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Objectives: IGF-binding protein 1 (IGFBP1) is a key regulator of insulin-like growth factors, impacting biological processes, including cancer progression and prognosis. Materials and methods: This study investigates genetic alterations affecting IGFBP1 expression in tumors using data from The Cancer Genome Atlas (TCGA) PanCancer Atlas via cBioPortal. We analyzed samples from 32 cancer types for mutation sites, including deep deletions, amplifications, and mutations. RNA-seq data were normalized using log2(value + 1). Statistical analyses, including survival outcomes, were conducted using R packages like ggplot2, stats, and car. Kaplan-Meier survival curves and log-rank tests assessed overall survival (OS) and progression-free survival (PFS). Univariate Cox regression was used to develop nomogram models for OS. Functional consequences of IGFBP1 mutations were explored through protein structure, stability, and IGF interaction analyses. Protein-protein interaction networks and functional enrichment were analyzed using GEPIA2, STRING, and Cytoscape. Gene Ontology (GO), KEGG, and Gene Set Enrichment Analysis (GSEA) provided insights into affected biological pathways. Results: Pan-cancer analysis revealed diverse expression patterns, including significant upregulation in cutaneous melanoma (SKCM) and downregulation in lung adenocarcinoma (LUAD) and stomach adenocarcinoma (STAD). Specifically, elevated IGFBP1 expression in SKCM patients led to a 25 % improvement in 5-year survival. In contrast, higher IGFBP1 levels in LUAD and OV patients resulted in a 30 % and 20 % decrease in survival, respectively. Elevated IGFBP1 levels are significantly linked to advanced tumor stage and grade in OV and LUAD, affecting prognostic outcomes. Nomogram models for OV, SKCM, LUAD, and STAD showed IGFBP1's predictive strength with AUC values ranging from 0.70 to 0.85, indicating its diagnostic potential. Genetic analyses revealed mutations in IGFBP1 in 12 % of STAD cases and 10 % of UCEC cases, indicating significant genetic variation. Immune analysis showed that high IGFBP1 expression significantly influenced immune cell infiltration, particularly macrophages and CD8+ T cells, thereby affecting survival in LUAD and OV. Functional enrichment and gene set enrichment analysis identified IGFBP1 involvement in crucial pathways, such as cell cycle regulation, immune response, and PD-1 signaling, highlighting its biological impact. Additionally, IGFBP1 expression delineates distinct molecular and immune subtypes, correlating with specific cancer behaviors and immune patterns. Conclusions: These findings highlight IGFBP1's potential as a biomarker and therapeutic target, particularly for immunoregulation and cancer subtype stratification.

Miura origami's reconfigurable characteristic and structural asymmetry, combined with electromagnetic (EM) wave manipulation, crashed a unique spark. However, the complexity of the three‐dimensional (3D) origami structure after folding makes it challenging to study the phase regulation mechanism. Here, we propose a reconfigurable phase gradient metasurface based on Miura origami and derive the underlying mechanism of phase modulation in detail under linearly and circularly polarized (LP and CP) incidence. We adopt the one‐dimensional (1D) gradient design along the x direction to verify the idea. The phase calculation formulas are given under LP and CP incidence through the Jones matrix's derivation. The beam deflector angles corresponding to LP and CP waves are identical in the planar state. As the folding angle increases, the phase evolution rules corresponding to the LP and CP waves are discrepant, leading to differential beam steering. Finally, the origami sample is processed for verification, and the experimental data are consistent with the simulation and theoretically calculated values. We believe this work can help analyze the EM behavior of complex 3D origami structures and lay a foundation for designing a multifunctional EM origami metasurface.

Empirical evidence of established measurement invariance of job insecurity measures may enhance the practical utility of job insecurity as a valid predictor when utilised over different cross-national samples. This study investigated the measurement invariance of the nine-item versions of the Job Security Index (a measure of cognitive job insecurity) and the Job Security Satisfaction Scale (a measure of affective job insecurity), across four countries (i.e. the United States, N = 486; China, N = 629; Italy, N = 482 and South Africa, N = 345). Based on a novel bifactor-(S-1) model approach we found evidence for partial metric, partial scalar and partial strict invariance of our substantive bifactor-(S-1) structure. The results extend measurement invariance research on job insecurity with obvious pragmatic implications (e.g. scaling units, measurement bias over cross-national interpretations). Contribution: This research provides evidence to support the applied use of cross-national comparisons of job insecurity scores across the nationalities included in this study. Theoretically, this research advances the debate about the nature of the relationship between cognitive and affective job insecurity, suggesting that in this cross-national dataset, a model where cognitive job insecurity is specified as the reference domain outperforms a model where affective job insecurity is assigned this status. Practically, it demonstrates that it is sensible and necessary to differentiate between cognitive and affective job insecurity and include measures of both constructs in future research on the construct.

Abstract Background Due to the highly heterogeneity of the breast cancer, it would be desirable to obtain a non-invasive method to early predict the treatment response and survival outcome of the locally advanced breast cancer (LABC) patients undergoing neoadjuvant chemotherapy (NAC). This study aimed at investigating whether strain elastography (SE) can early predict the pathologic complete response (pCR) and recurrence-free survival (RFS) in LABC patients receiving NAC. Methods In this single-center retrospective study, 122 consecutive women with LABC who underwent SE examination pre-NAC and after one and two cycles of NAC enrolled in the SHPD001(NCT02199418) and SHPD002 (NCT02221999) trials between January 2014 and August 2017 were included. The SE parameters (Elasticity score, ES; Strain ratio, SR; Hardness percentage, HP, and Area ratio, AR) before and during NAC were assessed. The relative changes in SE parameters after one and two cycles of NAC were describe as ΔA1 and ΔA2, respectively. Logistic regression analysis and Cox proportional hazards model were used to identify independent variables associated with pCR and RFS. Results Forty-nine (40.2%) of the 122 patients experienced pCR. After 2 cycles of NAC, SR2 (odds ratio [OR], 1.502; P = 0.003) and ΔSR2 (OR, 0.013; P = 0.015) were independently associated with pCR, and the area under the receiver operating characteristic curve for the combination of them to predict pCR was 0.855 (95%CI: 0.779, 0.912). Eighteen (14.8%) recurrences developed at a median follow-up of 60.7 months. A higher clinical T stage (hazard ratio [HR] = 4.165; P = 0.005.), a higher SR (HR = 1.114; P = 0.002.) and AR (HR = 1.064; P

In view of the scientific problems such as the difficulty of predicting the disaster before the earthquake, the slow and fragmented acquisition of disaster information after the earthquake, the large error of disaster assessment, the lack of decision support and the absence of disaster services, considering comprehensively pre-earthquake emergency preparedness and post-earthquake emergency response scenarios, this research focuses on the information acquisition and analysis methods of full-time disaster and decision-making, real-time convergence and fusion technology of disaster after earthquake, post-earthquake loss comprehensive analysis technique based on the combination of lethality and vulnerability, key points of assistant decision support for different regions, visualization generation technology for multi-user disaster information service product, establishing a disaster situation push and information quasi-real-time service platform and terminals, constructing the intelligent and visual earthquake emergency information whole process service platform based on cloud architecture, and carrying out emergency collaborative service demonstration, to realize the full-time service of disaster information for large earthquakes with magnitude above 7. The project enriches the means of obtaining earthquake disaster information and forms a technical platform of the whole process of earthquake emergency response, including disaster collection, information flash, monitoring and early warning, analysis and evaluation, intelligent coordination and dynamic release. It is of great significance to improve the ability of earthquake emergency information service for quick and scientific rescue.

AimLittle attention has been paid in the prognosis of colorectal signet ring cell carcinoma (SRCC). This study aims to explore the predictive capacity of log odds of positive lymph nodes (LODDS), lymph node ratio (LNR), and pN stage in the prognosis of patients with colorectal SRCC.MethodsA retrospective cohort study was designed, and data were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Data on demographic characteristics, clinicopathological features, and treatment were extracted. Outcomes were overall survival (OS) and cancer-specific survival (CSS). Association of LODDS, LNR, and pN stage with OS and CSS were explored using Cox proportional hazard model and Cox competing risk model, respectively, with results showing as hazard ratio and 95% confidence interval (CI). Predictive performance of LODDS, LNR, and pN stage in OS and CSS was assessed by calculating C-index.ResultsA total of 2,198 patients were included in this study. LODDS, LNR, and pN stage were associated with the OS and CSS of colorectal SRCC patients (all P

PurposeTo identify risk factors associated with short-term postoperative complications in patients with gastrointestinal cancer and develop and validate prediction models to predict the probability of complications.MethodsA total of 335 patients enrolled in the primary cohort of this study were divided into training and validation sets in a chronological order. Using univariate and multivariate logistic regression analyses, the risk factors for postoperative complications were determined, and nomogram prediction models were constructed. The performance of the nomogram was assessed with respect to the receiver operator characteristic and calibration curves.ResultsPatients with complications had a stronger postoperative stress response and a longer duration of daily fluid intake/output ratio >1 after surgery. Logistic analysis revealed that body mass index (BMI), body temperature on POD4 (T.POD4), neutrophil percentage on POD4 (N.POD4), fasting blood glucose on POD4 (FBG.POD4), and the presence of fluid intake/output ratio 1 were risk factors for POD30 complications. The areas under the curve of Nomogram-A for POD7 complications were 0.867 and 0.833 and those of Nomogram-B for POD30 complications were 0.920 and 0.918 in the primary and validation cohorts, respectively. The calibration curves showed good consistency in both cohorts.ConclusionThis study presented two nomogram models to predict short-term postoperative complications in patients with gastrointestinal cancer. The results could help clinicians identify patients at high risk of complications within POD7 or POD30.

Self-adaptable materials with autonomous morphological transformation by sensing environmental changes have emerged as one of the most promising but challenging approaches for various chiral devices. Unlike previous work on reconfigurable chirality through human intervention, we proposed a temperature-adaptive chiral meta-device. It can autonomously sense the environment and manipulate the optical chirality through 3D-to-3D morphological transformation. As a proof of concept, a 3D morphable chiral meta-device was designed with shape memory alloy (SMA), resulting in reconfigurable circular dichroism (CD). The curving direction of SMA enables the meta-device to switch between left-handed, right-handed, and non-chirality by sensing environmental temperature. The analysis of surface currents and CD spectra reveals that the underlying physical mechanism behind the chirality originates from the surge of toroidal and electric quadrupole dipole moments. Simultaneously, the spin-to-orbital angular momentum conversion is realized based on the Pancharatnam-Berry phase, where the topological charge is modulated by the environmental temperature. Encouragingly, this work paves the way for the self-adaptive chiral meta-devices with 3D morphological transformation and can be applied to a series of novel photon-spin-selective devices for optical communication and biosensing.

We aimed to explore the value of contrast-enhanced ultrasound (CEUS) in early prediction of pathologic complete response (pCR) and recurrence-free survival (RFS) in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NAC). LABC patients who underwent CEUS before and during NAC from March 2014 to October 2018 were included and assessed. Logistic regression analysis and the Cox proportional hazards model were used to identify independent variables associated with pCR and RFS. Among 122 women, 44 underwent pCR. Molecular subtype, peak intensity (PEAK) and change in diameter were independent predictors of pCR after one cycle of NAC (area under the receiver operating characteristic curve [AUC], 0.81; 95% CI: 0.73, 0.88); Molecular subtype, PEAK and change in time to peak (TTP) were independently associated with pCR after two cycles of NAC (AUC, 0.85; 95% CI: 0.77, 0.91). A higher clinical T (hazard ratio [HR] = 4.75; 95% CI: 1.75, 12.87; p = 0.002) and N stages (HR = 3.39; 95% CI: 1.25, 9.19; p = 0.02) and a longer TTP (HR = 1.06; 95% CI: 1.01, 1.11; p = 0.02) at pre-NAC CEUS were independently associated with poorer RFS. CEUS can be used as a technique to predict pCR and RFS early in LABC patients treated with NAC.

Abstract Background Gastric cancer, which is the fifth most common malignancy and the third most common cause of cancer-related death, is particularly predominant in East Asian countries, such as China, Japan and Korea. It is a serious global health issue that causes a heavy financial burden for the government and family. To our knowledge, there are few reports of multicentre randomized controlled trials on the utilization of CT angiography (CTA) for patients who are histologically diagnosed with gastric cancer before surgery. Therefore, we planned this RCT to verify whether the utilization of CTA can change the short- and long-term clinical outcomes. Method The GISSG 20–01 study is a multicentre, prospective, open-label clinical study that emphasises the application of CTA for patients who will undergo laparoscopic gastrectomy to prove its clinical findings. A total of 382 patients who meet the inclusion criteria will be recruited for the study and randomly divided into two groups in a 1:1 ratio: the CTA group (n = 191) and the non-CTA group (n = 191). Both groups will undergo upper abdomen enhanced CT, and the CTA group will also receive CT angiography. The primary endpoint of this trial is the volume of blood loss. The second primary endpoints are the number of retrieved lymph nodes, postoperative recovery course, hospitalization costs, length of hospitalization days, postoperative complications, 3-year OS and 3-year DFS. Discussion It is anticipated that the results of this trial will provide high-level evidence and have clinical value for the application of CTA in laparoscopic gastrectomy. Trial registration ClinicalTrials.gov , NCT04636099. Registered November 19, 2020

Introduction. Kidney injury diagnosis is often delayed in patients with gout. We aimed to determine the characteristics of gout patients with CKD using musculoskeletal ultrasound (MSUS) and whether MSUS could be used as an auxiliary assessment to evaluate kidney injury and predict renal outcome in patients with gout. Methods. Clinical information, laboratory indicators and MSUS findings were collected and compared between gout-only patients (gout-CKD) and gout patients with CKD (gout+CKD). Multivariate logistic regression was applied to identify risk factors for clinical and MSUS characteristics in both groups. Correlation analysis between MSUS signs and kidney-related indicators was performed, and the effects of MSUS characteristics on renal prognosis were evaluated. Results. In total, 176 patients with gout were included, namely, 89 gout-CKD and 87 gout+CKD cases. After adjusting for confounders, the gout patients with CKD showed more frequent episodes in the previous year, higher ultrasound semiquantitative scores and more tophi than gout patients without CKD. Additionally, the number of tophi, bone erosion and synovial hypertrophy measured by MSUS were found to be negatively correlated with the eGFR. The existence of tophi was independently associated with an increased risk of a ≥10% decline in eGFR in the first-year follow-up (OR 3.56, 95% CI 1.382-9.176). Conclusions. Ultrasound-detected tophi, bone erosion and synovial hypertrophy were associated with kidney injury in gout patients. The existence of tophi was associated with faster renal function deterioration. MSUS could be a potential auxiliary diagnostic method to evaluate kidney injury and predict renal outcome in gout patients.

ObjectiveThis study aimed to explore the value of strain elastography (SE) and shear wave elastography (SWE) following the World Federation of Ultrasound in Medicine and Biology (WFUMB) guidelines and recommendations in the real world in distinguishing benign and malignant breast lesions and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.MethodsThis prospective study included 274 breast lesions. The elastography score (ES) by the Tsukuba score, the strain ratio (SR) for SE, and Emax for SWE of the lesion(A) and the regions(A’) included the lesion and the margin (0.5-5 mm) surrounding the lesion were measured. The sensitivity, specificity, and AUC were calculated and compared by the cutoff values recommended by WFUMB guidelines.ResultsWhen scores of 1 to 3 were classified as probably benign by WFUMB recommendation, the ES was significantly higher in malignant lesions compared to benign lesions (p < 0.05) in all lesions. For the cohort by size >20 mm, the sensitivity was 100%, and the specificity was 45.5%. ES had the highest AUC: 0.79(95% CI 0.72-0.86) with a sensitivity of 96.2%, and a specificity of 61.8% for the cohort by size ≤20 mm. For the Emax-A’-S2.5mm, when the high stiffness would be considered with Emax above 80 kPa in SWE, the malignant lesions were diagnosed with a sensitivity of 95.8%, a specificity of 43.3% for all lesions, a sensitivity of 88.5% for lesions with size ≤20 mm, and sensitivity of 100.0% for lesions with size >20 mm. In 84 lesions of BI-RADS category 4a, if category 4a lesions with ES of 1-3 points or Emax-A’-S2.5 less than 80 kPa could be downgraded to category 3, 52 (61.9%) lesions could be no biopsy, including two malignancies. If category 4a lesions with ES of 1-3 points and Emax-A’-S2.5 less than 80kPa could be downgraded to category 3, 23 (27.4%) lesions could be no biopsy, with no malignancy.ConclusionsThe elastography score for SE and Emax-A’ for SWE after our modification were beneficial in the diagnosis of breast cancer. The combination of SWE and SE could effectively reduce the biopsy rate of BI-RADS category 4a lesions.

Molecular imaging visualizes, characterizes, and measures biological processes at the molecular and cellular level. In oncology, molecular imaging is an important technology to guide integrated and precise diagnosis and treatment. Photoacoustic imaging is mainly divided into three categories: photoacoustic microscopy, photoacoustic tomography and photoacoustic endoscopy. Different from traditional imaging technology, which uses the physical properties of tissues to detect and identify diseases, photoacoustic imaging uses the photoacoustic effect to obtain the internal information of tissues. During imaging, lasers excite either endogenous or exogenous photoacoustic contrast agents, which then send out ultrasonic waves. Currently, photoacoustic imaging in conjunction with targeted photoacoustic contrast agents is frequently employed in the research of tumor molecular imaging. In this study, we will examine the latest advancements in photoacoustic imaging technology and targeted photoacoustic contrast agents, as well as the developments in tumor molecular imaging research.

ObjectiveAs for ultrasound (US) guided stellate ganglion (SG) block, unsatisfactory curative outcomes and complications still remain. This problem could be greatly improved by identifying and monitoring SG. To the best of our knowledge, there are few reports to directly visualize SG in literature. This study explored the feasibility of detection of SG and summarized the findings of SG through US.MethodsFifty healthy adults with 100 SGs were enrolled. The size, shape, echogenicity, margin, the inferior pole of SG, the relationship between the superior pole of SG and the transverse process, the relationship between the superior pole of SG and the inferior thyroid artery, and the relationships between SG and other surrounding tissues were evaluated by US.ResultsThe SG was identified in 79% of the participants. No significant differences were found between the right and left sides regarding thickness, cross-sectional area (CSA), and position (all p > 0.05); however, there was a significant difference in the width of the right and left sides (p < 0.05). Side was associated with SG visibility (p < 0.05), however, the gender was not (p > 0.05). A total of 42% of SGs were oval-shaped. All SGs were hyperechogenic and had an ill-defined margin. In fact, 63% of SGs were located in the C7 transverse process level, 77% of SGs were located under the inferior thyroid artery, and all of these SGs were located lateral to the thyroid and medial to the anterior scalene muscle and the vagus nerve.ConclusionOur preliminary study demonstrates that US imaging provides the capability of detecting SG. This may be helpful in minimizing complications and improving the accuracy of US-guided SG block.

Diagnostic tools for the early detection of renal injury caused by hyperuricemia are still lacking. Here, we investigated whether contrast-enhanced ultrasound (CEUS) could be used as a diagnostic tool for hyperuricemic nephropathy (HN). In the HN rat model, CEUS detected a significant decline in renal cortical perfusion compared with that in control rats. Peak intensity (PI) values correlated significantly with serum KIM-1 levels and fibrosis scores in HN rats. An early decline in PI values was also observed in chronic kidney disease (CKD) stage 1 patients with HN compared with the controls (61.1±4.52 dB versus 65.80±7.10 dB) and correlated with renal function in the patients with HN. In contrast, an increase in time to reach PI values was detected in HN patients with stage 1 CKD (15.14±1.75 s versus 14.52±4.75 s) and was more pronounced in CKD stage 4 patients (67.32±3.29 s). CEUS was able to detect abnormal renal perfusion in early CKD with HN, which correlated with renal function decline, suggesting that CEUS could be used as a noninvasive tool for assessing renal function in patients with HN.

Abstract Background Recombinant insulin Lisargine is a new type of insulin. In this study, we aimed to compare its pharmacodynamic (PD) and pharmacokinetic (PK) with Lantus. Methods The PD test was performed by exploring the effect of single administration on blood glucose of normal rats and STZ-induced diabetic rats, and the effect of multiple administrations on blood glucose of STZ-induced diabetic rats. Further PD tests include receptor affinity test, receptor autophosphorylation test and adipocyte glucose uptake test. Four IU and 8 IU per dog Lisargine was used for PK test, insulin was measured and area under curve (AUC) was calculated. Results With single injection, Lisargine 1.5 IU/kg had significant hypoglycemic effects at 1 and 2 h, similar to that of Lantus. Lisargine 5 IU/kg and 10 IU/kg lowered the blood glucose of STZ-induced diabetic rats at 1, 2, 4 & 6 h significantly. With multiple injections, Lantus lowered blood glucose at 2, 4 & 6 h, Lisargine 2.5 IU/kg, 5 IU/kg, and 10 IU/kg lowered blood glucose at 2 & 4 h significantly, compared with vehicle. There was no difference for receptor affinity test, receptor autophosphorylation test and adipocyte glucose uptake test between Lisargine and Lantus. The PK of Lisargine and Lantus of healthy Beagle dogs was very similar. Conclusions This animal study demonstrated that PK and PD of Lisargine and Lantus were similar, suggesting the bioequivalence of these products.

An Ms 6.4 earthquake occurred in Yangbi County, Yunnan Province, on May 21, 2021. The magnitude is only 0.1 difference when compared with the 2014 Ms 6.5 earthquake in Ludian County, Yunnan Province, but the disasters show a big difference. Seismic signal includes the comprehensive information of source, propagation path, and site effect, which directly reflect the effect of the earthquake on the ground. The study mainly investigated the difference between seismic signals of two events in time domain and time-frequency-energy space based on variational mode decomposition and Hilbert transform to clarify the reasons for disaster differences. Most damaged buildings are column-and-tie timber structures with Earth walls with local collapse or vertical crack at the corner of the Earth wall in the Yangbi earthquake. Multistorey buildings are intact, and a few small landslides are triggered, whereas, in the Ludian earthquake, multistorey buildings with the frame structure and masonry structure occurred with serious X-type cracking, large interlayer displacement, and even complete collapse, and large landslides with length about 165 m are triggered. 53LLT and 53YBX are two strong motion stations in the Ludian earthquake and Yangbi earthquake, respectively, and are near the disaster investigation points. Peak ground acceleration in 53LLT is up to 949.2 cm/s2, which is larger than 720.3 cm/s2 in 53YBX, and the duration in 53LLT is longer than 53YBX. The instantaneous energy of 53YBX is concentrated within 0–10 Hz and 10–20 Hz, respectively; however, the instantaneous energy of 53LLT is concentrated at 5 Hz. Cumulative energy of 53YBX is mainly distributed at 0–5 Hz and 10–20 Hz, which is around the natural frequency of column-and-tie timber structure, while the energy of 53LLT is concentrated at 1.6 Hz and is much greater than other stations. Thus, large energy in high frequency caused the instantaneous and cumulative damage to short-period structures in Yangbi County and may cause the resonance of column-and-tie timber structure, and large energy in low frequency caused the instantaneous and cumulative damage to long-period structures of Longtou Village in Ludian earthquake. The result is meaningful to understanding the seismic disasters from the characteristics of seismic signals and can provide a reference for the seismic design of structures.

Abstract Background The incidence of gastric cancer in East Asia is much higher than the international average. Therefore, improving the prognosis of patients and establishing effective clinical pathways are important topics for the prevention and treatment of gastric cancer. At present, the enhanced recovery after surgery (ERAS) pathway is widely used in the field of gastric surgery. Many randomized controlled trial (RCT) studies have proven that the ERAS regimen can improve the short-term clinical outcomes of patients with gastric cancer. However, a prospective study on the effect of the ERAS pathway on the prognosis of patients with gastric cancer has not yet been reported. This trial aims to confirm whether the ERAS pathway can improve the disease-free survival and overall survival of patients undergoing laparoscopic-assisted radical resection for distal gastric cancer. Methods/design This study is a prospective, multicentre RCT. This experiment will consist of two groups – an experimental group and a control group – randomly divided in a 1:1 ratio. The perioperative period of the experimental group will be managed according to the ERAS pathway and that of the control group will be managed according to the traditional management mode. An estimated 400 patients will be enrolled. The main endpoint for comparison is the 3-year overall survival and disease-free survival between the two groups. Discussion The results of this RCT should clarify whether the ERAS pathway is superior to traditional treatment on inflammatory indexes, short-term clinical outcome and survival for laparoscopic-assisted radical resection of distal gastric cancer. It is hoped that our data will provide evidence that the ERAS pathway improves survival in patients with gastric cancer. Trial registration Chinese Clinical Trial Registry, CHiCTR1900022438 . Registered on 11 April 2019.

Background and Objectives: Whether the morphological changes in axillary lymph node (ALN) have occurred prior to metastasis remains unclear in breast cancer (BC) patients. The aim of this study is to investigate the influence of BC for the morphology of non-metastasis ALN (N−) and, further, to improve the performance of ultrasound (US) examination for metastasis ALN (N+). Materials and Methods: In this retrospective study, 653 patients with breast mass were enrolled and divided into normal group of 202 patients with benign breast tumor, N− group of 233 BC patients with negative ALN and N+ group of 218 BC patients with positive ALN. US features of ALN were evaluated and analyzed according to long (L) and short (S) diameter, the (L/S) axis ratio, cortical thickness, lymph node edge, replaced hilum and color Doppler flow imaging (CDFI). Results: ALN US features of short diameter, replaced hilum, cortical thickness and CDFI have significant statistical differences in N− group comparing with normal group and N+ group, respectively (p < 0.05). Conclusions: Therefore, BC can affect ALN and lead to US morphological changes whether lymph node metastasis is present, which reduces the sensitivity of axillary US. The combination of US and other examination methods should be applied to improve the diagnostic performance of N+.

Objectives: To develop a tool which can evaluate the severity of the joint injury in individuals with gout and asymptomatic hyperuricaemia. Methods: This retrospective study included 616 male patients: 245 with asymptomatic hyperuricaemia and 371 with intercritical gout. All patients underwent ultrasonography of the knee, ankle and first metatarsophalangeal (MTP) joints. Ultrasound features that were significantly different between groups were entered into a binary logistic regression analysis to identify discriminative factors. The ultrasound signs were scored based on their odds ratios, which were then used to evaluate the severity of gout and asymptomatic hyperuricaemia. The performance of the ultrasound score was validated in an additional population including 163 patients with asymptomatic hyperuricaemia and 196 patients with gout. Results: Ultrasound signs were scored as follows: knee joint: synovial effusion, 2 points, tophus, 5 points; ankle joint: synovial effusion, 2 points, synovial hypertrophy, 5 points, tophus, 3 points, bone erosion, 7 points; and first MTP joint: double contour sign, 2 points, synovial hypertrophy, 3 points, tophus, 9 points, bone erosion, 4 points. The maximum possible total score was 42. The optimal cut-off score for gout was 6.5. The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were 86.9%, 75.2% and 0.878, respectively. The patients were stratified according to their ultrasound score (range 0–42). The prevalence of intercritical gout, tophi, and bone erosion increased with the increase of the score. In the validation population, 83.20% of 193 patients with gout had ultrasound scores above 6.5; 76.10% of 163 patients with asymptomatic hyperuricaemia had ultrasound scores under 6.5. Conclusion: The scoring system based on the differential ultrasound signs can effectively evaluate the severity of joint injury in individuals with gout and asymptomatic hyperuricaemia.

The main objective of this study was to determine the predictive value of US characteristics for disease-free survival (DFS) in BC patients. We retrospectively analyzed the ultrasonic images and clinical data of BC patients who had previously undergone breast surgery at least 10 years before study enrollment and divided them into a case group and a control group according to the cutoff value of 120 months for DFS. Correlation analysis was performed to identify US characteristics as independent predictors for DFS by multivariable logistic regression and Kaplan–Meier survival analysis. A total of 374 patients were collected, including 174 patients in the case group with short-DFS and 200 patients in the control group with long-DFS. Three US characteristics (size on US, mass shape, mass growth orientation) and two clinical factors (axillary lymph node (ALN), molecular subtypes) were identified as independent predictors for DFS (p < 0.05). The ROC curve showed good performance of the multivariate linear regression model with the area under the curve being 0.777. The US characteristics of large size, irregular shape, and nonparallel orientation were significantly associated with short-DFS, which is a promising supplementary for clinicians to optimize clinical decisions and improve prognosis in BC patients.

Background: Although increased age is associated with higher systolic blood pressure (SBP) in general, there may be variation across individuals in how SBP changes over time. The goal of this paper is to identify heterogeneity in SBP trajectories among young adults with similar initial values and identify personal characteristics associated with different trajectory patterns. This may have important implications for prevention and prognosis. Methods: A cohort of 12,468 individuals aged 18–35 years in the Qingdao Port Cardiovascular Health Study in China was followed yearly during 2000–2011. Individuals were categorized into three strata according to their baseline SBP: ≤110 mmHg, 111–130 mmHg, and >130 mmHg. Within each stratum, group-based trajectory analyses were conducted to identify distinct SBP trajectory patterns, and their association with sociodemographic and baseline health characteristics was assessed by ordinal logistic regression. Results: Five distinct groups of individuals exhibiting divergent patterns of increasing, stable or decreasing SBP trends were identified within each stratum. This is a first report to identify a subgroup with decreasing trend in SBP. Individuals with more advanced age, having less than high school education, family history of cardiovascular diseases, greater body mass index, greater waist circumference, and hyperlipidemia at baseline were more likely to experience trajectories of higher SBP within each stratum. Conclusions: The diverging trajectories among young adults with similar initial SBP highlight the need for prevention and feasibility of effective blood pressure control, while the identified risk factors may inform targeted interventions.

Land ecological security (LES) is a cornerstone of sustainable development, and the study of the LES evaluation has become a hot field in the LES problems. The coordinated development of the Beijing–Tianjin–Hebei (BTH) region is one of China’s national development strategies. With the development of urbanization and industrialization, the conflicts between people and land in this area are increasingly prominent, and there are large regional differences in land ecological quality. To evaluate the land ecological security (LES) of this region, an evaluation index system is constructed based on the pressure–state–response (PSR) framework model, and the entropy-weighted TOPSIS method is applied to calculate the LES index. Then, the spatio-temporal changes of LES in the BTH region from 2007 to 2018 are analyzed. In addition, we adopt an obstacle degree model to analyze the obstacle indicators. The results show that the LES of the BTH region increased from 0.1934 to 0.3284 during 2007–2018, and the LES level increased from the dangerous level (I) to the critical level (III). Despite the improved LES in all areas in the BTH region, there were different trends (high in the central area, relatively low in the northern and southern areas). We identified seven obstacle indicators and discussed different development strategies. Our findings will provide guidelines for land use management and offer references for the coordinated development of the BTH region.

Abstract Background Hepatitis B virus (HBV) is predominantly transmitted through mother-to-child transmission (MTCT). To date, it remains unclear whether the method of parturition affects MTCT of HBV. In order to clarify whether cesarean section, when compared with vaginal delivery, could reduce the risk of MTCT of HBV in China, we conducted this meta-analysis. Methods A systematic literature search was performed of the PubMed (Medline), Embase, ISI Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals databases for articles written in English or Chinese through July 2015.The reference lists of relevant articles were also scrutinized for additional papers. Randomized controlled trials, cohort studies, or case-control studies investigating the effect of delivery mode on MTCT of HBV were included. Results This analysis involved 28 articles containing 30 datasets. The data encompassed 9906 participants. The MTCT rate of HBV was 6.76% (670 of 9906) overall, with individual rates of 4.37% (223 of 5105) for mothers who underwent cesarean section and 9.31% (447 of 4801) for those who underwent vaginal delivery. The summary relative risk (RR) was 0.51 (95%CI: 0.44–0.60, P

Abstract The main purpose of this paper is to establish a boundedness result for strong maximal functions with respect to certain non-doubling measures in R n $\mathbb{R}^{n}$ . More precisely, let d μ ( x 1 , … , x n ) = d μ 1 ( x 1 ) ⋯ d μ n ( x n ) $d\mu(x_{1}, \ldots, x_{n})=d\mu_{1}(x_{1})\cdots d\mu_{n}(x_{n})$ be a product measure which is not necessarily doubling in R n $\mathbb{R}^{n}$ (only assuming d μ i $d\mu_{i}$ is doubling on R $\mathbb{R}$ for i = 2 , … , n $i=2, \ldots, n$ ), and let ω be a nonnegative and locally integral function such that ω i ( ⋅ ) = ω ( x 1 , … , x i − 1 , ⋅ , x i + 1 , … , x n ) $\omega _{i}(\cdot)=\omega(x_{1}, \ldots, x_{i-1}, \cdot, x_{i+1}, \ldots, x_{n})$ is in A ∞ 1 ( d μ i ) $A_{\infty}^{1}(d\mu_{i})$ uniformly in x 1 , … , x i − 1 , x i + 1 , … , x n $x_{1}, \ldots, x_{i-1}, x_{i+1}, \ldots, x_{n}$ for each i = 1 , … , n − 1 $i=1, \ldots, n-1$ , let d ν = ω d μ $d\nu=\omega \,d\mu$ , ν ( E ) = ∫ E ω ( y ) d μ ( y ) $\nu(E)=\int_{E} \omega(y)\,d\mu(y)$ , and M ω d μ n $M_{\omega \,d\mu}^{n}$ be the strong maximal function defined by M ω d μ n f ( x ) = sup x ∈ R ∈ R 1 ν ( R ) ∫ R | f ( y ) | ω ( y ) d μ ( y ) , $$M_{\omega \,d\mu}^{n} f(x)=\sup_{x\in R\in\mathcal{R}} \frac{1}{\nu (R)} \int_{R} \bigl\vert f(y) \bigr\vert \omega(y)\,d\mu(y), $$ where R $\mathcal{R}$ is the collection of rectangles with sides parallel to the coordinate axes in R n $\mathbb{R}^{n}$ . Then we show that M ω d μ n $M_{\omega \,d\mu}^{n} $ is bounded on L ω d μ p ( R n ) $L^{p}_{\omega \,d\mu}(\mathbb{R}^{n})$ for 1 < p < ∞ $1< p

A class of lightweight FeCo/AlSi magnetostrictive composites was prepared in this study to explore the feasibility for 1-3 metal-matrix magnetostrictive materials for serving as sensors, actuators and energy harvesters. The FeCo fibers were inset into the AlSi metal liquid and then the composites were solidified at a protective atmosphere. The microstructural observations for these FeCo/AlSi composites illustrate the presence of the element diffusion and the disappearance of the cold-rolled preferred orientation. The refined microstructure was obtained during solidification and then further improved the magnetostrictive properties of the FeCo/AlSi composites. A zigzag interface with well transfer in stress and strain between the FeCo fiber and AlSi matrix existed through both physical and chemical bonding. There are two different experimental groups in this work. One group is aimed to evaluate the effect of the diameter of the FeCo/AlSi composite on the output voltage under compression. Another group with different numbers of the FeCo fibers is employed for analyzing the effect of the volume fraction of the FeCo fiber on the output performance. The results exhibit that a smaller diameter for the lightweight 1-3 FeCo/AlSi composite contributes to exciting a greater output voltage. Furthermore, the output voltage is proportional to the number of the FeCo fiber. An optimal resistive load of 500 Ω for this harvesting setup is obtained. Theoretical analysis through a magneto-mechanical coupling model for the FeCo/AlSi composites was conducted for accurately predicting the practical output performance. Keywords: Metal-matrix composite, Iron cobalt, Inverse magnetostrictive effect, Lightweight devices

BackgroundThe reasons for China's high stroke prevalence are not well understood. The cardiovascular risk factor profiles of China and the United States have not been directly compared in nationally representative population samples. Methods and ResultsUsing data from the CHARLS (China Health and Retirement Longitudinal Study) and the NHANES (US National Health and Nutrition Examination Survey), we compared cardiovascular risk factors from 2011 to 2012 among people aged 45 to 75 years between the 2 countries (China, 12 654 people; United States, 2607 people): blood pressure, cholesterol, body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, and high‐sensitivity C‐reactive protein. Compared with the United States, China had a lower prevalence of hypertension but a higher mean blood pressure and a higher proportion of patients with severe hypertension (≥160/100 mm Hg) (10.5% versus 4.5%). China had substantially lower rates of hypertension treatment (46.8% versus 77.9%) and control (20.3% versus 54.7%). Dyslipidemia was less common in China, but lipid levels were not significantly different because dyslipidemia awareness and control rates in China were 3‐ and 7‐fold lower than US rates, respectively. High‐sensitivity C‐reactive protein, body mass index, and waist circumference were significantly lower in China than in the United States. Clustering of hypertension with other cardiovascular risk factors was more common in China. ConclusionsHypertension is more common in the United States, but blood pressure levels are higher in China, which may be responsible for China's high stroke prevalence. The low rates of awareness, treatment, and control of hypertension provide an exceptional opportunity for China to reduce risk in its population.

BackgroundChina has gaps in the quality of care provided to patients with ST‐elevation myocardial infarction, but little is known about how quality varies between hospitals. Methods and ResultsUsing nationally representative data from the China PEACE‐Retrospective AMI Study, we characterized the quality of care for ST‐elevation myocardial infarction at the hospital level and examined variation between hospitals. Two summary measures were used to describe the overall quality of care at each hospital and to characterize variations in quality between hospitals in 2001, 2006, and 2011. The composite rate measured the proportion of opportunities a hospital had to deliver 6 guideline‐recommended treatments for ST‐elevation myocardial infarction that were successfully met, while the defect‐free rate measured the proportion of patients at each hospital receiving all guideline‐recommended treatments for which they were eligible. Risk‐standardized mortality rates were calculated. Our analysis included 12 108 patients treated for ST‐elevation myocardial infarction at 162 hospitals. The median composite rate increased from 56.8% (interquartile range [IQR], 45.9–72.0) in 2001 to 80.5% (IQR, 74.7–84.8) in 2011; however, substantial variation remained in 2011 with defect‐free rates ranging from 0.0% to 76.9%. The median risk‐standardized mortality rate increased from 9.9% (IQR, 9.1–11.7) in 2001 to 12.6% (IQR, 10.9–14.6) in 2006 before falling to 10.4% (IQR, 9.1–12.4) in 2011. ConclusionsHigher rates of guideline‐recommended care and a decline in variation between hospitals are indicative of an improvement in quality. Although some variation persisted in 2011, very top‐performing hospitals missed few opportunities to provide guideline‐recommended care. Quality improvement initiatives should focus on eliminating residual variation as well as measuring and improving outcomes. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Chronic arsenic exposure has been associated to cognitive deficits. However, mechanisms remain unknown. The present study investigated the neurotoxic effects of sodium arsenite in drinking water over different dosages and time periods. Based on results from the Morris water maze (MWM) and morphological analysis, an exposure to sodium arsenite could induce neuronal damage in the hippocampus, reduce learning ability, and accelerate memory impairment. Sodium arsenite significantly increased homocysteine levels in serum and brain. Moreover, sodium arsenite triggered unfolded protein response (UPR), leading to the phosphorylation of RNA-regulated protein kinase-like ER kinase (PERK) and eukaryotic translation initiation factor 2 subunit α (eIF2α), and the induction of activating transcription factor 4 (ATF4). Arsenite exposure also stimulated the expression of the endoplasmic reticulum (ER) stress markers, glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP) and the cleavage of caspase-12. Furthermore, exposure to arsenite enhanced apoptosis as demonstrated by expression of caspase-3 and TUNEL assay in the hippocampus. The results suggest that exposure to arsenite can significantly decrease learning ability and accelerate memory impairment. Potential mechanisms are related to enhancement of homocysteine and ER stress-induced apoptosis in the hippocampus.

BackgroundThis study was aimed to investigate the clinical relevance between glycoprotein Ia (GPIA) rs1126643C/T polymorphism and the outcome of coronary artery disease after coronary artery bypass graft (CABG) surgery and explore the involved potential mechanisms. Methods and ResultsWe genotyped GPIA rs1126643 polymorphism of 1592 patients who underwent CABG and followed up for a median period of 72.8 months. Patients who are GPIA rs1126643 T‐allele carriers have a higher major adverse cardiac or cerebrovascular events risk post‐CABG than those who are CC homozygotes (hazard ratio [HR]=1.29; P=0.022). The clinical association between the risk allele (T) carriage and major adverse cardiac or cerebrovascular events was confirmed in another cohort study, which included 646 CABG patients from various health centers across China. Meanwhile, rs1126643 T allele was also linked with increased risk of major adverse cardiac or cerebrovascular events (HR=1.73; P=0.019). To explore the underlying mechanisms, we prospectively recruited 131 coronary artery disease patients, assessed their platelet aggregation function, and focused on detecting their GPIA mRNA level and protein expression. Results showed that patients with rs1126643 T allele have elevated platelet aggregation activity (P=0.029) when protein expression is increased (P

BackgroundChina is experiencing a marked increase in ST‐segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in‐hospital death in relatively younger age groups (12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence‐based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P

BACKGROUND:Statin therapy is among the most effective treatments to improve short- and long-term mortality after acute myocardial infarction. The use of statin, and the intensity of their use, has not been described in acute myocardial infarction patients in China, a country with a rapidly growing burden of cardiovascular disease. METHODS AND RESULTS:Using a nationally representative sample of patients with acute myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006 and 2011, we identified 14,958 patients eligible for statin therapy to determine rates of statin use and the intensity of statin therapy, defined as those statin regimens with expected low-density lipoprotein cholesterol lowering of at least 40%, to identify factors associated with the use of statin therapy. Statin use among hospitalized patients with acute myocardial infarction increased from 27.9% in 2001 to 72.5% in 2006, and 88.8% in 2011 (P

ObjectivesTo describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).BackgroundCardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.MethodsBased on a nationally representative sample of Chinese hospitals in 2001, 2006 and 2011, we describe the temporal trends and regional differences in the hospital capability and rates of use of cardiac biomarker testing, as well as the variation in use across hospitals with testing capability, for patients labeled with the diagnosis of AMI.ResultsWe sampled 175 hospitals (162 participated in the study) and 18,631 AMI admissions. 14,370 patients were included in analysis of biomarker use. The proportion of hospitals with biomarker testing capability was 57.4% in 2001 (25.0% troponin and 32.4% creatine kinase MB fraction (CK-MB) only) and 96.3% (81.4% troponin and 14.9% CK-MB only) in 2011. The proportion of hospitals with troponin testing capability in 2011 was significantly higher in urban compared with rural hospitals (96.8% vs. 71.4%, p< 0.001). In 2011, only 55.9% of hospitals with troponin testing capability (71 out of 127 hospitals) used the assay for more than 80% of their patients with AMI. Among hospitals with either biomarker testing capability, there was marked variation in use in both rural (from 7.1% to 100.0% of patients) and urban hospitals (from 57.9% to 100.0% of patients). In 2011, 36.1% of the patients with AMI did not have troponin tested and 4.9% did not have either biomarker measured.ConclusionsThe recommended biomarker tests for AMI diagnosis are not universally available and the testing is not consistently applied when it is available in China.Trial registrationClinicalTrials.gov NCT01624883.

Although there are great changes of dietary in the past few decades in China, few are known about the aluminium exposure in Chinese diet. The aim of this study is to systematically evaluate the dietary aluminium intake level in residents of Shenzhen, China. A total of 853 persons from 244 household were investigated their diet by three days food records. Finally, 149 kinds of foods in 17 food groups were selected to be the most consumed foods. From them, 1399 food samples were collected from market to test aluminium concentration. High aluminium levels were found in jellyfish (median, 527.5 mg/kg), fried twisted cruller (median, 466.0 mg/kg), shell (median, 107.1 mg/kg). The Shenzhen residents' average dietary aluminium exposure was estimated at 1.263 mg/kg bw/week which is lower than the PTWI (provisional tolerable weekly intake). But 0-2 and 3-13 age groups have the highest aluminium intake exceeding the PTWI (3.356 mg/kg bw/week and 3.248 mg/kg bw/week) than other age groups. And the main dietary aluminium exposure sources are fried twisted cruller, leaf vegetables and bean products. Our study suggested that even three decades rapid economy development, children in Shenzhen still have high dietary aluminium exposure risk. How to control high dietary aluminium exposure still is a great public health challenge in Shenzhen, China.

ObjectiveTo determine whether educational level and overweight/obesity was associated with the development of diabetes among Chinese adult men and women.MethodsA cohort (2000-2011) of 10 704 participants aged 18-59 years (8 238 men, 2 466 women) in Qingdao Port Health Study (QPHS) were recruited in this study. The personal lifestyle, height, weight, waist circumference, resting heart rate, blood pressure, fasting blood glucose, total cholesterol, triglycerides and plasma uric acid were collected annually in a comprehensive health checkup program. Cox proportional hazards regression models were used to estimate the association of factors and incidence of diabetes.ResultsDuring 110 825 person-years of follow-up, 1 056 new onset cases (9.5 per 1 000 person-years) of diabetes were identified. With normal weight as reference, the multiple-adjusted hazard ratio (HR) (95%CI) of diabetes was 1.69(1.38-2.09) for overweight and 2.24(1.66-3.02) for obesity among men, which was 1.81(1.12-2.92) and 2.58(1.37-4.86) among women, respectively. Compared with the participants with high educational level, those with low educational level had a higher risk of diabetes (multiple-adjusted HR (95%CI): 1.43(1.11-1.86)) among men. The association was not found among women and the adjusted HR (95%CI) of diabetes was 1.56(0.89-2.76). The increased risks of low educational level were independent of mediators among men, through normal weight (P for trend = 0.0313) and overweight (P for trend = 0.0212) group but not obesity group (P for trend = 0.0957).ConclusionBaseline overweight/obesity was an independent risk factor for diabetes for both men and women. Low educational level was adversely associated with incidence of diabetes through normal weight, overweight and obesity groups, with the association being substantially attenuated by mediating factors only in the obesity group among men. The association was not found among women.