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Rare cases of arsenical keratosis are attributed to the ingestion of arsenic-containing traditional Chinese medicines for conditions such as psoriasis. Arsenic is a potent carcinogen, and squamous cell carcinoma is known to develop in arsenical keratosis. A 51-year-old male patient with a 30-year history of psoriasis and a history of arsenic poisoning presented with suppuration, ulceration, and pain one and a half years after trauma to the right thumb. These symptoms had recurred after wound debridement, lesion resection, and pedicle flap transplantation. Histopathological examination of the skin lesions had suggested squamous cell carcinoma, and subsequent PET-CT examination had shown proliferation and enlargement of lymph nodes. Following right forearm amputation and radiofrequency ablation, additional lumps had been observed, but the patient had declined further surgery. Physical examination showed palpable enlarged axillary lymph nodes, which was confirmed by ultrasound. After three cycles of first-line immunotherapy with toripalimab combined with albumin paclitaxel and cisplatin chemotherapy, masses in the right upper arm were reduced. This case highlights the risks of arsenic-containing medicines used for treating psoriasis. Attention should be paid to the use of standardized treatments in psoriasis, as well as the probability of malignant transformation in arsenical keratosis.

Summary: Background: Pulmonary embolism causes a substantial burden of morbidity and mortality. Although there are several well-established risk factors for pulmonary embolism, a substantial proportion of cases cannot be attributed to provoked or known risk factors. Accumulating evidence has suggested an association of clonal hematopoiesis of indeterminate potential (CHIP) with the risk of arterial thromboembolism. However, the association between CHIP and the risk of pulmonary embolism remains unknown. Methods: We performed a community-based cohort study (between 2006 and 2022) including 464,417 individuals with available whole exome sequencing (WES) data in the UK biobank (UKB) to examine the association between CHIP and pulmonary embolism. CHIP was ascertained by analyzing WES data. We used Cox regression models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) to assess the association between CHIP and pulmonary embolism. In addition, we performed analyses for several types of CHIP mutations, including DNMT3A, TET2, ASXL1, PPM1D, SRSF2, and JAK2. Findings: The study included 14,418 individuals with CHIP and 449,999 individuals without CHIP. The median age at cohort entry was 58 and 63 years among individuals without and with CHIP, respectively. We observed an increased risk of pulmonary embolism (HR 1.17, 95% CI, 1.05–1.31) among individuals with CHIP. The increased risk was mainly noted for CHIP with TET2 (HR 1.42, 95% CI 1.16–1.74) or JAK2 (HR 4.17, 95% CI 2.09–8.35) mutation, but not for DNMT3A mutation (HR 1.01, 95% CI 0.86–1.19), ASXL1 mutation (HR 1.15, 95% CI 0.83–1.60), PPM1D mutation (HR 1.22, 95% CI 0.66–2.27), or SRSF2 mutation (HR 0.62, 95% CI 0.20–1.93). Interpretation: Our results highlight the association of pulmonary embolism in individuals with CHIP, especially the TET2-mutant or JAK2-mutant CHIP. If further studies will identify a causal relationship between clonal hematopoiesis and pulmonary embolism, prioritizing early screening for pulmonary embolism in individuals with CHIP could be significantly beneficial. Funding: Initial Founding for High Level Talented Scholars in Nanfang Hospital, Southern Medical University (No. 2023G001) and the Outstanding Youths Development Scheme of Nanfang Hospital, Southern Medical University (Grant No. 2023J009).

Multiplatform fusion point clouds can effectively compensate for the disadvantages of individual platform point clouds in forest parameter extraction, maximizing the potential of LiDAR technology. However, existing registration algorithms often suffer from insufficient feature extraction and limited registration accuracy. To address these issues, we propose a ULS (Unmanned Aerial Vehicle Laser Scanning)-TLS (Terrestrial Laser Scanning) point cloud data registration method based on Similar Distance Search (SDS). This method enhances coarse registration by accurately retrieving points with similar features, leading to high overlap in the rough registration stage and further improving fine registration precision. (1) The proposed method was tested on four natural forest plots, including Pinus densata Mast., Pinus yunnanensis Franch., Pices asperata Mast., Abies fabri (Mast.) Craib, and demonstrated high registration accuracy. Both coarse and fine registration achieved superior results, significantly outperforming existing algorithms, with notable improvements over the TR algorithm. (2) In addition, the study evaluated the accuracy of individual tree parameter extraction from fusion point clouds versus single-platform point clouds. While ULS point clouds performed slightly better in some metrics, the fused point clouds offered more consistent and reliable results across varying conditions. Overall, the proposed SDS method and the resulting fusion point clouds provide strong technical support for efficient and accurate forest resource management, with significant scientific implications.

Molecularly imprinted polymers (MIPs) are synthetic polymers that mimic the functions of antibodies. Though MIPs are promising tools in various areas, achieving high selectivity in MIPs can be difficult. To improve selectivity, various approaches have been implemented; however, the role of polymerization methods or synthetic techniques in enhancing the selectivity of MIPs has not been studied and remains a crucial area for further research. MIPs are typically prepared from free radical reactions. Recently, we found that Dielectric Barrier Discharge (DBD) plasma can be used to initiate the polymerization of vinyl monomers. The DBD plasma method allows the monomers to associate with the template molecules and initiate polymerization with minimal disruption to the positioning of the monomers. We hypothesize that this could be a preferred method to prepare MIPs over the traditional radical reaction that may cause a disturbance of the pre-associated monomers on the templates for the polymerization. Chicken egg white serum albumin (CESA) was used as the template protein for the MIPs. Our results show that in all test conditions, approximately twofold improvement in selectivity was achieved, which is the primary performance metric for MIPs. This enhancement was evident across all categories, including MIPs prepared from various monomer combinations.

The scientific determination of crucial regions for ecological land restoration and reasonable early warnings for ecologically weak areas are vital for implementing land ecological restoration. Five major plateau lake basins in central Yunnan (China) are selected as the study area in this research. An ecological security pattern (ESP) is constructed using the source-resistance surface-corridor-pinch point framework to effectively identify crucial areas for ecological restoration. Finally, the land use/cover change (LUCC) in the study region in 2030 is simulated in terms of the natural development prospect (NDP), with priority given to urban development (PUD) and priority given to ecological protection (PEP) scenarios, and identify areas where future urban expansion poses a threat to current ecological source areas and corridors as early warning regions. The results indicate the following: (1) There are 15 ecological source regions in the Five Lakes Basin, mainly forestland and waters, with a total area of 787.54 km2. The ecological corridor spans 245.72 km, with a total area of 439.90 km2. (2) The key ecological restoration areas include 72.87 km2 of ecological pinch points, 70.46 km2 of barrier points of ecological, and 71 breakpoints. (3) The ecological land under the NDP scenario and the PUD scenario were damaged to varying degrees. The ecological land dominated by forestland and water area under the PEP scenario is effectively protected. (4) The seven ecological protection space early warning points are mainly distributed in the eastern part of Dianchi Lake and the northern part of Fuxian Lake, which have good economic development and better habitat quality. The comprehensive analysis identified key ecological restoration areas and identified future ecological stresses due to land use change in the Five-Lakes Basin. Restoration strategies are proposed based on current land use and future scenarios to enhance the ESP in central Yunnan's Five Lakes Basin.

BackgroundThe psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer.Methods and findingsWe performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child's cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings.ConclusionsIn this study, we observed an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child's cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.

ObjectiveArtificial intelligence (AI), with its potential to diagnose skin cancer, has the potential to revolutionize future medical and dermatological practices. However, the current knowledge regarding the utilization of AI in skin cancer diagnosis remains somewhat limited, necessitating further research. This study employs visual bibliometric analysis to consolidate and present insights into the evolution and deployment of AI in the context of skin cancer. Through this analysis, we aim to shed light on the research developments, focal areas of interest, and emerging trends within AI and its application to skin cancer diagnosis.MethodsOn July 14, 2023, articles and reviews about the application of AI in skin cancer, spanning the years from 1900 to 2023, were selected from the Web of Science Core Collection. Co-authorship, co-citation, and co-occurrence analyses of countries, institutions, authors, references, and keywords within this field were conducted using a combination of tools, including CiteSpace V (version 6.2. R3), VOSviewer (version 1.6.18), SCImago, Microsoft Excel 2019, and R 4.2.3.ResultsA total of 512 papers matching the search terms and inclusion/exclusion criteria were published between 1991 and 2023. The United States leads in publications with 149, followed by India with 61. Germany holds eight positions among the top 10 institutions, while the United States has two. The most prevalent journals cited were Cancer, the European Journal of Cancer, and Sensors. The most frequently cited keywords include “skin cancer”, “classification”, “artificial intelligence”, and “deep learning”.ConclusionsResearch into the application of AI in skin cancer is rapidly expanding, and an increasing number of scholars are dedicating their efforts to this field. With the advancement of AI technology, new opportunities have arisen to enhance the accuracy of skin imaging diagnosis, treatment based on big data, and prognosis prediction. However, at present, the majority of AI research in the field of skin cancer diagnosis is still in the feasibility study stage. It has not yet made significant progress toward practical implementation in clinical settings. To make substantial strides in this field, there is a need to enhance collaboration between countries and institutions. Despite the potential benefits of AI in skin cancer research, numerous challenges remain to be addressed, including developing robust algorithms, resolving data quality issues, and enhancing results interpretability. Consequently, sustained efforts are essential to surmount these obstacles and facilitate the practical application of AI in skin cancer research.

BackgroundInflammation is critically involved in the development of human cancer, and blood inflammatory biomarkers have been proposed to indicate the risk of different cancer types.MethodsUsing the Swedish Apolipoprotein-Related Mortality Risk (AMORIS) Cohort (N=812,073), we first performed a time-to-event analysis to evaluate the association of the baseline level of 12 blood inflammatory biomarkers measured during 1985-1996 with the subsequent risk of head and neck cancer (HNC) identified through the nationwide Swedish Cancer Register until end of 2020. A nested case-control study was further conducted to demonstrate the longitudinal trends of the studied biomarkers during the 30-year period prior to diagnosis of HNC.ResultsIn the time-to-event analysis, we identified a total of 2,510 newly diagnosed HNC cases. There was an increased risk of HNC per standard deviation (SD) increase of haptoglobin (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.21-1.30), leukocytes (HR: 1.22; 95%CI: 1.17-1.28), sedimentation rate (HR: 1.17; 95%CI: 1.07-1.29), and monocytes (HR: 1.34; 95%CI: 1.07-1.68) at baseline, after adjustment for age, sex, fasting status, occupational status, and country of birth. In contrast, there was a decreased risk of HNC per SD increase of lymphocytes in % (HR: 0.85; 95%CI: 0.73-0.99) and lymphocyte-to-monocyte ratio (LMR) (HR: 0.81; 95%CI: 0.69-0.95) at baseline. In the nested case-control study using repeatedly measured biomarker levels, we found that individuals with HNC had consistently higher levels of haptoglobin, leukocytes, sedimentation rate, and monocytes, as well as consistently lower levels of lymphocytes in % and LMR, during the 30-year period prior to diagnosis, compared to controls.ConclusionBased on a cohort of more than half a million participants with up to 35 years of follow-up, our findings provide solid evidence supporting the presence of alterations in blood inflammatory biomarkers during the decades before diagnosis of HNC.

Abstract Following the COVID-19 outbreak, psychological stress was particularly pronounced in the student population due to prolonged home isolation, online study, closed management, graduation, and employment pressures. The objective of this study is to identify the incidence of psychological stress reactions in student populations following a global outbreak and the associated influencing factors. Four English databases (Pubmed, Embase, Cochrane Library, Web of Science) and four Chinese biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, Wanfang) were searched in this study. We also retrieved other search engines manually. The search period was from the time of database creation to 10 March 2022. This study included cross-sectional studies related to psychological stress reactions in student populations during the COVID-19 epidemic. Three groups of researchers screened the retrieved studies and assessed the quality of the included studies using the Agency for Healthcare Research and Quality Cross-Sectional Study Quality Assessment Checklist. A random-effects model was used to analyze the prevalence of depression, anxiety, stress, and fear symptoms in the student population during the COVID-19 epidemic. Of the 146,330 records retrieved, we included 104 studies (n = 2,088,032). The quality of included studies was moderate. The prevalence of depressive symptoms in the student population during the epidemic was 32.0% (95% CI [28.0–37.0%]); anxiety symptoms was 28.0% (95% CI [24.0–32.0%]); stress symptoms was 31.0% (95% CI [23.0–39.0%]); and fear symptoms was 33.0% (95% CI [20.0–49.0%]). The prevalence differed by gender, epidemic stage, region, education stage, student major and assessment tool. The prevalence of psychological stress in the student population during the COVID-19 epidemic may be higher compared to the global prevalence of psychological stress. We need to alleviate psychological stress in the student population in a targeted manner to provide mental health services to safeguard the student population.

Forest ecosystems can be regarded as huge carbon sinks. In order to effectively assess carbon balance in such ecosystems, rapid and accurate estimation of the aboveground biomass of a forest is critically needed. However, the current methods for biomass estimation and mapping are of limited spatial resolution and mostly depend on large numbers of measurements. In order to obtain better biomass estimation outcomes with higher spatial resolution, a rapid method is introduced for region-scale biomass estimation in alpine and canyon areas using space-borne light detection and ranging (LiDAR) data and optical remote-sensing images. Specifically, we explored alpine and canyon areas in Shangri-La City in China using space-borne LiDAR data from ICESAT-2 and optical remote-sensing images from Landsat8 OLI, Sentinel-2, and Microwave remote sensing Sentinel-1. An extrapolation model of the forest canopy heights in these areas was constructed with a 30-m resolution of continuous canopy height outputs. For continuously estimating the diameter at breast height (DBH) in Shangri-La City, a tree height-DBH growth model was constructed based on the LiDAR and remote-sensing measurements. Finally, based on the average DBH of the explored forests, a model was constructed for estimating and mapping the aboveground biomass and carbon storage in Shangri-La with a spatial resolution of 30 m. The results show that the forest canopy height in Shangri-La City is mainly in the range of 2.82–30.96 m, and that the estimation accuracy is verified by the LiDAR-based canopy height model (CHM) with a coefficient of determination of R2 = 0.7143. The inversion results were still largely affected by geospatial location factors (longitude, latitude), terrain factors (slope, elevation), and vegetation indices (NBR, NDGI, NDVI). Based on the relationship between the tree height and the DBH, the DBH of trees in Shangri-La City was estimated to be mainly in the range of 20 cm to 30 cm, and this estimate was verified by actual measurements with R2 greater than 0.7 all. Finally, the established model estimated the aboveground forest biomass and carbon storage of the study area of Shangri-La City in 2020 to be 1.28 × 108 t and 6.41 × 107 t, respectively. These estimates correspond to total accuracies of 92.28%, respectively.

BackgroundA knowledge gap exists about the risk of cancer in individuals with intellectual disability (ID). The primary aim of this study was to estimate the cancer risk among individuals with ID compared to individuals without ID.Methods and findingsWe conducted a population-based cohort study of all children live-born in Sweden between 1974 and 2013 and whose mothers were born in a Nordic country. All individuals were followed from birth until cancer diagnosis, emigration, death, or 31 December 2016 (up to age 43 years), whichever came first. Incident cancers were identified from the Swedish Cancer Register. We fitted Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) as measures of cancer risk in relation to ID after adjusting for several potential confounders. We analyzed ID by severity, as well as idiopathic ID and syndromic ID separately. We performed a sibling comparison to investigate familial confounding. The study cohort included a total of 3,531,305 individuals, including 27,956 (0.8%) individuals diagnosed with ID. Compared with the reference group (individuals without ID and without a full sibling with ID), individuals with ID were in general more likely to be male. The median follow-up time was 8.9 and 23.0 years for individuals with ID and individuals without ID, respectively. A total of 188 cancer cases were identified among individuals with ID (incidence rate [IR], 62 per 1,000 person-years), and 24,960 among individuals in the reference group (IR, 31 per 1,000 person-years). A statistically significantly increased risk was observed for any cancer (HR 1.57, 95% CI 1.35-1.82; P < 0.001), as well as for several cancer types, including cancers of the esophagus (HR 28.4, 95% CI 6.2-130.6; P < 0.001), stomach (HR 6.1, 95% CI 1.5-24.9; P = 0.013), small intestine (HR 12.0, 95% CI 2.9-50.1; P < 0.001), colon (HR 2.0, 95% CI 1.0-4.1; P = 0.045), pancreas (HR 6.0, 95% CI 1.5-24.8; P = 0.013), uterus (HR 11.7, 95% CI 1.5-90.7; P = 0.019), kidney (HR 4.4, 95% CI 2.0-9.8; P < 0.001), central nervous system (HR 2.7, 95% CI 2.0-3.7; P < 0.001), and other or unspecified sites (HR 4.8, 95% CI 1.8-12.9; P = 0.002), as well as acute lymphoid leukemia (HR 2.4, 95% CI 1.3-4.4; P = 0.003) and acute myeloid leukemia (HR 3.0, 95% CI 1.4-6.4; P = 0.004). Cancer risk was not modified by ID severity or sex but was higher for syndromic ID. The sibling comparison showed little support for familial confounding. The main study limitations were the limited statistical power for the analyses of specific cancer types, and the potential for underestimation of the studied associations (e.g., due to potential underdetection or delayed diagnosis of cancer among individuals with ID).ConclusionsIn this study, we found that individuals with ID showed an increased risk of any cancer, as well as of several specific cancer types. These findings suggest that extended surveillance and early intervention for cancer among individuals with ID are warranted.

Carbon source precursors for high-grade, clean, and low-carbon refractories were obtained by in situ exfoliation of flake graphite (FG) and phenol−formaldehyde resin (PF) composites with three-roll milling (TRM) for the fabrication of graphite nanoplatelets. In addition, by using Ni(NO3)2·6H2O as a catalyst in the pyrolysis process, multidimensional carbon nanostructures were obtained with coexisting graphite nanoplatelets (GNPs), glassy carbon (GC), and carbon nanotubes (CNTs). The resulting GNPs (exfoliated 16 times) had sizes of 10−30 μm, thicknesses of 30−50 nm, and could be uniformly dispersed in GC from the PF pyrolysis. Moreover, Ni(NO3)2·6H2O played a key role in the formation and growth of CNTs from a catalytic pyrolysis of partial PF with the V−S/tip growth mechanisms. The resulting multidimensional carbon nanostructures with GNPs/GC/CNTs are attributed to the shear force of the TRM process, pyrolysis, and catalytic action of nitrates. This method reduced the production costs of carbon source precursors for low-carbon refractories, and the precursors exhibited excellent performances when fabricated on large scales.