage, no significant differences were observed among patients at different BCLC stages. The sPD-1 level on day 3 after D-TACE was similar to that on day 7 after D-TACE and significantly lower than the initial level. The sPD-1 level on day 30 after D-TACE was significantly higher than that on day 3 and day 7 after D-TACE and nearly returned to the initial level before D-TACE.Conclusion: The level of sPD-1 was found to be significantly elevated in patients with HCC. However, further research is deemed necessary to fully understand the role of sPD-1 as a potential biomarker in the initiation, progression, and prognosis of HCC. The decrease in sPD-1 following D-TACE suggests that immune effector cells might potentially be reduced, as well as immune function weakened, highlighting the need to avoid the prompt administration of ICIs after D-TACE.Keywords: hepatocellular carcinoma, immunotherapy, soluble programmed cell death protein 1, drug-eluting beads transarterial chemoembolization

Supersaturated (Ti,Al)N materials with face centered cubic (fcc) structure offer unique combinations of thermal stability and mechanical properties. However, their thermally-induced decomposition processes are crucial for extracting their full potential. Detailed experimental studies by X-ray diffraction and transmission electron microscopy reveal that the formation of the thermodynamically stable wurtzite-type w-AlN starts with 1000 °C at 100 °C lower annealing temperatures (Ta) when applying a multilayer-concept with TiN to form (Ti,Al)N/TiN multilayers. Nevertheless, the hardness of (Ti,Al)N/TiN multilayers peaks with 32.3 ± 1.0 GPa at a 100 °C higher Ta (900 °C) than the (Ti,Al)N coating, and the hardness declining trend with increasing Ta is milder. This is because the (Ti,Al)N decomposes towards a layered structure of Al-rich and Ti-rich regions, when coherently grown with fcc-TiN. Ab initio calculations highlight that Al within the (Ti,Al)N layers preferentially diffuses away from the coherent interface with the TiN layers. Thus, out of one (Ti,Al)N layer more layers form, and even upon the phase-transformation of the Al-rich layers to w-AlN, their layered structure remains. Together, the computational and experimental results suggest that the layered arrangement provides a higher resistance against dislocation glide and is beneficial for the coating integrity.

Tingting Zhou,1,2 Yili Yang,2 Min Hu,3 Weiyan Jian,4 Jay Pan1,2 1HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, People’s Republic of China; 3School of Public Health, Fudan University, Shanghai, People’s Republic of China; 4Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of ChinaCorrespondence: Jay PanHEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan, 610041, People’s Republic of ChinaEmail panjie.jay@scu.edu.cnBackground: This study was conducted for assessing the degrees of perceived competition reported by county hospital directors in rural China as well as hospitals’ competitive behaviors in response to competition.Methods: The data were collected from Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH) project which had been implemented among county hospitals in China’s Guizhou province. Competition was measured by asking hospital directors to rate the levels of competitive pressure as they perceived. Hospitals’ competitive behaviors were obtained by asking hospitals’ directors about specific strategies they had adopted. A multivariable linear regression model was developed to examine the relationship between perceived competition and the positivity of competitive behavior, and multivariable logistic regressions were used to evaluate the influence of perceived competition on the adoption of specific competitive strategies.Results: Among 218 directors engaged in this study, 210 (96.3%) directors reported the perception of certain degrees of competition, for which the competitive pressure was mainly posed by public hospitals (42.4%). Director-perceived competition level was found to be positively associated with the positivity of competitive behavior, and directors under higher competitive pressure were found to be more likely to adopt multiple competitive strategies including improving the efficiency of hospitals’ internal management, optimizing hospitals’ environment as well as promoting health-care services.Conclusion: This study suggested that almost all of the county hospital directors in rural China perceived certain degrees of competitive pressure, and higher levels of perceived competition were found to be significantly associated with increased positivity in adopting competitive strategies. Our findings are expected to provide evidence-based implications for the implementation of a series of pro-competition policies throughout health-care reforms.Keywords: perceived competition, hospital behavior, county hospital, director, China

Xiaojun Lin,1,2 Weiyan Jian,3 Winnie Yip,4 Jay Pan1,2 1West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China; 2West China Research Center for Rural Health Development, Sichuan University, Chengdu, People’s Republic of China; 3Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China; 4Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USACorrespondence: Jay PanWest China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu 610041, Sichuan, People’s Republic of ChinaTel +86 28 8550 1096Fax +86 28 8550 1528Email panjie.jay@scu.edu.cnPurpose: Although there is much debate about the effect of hospital competition on healthcare quality, its impact on the process of care remains unclear. This study aimed to determine whether hospital competition improves the process of care in rural China.Patients and Methods: The county hospital questionnaire survey data and the randomly sampled medical records of bacterial pneumonia patients in 2015 in rural area of Guizhou, China, were used in this study. The processes of care for bacterial pneumonia were measured by the following three measures: 1) oxygenation assessment, 2) antibiotic treatment, and 3) first antibiotic treatment within 6 hours after admission. Hospital competition was measured by asking hospital directors to rate the competition pressure they perceive from other hospitals. Multivariate logistic regression models were employed to determine the relationship between perceived competition and the processes of care for patients with bacterial pneumonia.Results: A total of 2167 bacterial pneumonia patients from 24 county hospitals in 2015 were included in our study. Our results suggested that the likelihood of receiving antibiotic treatment and first antibiotic treatment within 6 hours after admission was significantly higher in the hospitals perceiving higher competition pressure. However, no significant relationship was found between perceived competition and oxygenation assessment for patients with bacterial pneumonia.Conclusion: This study revealed the role of perceived competition in improving the process of care under the fee-for-service payment system and provided empirical evidence to support the pro-competition policies in China’s new round of national healthcare reform.Keywords: perceived competition, market concentration, process of care, pneumonia, quality, healthcare reform

We describe frontal language reorganization in a 50–60 year-old right-handed patient with a low-grade left frontotemporal insular glioma. Pre-operative fMRI revealed robust activation in the left superior temporal gyrus (Wernicke Area, WA) and in the right inferior frontal gyrus (right anatomical homolog of Broca Area, BA). Intra-operative cortical stimulation of the left inferior frontal gyrus and adjacent cortices elicited no speech deficits, and gross total resection including the expected location of BA resulted in no speech impairment. We employed statistical inference methods to reconstruct the functional brain network and determined how different brain areas connect with one another. We found that the right homolog of the BA in this patient functionally connected to the same areas as the left BA in a typical healthy control. As opposed to the functional connection of the left BA in a healthy brain, the right BA did not connect directly with the left WA, but connected indirectly, mediated by the pre-Supplementary Motor Area and the Middle Frontal Gyrus. This case illustrates that pre-surgical fMRI may be used to identify atypical hemispheric language reorganization in the presence of brain tumor and that network theory opens the possibility for future insight into the neural mechanism underlying the language reorganization.

Chunlan Chen,* Wenhua Jian,* Yi Gao, Yanqing Xie, Yan Song, Jinping Zheng State Key Laboratory of Respiratory Disease, China National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: It is unknown whether aggressive medication strategies should be used for early COPD with or without lung hyperinflation. We aimed to explore the characteristics and bronchodilator responsiveness of early COPD patients (stages I and II) with/without lung hyperinflation.Methods: Four hundred and six patients with COPD who performed both lung volume and bronchodilation tests were retrospectively analyzed. Residual volume to total lung capacity >120% of predicted values indicated lung hyperinflation. The characteristics and bronchodilator responsiveness were compared between the patients with and without lung hyperinflation across all stages of COPD.Results: The percentages of patients with lung hyperinflation were 72.7% in the entire cohort, 19.4% in stage I, 68.5% in stage II, 95.3% in stage III, and 100.0% in stage IV. The patients with lung hyperinflation exhibited poorer lung function but better bronchodilator responsiveness of both forced expiratory volume in 1 second and forced vital capacity than those without lung hyperinflation during early COPD (t=2.21–5.70, P=0.000–0.029), especially in stage I, while age, body mass index, smoking status, smoking history, and disease duration were similar between the two subgroups in the same stages. From stages I to IV of subgroups with lung hyperinflation, stage I patients had the best bronchodilator responsiveness. Use of bronchodilator responsiveness of forced vital capacity to detect the presence of lung hyperinflation in COPD patients showed relatively high sensitivities (69.5%–75.3%) and specificities (70.3%–75.7%).Conclusion: We demonstrated the novel finding that early COPD patients with lung hyperinflation are associated with poorer lung function but better bronchodilator responsiveness and established a simple method for detecting lung hyperinflation. Keywords: GOLD I, GOLD II, RV/TLC, bronchodilation test

OBJECTIVE: The purpose of this study is to use bibliometrics to explore the research overview and research hotspots. MATERIALS AND METHODS: The relevant literature on intestinal flora and diabetic nephropathy in the Web of Science Core Collection was sorted out, and VOSviewer, CiteSpace, Scimago Graphica and other software were used to conduct data visualization analysis on the number of publications, countries, institutions, journals, authors, keywords and citations. RESULTS: A total of 124 relevant literatures were included. From 2015 to 2022, the number of published papers increased every year. The countries, institutions and journals that published the most articles in this field are China, Isfahan University Medical Science and Frontiers in Pharmacology. Liu Bicheng and Mirlohi Maryam are the authors with the most published articles in this field. The main keywords of research in this field are obesity, inflammation, oxidative stress, indoxyl sulfate, short-chain fatty acids (SCFAs) and Chinese herbal medicine. CONCLUSIONS: This is the first bibliometric analysis of diabetic nephropathy and gut microbiota, reporting hot spots and emerging trends. Obesity, inflammation, oxidative stress, indoxyl sulfate, SCFAs and Chinese herbal medicine are the main keywords of current research, and SCFAs and Chinese herbal medicine may be the hotspots of future research. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of gender disparities in physical, mental, and cognitive disorders among elderly hypertensive individuals in rural areas remains unclear. This study evaluates these disparities and the factors contributing to multimorbidity in this demographic. Methods A face-to-face survey was conducted from July 1 to August 31, 2023, involving the hypertensive population registered with the National Basic Public Health Service Program in Jia County. Physical disorder was defined as having one or more self-reported chronic conditions other than hypertension. Participants experiencing anxiety or depression were as having a psychological disorder. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptomatology, and anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder questionnaire (GAD-7). Cognitive disorders were assessed using the Brief Mental Status Examination Scale (MMSE). Multifactorial logistic regression models were used to analyze factors affecting different disorder combinations in both genders. The net difference in multimorbidity prevalence between genders was determined using the propensity score matching (PSM). Results Out of 18,447 hypertensive individuals aged 65 years and above (42.28% men), the prevalence of multimorbidity was 30.64% in men and 38.67% in women. Outcomes included seven categories: physical disorders, psychological disorders, cognitive disorders, and four different combinations of these disorders. The primary outcome was the presence of two or more disorders. The prevalence of physical, psychological, and cognitive disorders and their four combinations were higher in women than in men; Key factors influencing multimorbidity risk included subjective health status, illness duration, medication history, blood pressure control, and lifestyle behaviors in both men and women. Post-PSM analysis revealed that women had a 6.74% higher multimorbidity prevalence than men. Conclusions Physical, psychological, and cognitive disorders, along with their various multimorbid combinations, significantly impact the elderly hypertensive population. Prioritizing a healthy lifestyle is essential to mitigate multimorbidity risks. Considering that the prevalence of multimorbidity is higher in women than in men with hypertension, sufficient sleep, maintaining a healthy waist circumference, and medication adherence are vital for managing blood pressure and reducing multimorbidity risks.

Abstract The purpose of this study was to examine the effects of different dryland warm-up protocols on knee isokinetic strength, vertical jumping, and sprint performance in competitive swimmers. Twenty-four male swimmers were randomly assigned to the FIFA 11 + group (n = 12) or the post-activation performance enhancement (PAPE) group (n = 12). The FIFA 11 + group performed the FIFA 11 + warm-up program three times per week for 6 weeks, whereas the PAPE group consisted of performing general activities and three sets of five drop jumps. Performance test included concentric (con) and eccentric (ecc) isokinetic strength of the quadriceps (Q) and hamstrings (H) of the dominant (DL) and non-dominant (NDL) limbs at three angular velocities, countermovement jump (CMJ), squat jump (SJ) and a 50-m time trial. The conventional (Hcon: Qcon) and functional (Hecc: Qcon) ratios were calculated pre- and post- intervention. The FIFA 11 + group showed a significant increase in DL-Hcon (p

Abstract Background Both initial mechanical stability and subsequent axial interfragmentary micromotion at fracture ends play crucial roles in fracture healing. However, the conversion timing of variable fixation and its effect on and mechanism of fracture healing remain inadequately explored. Methods A magnesium degradation-induced variable fixation plate (MVFP) for femurs was designed, and its conversion timing was investigated both in vitro and in vivo. Then, locking plates and MVFPs with and without a magnesium shim were implanted in rabbit femur fracture models. X-ray photography and micro computed tomography (micro-CT) were performed to observe the healing of the fracture. Toluidine blue and Masson’s trichrome staining were performed to observe new bone formation. The torsion test was used to determine the strength of the bone after healing. Finally, reverse transcription-polymerase chain reaction (RT-PCR) and western blotting were used to detect the expression of osteogenesis-related genes in the three groups. Results The MVFP with sample 3 magnesium shim showed greater axial displacement within 15 days in vitro, and its variable capability was likewise confirmed in vivo. X-ray photography and micro-CT indicated increased callus formation in the variable fixation group. Toluidine blue and Masson’s trichrome staining revealed less callus formation on the rigid fixation side of the locking plate, whereas the variable fixation group presented more callus formation, more symmetrical intraosseous calli, and greater maturity. The torsion test indicated greater torsional resistance of the healed bone in the variable fixation group. RT-PCR and western blotting revealed that the expression levels of BMP2 and OPG increased during early fracture stages but decreased in late fracture stages, whereas RANKL expression showed the opposite trend in the variable fixation group. Conclusions MVFP promoted faster and stronger bone healing in rabbits, potentially by accelerating the expression of BMP2 and modulating the OPG/RANKL/RANK signaling axis. This study offers valuable insights for the clinical application of variable fixation technology in bone plates and contributes to the advancement of both internal fixation technology and theory. Level of evidence: level V. Graphical Abstract

Abstract Background Acetabular component anteversion (ACA) markedly impacts the outcome of total hip arthroplasty (THA) and thus is routinely measured on radiographs postoperatively. However, clinical ACA measurement methods are either too complicated or subjective due to three drawbacks: complex calculations, measurement of obscured points, and complex geometric drawings. This study aimed to develop a precise and convenient novel method of measuring ACA on routine radiographs without the three drawbacks and to verify its accuracy and reliability by comparing it against existing methods. Methods A novel geometric principle to measure ACA was developed. Accordingly, a protractor was designed to measure radiographic anteversion (RA) on anteroposterior (AP) hip radiographs. Three researchers measured RA twice, using the protractor, McLaren’s, and Pradhan’s method on 26 computer-simulated radiographs with pre-set RAs and 20 actual radiographs. Accuracy was assessed by errors on simulated radiographs, and reliability was assessed by results of measurements on simulated and actual radiographs. Results The absolute error of the novel method (1.01° ± 1.06°) was lower than McLaren’s method (1.34° ± 1.16°) (p