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Sonic hedgehog (SHH) signaling pathway and glioma-associated oncogene homolog 1 (GLI1) play important roles in the initiation and progression of pancreatic ductal adenocarcinoma (PDAC). GS homeobox 2 (GSX2, formerly GSH2) is a downstream target of SHH signaling, but its role in pancreatic cancer remains unclear. This study evaluates the role of GSH2 in the development and drug resistance of pancreatic cancer. Both cell culture and xenograft mouse model were used. Immunohistochemistry, Western blotting and quantitative RT-PCR were used to examine the expression of GSH2 and other related molecules. CCK8 assay was used to test the cell proliferation, and flow cytometry used to examine cell apoptosis upon gemcitabine treatment. It was found that GSH2 is overexpressed in human pancreatic cancer tissues and cells. The expression of SHH and GLI1 was reversely correlated with GSH2 in pancreatic cancer cells. SHH and GLI1 have protein-protein interactions with GSH2. GSH2 silencing in pancreatic cancer cells inhibited cell proliferation, migration and invasion, increased cell apoptosis and sensitized pancreatic cancer cells to gemcitabine treatment. Furthermore, in vivo study demonstrated that silencing GSH2 increased the efficacy of gemcitabine-based treatment. Our results indicate that GSH2 is overexpressed in pancreatic cancer. GSH2 silencing in pancreatic cancer alleviates gemcitabine resistance by activating SHH/GLI1 pathway. Thus, targeting GSH2 in PDAC could be a novel cancer therapeutic strategy.

Glutathione-S-transferases (GSTs) not only show cytoprotective role and their involvement in the development of anticancer drug resistance, but also transmit signals that control cell proliferation and apoptosis. However, the role of GST isoforms in chemotherapy resistance remains elusive in pancreatic cancer. Here, we demonstrated that gemcitabine treatment increased the GSTM2 expression in pancreatic cancer cell lines. Knockdown of GSTM2 by siRNA elevated apoptosis and decreased viability of pancreatic cancer cells treated with gemcitabine. Moreover, in vivo experiments further showed that shRNA induced GSTM2 downregulation enhanced drug sensitivity of gemcitabine in orthotopic pancreatic tumor mice. We also found that GSTM2 levels were lower in tumor tissues than in non-tumor tissues and higher GSTM2 expression was significantly associated with longer overall survival. In conclusion, our findings indicate that GSTM2 expression is essential for the survival of pancreatic cancer cells undergoing gemcitabine treatment and leads to chemo resistance. Downregulation of GSTM2 in pancreatic cancer may benefit gemcitabine treatment. GSTM2 expression in patients also shows significant correlation with overall survival. Thus, our study suggests that GSTM2 is a potential target for chemotherapy optimization and prognostic biomarker of pancreatic cancer.

Conventional EUS plays an important role in identifying pancreatic cancer. However, the accuracy of EUS is strongly influenced by the operator's experience in performing EUS. Artificial intelligence (AI) is increasingly being used in various clinical diagnoses, especially in terms of image classification. This study aimed to evaluate the diagnostic test accuracy of AI for the prediction of pancreatic cancer using EUS images. We searched the Embase, PubMed, and Cochrane Library databases to identify studies that used endoscopic ultrasound images of pancreatic cancer and AI to predict the diagnostic accuracy of pancreatic cancer. Two reviewers extracted the data independently. The risk of bias of eligible studies was assessed using a Deek funnel plot. The quality of the included studies was measured by the QUDAS-2 tool. Seven studies involving 1110 participants were included: 634 participants with pancreatic cancer and 476 participants with nonpancreatic cancer. The accuracy of the AI for the prediction of pancreatic cancer (area under the curve) was 0.95 (95% confidence interval [CI], 0.93-0.97), with a corresponding pooled sensitivity of 93% (95% CI, 0.90-0.95), specificity of 90% (95% CI, 0.8-0.95), positive likelihood ratio 9.1 (95% CI 4.4-18.6), negative likelihood ratio 0.08 (95% CI 0.06-0.11), and diagnostic odds ratio 114 (95% CI 56-236). The methodological quality in each study was found to be the source of heterogeneity in the meta-regression combined model, which was statistically significant (P = 0.01). There was no evidence of publication bias. The accuracy of AI in diagnosing pancreatic cancer appears to be reliable. Further research and investment in AI could lead to substantial improvements in screening and early diagnosis.

To compare the diagnostic efficacy of SonoVue and Sonazoid contrast enhanced ultrasound (CEUS) in correctly detecting and characterizing colorectal liver metastasis (CRLM) after chemotherapy.Patients with CRLMs treated with chemotherapy and subsequently scheduled for hepatic resection were prospectively enrolled from April 2020 to January 2021. Lesions detected by SonoVue or Sonazoid CEUS were recorded as and characterized as metastases or non-metastatic lesions respectively. Histopathology or intraoperative ultrasound with MRI were the reference standard.A total of 348 focal liver lesions in 42 patients were investigated, including 297 CRLMs and 51 non-metastatic lesions. SonoVue showed significantly higher diagnostic accuracy (64.7% versus 54.0%; P .001) and sensitivity (63.3% versus 50.5%; P .001) in the diagnosis of CRLMs than Sonazoid, both methods presented with similar specificity (72.5% versus 74.5%; P = 1.0). Forty metastases appeared non-hypoenhancing (hyperenhancing or isoenhancing) in the late phase and postvascular phase of Sonazoid CEUS and were mischaracterized as benign lesions.SonoVue performed significantly better than Sonazoid in the diagnosis of CRLMs after chemotherapy.

Background and aim The European evidence-based guidelines (EEG) and American College of Gastroenterology Guidelines (ACGG) have been published to guide the management of pancreatic cystic lesions. We aim to evaluate the value of both guidelines in predicting advanced pancreatic cystic lesions (A-PCLs) with preoperatively imaging-suspected cystic mucinous pancreatic neoplasms (cMNs). Methods One hundred ninety-eight patients who underwent resections from 2013 to 2019 for suspected cMNs were retrospectively reviewed. Receiver operating characteristic curves were calculated and compared with measure diagnostic value. Results Sixty-two patients were diagnosed with A-PCLs pathologically. Cross-imaging modalities had comparable diagnostic accuracy to endoscopic ultrasound in type classification and A-PCLs prediction. Receiver operating characteristic curve comparison analyses showed that EEG absolute + MCN (EEGAM ) and EEG relative + MCN (EEGRM ) having at least one indications criteria were comparable to the ACGG (P = 0.21 and P = 0.45). For the criteria having at least two indications, ACGG was superior to EEGAM (P = 0.001) but comparable to EEGRM (P = 0.12). EEGAM ≥ 1 indication criteria was superior to ≥ 2 indications criteria (P = 0.02). EEGRM ≥ 1 indication criteria had comparable diagnostic performance with ≥ 2 indications criteria (P = 0.86). ACGG ≥ 2 indications criteria was superior to ≥ 1 indication criteria (P = 0.02). Conclusion On the basis of cross-imaging evaluations, both sets of guidelines were found to be helpful in identifying A-PCLs in suspected cMNs with comparable performance. EEGAM ≥ 1 indication criteria was superior to ≥ 2 indications criteria. ACGG ≥ 2 indications criteria was superior to ≥ 1 indication criteria.

Background. Traditional Chinese medicine (TCM) is an integral part of the mainstream health care system in China. Public community health services are required by the government to deliver TCM services. This study aimed to assess patient perceived quality of TCM care in community health services. Methods. A cross-sectional questionnaire survey was conducted on 471 TCM users in four community health centers in Hangzhou. Respondents were asked to rate their experiences on a Likert scale about tangibility, reliability, responsiveness, assurance and empathy of the TCM services they received. Linear regression models were established to determine the sociodemographic and services factors associated with the ratings. Results. Average ratings on the five aspects of the TCM care ranged from 78 to 88 out of a possible 100, with assurance attracting the highest and empathy attracting the lowest score. Overall, higher perceived quality of TCM care (except for assurance) was associated with a choice of TCM in preference to western medicine. Those who reported higher cost (≥100 yuan) of TCM care rated higher on responsiveness and empathy of the care. But higher frequency of visits to community TCM services was associated with lower ratings on reliability, assurance and empathy. Those who received two or more TCM modalities also perceived lower tangible care. In addition, higher ratings on reliability and responsiveness were found in women. The respondents with a university qualification gave higher ratings on reliability and responsiveness; by contrast, those with a highest education of senior high school rated lower on assurance and empathy. Lower perceived tangibility and assurance was also associated with rural residency. Compared with those working in the public sector, the respondents from the retail and services sector gave a higher rating on assurance but a lower rating on empathy. Conclusion. Overall, the TCM users perceived high quality of TCM care in community health services in Hangzhou. However, there is a need to further improve TCM care from all quality perspectives in order to attract and maintain consumer trust in TCM.

With anisotropic particles attracting much attention for both theoretical and practical application considerations, it was critical to simply manufacture the special morphology particles with different structure or/and surface chemistry. Herein, a novel one-step dissolution template method was described to prepare PSt@TiO2 (Polystyrene @ Titania) navel-like hollow Janus particles (NHJPs). These NHJPs could be obtained simply with dissolution of sulfonated-PSt core template only by regulating the volume ratio of tetrahydrofuran-ethanol solution. The morphologies of these particles were characterized by SEM and TEM. The FT-IR, XPS, XRD and TGA were performed to determine the composition. The formation mechanism of NHJPs was also studied, and the morphology could be control by regulating the dissolution time and the solubility parameters of solvent. The NHJPs showed excellent ultraviolet absorption and the band gap of NHJPs was obtained by UVDRS, which was further proved their highly attractive for photocatalytic materials. Moreover, the preparation method of the PSt@TiO2 NHJPs presented here was scalable and can be extended to other similar systems.

BACKGROUND AND AIM Incidental pancreatic cystic lesions (PCLs) are being diagnosed more frequently. However, little is known about the prevalence of PCLs in the Chinese population. The aim of the study was to assess the crude prevalence of PCLs in individuals who underwent magnetic resonance imaging (MRI). METHODS Data from consecutive patients who underwent MRI without pancreatic indications were included. MRI images were reviewed for the presence of pancreatic cysts. The prevalence of PCLs and high-risk PCLs in different gender and age groups was calculated. To assess the crude prevalence, the prevalence and demographic data were standardized on the basis of Chinese national population data in 2017. RESULTS A total of 10 987 individuals were included (7344 men). Incidental PCLs were identified in 212 individual (128 men). The prevalence of PCLs was 1.93%, and PCLs were more often discovered in women (1.74% vs 2.31%, P = 0.043). Prevalence increased with age (r = 0.804, P

Double-shell hollow particles (DSHPs) have attracted significant attention due to their diverse potential applications. DSHPs are usually obtained by multi-step sacrificial template method which is tedious and inefficient. In this work, a facile synthesis of silica DSHPs has been developed via a novel one-step template method, which is using single-hole hollow particles (SHHPs) as the templates. The shapes and internal structures of the DSHPs were determined by SEM and TEM, and the average diameters of inner and outer shells were about 0.6 and 1.6 μm, respectively. According to FTIR analyses, the compositions of silica DSHPs were identified as well. Furthermore, the silica DSHPs was applied to Li-ion batteries as a modifier of gel polymer electrolyte (GPEs), and the results showed that the gel composite electrolytes (GCEs) could display higher capability, higher ionic conductivity and better rate performance at high current density for GCEs-cell. Properties of the silica DSHPs such as larger specific surface area, more porous structures and Lewis acid-base effect were important for high-performance Li-ion batteries.

This paper presents a two-channel 10-bit successive approximation register (SAR) analog-to-digital converter (ADC) in 28 nm CMOS. Multi-bit/cycle SAR ADC with redundancy is proposed. Novel background calibration for multi-bit/cycle SAR ADC is applied in the prototype ADC monitoring and calibrating the offset between DACs. The ADC achieves both high speed and low power by combining several features, namely digital calibration, redundancy, foreground calibrated dynamic comparator and leakage-immune dynamic logic. According to the simulation, the proposed calibration technique significantly improves linearity exhibiting 77.69 dB SFDR and 60.95 dB SNDR with Nyquist-frequency input at 1 GS/s sampling rate.

Prussian blue and its analogues have been intensively studied as potential electrode materials for sodium ion batteries. In this work, a prussian blue sample was prepared by a simple precipitation method and the electrochemical performance of the prussian blue (PB) cathode was investigated at various temperatures and in different voltage ranges. When cycled in the voltage range of 2.0 − 4.0 V vs. Na/Na+, the PB cathode exhibited initial discharge capacities of 135.4 mAh g−1 (55 °C), 128.5 mAh g−1 (25 °C) and 99.2 mAh g−1 (-10 °C) at 10 mA g−1. The PB cathode showed good cycling stability at low temperature, however the cycling capacity degraded remarkably at elevated temperature. CV test indicated that the capacity fade was mainly due to the side reactions on the electrode-electrolyte interface at near 4.0 V vs. Na/Na+. XPS and FTIR analyses revealed several types of compounds formed on the cathode surface which indicated the complexity of the side reactions. Controlling the high cut-off voltage at 3.8 V vs. Na/Na+ significantly improved the cycling stability of the PB electrode. The PB cathode delivered 1C rate reversible capacity of 100.0 mAh g−1 in 2.0 − 3.8 V vs. Na/Na+ with outstanding capacity retention of 98.2% after 300 cycles.

The management of pancreatic cystic lesions (PCLs) remains controversial. We performed a retrospective study to determine characteristics associated with advanced PCLs (A-PCLs) and whether these characteristics vary in different pathological types of PCLs. The additional diagnostic value of endoscopic ultrasound (EUS) was also evaluated. Patients who underwent surgical resection for an identified PCLs by imaging modalities were included. A logistic regression model was developed to identify significant characteristics for A-PCLs. EUS data was assessed separately. Three hundred and fifty-three patients were included, and 125 patients (35.4%) were A-PCLs. The presence of main pancreatic duct (MPD) diameter ≥ 10 mm (odds ratio [OR], 11.7; 95% confidence interval [CI], 1.53–89.2; P = 0.018), mural nodules ≥ 5 mm (OR, 11.67; 95% CI, 2.3–59.05; P = 0.003), solid components within cysts (OR, 30.87; 95% CI, 7.23–131.7; P

BACKGROUND AND AIM Brush cytology is widely applied to diagnosis indeterminate biliary stricture but suffer from low sensitivity. Changes in DNA content are a character of malignant cell and can be detected by DNA image cytometry (DNA-ICM). The study aimed to estimate the value of routine cytology (RC), DNA-ICM, and their combination in diagnosing indeterminate biliary strictures. METHODS A total of 362 patients who underwent both RC and DNA-ICM tests were analysed. Their results were retrospectively applied to final diagnoses. Diagnostic values were compared among RC, DNA-ICM, and their combination based on the location of strictures. RESULTS The DNA-ICM and combination of two methods had higher diagnostic accuracy than RC in all strictures (63.3% vs 42.3%, P

Pancreatic cystic neoplasms (PCNs) are being detected increasingly frequently due to the widespread use of high-resolution abdominal imaging modalities. Some subtypes of PCNs have the potential for malignant transformation. Therefore, accurate diagnosis of PCNs is crucial to determine whether surgical resection or surveillance is the best management strategy. However, the current cross-section imaging modalities are not accurate enough to enable definite diagnoses. In the last decade, EUS-based techniques have emerged, aiming to overcome the limitations of standard cross-section imaging modalities. These novel EUS-based techniques were primarily designed to acquire distinct images to make radiological diagnoses, collect cyst fluid to undergo biochemical or molecular analyses, and obtain tissue to conclude the pathological diagnoses. In this article, we present a comprehensive and critical review of these emerging EUS techniques for the diagnosis of PCNs, with emphasis being placed on the advantages, feasibilities, diagnostic performances, and limitations of these novel techniques.

O3-type NaNi

Background Equity is one of the major goals of China’s recent health system reform. This study aimed to evaluate the equality of the distribution of health resources and health services between hospitals and primary care institutions. Methods Data of this study were drawn from the China Health Statistical Year Books. We calculated Gini coefficients based on population size and geographic size, respectively, for the indicators: number of institutions, number of health workers and number of beds; and the concentration index (CI) for the indicators: per capita outpatient visits and annual hospitalization rates. Results The Gini coefficients against population size ranged between 0.17 and 0.44 in the hospital sector, indicating a relatively good equality. The primary care sector showed a slightly higher level of Gini coefficients (around 0.45) in the number of health workers. However, inequality was evident in the geographic distribution of health resources. The Gini coefficients exceeded 0.7 in the geographic distribution of institutions, health workers and beds in both the hospital and the primary care sectors, indicating high levels of inequality. The CI values of hospital inpatient care and outpatient visits to primary care institutions were small (ranging from -0.02 to 0.02), indicating good wealth-related equality. The CI values of outpatient visits to hospitals ranged from 0.16 to 0.21, indicating a concentration of services towards the richer populations. By contrast, the CI values of inpatient care in primary care institutions ranged from -0.24 to -0.22, indicating a concentration of services towards the poorer populations. The eastern developed region also had a high internal inequality compared with the other less developed regions. Conclusion Significant inequality in the geographic distribution of health resources is evident, despite a more equitable per capita distribution of resources. Richer people are more likely to use well-resourced hospitals for outpatient care. By contrast, poorer people are more likely to use poorly-resourced primary care institutions for inpatient care. There is a risk of the emergence of a two-tiered health care delivery system.

O3-type NaNi1/3 Fe1/3 Mn1/3 O2 (NaNFM) is well investigated as a promising cathode material for sodium-ion batteries (SIBs), but the cycling stability of NaNFM still needs to be improved by using novel electrolytes or optimizing their structure with the substitution of different elements sites. To enlarge the alkali-layer distance inside the layer structure of NaNFM may benefit Na+ diffusion. Herein, the effect of Ca-substitution is reported in Na sites on the structural and electrochemical properties of Na1-x Cax/2 NFM (x = 0, 0.05, 0.1). X-ray diffraction (XRD) patterns of the prepared Na1-x Cax/2 NFM samples show single α-NaFeO2 type phase with slightly increased alkali-layer distance as Ca content increases. The cycling stabilities of Ca-substituted samples are remarkably improved. The Na0.9 Ca0.05 Ni1/3 Fe1/3 Mn1/3 O2 (Na0.9 Ca0.05 NFM) cathode delivers a capacity of 116.3 mAh g-1 with capacity retention of 92% after 200 cycles at 1C rate. In operando XRD indicates a reversible structural evolution through an O3-P3-P3-O3 sequence of Na0.9 Ca0.05 NFM cathode during cycling. Compared to NaNMF, the Na0.9 Ca0.05 NFM cathode shows a wider voltage range in pure P3 phase state during the charge/discharge process and exhibits better structure recoverability after cycling. The superior cycling stability of Na0.9 Ca0.05 NFM makes it a promising material for practical applications in sodium-ion batteries.