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Zhu-Xi Yu, Yang Pi, Mei-Kai Chen, Dan-Jiang Dong, Qin Gu Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 21008, People’s Republic of ChinaCorrespondence: Qin Gu, Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical school, Nanjing, Jiangsu, 21008, People’s Republic of China, Tel +86-13705150348, Email guqin123456202206@163.comAbstract: Hemodynamic instability in patients with clozapine intoxication can indirectly reflect the serum concentration of clozapine.We have described a case of a 32-year-old pregnant woman who developed life-threatening clozapine toxicity at 28 weeks of gestation. The levels of clozapine and norclozapine in the serum were high. We initiated hemoperfusion(HP) and other detoxification therapies to remove the drug. The patient had severely dilated peripheral blood vessels, which led to cardiac symptoms such as fatal hypotension and uncontrollable tachycardia, resulting in very high cardiac output and elevated Central venous oxygen saturation (ScvO2). Pharmacological intervention significantly improved the hemodynamics.In light of our observations in the ongoing case, we posit that evaluating hemodynamic parameters before and after blood detoxification could serve as a valuable means to gauge effectiveness and provide guidance for treatment.Keywords: clozapine, toxicity, pulse index continuous cardiac output, PICCO, hemoperfusion, HP

Zitian Liang,1,* Ding Chen,2,* Ye Jiang,1 Zhikang Su,2 Yixing Pi,2 Tao Luo,2 Qianzhou Jiang,1 Li Yang,1 Lvhua Guo2 1Department of Endodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China; 2Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, 510182, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li Yang; Lvhua Guo, Affiliated Stomatology Hospital of Guangzhou Medical University, No. 195 West Dongfeng Road, Guangzhou, 510182, People’s Republic of China, Tel +86-020-81299942, Email 2019686001@gzhmu.edu.cn; 2010686002@gzhmu.edu.cnIntroduction: Effective infection control without irritating the pulp tissue is the key to successful vital pulp therapy. Developing a novel antibacterial biomaterial that promotes dentin regeneration for pulp capping is thus a promising strategy for enhancing vital pulp therapy.Methods: Lithium-doped mesoporous nanoparticles (Li-MNPs) were synthesized using an alkali-catalyzed sol-gel method. The particle size, elemental distribution, surface morphology, pore structure, and ion release from Li-MNPs were measured. Human dental pulp stem cells (hDPSCs) and Streptococcus mutans (S. mutans) were used to evaluate the biological effects of Li-MNPs. In addition, a dental pulp exposure mouse model was used to evaluate the regenerative effects of Li-MNPs.Results: Li-MNPs had a larger surface area (221.18 m2/g), a larger pore volume (0.25 cm3/g), and a smaller particle size (520.92 ± 35.21 nm) than MNPs. The in vitro investigation demonstrated that Li-MNPs greatly enhanced the biomineralization and odontogenic differentiation of hDPSCs through the Wnt/β-catenin signaling pathway. Li-MNPs showed a strong antibacterial effect on S. mutans. As expected, Li-MNPs significantly promoted dentin regeneration in situ and in vivo.Conclusion: Li-MNPs promoted dentin regeneration and inhibited S. mutans growth, implying a possible application as a pulp capping agent in vital pulp therapy.Graphical Abstract: Keywords: lithium, mesoporous nanoparticles, dental pulp stem cells, dentin regeneration, Wnt/β-catenin signaling pathway, antibacterial properties

Pengyi Hou,1,2 Yangyang Pi,1,2 Ziming Jiao,1 Xueyan Tian,1 Wenxuan Hu,1 Yuhong Zhang,1,2 Yi Zhao,1,2 Faxuan Wang1,2 1School of Public Health and Management, Ningxia Medical University, Yinchuan, People’s Republic of China; 2Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, People’s Republic of ChinaCorrespondence: Faxuan Wang, Email faxuan203@163.comBackground: In recent decades, obesity has become an epidemic worldwide and is a risk factor for many chronic diseases. Lung function is also a predictor of various chronic diseases. However, research results on the association between obesity and lung function are inconsistent and few studies have evaluated the association between central obesity indicators and lung function. Therefore, this study explored the correlation between central obesity and lung function.Methods: This study is a cross-sectional study. The basic participant characteristics were collected by questionnaire. A tape measure was used to measure waist circumference (WC) and hip circumference (HC). Body fat percentage was measured using an InBody370. Lung function parameters were measured using a digital spirometer connected to a computer (Chestgraph HI-101). R (R4.0.5) software was used for data analysis. A generalized linear model was used to analyze the association between obesity and lung function.Results: This study found that body mass index (BMI) adjusted for WC was negatively correlated with forced vital capacity (FVC) (β=− 0.05 [− 0.06, − 0.03] in men, β=− 0.05 [− 0.07, − 0.04] in women) and forced expiratory volume in 1 s (FEV1)(β=− 0.02 [− 0.03, − 0.00] in men, β=− 0.03 [− 0.04, − 0.02] in women). Body fat percentage was negatively correlated with FVC (β=− 0.01 [− 0.01, − 0.01] in men, β=− 0.01 [− 0.01, − 0.00] in women).Conclusion: Central obesity and combined central and general obesity were more strongly positively correlated with lung function. WC-adjusted BMI was negatively correlated with lung function. Body fat percentage was negatively correlated with lung function.Keywords: lung function, central obesity, body mass index, waist circumference

Yubo Pi, Jingshi Wang, Zhao Wang Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of ChinaCorrespondence: Zhao Wang, Department of Hematology, Beijing Friendship Hospital, Capital Medical University, YongAn Road 95th Xicheng District, Beijing, 100050, People’s Republic of China, Tel +86-10-63138303, Email wangzhao@ccmu.edu.cnBackground: Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is a rare and aggressive disease with high mortality and poor prognosis. To date, allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only way to cure EBV-HLH. However, relapse of EBV-HLH after allo-HSCT is common and remains a major challenge.Case Presentation: A 22-year-old woman with persistent fever for a month presented to our center with EBV-HLH. After induction of remission using two cycles of the L-DEP (PEG-aspargase, liposomal doxorubicin, etoposide, and high-dose methylprednisolone) regimen, the patient underwent an human leukocyte antigen (HLA)-identical sibling allo-HSCT. However, she experienced disease relapse soon after the procedure, and none of the possible treatment options achieved a sustained response. Finally, she received a sintilimab injection and achieved complete resolution of EBV-HLH.Conclusion: We summarize a case of relapsed EBV-HLH after allo-HSCT that was successfully treated with a programmed cell death protein-1 (PD-1) antibody. Further studies are needed to determine whether PD-1 blockade has therapeutic potential for relapsed EBV-HLH after allo-HSCT.Keywords: Epstein–Barr virus, allogeneic hematopoietic stem cell transplantation, PD-1 antibody, graft-versus-host disease

Hong-Su Zhou,1 Ting-Ting Li,2 Yu Pi,3 Song Wen,4 Ting-Hua Wang,1 Liu-Lin Xiong1 1Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 2Editorial Department of Ibrain Journal, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 3National Traditional Chinese Medicine Clinical Research Base and Western Medicine Translational Medicine Research Center, South West Medical University, Luzhou, 646000, People’s Republic of China; 4Pain Management, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of ChinaCorrespondence: Liu-Lin XiongDepartment of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 201. Da Lian Road, Hui Chuan District, Zunyi, Guizhou, 563000, People’s Republic of ChinaEmail 499465010@qq.comTing-Hua WangDepartment of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 201. Da Lian Road, Hui Chuan District, Zunyi, Guizhou, 563000, People’s Republic of ChinaEmail Wangth_email@163.comObjective: The current study aimed to further verify the feasibility of ultrasound-guided selective pulsed radiofrequency (PRF) therapy of greater auricular nerve (GAN) in the treatment of head and neck post-herpetic neuralgia (PHN) by observing the efficacy and safety.Methods: Under the guidance of high-frequency ultrasound (Frequency: 10 MHz), the GAN was identified by a radiofrequency electrode trocar with a transverse in-plane approach, which was inserted into the GAN, then the inner needle of the trocar was retracted. After adjusting the technical variables (electrode tip temperature: 42°C, output voltage: 60 V, pulse frequency: 2 Hz, pulse width: 22 ms, single duration: 240 s, two times), the radiofrequency electrode placed on the auricle and below the ear for sensory and motor tests began to work.Results: The pain in the left head and neck of the patient lasted for more than 1 month, we decided to try selective PRF of GAN guided by ultrasound for the first time. Immediately after the treatment, 11-point pain intensity numerical rating scale (PI-NRS) score ranged from 5 to 1. During his hospitalization, mecobalamine and gabapentin were taken instead of opioids. Seven days after the procedure, PI-NRS score was 2, the degree of numbness the patient he felt by himself in the original lesion area relieved from 100% to 40%, the depression module of the Patient Health Questionnaire-9 (PHQ-9) score was from 7 to 5, the Generalized Anxiety Disorder-7 (GAD-7) score from 8 to 4, the range of pain areas was reduced to external auditory tract, and there were no adverse events occurring.Conclusion: The ultrasound-guided selective PRF treatment of GAN was safe and effective in the improvement of PHN in the head and neck, which is worthy of clinical promotion.Keywords: post-herpetic neuralgia, great auricular nerve, pulsed radiofrequency

Dongxing Zhao1,2 ,* Asghar Abbasi2 ,* Harry B Rossiter,2,3 Xiaofen Su,1 Heng Liu,1 Yuhong Pi,1 Li Sang,1 Weiyong Zhong,1 Qifeng Yang,1 Xiongtian Guo,1 Yanyan Zhou,1 Tianyang Li,1 Richard Casaburi,2 Nuofu Zhang1 1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, People’s Republic of China; 2Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA; 3Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK*These authors contributed equally to this workCorrespondence: Nuofu ZhangState Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, People’s Republic of ChinaEmail nfzhanggird@163.comBackground: We sought to determine whether circulating inflammatory biomarkers were associated with the frequent exacerbator phenotype in stable COPD patients ie, those with two or more exacerbations in the previous year.Methods: Eighty-eight stable, severe, COPD patients (4 females) were assessed for exacerbation frequency, pulmonary function, fraction of expired nitric oxide (FENO); inflammatory variables were measured in venous blood. Logistic regression assessed associations between the frequent exacerbator phenotype and systemic inflammation.Results: Compared with infrequent exacerbators, frequent exacerbators (n=10; 11.4%) had greater serum concentration (median (25th-75th quartile)) of serum amyloid A (SAA; 134 (84– 178) vs 71 (38– 116) ng/mL; P=0.024), surfactant protein D (SP-D; 15.6 (9.0– 19.3) vs 8.5 (3.6– 14.9) ng/mL; P=0.049) and interleukin-4 (IL-4; 0.12 (0.08– 1.44) vs 0.03 (0.01– 0.10) pg/mL; P=0.001). SAA, SP-D and IL-4 were not significantly correlated with FEV1%predicted or FVC %predicted. After adjusting for sex, age, BMI, FEV1/FVC and smoking pack-years, only SAA remained independently associated with the frequent exacerbator phenotype (OR 1.49[1.09– 2.04]; P=0.012). The odds of being a frequent exacerbator was 18-times greater in the highest SAA quartile (≥ 124.1 ng/mL) than the lowest SAA quartile (≤ 44.1 ng/mL) (OR 18.34[1.30– 258.81]; P=0.031), and there was a significant positive trend of increasing OR with increasing SAA quartile (P=0.008). For SAA, the area under the receiver operating characteristic curve was 0.721 for identification of frequent exacerbators; an SAA cut-off of 87.0 ng/mL yielded an 80% sensitivity and 61.5% specificity.Conclusion: In stable COPD patients, SAA was independently associated with the frequent exacerbator phenotype, suggesting that SAA may be a useful serum biomarker to inform progression or management in COPD.Keywords: inflammation, surfactant protein D, interleukin-4

This paper is concerned with the in-plane elastic stability of arches with a symmetric cross section and subjected to a central concentrated load. The classical methods of predicting elastic buckling loads consider bifurcation from a prebuckling equilibrium path to an orthogonal buckling path. The prebuckling equilibrium path of an arch involves both axial and transverse deformations and so the arch is subjected to both axial compression and bending in the prebuckling stage. In addition, the prebuckling behavior of an arch may become nonlinear. The bending and nonlinearity are not considered in prebuckling analysis of classical methods. A virtual work formulation is used to establish both the nonlinear equilibrium conditions and the buckling equilibrium equations for shallow arches. Analytical solutions for antisymmetric bifurcation buckling and symmetric snap-through buckling loads of shallow arches subjected to this loading regime are obtained. Approximations for the symmetric buckling load of shallow arches and nonshallow fixed arches and for the antisymmetric buckling load of nonshallow pin-ended arches, and criteria that delineate shallow and nonshallow arches are proposed. Comparisons with finite element results demonstrate that the solutions and approximations are accurate. It is found that the existence of antisymmetric bifurcation buckling loads is not a sufficient condition for antisymmetric bifurcation buckling to take place. DOI: 10.1061/(ASCE)0733-9399(2002)128:7(710) CE Database keywords: Bifurcation; Buckling; Concentrated loads; Arches.