Search

Jordan Gipe, Alexandra Z Agathis, SQ Nguyen Department of Surgery, Mount Sinai Hospital, New York, NY, USACorrespondence: Jordan Gipe, Department of Surgery Box 1259 The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY, 10029, Tel +1818-935-3352, Email Jordan.Gipe@mountsinai.orgAbstract: Postoperative leaks after sleeve gastrectomy are a troublesome complication that occur in 0.7– 5.3% of cases depending on the referenced source. These complications cause significant morbidity for patients requiring prolonged hospitalizations, nutritional support, intravenous antibiotics, and at times additional operations and procedures that risk further downstream complications. The patient presentation varies from relatively benign with minimal or no symptomatology, to the acutely ill with life-threatening sepsis. The management of gastric leak is dependent on a multitude of factors, including the initial presentation as well the surgeon’s experience and preference. Here, we will summarize the current literature and discuss the different options that exist for the management of gastric leaks after sleeve gastrectomy including laparoscopic lavage, endoscopic stenting, endoscopic pigtail catheters, endoscopic vacuum therapy, and salvage surgical operations such as fistula jejunostomy and total gastrectomy. The aim is to provide a source for surgeons to reference when they encounter this disease pathology and to shed light on a daunting challenge for the modern bariatric surgeon.Keywords: sleeve gastrectomy, leak, fistula, management

Fu-zhen Wang,1,&ast; Shi-hong Xiang,1,2,&ast; Sen-qing Lin,1 Feng-qi Qian,1 Qiu-xia Zhang,1 Ming-hui Geng,1 Jin-xiu Deng,1 Sen-chao Wu1 1Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian 364000, People’s Republic of China; 2Department of Nephrology, Xuanhan County People’s Hospital, Dazhou, Sichuan, 636150, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Sen-chao Wu; Jin-xiu Deng, Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, Fujian, 364000, People’s Republic of China, Tel +86 13860217030 ; Tel +86 18159828598, Email wusenchaowsc@126.com; dengjinxiudjx@126.comObjective: To enhance the understanding of rhabdomyolysis (RM) caused by snakebites and to promptly identify and intervene in the risk factors associated with RM.Methods: A retrospective analysis involving 209 snakebite victims who visited our hospital for snakebite cases was conducted. Among these, 43 were related to RM, while 166 did not exhibit RM (NRM). The clinical characteristics, treatment, and prognostic outcomes of both groups were statistically analyzed, with the aim of interpreting the risk factors associated with snakebites concurrent with RM through logistic regression analysis.Results: Snakebite incidents commonly manifest during the summer and autumn seasons, predominantly affecting middle-aged and elderly populations, with injuries mostly occurring in the limbs. Creatine kinase (CK), CK isoenzyme MB, and lactate dehydrogenase indicators exhibited significantly elevated levels in the RM group compared to the NRM group (P < 0.05). Moreover, the RM Group displayed heightened susceptibility to complications such as osteofascial compartment syndrome, multiple organ dysfunction (MODS), acute kidney injury, etc. (P < 0.05). Debridement and blood purification procedures were more frequently administered to the RM group in comparison to the NRM group (P < 0.05). Notably, visitation beyond 6 hours post-bite and hemoglobin levels below 90 mg/dl emerged as independent risk factors for those with RM following snakebites, while female gender and albumin levels > 40 g/L were identified as protective factors against such occurrences.Conclusion: Snakebite victims with RM have more severe clinical conditions, necessitating prolonged treatment duration, and exhibit heightened mortality rates in comparison to those without RM.Keywords: acute kidney injury, clinical features, rhabdomyolysis, risk factors, snakebite

Ming Jin,1,&ast; Zhi-qing Jiang,2,&ast; Jia-hui Qin,3,&ast; Hui-xia Qin,4,&ast; Kai-wen Jiang,3,&ast; Hou-xiang Ya,3 Jing Gu,3 Mo-rui Gui,5 Yao-hua Li,3 Long-kuan Xu,6 Hai-xiao Fu,6 Xu-hua Xiao,7 Shu-qun Li3 1Department of Vascular Intervention, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 2Department of Gastrointestinal Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 3Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 4Interventional Center, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 5Department of Burn Wound Repair and Plastic Surgery, Medical Aesthetic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 6Department of Pathology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China; 7Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shu-qun Li, Email lishuqun2008@126.comPurpose: Transarterial chemoembolization (TACE) is recommended as a standard therapy for intermediate-stage hepatocellular carcinoma (HCC) and is the most widely used first-line treatment for advanced HCC. This study aimed to evaluate the clinical benefits and tolerability of TACE added to a combination of lenvatinib and programmed death-1 (PD-1) inhibitor in patients with unresectable HCC (uHCC).Patients and Methods: We conducted a retrospective cohort study involving 144 patients with uHCC treated between August 2020 and August 2023. Patients received a combination of lenvatinib and a PD-1 inhibitor with or without TACE (T+L+P, n=81 or L+P, n=63, respectively). The baseline characteristics of the two groups were compared, and propensity score matching (PSM) was used to minimize bias. The study endpoints included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Factors influencing survival rates were analyzed using Cox regression, and adverse events (AEs) were documented and assessed.Results: Before PSM, the T+L+P group showed significantly higher ORR (64.1% vs 44.4%, p < 0.05), longer median PFS (14.3 vs 9.6 months, p < 0.05), and longer median OS (24.6 vs 19.5 months, p < 0.05) compared to the L+P group. Even post-PSM, the T+L+P group showed significantly better OS and PFS compared to the L+P group (mOS: 28.0 vs 17.6 months p=0.0011, mPFS: 15.8 vs 9.3 months, p < 0.05). Univariate and multivariate analyses identified treatment options as independent factors for PFS and OS. The safety profile of the T+L+P regimen was acceptableThe incidence and severity of adverse reactions in the T+L+P group were not significantly different compared to the L+P group (any grade, 90.1 vs 93.6%, p=0.551; grade≥ 3, 25.9 vs 23.8%, p=0.843).Keywords: unresectable hepatocellular carcinoma, lenvatinib, transarterial chemoembolization, PD-1 inhibitor, combination therapy, propensity score matching

Sen-Qing Lin,&ast; Jin-Xiu Deng,&ast; Hui Jiang, Shi-Hong Xiang, Wen-Jing Lin, Feng-Qi Qian, Sen-Chao Wu, Fu-Zhen Wang Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fu-Zhen Wang; Sen-Chao Wu, Department of Nephrology, Longyan First Affiliated Hospital of Fujian Medical University, No. 105 Jiuyi North Road, Longyan, Fujian, People’s Republic of China, Tel +86 13599330411 ; +86 13860217030, Email wangfuzhenwfz@126.com; wusenchaowsc@126.comObjective: IgA nephropathy (IgAN) is the prevailing primary glomerulonephritis globally and is the key factor contributing to the onset of chronic kidney disease and eventual progression to end-stage renal disease. This study aims to explore the mutated gene in a familial case of IgAN, especially COL4A3.Methods: Family lineages diagnosed with familial IgAN at the Longyan First Hospital of Fujian Medical University were selected for this study, followed by comprehensive whole exome sequencing. After obtaining the sequencing data, bioinformatics analyses were conducted to discern potential mutated genes. These findings within the familial lineages were validated using Sanger sequencing to identify IgAN-associated mutated genes, based on literature references and in accordance with the genetic variation classification criteria determined by the American College of Medical Genetics and Genomics.Results: Whole exome sequencing analysis of familial IgAN family lineages led to the identification of a total of 212,187 single nucleotide variant/insertion-deletion mutation sites, annotated using ANNOVAR. These sites were screened targeting four mutated genes, revealing three mutations of undetermined significance along with a single disease-causing mutation: a heterozygous disease-causing mutation within COL4A3 (p.G1167R). This mutation manifested across seven family members within the group, encompassing both family members diagnosed with kidney disease and those serving as normal carriers. Notably, one additional family member with IgAN within the familial lineage exhibited an absence of the pathogenic mutation.Conclusion: This study identified four mutated genes that may be involved in the onset and progression of IgAN, further revealing the complex multigenic inheritance characteristics of IgAN. The underlying mechanisms of the disease require further investigation. Additionally, we discovered potential mutations associated with known genetic kidney diseases, such as COL4A3 mutations. Therefore, we recommend comprehensive genetic screening in familial cases of IgAN to improve disease diagnosis and facilitate genetic counseling.Keywords: IgA nephropathy, COL4A3, bioinformatics analysis, familial, whole exome sequencing

Anwar E Ahmed,1 Callista B Martin,2 Bassam Dahman,3 Gregory T Chesnut,4,5 Sean Q Kern4,5 1Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 2School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 3Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA; 4Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 5Center for Prostate Disease Research, Murtha Cancer Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USACorrespondence: Anwar E Ahmed, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road A-1039D, Bethesda, MD, 20814, USA, Tel +1 301-295-9756, Email anwar.ahmed@usuhs.eduBackground: Research suggests inconsistent evidence regarding the association between general obesity and prostate cancer among men in the United States. This study aimed to examine whether the association between general obesity and prostate cancer is influenced by abdominal obesity and ethnic groups.Methods: The study utilized data from the National Health and Nutrition Examination Survey (NHANES). The analysis was restricted to non-Hispanic men (10,683 White and 6,020 Black). Obesity was defined as body mass index (BMI) ≥ 30 and abdominal obesity as waist circumference (WC) ≥ 102 cm.Results: No significant difference was identified in the overall prevalence of prostate cancer between obese and non-obese (2.14% vs 2.25%, P = 0.678). When both obesity measures were combined, the general and abdominal obesity category was associated with a significant increase in the odds of prostate cancer in Black men [odds ratio (OR) = 1.49, 95% confidence interval (CI) (1.09, 2.04)], but not in White men [OR = 1.29, 95% CI (0.91, 1.82)]. In both Black [OR = 2.46, 95% CI (1.48, 4.06)] and White men [OR = 1.60, 95% CI (1.16, 2.21)], abdominal obesity was associated with significant increase in the odds of prostate cancer.Conclusion: The association between general obesity and prevalence of prostate cancer depends on abdominal obesity and ethnic groups. Our study utilized a nationally representative survey and emphasized the potential of combined effect of general and abdominal obesity as a modifiable factor to decrease racial disparity in prostate cancer screening and poor outcomes.Keywords: prostate cancer, waist circumference, obesity, Black men, racial disparity

Zi-jun He,1,2,&ast; Jin-tao Wei,1,&ast; Hai-mei Jiang,1 Jin-yong Wang,1 Jiong-yao Lai,1 Shu-qing Li,1 Zhi Chen,1 Qing-lu Luo1– 3 1Department of Rehabilitation Medicine, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, People’s Republic of China; 2Dongguan Experimental Centre for Sports Rehabilitation Research, Dongguan, People’s Republic of China; 3Dongguan Key Specialty of Traditional Chinese Medicine (Rehabilitation Department), Dongguan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qing-lu Luo; Zhi Chen, Department of Rehabilitation Medicine, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s hospital), Wanjiang District, Dongguan, Guangdong, 510280, People’s Republic of China, Email luo_qinglu@126.com; 13686616688@139.comObjective: To identify distinct developmental trajectories of weight-bearing pain (WBP) and non-weight-bearing pain (NWBP) and examine the trajectory predictors in individuals with or at risk of knee osteoarthritis.Methods: We included 971 participants from the Osteoarthritis Initiative whose baseline magnetic resonance imaging data and 9-year follow-up data on pain were available. We applied group-based trajectory modeling to identify WBP and NWBP trajectories over 9 years. Univariate and multivariate multinomial logistic regression analyses were performed to examine the predictors of identified trajectories.Results: Three distinct WBP trajectories were identified: “no pain” (32.4%), “mild pain” (44.6%), and “moderate pain” (23%). Three distinct NWBP trajectories were identified: “no pain” (50.9%), “mild pain” (33.4%), and “moderate pain” (15.7%). In multivariate analyses, high body mass index, depression, multisite pain, radiographic knee OA, and comorbidities were associated with worse development trajectories for WBP and NWBP. Weak quadriceps strength and bone marrow lesion were only associated with worse WBP trajectories, whereas low education level was only associated with worse NWBP trajectories.Conclusion: The developmental course of pain is heterogeneous in WBP or NWBP. Quadriceps strength and bone marrow leisure may be WBP-specific predictors, whereas education level may be a NWBP-specific predictor. The assessment of knee pain should be more accurate, which may help select appropriate therapeutic targets.Keywords: knee osteoarthritis, pain, weight-bearing, trajectories, predictors

Min-Dong Du,1,2,&ast; Kai-Yi He,3,&ast; Si-Qi Fan,3 Jin-Yi Li,3 Jin-Fu Liu,3 Zi-Qiang Lei,3 Gang Qin3 1Department of Osteoarthrosis, Xing-An Jieshou Orthopedics Hospital, Guilin, People’s Republic of China; 2Department of Orthopaedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 3Department of Osteoarthrosis, The First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Gang Qin, Department of Osteoarthrosis, The First Affiliated Hospital of Guangxi Traditional Chinese Medical University, 89-9 Dongge Road, Nanning, Guangxi, 530023, People’s Republic of China, Tel +86-771-5361264, Email qqvvcbgq6016@163.comBackground: Cyperus rotundus (CR) is widely used in traditional Chinese medicine to prevent and treat a variety of diseases. However, its functions and mechanism of action in osteoarthritis (OA) has not been elucidated. Here, a comprehensive strategy combining network pharmacology, molecular docking, molecular dynamics simulation and in vitro experiments was used to address this issue.Methods: The bioactive ingredients of CR were screened in TCMSP database, and the potential targets of these ingredients were obtained through Swiss Target Prediction database. Genes in OA pathogenesis were collected through GeneCards, OMIM and DisGeNET databases. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed using DAVID database. STRING database and Cytoscape 3.10 software were used to construct “component-target-pathway” network, and predict the core targets affected by CR. The binding affinity between bioactive components and the core targets was evaluated by molecular docking and molecular dynamics simulation. The therapeutic activity of kaempferol on chondrocytes in inflammatory conditions was verified by in vitro experiments.Results: Fifteen CR bioactive ingredients were obtained, targeting 192 OA-related genes. A series of biological processes, cell components, molecular functions and pathways were predicted to be modulated by CR components. The core targets of CR in OA treatment were AKT serine/threonine kinase 1 (AKT1), interleukin 1 beta (IL1B), SRC proto-oncogene, non-receptor tyrosine kinase (SRC), BCL2 apoptosis regulator (BCL2), signal transducer and activator of transcription 3 (STAT3), epidermal growth factor receptor (EGFR), hypoxia-inducible factor 1 subunit alpha (HIF1A), matrix metallopeptidase 9 (MMP9), estrogen receptor 1 (ESR1) and PPARG orthologs from vertebrates (PPARG), and the main bioactive ingredients of CR showed good binding affinity with these targets. In addition, kaempferol, one of the CR bioactive components, weakens the effects of IL-1β on the viability, apoptosis and inflammation of chondrocytes.Conclusion: Theoretically, CR has great potential to ameliorate the symptoms and progression of OA, via multiple components, multiple targets, and multiple downstream pathways. Keywords: osteoarthritis, Cyperus rotundus, network pharmacology, molecular docking

Yan-fei Lu,1,&ast; Ji-min Wu,2,&ast; Hai-yan Lan,2 Qiao-min Xu,2 Shu-qi Shi,2 Gong-chen Duan2 1Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, People’s Republic of China; 2Department of Anesthesiology, Lishui People’s Hospital, Wenzhou Medical University Lishui Hospital, Lishui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Gong-chen Duan, Department of Anesthesiology, Lishui People’s Hospital, Wenzhou Medical University Lishui Hospital, No. 1188, Liyang Street, Lishui, Zhejiang, 323000, People’s Republic of China, Tel/Fax +8618957093030, Email 981225178@qq.comBackground: Ciprofol is a new intravenous sedative / anesthetic drug. In recent years, many clinical studies have also confirmed the sedative effect of ciprofol. However, more clinical research is still needed on its clinical application characteristics in special populations.Objective: The aim of this study was to compare the clinical effects of ciprofol and propofol in general anesthesia induction of elderly patients.Methods: 60 elderly (aged ≥ 75 years) patients underwent hip fracture surgery were randomly into two groups of a 1:1 ratio. Group C (ciprofol group): 0.3mg/kg ciprofol was infused. Group P (propofol group): 1.5mg/kg propofol was infused. The observation period was from the infusion of test drug to 5 min after endotracheal intubation. The primary outcomes included the incidence of severe hypotension and hypotension during the observation period. The secondary outcomes were as follows: the success rate of general anesthesia induction, the number of additional sedation, the time of loss of consciousness (LOC), Δ MAP, Δ HR, adverse events and the frequency of vasoactive drugs used.Results: Finally, 60 subjects completed the study. Compared with Group P, the incidence of severe hypotension in Group C was lower (26.7% vs 53.3%, P = 0.035), the incidence of hypotension was also lower (36.7% vs 63.3%, P = 0.037), Δ MAP in Group C was significantly lower (31.4 ± 11.4 vs 39.6 ± 15.7, P = 0.025), the frequency of ephedrine used and the incidence of injection pain in Group C were also significantly lower.Conclusion: Ciprofol showed similar efficacy to propofol when used for general anesthesia induction in elderly patients underwent hip fracture surgery and could maintain more stable blood pressure.Keywords: Ciprofol, elderly, Hip fracture surgery, general anesthesia, hypotension

Fan Li,1,&ast; Chuan-Guo Chen,2,&ast; Jiao-Fei Wei,1,3 Jia-Wen Lin,4 Zi-Ang Dou,3,4 Jun Shen,1 Shu-Qin Li1,3,4 1Department of Breast Surgery, the First People’s Hospital of Lianyungang, The Affiliated Hospital of XuZhou Medical University, Lianyungang, Jiangsu, People’s Republic of China; 2Department of General Surgery, Nanjing Meishan Hospital, Nanjing, Jiangsu, People’s Republic of China; 3Department of Clinical Medicine, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China; 4Department of clinical medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Shen; Shu-Qin Li, Department of Breast Surgery, the First People’s Hospital of Lianyungang, The Affiliated Hospital of XuZhou Medical University, No. 6 Zhenhua East Road, High-tech Square, Lianyungang, Jiangsu Province, 222002, People’s Republic of China, Tel +861896132532 ; +8618961325781, Email shenjun2257@126.com; shuqinlilsh@126.comObjective: In this study, we aimed to establish the role of regenerating islet-derived family member 4 (Reg IV) as an independent risk factor and prognostic predictor in patients with T2-3 stage breast cancer who exhibit a non-pathological complete response (non-pCR) following neoadjuvant chemotherapy (NACT). Additionally, we examined the potential correlation and interaction between Reg IV and epidermal growth factor receptor (EGFR).Methods: A total of 67 patients with T2-3 stage breast cancer exhibiting non-pCR after NACT between September 2019 and December 2021 were included in this study. The analysis involved Kaplan–Meier survival comparisons, pooled hazard ratios for risk quantification, Cox regression analysis to isolate the impact of Reg IV on prognosis, Riskplots for visualizing risk profiles, and SHAP analysis to assess the importance of variables in predicting outcomes.Results: The findings indicate that patients positive for Reg IV had a significantly poorer prognosis (HR: 2.62, 95% CI: 1.06– 6.47). Co-expression of Reg IV and EGFR was associated with the worst outcomes compared to patients negative for both markers. Cox regression analysis confirmed the independent prognostic impact of Reg IV (HR: 2.63, 95% CI: 1.66– 3.59). Riskplot analysis showed that patients positive for both Reg IV and EGFR predominantly experienced disease progression. SHAP analysis further reinforced the significant effect of Reg IV on the disease course, without substantial interaction with EGFR.Conclusion: Reg IV may serve as an independent risk factor and predictive marker for adverse outcomes in patients with T2-3 stage breast cancer who do not achieve non-pCR following NACT.Keywords: breast cancer, NACT, neoadjuvant chemotherapy, non-pCR, non-pathologic complete response, reg IV, risk factor

Abstract Serious infection is common in patients with multiple myeloma due to immune deficiency from the underlying disease and/or its treatment. Immunoglobulin replacement is one approach to reduce infection risk in these patients. However, few real‐world data exist on its use in patients with myeloma. We investigated immunoglobulin use in Australia, New Zealand and Asia‐Pacific using registry data and explored its association with survival outcomes. A total of 2374 patients with a median follow‐up time of 29.5 months (interquartile range 13.3–54.3 months) were included in the analysis – 1673 from Australia, 313 Korea, 281 New Zealand and 107 Singapore. Overall, 7.1% of participants received immunoglobulin replacement within 24 months of diagnosis. Patients who received immunoglobulin replacement were likely to be younger, had lower baseline IgG levels (excluding paraprotein), were more likely to have baseline hypogammaglobulinaemia, baseline severe hypogammaglobulinaemia and abnormal baseline fluorescent in‐situ hybridisation status, receive first‐line myeloma treatment with immunomodulatory drugs or anti‐CD38 therapy and undergo upfront autologous stem cell transplant. In our patient cohort, the use of immunoglobulin was not associated with overall survival benefit at the time of last follow‐up (adjusted hazard ratio 0.72, 95% CI 0.46–1.14, p = 0.16). Understanding treatment approaches in clinical practice can help support future planning and provision of immunoglobulin resources.

Yu-Kai Li,1,&ast; Song Wu,2,&ast; Yu-Shan Wu,3,&ast; Wei-Hu Zhang,4,&ast; Yan Wang,5,&ast; Yue-Hua Li,1,&ast; Qiang Kang,1,&ast; Song-Quan Huang,1,&ast; Kai Zheng,1 Gai-Ming Jiang,1 Qing-Bo Wang,1 Yu-Bo Liang,1 Jin Li,1 Yawhan Lakang,1 Chen Yang,1 Jing Li,1 Jia-Ping Wang,4 Xiang Kui,5 Yang Ke1,6,7 1Department of Hepato-Biliary-Pancreatic, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 2Preventive Medicine Division, School of Life Science, Anhui University of Chinese Medicine, Hefei, AH, 230012, People’s Republic of China; 3The Second Clinical Medical College, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 4Department of Radiology, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 5Department of Pathology, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 6Department of Surgical Education and Research, the Second Affiliated Hospital, Kunming Medical University, Kunming, YN, 650101, People’s Republic of China; 7Yunnan Yunke Bio-Technology Institution, Kunming, YN, 650201, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiang Kui, Department of Pathology, the Second Affiliated Hospital, Kunming Medical University, No. 374 Kunrui Road, Wuhua District, Kunming, YN, 650101, People’s Republic of China, Tel +8613708729335, Email kuixiang@foxmail.com Yang Ke, Department of Hepato-Biliary-Pancreatic, the Second Affiliated Hospital, Kunming Medical University, No. 374 Kunrui Road, Wuhua District, Kunming, YN, 650101, People’s Republic of China, Tel +8615808875159, Email keyang1218@126.comBackground: The dominant artery blood supply is a characteristic of hepatocellular carcinoma (HCC). However, it is not known whether the blood supply can predict the post-hepatectomy prognosis of patients with HCC. This retrospective study investigated the prognostic value of the portal venous and arterial blood supply estimated on triphasic liver CT (as a portal venous coefficient, PVC, and hepatic arterial coefficient, HAC, respectively) in patients with HCC following hepatectomy.Methods: HCC patients who were tested by triphasic liver CT 2 weeks before hepatectomy and received R0 hepatectomy at the Second Affiliated Hospital, Kunming Medical University between January 1, 2016 and December 31, 2020, were retrospectively screened. Their PVC and HAC, and other variables were analyzed for the prediction of overall survival (OS) and recurrence-free survival (RFS) using the least absolute shrinkage and selection operator and Cox proportional hazard regression models.Results: Four hundred and nineteen patients (53.2 ± 10.6 years of age and 370 men) were evaluated. A shorter OS was independently associated with higher blood albumin and total bilirubin grade [hazard ratio (HR) 2.020, 95% confidence interval (CI) 1.534– 2.660], higher Barcelona Clinic Liver Cancer (BCLC) stage (HR 1.514, 95% CI 1.290– 1.777), PVC ≤ 0.386 (HR 1.628, 95% CI 1.149– 2.305), and HAC > 0.029 (HR 1.969, 95% CI 1.380– 2.809). A shorter RFS was independently associated with male (HR 1.652, 95% CI 1.005– 2.716), higher serum α-fetoprotein ≥ 400 ng/mL (HR 1.672, 95% CI 1.236– 2.263), higher BCLC stage (HR 1.516, 95% CI 1.300– 1.768), tumor PVC ≤ 0.386 (HR 1.641, 95% CI 1.198– 2.249), and tumor HAC > 0.029 (HR 1.455, 95% CI 1.060– 1.997).Conclusion: Tumor PVC or HAC before hepatectomy is valuable for independently predicting postoperative survival of HCC patients. Keywords: blood supply, computed tomography, hepatectomy, hepatocellular carcinoma, recurrence, survival

Abstract Background Breastfeeding is recognized as the gold standard of infant feeding and nutrition. The World Health Organization recommends exclusive breastfeeding (EBF) of infants for the first 6 months of life. A variety of factors may impact breastfeeding practices in-hospital which may continue after hospital discharge, such as the use of breastmilk substitutes (BMS). The Baby-Friendly Initiative (BFI), which aims to promote and support breastfeeding practices, established a target rate of 75% for EBF from birth to hospital discharge. Currently, this target is not being met at The Ottawa Hospital (TOH), indicating there is room for improvement in EBF rates. The purpose of this study is to explore health care professionals (HCP) decision-making around use of BMS and identify factors that drive the use of BMS with and without medical indications. Methods In this qualitative study, semi-structured interviews were conducted with HCPs within TOH from January to June 2022. All participants had experience in maternity or postpartum care and were probed on factors influencing use of BMS at this institution. Interview transcripts were coded using an inductive approach. Results A total of 18 HCPs were interviewed including physicians, midwives, lactation consultants, and registered nurses. Multilevel barriers influencing the use of BMS were categorized into patient, HCP, and institution-level factors. Subthemes that emerged ranged from parental preferences, training differences amongst HCPs, to budget and staffing issues. Over half of HCPs were prepared to answer questions on EBF and were familiar with the BFI. Although most were supportive of this institution receiving BFI designation, a few providers raised concerns of its impact on parents who would like to supplement. Conclusions Several modifiable factors influencing decision-making for use of BMS were identified. These findings will be used to inform unit leads, help identify effective strategies to address modifiable barriers, and develop tailored breastfeeding supports to improve EBF rates.

Xiao-tian Nan,1,&ast; Ma-chao Li,1,&ast; Tong-yang Xiao,2,&ast; Hai-can Liu,1,&ast; Shi-qiang Lin,3 Wei Wang,1 Cheng Qian,4 Hao Hang,1 Gui-lian Li,1 Xiu-qin Zhao,1 Kang-Lin Wan,1 Li-li Zhao1 1National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China; 2Department of Clinical Laboratory, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, People’s Republic of China; 3College of Life Science, Fujian Agriculture and Forestry University, Fuzhou, 350002, People’s Republic of China; 4Beijing Center for Disease Control and Prevention, Beijing, 100013, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li-li Zhao, Email zhaolili@icdc.cnObjective: To explore the association between the variant mutations within embB and ubiA, and the degree of ethambutol (EMB) resistance of Mycobacterium tuberculosis (M. tuberculosis) isolates.Methods: A total of 146 M. tuberculosis isolates were used to determine the minimum inhibitory concentrations (MICs) of EMB with a 96-well microplate-based assay. The mutations within embB and ubiA among these isolates were identified with DNA sequencing. Moreover, a multivariate regression model and a computer model were established to assess the effects of mutations on EMB resistance.Results: Our data showed that overall 100 isolates exhibited 28 mutated patterns within the sequenced embB and ubiA. Statistical analysis indicated that embB mutations Met306Val, Met306Ile, Gly406Ala, and Gln497Arg, were strongly associated with EMB resistance. Of these mutations, Met306Val and Gln497Arg were significantly associated with high-level EMB resistance. Almost all multiple mutations occurred in high-level EMB-resistant isolates. Although the mutation within ubiA accompanied with embB mutation presented exclusively in EMB-resistant isolates, four single ubiA mutations (Ala39Glu, Ser173Ala, Trp175Cys, and Val283Leu) leading to protein instability were observed in EMB-susceptible isolates.Conclusion: This study highlighted the complexity of EMB resistance. Some individual mutations and multiple mutations within embB and ubiA contributed to the different levels of EMB resistance.Keywords: ethambutol, multidrug-resistant tuberculosis, embB, ubiA, mutations, minimum inhibitory concentration

Yang Yu,1,&ast; Xiao-Hui Wang,2,&ast; Wen-Jie Hu,1 De-Hua Chen,1 Zi-Li Hu,3 Shao-Qiang Li1 1Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China; 2Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha, Hunan Province, 410005, People’s Republic of China; 3Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangdong, 510060, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shao-Qiang Li, Hepatic Pancreatobiliary Surgery Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China, Tel +86-020-87755766-8214, Fax +86-020-87755766-8661, Email lishaoq@mail.sysu.edu.cnPurpose: The patterns and risk factors of postsurgical recurrence of patient with hepatocellular carcinoma (HCC) with microvascular invasion (MVI) are not clarified. This study aimed to decipher and compare the postoperative recurrent patterns and the risk factors contributing to recurrence between MVI positive (MVI(+)) and MVI negative (MVI(-)) HCC after hepatectomy.Patients and methods: Patients with HCC who underwent hepatectomy in three Chinese academic hospitals between January 1, 2009, and December 31, 2018, were enrolled. Recurrent patterns included early (≤ 2 years) or late (> 2 years) recurrence, recurrent sites and number, and risk factors of recurrence were compared between the MVI(+)and MVI(-) groups by propensity score–matching (PSM).Results: Of 1756 patients included, 581 (33.1%) were MVI(+), and 875 (49.8%) patients developed early recurrence. Compared with the MVI(-) group, the MVI(+) group had a higher 2-year recurrence rate in the PSM cohort (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.59– 2.10; P < 0.001), and more patients with multiple tumor recurrence. Patients with early recurrence in the MVI(+) group had a worse overall survival (OS) than those in the MVI(-) group (HR, 1.24; 95% CI, 1.02– 1.50; P = 0.034). Resection margin (RM) ≤ 1.0 cm is a surgical predictor of early recurrence for the MVI(+) group (HR, 0.68; 95% CI, 0.54– 0.87; P = 0.002), but not for the MVI(-) group.Conclusion: Compared to MVI(-) HCC, MVI(+) HCC tends to be early, multiple recurrence and lung and lymph node metastasis after resection. RM ≤ 1.0 cm is a surgical risk factor of early recurrence for patient with MVI.Keywords: hepatocellular carcinoma, microvascular invasion, recurrence patterns, risk factors, outcomes

Wen-Bin Duan,1 Xiao-Hui Wang,2 Guo-Can Zhang,2 Zhuo He,1 Shao-Qiang Li,3 Jie Zhou1 1Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People’s Republic of China; 2Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China; 3Hepatic Pancreatobiliary Surgery Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of ChinaCorrespondence: Xiao-Hui Wang, Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, 410005, People’s Republic of China, Tel +86-0731-83928052, Email xiaohuiwang21@163.com Jie Zhou, Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China, Tel +86-020-61641701, Email jacky_nfyy@163.comBackground: Lenvatinib or Sorafenib combined with programmed cell death protein-1 (PD-1) inhibitor as recommend treatment of advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM). We aimed to compared the prognosis of Lenvatinib plus PD-1 inhibitor (Len+PD-1) versus Sorafenib plus PD-1 (Sora+PD-1) as an initial therapy for HCC with EHM.Methods: Incorporating a sum of 229 HCC patients with EHM were encompassed within this study, with 127 in the Sora+PD-1 group and 102 in the Len+PD-1 group. Through propensity score matching (PSM), we compared overall survival (OS), progression-free survival (PFS), and patient safety between these two groups.Results: The median OS were 13.0 months and 14.2 months in the Sora+PD-1 group and Len+PD-1 group. The 6-, 12-, and 24-month OS rates were 92.9%, 58.9% and 5.6% in Sora+PD-1 group and 93.1%, 61.8% and 22.6% in Len+PD-1 group, respectively. The Len+PD-1 group had obviously better OS than the Sora+PD-1 group (P = 0.002). The 3-, 6-, and 12-month PFS rates were 76.4%, 27.6% and 1.6% in Sora+PD-1 group and 86.2%, 50.5% and 12.2% in Len+PD-1 group, respectively. Compared with Sora+PD-1 group, the Len+PD-1 group had obviously better PFS (P < 0.001). Analysis within subgroups showed that OS was significant in patients receiving TACE in Len+PD-1 group than Sora+PD-1 group (p = 0.003).Conclusion: Len+PD-1 group had longer OS and PFS than Sora+PD-1 group for patient with EHM. In addition, OS in patients received TACE was improved with Len+PD-1 treatment. For patients without TACE, there was no significance between Sora+PD-1 and Len+PD-1 groups.Keywords: hepatocellular carcinoma, extrahepatic metastasis, lenvatinib, sorafenib, PD-1 inhibitor

Jing Ning,1 Fang Wang,1 Shui-Qing Liu,2 Ru-Zhi Zhang,3 Dan-Min Liu,1 Yan Li1 1Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China; 2Department of Ultrasound in Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China; 3Department of Dermatology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 240000, People’s Republic of ChinaCorrespondence: Ru-Zhi Zhang, Email zhangruzhi628@163.comBackground: Hematoporphyrin monomethyl ether (HMME) is a promising photosensitizer for photodynamic therapy (PDT) and has found wide application in the treatment of port-wine stains (PWS).Objective: This study aims to observe and analyze the clinical efficacy and safety of HMME-PDT in the treatment of PWS patients. It also aims to evaluate the usefulness of color Doppler flow imaging (CDFI), an ultrasound technique for detecting blood flow in skin lesions, in assessing clinical efficacy.Methods: Thirty-three patients with PWS underwent HMME-PDT at our dermatology outpatient clinic between January 2019 and March 2020. Data on patient demographics, lesion location, lesion type (pink, purple, nodular thickening), treatment frequency, and pre- and post-treatment images were collected and retrospectively analyzed. CDFI was performed on three patients.Results: All patients received intravenous HMME and underwent irradiation with 532 nm green LED light. Of these, 5 patients received 1 session of HMME-PDT, 14 received 2 sessions, 9 received 3 sessions and the remaining 5 patients received more than 3 sessions. Of the 33 patients, 9 were cured (27.27%), 10 showed improvement (30.30%), 11 experienced a reduction in symptoms (33.33%), and 3 showed no significant improvement (9.09%). Most patients reported local pain and oedema, and no systemic adverse effects were observed. Clinical efficacy correlated with lesion type and total number of treatment sessions. CDFI appears to be an excellent technique for assessing clinical efficacy.Conclusion: HMME-PDT is a safe and effective method for the treatment of PWS. CDFI examination appears to be a promising assessment tool. However, further validation with larger sample sizes is warranted.Keywords: port-wine stains, hematoporphyrin monomethyl ether, photodynamic therapy, color Doppler flow imaging

Peng-Yu Chen,1 Minxue Shen,2– 4 Sui-Qing Cai,1 Zhen-Wei Tang1 1Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China; 2Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, People’s Republic of China; 3Hunan Engineering Research Center of Skin Health and Disease; Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), Changsha, 410008, People’s Republic of China; 4Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, People’s Republic of ChinaCorrespondence: Zhen-Wei Tang; Sui-Qing Cai, Email tangzhenwei@zju.edu.cn; 2191008@zju.edu.cnAbstract: As one of the most prevalent chronic inflammatory skin diseases, atopic dermatitis (AD) increasingly affects the aging population. Amid the ongoing global aging trend, it’s essential to recognize the intricate relationship between AD and aging. This paper reviews existing knowledge, summarizing clinical observations of associations between AD and aging-related diseases in various systems, including endocrine, cardiovascular, and neurological. Additionally, it discusses major theories explaining the correlation, encompassing skin-mucosal barriers, systemic inflammation and stress, genes, signal transduction, and environmental and behavioral factors. The association between AD and aging holds significant importance, both in population and basic perspectives. While further research is warranted, this paper aims to inspire deeper exploration of inflammation/allergy-aging dynamics and the timely management of elderly patients with AD.Keywords: atopic dermatitis, aging, age-related diseases, clinical observations, mechanical theories

Li Guo,1,&ast; Shi-Cui Hong,1,2,&ast; Xuan Wang,1,3,&ast; Sheng-Qi Wang,1,4 Neng Wang,4,5 Xiao-Qing Wei,1 Hong-Lin Situ,1,3,4 Zhi-Yu Wang1– 5 1Breast Disease Specialist Hospital of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China; 2The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China; 3Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China; 4Guangdong-Hong Kong-Macau Joint Laboratory on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China; 5The Research Center for Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhi-Yu Wang, Breast Disease Specialist Hospital of Guangdong Provincial Hospital of Chinese Medicine, No. 55, Inner Road West, Higher Education Mega Center(Hospital Branch Address), Guangzhou, 510120, Guangdong, People’s Republic of China, Tel +86-18819480766, Email wangzhiyu@gzucm.edu.cnBackground: Triple-negative breast cancer (TNBC) is the most aggressive malignancy. Psychological distress and elevated CXCL1 level have been reported to be closely associated with the poor prognosis and quality of life of patients with TNBC. In preclinical studies using xenograft mouse models, XIAOPI formula, a nationally approved drug prescribed to patients at high risk for breast cancer, inhibited CXCL1 expression and improved survival. Traditional Chinese medicine has unique advantages in improving patients’ emotional disorders and quality of life. However, the impact of XIAOPI formula on the serum level of CXCL1, psychological distress, and quality of life among patients with TNBC is currently unknown.Methods: In this study, we designed a randomized, double-blind, placebo-controlled trial. Patients with TNBC were randomly assigned to receive either the XIAOPI formula or a placebo for three months. The primary outcomes include serum CXCL1 expression, Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS). Secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and the Functional Assessment of Cancer Therapy-Breast (FACT-B).Results: A total of 60 patients with TNBC were enrolled in the investigation. The results showed that the XIAOPI formula significantly decreased CXCL1 expression compared with the control group. Moreover, in comparison to the placebo, the XIAOPI formula increased FACT-B scores while decreasing SDS, SAS, and PSQI scores.Conclusion: In patients with TNBC, XIAOPI formula may be effective in reducing CXCL1 levels, enhancing psychological well-being, and quality of life. While our research offers a natural alternative therapy that may enhance the prognosis of TNBC, future validation of its therapeutic effects will require large-scale, long-term clinical trials.Clinical Registration Number: Registration website: www.chictr.org.cn, Registration date: 2018-1-19, Registration number: ChiCTR1800014535.Keywords: anxiety, CXCL1, depression, quality of life, sleep quality, triple-negative breast cancer, XIAOPI formula

Immune Tolerance Induction (ITI) is the only treatment to eradicate inhibitors in people with Severe Hemophilia A (SHA). Successful ITI restores Factor VIII (FVIII) tolerance. ITI is demanding and successful in approximately 70% of people. Therefore, identifying predictors of ITI outcome is essential to guide clinical decision-making. We aimed to identify genetic predictors of ITI success in people with SHA and inhibitors who underwent ITI. This observational multicenter study included people with SHA who underwent ITI, between 2015 and 2023. Clinical and patient data including factor VIII gene (F8) mutation type and DNA samples were collected. Successful ITI was defined by a negative inhibitor titer and an adequate response to FVIII concentrates. The associations between ITI success and F8 genotype and 216 candidate predictors including single nucleotide polymorphisms (SNPs) and human leukocyte antigen (HLA)-variants employing a global screening array (GSA), CA dinucleotide Short Tandem Repeat (STR) polymorphisms in the Interleukin (IL)-10 promoter region, and FCGR2/3 gene locus variations were analyzed. Of 204 participants, 147 (72.1%) achieved ITI success. The majority (52.0%) of participants had F8 intron 22 inversion. None of the candidate SNPs/HLA-variants, IL-10 CA dinucleotide STR, or FCGR2/3 gene locus variations were associated with ITI success. F8 large deletions were negatively associated with ITI success (OR = 0.15, 95% CI 0.04‒0.51, p = 0.002). Our study including 204 people with SHA identified F8 large deletions as a predictor of ITI failure. Pooling cohorts may allow the identification of additional genetic predictors of ITI success in the future.

Su-Hua Yang,1,&ast; Yi-Shan He,2,&ast; Shu-Qin Zheng,3 Xiu-Jun Zhang,3 Hong Dai,1,&ast; Yuan Xue2,3,&ast; 1Department of General Surgery, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China; 2Department of Infectious Diseases, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China; 3Institute of Hepatology, Changzhou Third People’s Hospital, Changzhou, Jiangsu Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hong Dai, Department of General Surgery, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China, Email daihong@njmu.edu.cn Yuan Xue, Institute of Hepatology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, No. 300 Lanling North Road, Changzhou, Jiangsu, 213000, People’s Republic of China, Tel +86 519 82009059, Email xueyuan@njmu.edu.cnAim: This study aimed to explore the effects of the triglyceride-glucose (TyG) index on hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related liver cirrhosis (LC).Methods: A total of 242 patients with HBV-related LC were enrolled and followed-up. Logistic regression analysis was performed to investigate risk factors for HCC.Results: The median follow-up time was 37 months (range: 6– 123 months). At the end of the follow-up, 11 (11.3%) patients with compensated cirrhosis (CC) and 45 (31.0%) with decompensated cirrhosis (DC) developed HCC. The TyG index was higher in the HCC group than in the non-HCC group (P=0.05). Univariate analysis showed that age (P< 0.01), DC (P< 0.01), TyG index (P=0.08), albumin (ALB) level (P=0.05), platelet (PLT) count (P< 0.01), and HBV DNA positivity (P< 0.01) were associated with HCC development. Multivariate analysis revealed that age, DC, TyG index, PLT count, and HBV DNA positivity were independent risk factors for HCC development (P=0.01, 0.01, < 0.01, 0.05, and < 0.01, respectively). For patients with DC, multivariate logistic regression analysis revealed that age, TyG index, and HBV DNA positivity were independent risk factors for HCC development (all P< 0.05). A new model encompassing age, DC, TyG, PLT, and positive HBV DNA had optimal predictive accuracy in patients with DC or CC, with a cutoff value of 0.197. The areas under the receiver operating characteristic curves (AUROCs) of the model for predicting HCC development in patients with LC, DC, and CC were 0.778, 0.721, and 0.783, respectively.Conclusion: TyG index was identified as an independent risk factor for HCC development in patients with LC.Keywords: hepatocellular carcinoma, triglyceride-glucose index, insulin resistance, liver cirrhosis, decompensated cirrhosis

Samia Q Alghamdi,1 NF Alotaibi,2 Sameera N Al-Ghamdi,3 Laila S Alqarni,4 Touseef Amna,1 Shaima MN Moustafa,5 Ibrahim Hotan Alsohaimi,2 IA Alruwaili,2 AM Nassar2 1Department of Biology, Faculty of Science, Al-Baha University, Al-Baha, 65799 Saudi Arabia; 2Chemistry Department, College of Science, Jouf University, Sakaka, Saudi Arabia; 3Chemistry Department, Faculty of Science, Al-Baha University, Al-Baha, Saudi Arabia; 4Chemistry Department, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623 Saudi Arabia; 5Biology Department, College of Science, Jouf University, Sakaka, Saudi ArabiaCorrespondence: AM Nassar, Jouf University, Sakaka, Aljouf, 2014, Saudi Arabia, Tel +966555978016, Email amnassar@ju.edu.saBackground: Nowadays, recycling agricultural waste is of the utmost importance in the world for the production of valuable bioactive compounds and environmental protection. Olive leaf bioactive compounds have a significant potential impact on the pharmaceutical industry. These compounds possess remarkable biological characteristics, including antimicrobial, antiviral, anti-inflammatory, hypoglycemic, and antioxidant properties.Methods: The present study demonstrates a green synthetic approach for the fabrication of nickel oxide nanoparticles (NiO-olive) using aqueous wasted olive leaf extract. Calcination of NiO-olive at 500°C led to the fabrication of pure NiO nanoparticles (NiO-pure). Different techniques, such as thermal gravimetric analysis (TGA), Fourier-transform infrared spectra (FTIR), ultraviolet-visible spectra (UV-Vis), X-ray diffraction (XRD), scanning electron microscopy (SEM) fitted with energy-dispersive X-ray analysis (EDX), and transmission electron microscopy (TEM), were used to characterize both NiO-olive and NiO-pure. The extract and nanoparticles were assessed for antiparasitic activity against adult ticks (Hyalomma dromedarii) and antimicrobial activity against Bacillus cereus, Pseudomonas aeruginosa, Aspergillus niger, and Candida albicans.Results: From XRD, the crystal sizes of NiO-olive and NiO-pure were 32.94 nm and 13.85 nm, respectively. TGA, FTIR, and EDX showed the presence of olive organic residues in NiO-olive and their absence in NiO-pure. SEM and TEM showed an asymmetrical structure of NiO-olive and a regular, semi-spherical structure of NiO-pure. UV–Vis spectra showed surface plasmon resonance of NPs. Antiparasitic activity showed the highest mortality rate of 95% observed at a concentration of 0.06 mg/mL after four days of incubation. The antimicrobial activity showed the largest inhibition zone diameter of 33 ± 0.2 mm against the Candida albicans strain.Conclusion: Nanoparticles of NiO-olive outperformed nanoparticles of NiO-pure and olive leaf extract in both antiparasitic and antimicrobial tests. These findings imply that NiO-olive may be widely used as an eco-friendly and effective antiparasitic and disinfection of sewage.Keywords: biosynthesis, olive, NiO-NP, antiparasitic, antimicrobial]

Yue Liu, Shi Qi Xie, Xia Yang, Jing Lan Chen, Jian Rong Zhou School of Nursing, Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Jian Rong Zhou; Shi Qi Xie, School of Nursing, Chongqing Medical University, 1 Medical College Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China, Tel +86-135 0830 0955 ; +86-156 0833 2043, Fax +86-23-63555767, Email 202028@cqmu.edu.cn; xie47@cqmu.edu.cnPurpose: The clinical presentation of Obstructive Sleep Apnea (OSA) in children is insidious and harmful. Early identification of children with OSA, particularly those at a higher risk for severe symptoms, is essential for making informed clinical decisions and improving long-term outcomes. Therefore, we developed and validated a risk prediction model for severity in Chinese children with OSA to effectively identify children with moderate-to-severe OSA in a clinical setting.Patients and Methods: From June 2023 to September 2023, we retrospectively analyzed the medical records of 367 Children diagnosed with OSA through portable bedside polysomnography (PSG). Predictor variables were screened using the least absolute shrinkage and selection operator (LASSO) and logistic regression techniques to construct nomogram to predict the severity of OSA. Receiver operating characteristic curve (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were used to determine the discrimination, calibration, and clinical usefulness of the nomogram.Results: A total of 367 children with a median age of 84 months were included in this study. Neck circumference, ANB, gender, learning problem, and level of obstruction were identified as independent risk factors for moderate-severe OSA. The consistency indices of the nomogram in the training and validation cohorts were 0.841 and 0.75, respectively. The nomogram demonstrated a strong concordance between the predicted probabilities and the observed probabilities for children diagnosed with moderate-severe OSA. With threshold probabilities ranging from 0.1 to 1.0, the predictive model demonstrated strong predictive efficacy and yielded improved net benefit for clinical decision-making. ROC analysis was employed to classify the children into high and low-risk groups, utilizing the Optimal Cutoff value of 0.39.Conclusion: A predictive model using LASSO regression was developed and validated for children with varying levels of OSA. This model identifies children at risk of developing OSA at an early stage.Keywords: obstructive sleep apnea, children, cephalometric, prediction nomogram, risk prediction model

Bai-Bing Gao,1,2,&ast; Qing-qing Zhang,1,&ast; Shu-qin Dong,1,2 Fei Gao,1,2 Xia Liu,3 Jing Wei,3 Yu Lu1 1Department of Endocrinology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, People’s Republic of China; 2Dalian Medical University, Dalian, Liaoning, 116044, People’s Republic of China; 3Department of Obstetrics and Gynecology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yu Lu; Jing Wei, Email luyu_666@126.com; qlm_weijin@163.comAim: We investigate the association of mammalian sterile line 20-like kinase 1 (MST1) in the first trimester with the risks of gestational diabetes mellitus (GDM) and adverse pregnancy outcomes.Methods: Pregnancies were recruited during their first antenatal care visit between 8 and 12 gestational weeks. These pregnancies underwent an oral glucose tolerance test between 24 and 28 gestational weeks and were followed up until delivery. Serum MST1 levels at 8– 12 gestational weeks and 24– 28 gestational weeks were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Logistic regression models were used to evaluate the association between MST1 levels in the first trimester and the risks of GDM and adverse pregnancy outcomes.Results: This cohort study enrolled a total of 231 pregnancies. GDM was present in 42 (18.18%) women. Compared to the normal glucose tolerance (NGT) group, the GDM group had higher levels of FPG, HOMA-IR, and MST1 both in the first and second trimesters, but had lower HOMA-β levels only in the second trimester. Then participants were classified according to the median MST1 value in the first trimester. Incidences of GDM, composite adverse pregnancy outcomes, preterm birth, and macrosomia increased in women with higher MST1 values. Serum MST1 in the first trimester was correlated with FPG, 1hr PG, 2hr PG, and HOMA-IR, while inversely correlated with HOMA-β in the second trimester. Furthermore, after adjusting for traditional risk factors, women with higher first-trimester MST1 values had greater odds of GDM, composite adverse pregnancy outcomes, preterm birth, and macrosomia (aOR 2.276, P=0.030; aOR 2.690, P=0.003; aOR 3.210, P=0.048; aOR 5.488, P=0.010).Conclusion: Elevated levels of MST1 in the first trimester of pregnancies are associated with increased risks of GDM and adverse pregnancy outcomes.Keywords: mammalian sterile line 20-like kinase 1, gestational diabetes mellitus, adverse pregnancy outcome, blood glucose

Jia-Yi Wu,1,2,&ast; Jun-Yi Wu,1,2,&ast; De-Yi Liu,1,&ast; Han Li,1,&ast; Shao-Wu Zhuang,3 Bin Li,4 Jian-Yin Zhou,5 Jing-Yao Huang,6 Zhi-Bo Zhang,7 Shu-Qun Li,8 Mao-Lin Yan,1,2 Yao-Dong Wang1,2 1Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China; 2Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, People’s Republic of China; 3Department of Interventional Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People’s Republic of China; 4Department of Hepato-Biliary-Pancreatic and Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China; 5Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China; 6Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People’s Republic of China; 7Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China; 8Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mao-Lin Yan; Yao-Dong Wang, The Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Dongjie Road 134, Fuzhou, Fujian Province, 350001, People’s Republic of China, Tel +86 591-88217140 ; +86 591-88217130, Fax +86 591-87557768, Email yanmaolin74@163.com; wangyaodongfjsl@163.comBackground: This study aimed to determine whether salvage hepatectomy offers prognostic advantages for unresectable hepatocellular carcinoma (uHCC) patients with clinical complete response (cCR) after conversion therapy.Methods: A total of 74 consecutive uHCC patients with cCR after conversion therapy at seven major cancer centers in China between October 2018 and December 2021 were included. One-to-one propensity score matching (PSM) was performed to minimize the influence of potential confounders. Disease-free survival (DFS) and overall survival (OS) rates were compared between the surgical group and the non-surgical group.Results: Before PSM, 45 patients received salvage hepatectomy, and 29 patients received nonsurgical treatment. The 1-, 2-, and 3-year DFS rates were 77.8%, 61.5%, and 61.5% in the surgical group and 81.2%, 60.9%, and 60.9% in the non-surgical group, respectively. The 1-, 2-, and 3-year OS rates were 92.9%, 92.9%, and 69.7% in the surgical group and 100%, 70%, and 70% in the non-surgical group, respectively. There were no statistical differences in DFS and OS between groups [hazard ratio (HR)=0.715, 95% confidence interval (CI): 0.250– 2.043, p=0.531; HR=0.980, 95% CI: 0.177– 5.418, p=0.982, respectively]. After PSM, 26 pairs of patents were selected; there remained no significant differences in DFS and OS between these two groups (HR=1.547, 95% CI: 0.512– 4.669, p=0.439; HR=1.024, 95% CI: 0.168– 6.242, p=0.979, respectively).Conclusion: Through the study, it tend to show that salvage hepatectomy may be not essential for uHCC patients with cCR, especially for patients with a high risk of surgical complications. Prospective trials with long term follow-up are warranted to evaluate this treatment option.Plain Language Summary: To date, there is limited evidence on the prognosis of the unresectable hepatocellular carcinoma (uHCC) patients with clinical complete response (cCR), and the necessity of salvage surgery remains controversial. In this study, they compare and evaluate therapeutic benefits of salvage hepatectomy and nonsurgical treatment in the management of uHCC patients with cCR after conversion therapy. Finally, a total of 74 consecutive uHCC patients with cCR after conversion therapy at seven major cancer centers in China were included. There were no statistically significant differences for disease-free survival and overall survival were observed before and after propensity score matching. They revealed that cCR after conversion therapy led to a good prognosis for patients with uHCC. Furthermore, nonsurgical treatment provided similar survival benefits to those of salvage hepatectomy, suggesting that salvage hepatectomy may be not essential for uHCC patients with cCR.Keywords: conversion therapy, hepatocellular carcinoma, overall survival, disease-free survival, salvage surgery

Qian Wei,1,2,&ast; Yu-Chao Hou,3,&ast; Fei-Fei Mao,4,&ast; Jin-Kai Feng,2 Xu Wang,3 Shu-Qun Cheng1,2,&ast; 1The First Clinical Medicine School, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 2Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 3Cancer Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 4Tongji University Cancer Center, Shanghai 10th People’s Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shu-Qun Cheng, The First Clinical Medicine School, Guangdong Pharmaceutical University, 19 Nonglin Xia Road, Guangzhou, 510080, People’s Republic of China, Email chengshuqun@aliyun.comPurpose: Hepatocellular carcinoma (HCC) is a prevalent form of cancer that is distributed globally. Disulfidptosis, characterized by the fragility of the actin cytoskeleton, represents a distinct type of cell death and holds promise for novel cancer therapies. Nevertheless, the connection among disulfidptosis-associated long non-coding RNAs (lncRNAs) and HCC is still unexplored. This study uses an in silico approach to provide the novel biomarkers of disulfidptosis-associated lncRNAs for predicting the immune response and prognosis with HCC.Methods: In order to address this gap, we integrated transcriptomic data of HCC from The Cancer Genome Atlas (TCGA) and identified genes that exhibit differential expression with disulfidptosis and lncRNAs. Through co-expression analysis, we identified disulfidptosis-related lncRNAs. Afterwards, by employing univariate Cox regression analysis and the least absolute shrinkage and selection operator (LASSO), a model for disulfidptosis-associated lncRNA was constructed. The risk model underwent assessment through the utilization of diverse analytical methodologies, including functional enrichment annotation, Kaplan-Meier analysis, principal component analysis (PCA), immune infiltration and immune status analysis, as well as tumor mutation analysis. Furthermore, we discussed the implications of the model in predicting drug sensitivity.Results: Our study culminated in the construction of a disulfidptosis-related lncRNA model comprising four prognostic disulfidptosis-related lncRNAs (ACYTOR, NRAV, AL080248.1, and AC069307.1). This model demonstrates exceptional diagnostic value for HCC patients and holds practical implications for guiding clinicians in personalizing immunotherapy and drug selection based on individual variations.Conclusion: In summary, our research introduces a novel predictive tool utilizing disulfidptosis-related lncRNAs, offering potential guidance for the therapeutic management of HCC.Keywords: disulfidptosis, hepatocellular carcinoma, long noncoding RNA, prognosis, immune response

Peng-Cheng Zhang,1,2 Yi Hong,3 Shi-Qin Zong,1,2 Long Chen,1,2 Chong Zhang,4 Dai-Zhi Tian,4 Dan Ke,5 Li-Ming Tian1,2,4 1Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 2Hubei Provincial Key Laboratory of Skin Infection and Immunity, Wuhan No.1 Hospital, Wuhan, 430022, People’s Republic of China; 3College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, People’s Republic of China; 4Institute of Geriatrics, Hubei University of Chinese Medicine, Wuhan, 430065, People’s Republic of China; 5Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400000, People’s Republic of ChinaCorrespondence: Dan Ke, Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, No. 40 of Daomenkou, Yuzhong District, Chongqing, 400000, People’s Republic of China, Tel +86 23 6390 1120, Fax +86 23 6373 1325, Email 2306896229@qq.com Li-Ming Tian, Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 215 of Zhongshan Avenue, Qiaokou District, Wuhan, 430022, People’s Republic of China, Tel +86 27 8533 2606, Fax +86 27 8583 2563, Email jolly0731@126.comObjective: To investigate the variation of ferroptosis-related markers in HaCaT cell photoaging models induced by ultraviolet-B (UVB).Methods: UVB-treated HaCaT cells served as the model (UVB group) for cellular photoaging, whereas untreated HaCaT cells served as the control group. HaCaT cells were exposed to UVB and the ferroptosis inhibitor Ferrostatin-1 (Fer-1) as part of the UVB+Fer-1 group, and co-cultured with the ferroptosis inducer Erastin as part of the UVB+Erastin group. Reactive oxygen species (ROS) detection kit and senescence-related β galactosidase (SA-β-gal) staining were used to evaluate the senescence of HaCaT cells. Lipid reactive oxygen species were detected by C11 BODIPY581/591 probe and mitochondrial morphology was observed by transmission electron microscopy. The mRNA expressions of glutathione peroxidase 4 (GPX4) and ferroptosis-suppressor-protein 1 (FSP1) were detected by real-time reverse transcription-PCR (RT-RCP), and the level of GPX4 protein was measured by immunofluorescence assay.Results: The UVB group had considerably greater levels of ROS, SA-β-gal, and lipid reactive oxygen species than the control group. The UVB group’s mitochondrial volume was reduced, the membrane density increased, and the mitochondrial crest decreased or even disappeared. GPX4 and FSP1 expression levels were similarly found to be lower in the UVB group. Furthermore, the positive rate of SA-β-gal and lipid reactive oxygen species in the UVB+Fer-1 group was much lower than in the UVB group, but it was reverse in the UVB+Erastin group. This study showed that induced ferroptosis can aggravate aging, and vice versa.Conclusion: According to the findings, ferroptosis may be linked to UVB-induced skin photoaging, which could be attenuated by inhibition of ferroptosis.Keywords: skin aging, ferroptosis, oxidative stress

Shu-Qun Li,1– 3,&ast; Jun-Yi Wu,1,2,&ast; Jia-Yi Wu,1,2,&ast; Huang Xie,4,&ast; Jin-Hai Li,1,2 Zhen-Xin Zeng,1,2 Yang-Kai Fu,1,2 De-Yi Liu,1,2 Han Li,1,2 Wei-Zhao Chen,1,2 Jing-Yao Huang,4 Mao-Lin Yan1,2 1Department of Hepatobiliary Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China; 2Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China; 3Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, 450001, People’s Republic of China; 4Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mao-Lin Yan; Jing-Yao Huang, Tel +86 591-88217130 ; +86 13705962563, Fax +86 591-87557768 ; +86 591-87113828, Email yanmaolin74@163.com; hjy999@126.comPurpose: In recent years, immune checkpoint inhibitors have been used in combination with tyrosine kinase inhibitors and local therapies, creating a new era in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, the benefits of this triple therapy remain unclear. Thus, this study evaluated whether the combination of transarterial chemoembolization (TACE), lenvatinib, and programmed death-1 (PD-1) inhibitors (triple therapy) was effective and safe for unresectable HCC with main trunk portal vein tumor thrombus (Vp4).Patients and Methods: This study enrolled patients receiving triple therapy at four institutions between August 2018 and April 2022. Patient characteristics and course of treatment were extracted from patient records. Tumors and tumor thrombus response were evaluated using an HCC-specific modified RECIST. Kaplan–Meier curve analysis demonstrated overall survival (OS) and progression-free survival (PFS). Adverse events (AEs) were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0.Results: Median follow-up duration was 18 (4.0– 26.3) months. Overall, 41 patients with HCC and Vp4 receiving first-line triple therapy were enrolled. The intrahepatic tumor objective response rate was 68.3%. The median OS was 21.7 (range, 2.8– 30.5) months, whereas the median PFS was 14.5 (range, 1.3– 27.6) months. Twelve patients received sequential resections. Resection was independently associated with favorable OS and PFS. Fever (31.7%), hypertension (26.8%), fatigue (24.4%), abnormal liver function (63.4%) and decreased appetite (21.9%) were the AEs frequently associated with treatment. No treatment-related mortality occurred.Conclusion: TACE plus lenvatinib and PD-1 inhibition was effective and tolerable for treating unresectable HCC with Vp4, with a high tumor response rate and favorable prognosis.Keywords: transarterial chemoembolization, lenvatinib, programmed death 1 inhibitor, hepatic cellular carcinoma, main trunk portal vein, triple therapy

Zi-Qiang Li,1,&ast; Ye Qin,2,&ast; Wen-Peng Cai,1,&ast; Si-Qi Deng,3 Xiao-Fei Mao,1 Jian-Guo Zhang,1 Tian-Ya Hou,1 Yu Pan,4 Yi Cui,1 Ying-Nan Ge,5 Wei Dong,1,&ast; Yun-Xiang Tang1,&ast; 1Faculty of Psychology, Naval Medical University, Shanghai, 200433, People’s Republic of China; 2The School of Mechanical Engineering, Changzhou University, Changzhou, 210046, People’s Republic of China; 3Department of Clinical Psychological Counseling, Shanghai Tongxinjici Health Couseling Center, Shanghai, 200433, People’s Republic of China; 4Department of Medical Psychology, Chinese PLA General Hospital, Beijing, 100830, People’s Republic of China; 5Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, 518000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wei Dong; Yun-Xiang Tang, Faculty of Psychology, Naval Medical University, No. 800 Xiangyin Road, Shanghai, 200433, People’s Republic of China, Tel/Fax +86-13524435414 ; +86-13386271042, Email sophiedongwei@163.com; tangyun7633@sina.comPurpose: This study aims to examine the impact of sleep deprivation on individual cognitive reappraisal ability using a standardized behavioral paradigm.Methods: A randomized pretest-posttest control group design was conducted. Thirty-nine participants were eventually enrolled and randomly assigned to receive either the sleep control (SC: n = 17) or the sleep deprivation (SD: n = 22). Both of them were required to perform a standardized behavioral paradigm of measuring cognitive reappraisal ability one time under sleep-rested condition and another time under the condition of different sleep manipulation a week later.Results: Mean valence ratings of SD group were more negative than SC group’s (p < 0.05) and mean arousal ratings of SD group were higher than SC group’s (p < 0.01).Conclusion: Sleep deprivation may impair individual cognitive reappraisal ability and could potentially undermine the efficacy of cognitive therapy in terms of emotion regulation.Keywords: sleep deprivation, emotion regulation, cognitive reappraisal, IAPS, CRA

Tao Zhang,1 Zhu-Bin Pan,1 Wen-Jia Tong,2 Yu-Liang Zhou,1 Yuan Cheng,1 Dan-Qun Jin,2 Shi-Qin Qi,1 Zhen-Qiang Zhang1 1Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of China; 2Department of Pediatric Intensive Care Unit, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, Hefei, 230000, People’s Republic of ChinaCorrespondence: Zhu-Bin Pan, Department of General Surgery, Anhui Provincial Children’s Hospital, Children’s Hospital of Fudan University Anhui Hospital, Children’s Hospital of Anhui Medical University, No. 39 of Wang Jiang Dong Street, Bao He District, Hefei, 230000, People’s Republic of China, Tel +86 13349207050, Fax +86 551 62237461, Email panzhubinpzb5@126.comBackground: Paraneoplastic syndromes often cause endocrine, neurological, cutaneous, and hematologic pathologies, and cases with digestive symptoms as prominent cases are rare.Case Description: A 1-year-old child admitted to the emergency department with severe abdominal distension was later diagnosed with sacrococcygeal yolk cystoma with ulcerative colitis. After symptomatic management, surgical removal of the tumor, and JEB chemotherapy, the symptoms of ulcerative colitis disappeared completely. After 7 years of follow-up, the child grew and developed well, and there was no recurrence of tumor and ulcerative colitis.Conclusion: Yolk sac tumor with ulcerative colitis is a rare paraneoplastic syndrome with complex clinical manifestations.Keywords: children, paraneoplastic syndrome, toxic megacolon, ulcerative colitis, yolk sac tumor

Objectives: Currently, pH values are used in fetal scalp blood sampling as a parameter to rule out fetal distress during the delivery. Due to a high number of pre-analytical errors in pH measurements, lactate measurement is already extensively examined as an alternative. Our objectives were to confirm the analytical performance of the StatStrip lactate POCT analyzer and to compare pH and lactate as a marker of fetal distress. Design: and methods: Fetal blood scalp, umbilical and arterial blood test results (n = 100) were analyzed to compare the current POC blood gas analyzer including lactate (iSTAT-1) with the new POCT analyzer (StatStrip) to test the analytical performance. Furthermore, in all fetal scalp blood tests with a lactate en pH measurement from 2021 to 2023, clinical delivery data was collected to perform a clinical verification. Results: The lactate concentration on the StatStrip analyzer correlated well with the iSTAT-1 (Pearson's r ≥ 0.95). 73 Fetal scalp blood tests showed 18% discrepant results when comparing pH and lactate with regard to fetal distress and consequent delivery intervention. Lactate showed more false positive results than pH (4 versus 1), but no false negatives as opposed to pH (0 versus 1). Conclusions: The lactate Statstrip and iSTAT-1 POCT analyzers were analytically equivalent. The clinical verification study showed that lactate is a good predictor of fetal distress, although more false positive results were found in our limited dataset. However, unnecessary interventions due to failed pH measurements might be prevented when a lactate measurement is introduced.

Ying Ni Lin,1,2,&ast; Li Na Zhou,1,2,&ast; Zhuo Ran Liu,3,&ast; Yi Wang,1,2 Shi Qi Li,1,2 Fang Ying Lu,1,2 Liu Zhang,1,2 Qing Yun Li1,2 1Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China; 2Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China; 3Department of Thyroid and Vascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qing Yun Li, Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China, Tel +81-21-64370045, Email liqingyun68@hotmail.comPurpose: Sleep disturbance has been implicated in poor prognosis of coronavirus disease 2019 (COVID-19), but less is known about the influence of short sleep duration on COVID-19 outcomes. We aim to investigate whether short sleep duration is associated with prolonged virus shedding duration in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-infected patients.Patients and Methods: A total of 270 patients with a laboratory confirmed COVID-19 diagnosis during SARS-CoV-2 Omicron-predominant period were recruited. Self-reported sleep duration of the patients was collected. The two-way analysis of variance (ANOVA) was used to determine the interactions between sleep duration and variables, and multivariate logistic regression analysis was used to analyze the effect of independent variables on longer virus shedding duration.Results: The two-way ANOVA revealed a significant sleep duration × snoring interaction effect for virus shedding duration, and a sleep duration × sex interaction effect for virus shedding duration. Multivariate logistic regression model illustrated that patients sleeping < 6 h were at greater risk of prolonged virus shedding duration compared to those sleeping ≥ 6 hours (OR = 1.80, 95% CI = 1.01– 3.26), independent of age, sex, co-existing diseases, vaccination condition, and antiviral treatment.Conclusion: Short sleep duration (< 6 h) was associated with increased virus shedding in SARS-CoV-2 Omicron-infected patients.Keywords: sleep duration, SARS-CoV-2 Omicron, COVID-19 pandemic

Within an advanced Langevin-hydrodynamics framework coupled to a hybrid fragmentation-coalescence hadronization model, we study heavy flavor quenching and flow in relativistic heavy-ion collisions. We investigate how the initial heavy quark spectrum, the in-medium energy loss and hadronization mechanisms of heavy quarks, the evolution profile of the pre-equilibrium stage, the medium flow, and the temperature dependence of heavy quark diffusion coefficients influence the suppression and elliptic flow of heavy mesons at the RHIC and the LHC. Our results show that the different modeling of initial conditions, pre-equilibrium evolution, and in-medium interactions can individually yield uncertainties of approximately 10-40% in D meson suppression and flow at a low transverse momentum. We also find that proper combinations of collisional versus radiative energy loss, coalescence versus fragmentation in hadronization, and the inclusion of medium flow are the most important factors for describing the suppression and elliptic flow of heavy mesons.

We develop for charmed hadron production in relativistic heavy-ion collisions a comprehensive coalescence model that includes an extensive set of s and p-wave hadronic states as well as the strict energy-momentum conservation, which ensures the boost invariance of the coalescence probability and the thermal limit of the produced hadron spectrum. By combining our hadronization scheme with an advanced Langevin-hydrodynamics model that incorporates both elastic and inelastic energy loss of heavy quarks inside the dynamical quark-gluon plasma, we obtain a successful description of the pT-integrated and differential Λc/D0 and Ds/D0 ratios measured at RHIC and the LHC. We find that including the effect of radial flow of the medium is essential for describing the enhanced Λc/D0 ratio observed in relativistic heavy-ion collisions. We also find that the puzzling larger Λc/D0 ratio observed in Au+Au collisions at RHIC than in Pb+Pb collisions at the LHC is due to the interplay between the effects of the QGP radial flow and the charm quark transverse momentum spectrum at hadronization. Our study further suggests that charmed hadrons have larger sizes in medium than in vacuum.

Hua-Xi Zou,1,2,&ast; Tie Hu,1,2,&ast; Jia-Yi Zhao,2,3,&ast; Bai-Quan Qiu,2,4 Chen-Chao Zou,2,4 Qi-Rong Xu,1 Ji-Chun Liu,1,2 Song-Qing Lai,1,2 Huang Huang1,2 1Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 2Institute of Cardiovascular Diseases, Jiangxi Academy of Clinical Medical Sciences, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 3Medical Innovation Experimental Program, Huan Kui College, Nanchang University, Nanchang, People’s Republic of China; 4Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Huang Huang; Song-Qing Lai, Email jack19871212@hotmail.com; ndyfy03743@ncu.edu.cnIntroduction: Sepsis is currently a common condition in emergency and intensive care units, and is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Cardiac dysfunction caused by septic myocardial injury (SMI) is associated with adverse prognosis and has significant economic and human costs. The pathophysiological mechanisms underlying SMI have long been a subject of interest. Recent studies have identified ferroptosis, a form of programmed cell death associated with iron accumulation and lipid peroxidation, as a pathological factor in the development of SMI. However, the current understanding of how ferroptosis functions and regulates in SMI remains limited, particularly in the absence of direct evidence from human heart.Methods: We performed a sequential comprehensive bioinformatics analysis of human sepsis cardiac transcriptome data obtained through the GEO database. The lipopolysaccharide-induced mouse SMI model was used to validate the ferroptosis features and transcriptional expression of key genes.Results: We identified widespread dysregulation of ferroptosis-related genes (FRGs) in SMI based on the human septic heart transcriptomes, deeply explored the underlying biological mechanisms and crosstalks, followed by the identification of key functional modules and hub genes through the construction of protein-protein interaction network. Eight key FRGs that regulate ferroptosis in SMI, including HIF1A, MAPK3, NOX4, PPARA, PTEN, RELA, STAT3 and TP53, were identified, as well as the ferroptosis features. All the key FRGs showed excellent diagnostic capability for SMI, part of them was associated with the prognosis of sepsis patients and the immune infiltration in the septic hearts, and potential ferroptosis-modulating drugs for SMI were predicted based on key FRGs.Conclusion: This study provides human septic heart transcriptome-based evidence and brings new insights into the role of ferroptosis in SMI, which is significant for expanding the understanding of the pathobiological mechanisms of SMI and exploring promising diagnostic and therapeutic targets for SMI.Keywords: septic myocardial injury, ferroptosis, heart transcriptome, key genes, database

Jian-Xiong Wang,&ast; Xu Zhao,&ast; Sheng-Qian Xu Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Sheng-Qian Xu, Email xsqian-1112@163.comBackground: Long non-coding RNAs (lncRNAs) are important regulators in ankylosing spondylitis (AS). Few studies have examined the lncRNA-RNA binding protein (RBP) interaction in AS. This study performed bioinformatics analysis and clinical verification to identify key lncRNAs and propose their RBP interaction.Methods: Three GEO datasets of AS were analyzed by differential expression analysis. The differentially expressed lncRNAs between the AS and control groups were screened out, and the intersecting lncRNAs were regarded as target lncRNAs. Functional was performed to identify target lncRNAs by enrichment analysis, co-expressed RNA analysis, and lncRNA-RBP interaction analysis. Finally, this study analyzed the differential expression level and clinical value of lncRNAs between the AS and control groups.Results: Linc00304, linc00926, and MIAT were differentially expressed and upregulated. Enrichment analysis indicated that the key KEGG terms were the T-cell receptor signaling pathway and B-cell receptor signaling pathway. The key molecular function term was protein binding, and the key biological process term was adaptive immune response. In qRT-PCR results, 44 samples were validated. linc00304 expression was positively correlated with bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). linc00926 expression was only positively correlated with ESR, whereas MIAT expression was positively correlated with BASFI, ESR, and CRP. Logistic regression revealed that linc00304, ESR, and CRP were the independent risk factors for BASDAI activation. The area under the curve (AUC) of serum linc00304 level in the diagnosis of AS was 0.687 (cutoff value: 0.413, specificity: 0.423, sensitivity: 0.900). AUC of linc00926 was 0.664 (cutoff value: 0.299, sensitivity: 0.882, specificity: 0.417). AUC of MIAT was 0.623 (cutoff value: 0.432, specificity: 0.443, sensitivity: 0.890) (all P < 0.05).Conclusion: Overall, this study uncovered three novel lncRNAs, which were upregulated in AS, and proposed a new lncRNA-RBP-mRNA interaction that might regulate adaptive immune response.Keywords: ankylosing spondylitis, long non-coding RNA, RNA binding protein, RNA sequencing

Ma-Chao Li,1,&ast; Xiao-Yue Wang,1,&ast; Tong-Yang Xiao,2,&ast; Shi-Qiang Lin,3 Hai-Can Liu,1 Cheng Qian,4 Da Xu,1 Gui-Lian Li,1 Xiu-Qin Zhao,1 Zhi-Guang Liu,1 Li-Li Zhao,1 Kang-Lin Wan1 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China; 2Department of Clinical Laboratory, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China; 3Department of Bioinformatics, College of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, Fujian Province, People’s Republic of China; 4Beijing Center for Disease Control and Prevention, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li-Li Zhao; Kang-Lin Wan, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, P.O. Box 5, Changping, Beijing, 102206, People’s Republic of China, Tel/Fax +86 10 58900779, Email zhaolili@icdc.cn; wankanglin@icdc.cnObjective: To assess the relationship between the variant rpoB mutations and the degree of rifampin (RIF)/rifabutin (RFB) resistance in Mycobacterium tuberculosis (M. tuberculosis).Methods: We analyzed the whole rpoB gene in 177 M. tuberculosis clinical isolates and quantified their minimum inhibitory concentrations (MICs) using microplate-based assays.Results: The results revealed that of the 177 isolates, 116 were resistant to both RIF and RFB. There were 38 mutated patterns within the sequenced whole rpoB gene of the 120 isolates. Statistical analysis indicated that mutations, S450L, H445D, H445Y, and H445R, were associated with RIF and RFB resistance. Of these mutations, S450L, H445D, and H445Y were associated with high-level RIF and RFB MIC. H445R was associated with high-level RIF MIC, but not high-level RFB MIC. D435V and L452P were associated with only RIF, but not RFB resistance. Q432K and Q432L were associated with high-level RFB MIC. Several single mutations without statistical association with rifamycin resistance, such as V170F, occurred exclusively in low-level RIF but high-level RFB resistant isolates. Additionally, although cross-resistance to RIF and RFB is common, 21 RIF-resistant/RFB-susceptible isolates were identified.Conclusion: This study highlighted the complexity of rifamycin resistance. Identification of the rpoB polymorphism will be helpful to diagnose the RIF-resistant tuberculosis that has the potential to benefit from a treatment regimen including RFB.Keywords: Mycobacterium tuberculosis, rifampin resistance, rifabutin resistance, mutation

Introdução: O Patient Blood Management (PBM) é uma abordagem multidisciplinar, focada no paciente, que objetiva, entre outras coisas, diminuir perdas sanguíneas e promover o uso racional da transfusão, evitando assim complicações como infecção, aumento do tempo de internação e mortalidade. Gerir de forma racional as transfusões em um cenário de hemorragia aguda é desafiador e necessita de envolvimento multidisciplinar. Frente a este cenário, foi estabelecido um protocolo gerenciado (Código Hemorrágico) para garantir padronização e celeridade no atendimento. Objetivo: Avaliar o impacto da instalação do Código Hemorrágico em pacientes com hemorragia aguda através da análise da mediana mensal de transfusões realizadas, além da mediana do consumo mensal de ácido tranexâmico, antes e após a aplicação deste protocolo. Materiais e métodos: Análise retrospectiva das transfusões comparando dados de nove meses antes e nove meses depois da instalação de um protocolo gerenciado de transfusão em casos de hemorragia aguda (2021 versus 2022). O protocolo “Código Hemorrágico” é iniciado diante de um quadro de sangramento agudo significativo onde todos os setores potencialmente envolvidos no tratamento são avisados: centro cirúrgico, anestesiologia, hemodinâmica e banco de sangue. É colhido um pacote de exames laboratoriais, incluindo tromboelastometria e disponibilizados concentrados de hemácias em extrema urgência. Os dados são demonstrados com a mediana devido distribuição não normal e a comparação estatística foi feita por teste t não paramétrico (Man-Whitney) com erro tipo alpha significante abaixo de 5%. Resultados: Em nossa amostra houve diferença estatisticamente significante na mediana do número mensal de transfusões, com 396 em 2021 vs. 356 em 2022 (p = 0.04). Houve aumento na mediana mensal de frascos ácido tranexâmico consumidos, com 525 frascos em 2021 vs. 783 frascos em 2022 (p = 0.006). A relação entre o número total de frascos de ácido tranexâmico administrados e o número total de transfusões foi de 1,24 frasco por transfusão em 2021 para 2,56 em 2022. Discussão: Espera-se que a instalação do protocolo resulte em: a) Menor número mensal de transfusões refletindo controle mais rápido da hemorragia e opção pela estratégia transfusional guiada por tromboleastometria; b) Aumento do consumo de ácido tranexâmico refletindo o controle da hiperfibrinólise. Ambas as expectativas foram atingidas em nossa instituição após a instalação do protocolo. Além disso, houve um aumento substancial no consumo de transamin conforme resultados acima, denotando utilização precoce conforme preconiza a literatura. Destacamos, por outro lado, que o perfil dos pacientes nesses dois períodos analisados foi bastante diferente, devido, em especial a pandemia de COVID-19, com maior número de casos graves em 2021, podendo constituir importante viés em nossa análise. Conclusão: A implementação do Código Hemorrágico em pacientes com hemorragia aguda significativa se relacionou a redução no número total de transfusões e aumento substancial na utilização de ácido tranexâmico, o que reforça a ideia de mudança cultural, com tendência a um manejo de sangramento racional e guiado e indo ao encontro do início da implementação do programa PBM.

Extensive efforts have been devoted in both the engineering and scientific domains to seek new designs and processing techniques capable of making stronger and tougher materials. One such method for enhancing such damage-tolerance in metallic alloys is a surface nano-crystallization technology that involves the use of hundreds of small hard balls which are vibrated using high-power ultrasound so that they impact onto the surface of a material at high speed (termed Surface Mechanical Attrition Treatment or SMAT). However, few studies have been devoted to the precise underlying mechanical mechanisms associated with this technology and the effect of processing parameters. As SMAT is dynamic plastic deformation process, here we use random impact deformation as a means to investigate the relationship between impact deformation and the parameters involved in the processing, specifically ball size, impact velocity, ball density and kinetic energy. Using analytical and numerical solutions, we examine the size of the indents and the depths of the associated plastic zones induced by random impacts, with results verified by experiment in austenitic stainless steels. In addition, global random impact and local impact frequency models are developed to analyze the statistical characteristics of random impact coverage, together with a description of the effect of random multiple impacts, which are more reflective of SMAT. We believe that these models will serve as a necessary foundation for further, and more energy-efficient, development of such surface nano-crystalline processing technologies for the strengthening of metallic materials.

Li Yue Zhang,1,2,&ast; Xian Wen Sun,1,2,&ast; Yong Jie Ding,1,2,&ast; Ya Ru Yan,1,2 Yi Wang,1,2 Chuan Xiang Li,1– 3 Shi Qi Li,1,2 Liu Zhang,1,2 He Jie Song,1,2 Hong Peng Li,1,2 Qing Yun Li1,2 1Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Tongren Hospital Affiliated to Wuhan University, The Third Hospital of Wuhan, Wuhan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qing Yun Li, Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, People’s Republic of China, Email liqingyun68@hotmail.comPurpose: The mechanism of lung cancer (LC) in male patients with chronic obstructive pulmonary disease (COPD) has not been well understood, and the early diagnosis is currently challenging. The study aimed to explore the association of DNA methylation levels with LC development in male COPD patients.Patients and Methods: A total of 147 male participants were divided into four groups, ie, COPD+LC group, COPD group, LC group, and control (CON) group. The methylation levels of human serine protease inhibitor A1 (SERPINA1) and the serum levels of inflammatory biomarkers were compared among groups. Multivariate logistic regression was performed to explore the correlation of inflammatory biomarkers and gene methylation with lung cancer combining COPD.Results: SERPINA1 methylation levels were significantly higher in the COPD+LC group than that in the COPD group and LC group, respectively (all p

He-xiang Zong, Sheng-qian Xu, Jian-xiong Wang, Yi-ran Chu, Ke-ming Chen, Cong Wang, Wan-qiu Tong, Xi-le Wang Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of ChinaCorrespondence: Sheng-qian Xu, Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, No. 218, Ji-xi Road, Hefei, Anhui, 230022, People’s Republic of China, Tel +86 551 62922261, Fax +86 551 62923040, Email xsqian-1112@163.comPurpose: Non-steroidal anti-inflammatory drugs (NSAIDs) have generally been viewed as first-line therapy for axial spondyloarthritis (axSpA). Imrecoxib is a selective COX-2 inhibitor developed independently in China. At present, only one single-center RCT trial has shown that imrecoxib is equally effective as celecoxib in treating axSpA. Based on real-world data, our study aims to explore the efficiency of imrecoxib and TNF inhibitor (TNFi) combined with imrecoxib in treating axSpA.Patients and Methods: A total of 163 patients with axSpA who had more than two follow-up records in 6 months and treated with imrecoxib/celecoxib/TNFi combined with imrecoxib/TNFi combined with celecoxib from the First Affiliated Hospital of Anhui Medical University SpA Real World Database (AHSpA) were selected for analysis of our study. The linear mixed model was used to compare efficacy indexes before and after treatment and between different groups, adjust baseline measurement value and follow-up time. The Kaplan–Meier survival analysis was used to identify the differences in cumulative clinical remission rates between groups with different treatment at the follow-up period.Results: Results showed that after treatment ASDAScrp was slightly improved in imrecoxib group and celecoxib group within 6 months (p < 0.05). CRP, ESR, BASDAI, ASDAScrp, BASFI, occiput to wall distance and finger floor distance all significantly improved in TNFi combined with imrecoxib group and TNFi combined with celecoxib group within 6 months (all p < 0.05). According to the Kaplan–Meier survival curve and Log rank test analysis, the clinical remission rate was not significantly different between different treatment during 24-month follow-up (all p > 0.05).Conclusion: ASDAScrp improved slightly within 6 months after treatment with imrecoxib, and TNFi combined with imrecoxib significantly improved multiple effect indexes in axSpA patients. The efficacy of imrecoxib and celecoxib in the treatment of axSpA is equivalent. Also, they have the same efficacy after being combined with TNFi.Keywords: axial spondyloarthritis, imrecoxib, celecoxib, TNF inhibitor

Wen Yin,&ast; Si-Qi Zhang,&ast; Wen-Lin Pang,&ast; Xiao-Jiao Chen, Jing Wen, Jiong Hou, Cui Wang, Li-Yun Song, Zhen-Ming Qiu, Peng-Tao Liang, Jia-Li Yuan, Zhong-Shan Yang, Yao Bian Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhong-Shan Yang; Yao Bian, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China, Tel +86-871-65919932, Email yangzhongshan@ynutcm.edu.cn; 1345538930@qq.comPurpose: Type 2 diabetes mellitus (T2DM) is a complex genetic disease associated with genetic and environmental factors. Previous studies have shown that changes in the gut microbiota may affect the development of host metabolic diseases and promote the progression of T2DM. Tang-ping-san (TPS) decoction can effectively treat T2DM. However, its specific mechanisms must be evaluated.Patients and Methods: In the present study, we established an animal model of T2DM using a high‑fat diet (HFD) with intraperitoneal injection streptozotocin injection.Results: The therapeutic effect of TPS decoction on T2DM in mice was initially evaluated. TPS decoction was found to improve hyperglycemia, hyperlipidemia, insulin resistance, and pathological liver, pancreatic, and colon changes. Moreover, it reduced the pro-inflammatory cytokine levels. Based on 16SrRNA sequencing, TPS decoction reduced the Firmicutes/Bacteroidetes ratio at the phylum level. At the genus level, it increased the relative abundances of Akkermansia, Muribaculaceae, and the Eubacterium coprostanoligenes group and decreased the relative abundance of Fusobacterium, Escherichia coli, Dubosiella, and Helicobacter.Conclusion: TPS decoction improves T2DM and liver function and reduces the risk of hyperglycemia, hyperlipidemia, insulin resistance, pathological organ changes, and inflammatory reactions. The mechanism of TPS decoction in T2DM can be correlated with the reversal of gut microbiota dysfunction and repair of the intestinal mucosal barrier.Keywords: type 2 diabetes mellitus, tang-ping-san decoction, gut microbiota, glycolipid metabolism, insulin resistance

INTRODUCTION: Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies affecting patients' life. Performing endoscopic carpal tunnel release is now a new technique that is being gradually applied in Vietnam. This paper seeks to investigate the effectiveness of Chow’s method for CTS treatment. MATERIALS AND METHODS: This is a prospective cohort study involving seventy-seven patients with CTS who underwent Chow’s endoscopic method at our hospital from March 2019 to January 2020. The Boston Carpal Tunnel Questionnaire and electromyography (EMG) were used primarily to evaluate surgical decompression pre-operatively, one week, three weeks, three months, and six months after surgery. We also recorded incision length, pain at the scar, the improvement of symptoms and thenar atrophy and return-to-work time after surgery. RESULTS: A total of 85.7% of the patients were women. A moderate severity of EMG was seen in 64.9% of cases. Six-month post-operative functional status scale (FSS) (1.05±0.1) and symptom severity scale (SSS) (1.05±0.1) showed significant improvement when compared with pre- operative FSS (2.8±0.5) and SSS (3.2±0.5). Post-operative EMG showed the distal sensory latency (DSL) and distal motor latency (DML) had returned to the norm in 88% and 89.3%, respectively. The average incision length was 12.1±1.2mm. Six months after surgery, numbness and hand pain had resolved in 97.4%, a painless scar was seen in 94.7%, but full recovery of thenar atrophy was only seen in 9.1%. Patients could get back to work after 10.2±2.4 days. CONCLUSION: Chow’s endoscopic carpal tunnel release is a safe and effective procedure for patients suffering from carpal tunnel syndrome that showed promising outcomes on clinical symptoms and functions on EMG with minimal pain and scarring, and early return to work.

Zhao-Ming Chen,1,&ast; Xiao-Yun Yang,1,2,&ast; Zheng-Tu Li,1,&ast; Wei-Jie Guan,1,3 Ye Qiu,4 Shao-Qiang Li,1 Yang-Qing Zhan,1 Zi-Ying Lei,5 Jing Liu,4 Jian-Quan Zhang,6 Zhong-Fang Wang,1,2 Feng Ye1 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, People’s Republic of China; 2Guangzhou Laboratory, Bio-Island, Guangzhou, Guangdong, People’s Republic of China; 3Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 4Department of Comprehensive Internal Medicine, the Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 5Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China; 6Department of Infectious Diseases, the Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Feng Ye, State 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, Tel +86-020-83062836, Fax +86-020-83062836, Email yefeng@gird.cnBackground: Although anti-IFN-γ autoantibodies predispose patients to Talaromyces marneffei infection, whether this is mediated by T cell attenuation remains elusive.Methods: Total peripheral blood mononuclear cells (PBMCs) from healthy donors or patients with T. marneffei infection were stimulated with M158− 66, and immunodominant influenza H1N1 peptide, or heat-inactivated T. marneffei in the presence of serum from anti-IFN-γ autoantibody-positive patients or healthy controls. The percentages of IFN-γ+TNF+CD8+ T cells and IFN-γ+CD4+ T cells were determined by flow cytometry and cytokines released in the supernatant were detected by Cytometric Bead Array. Furthermore, PBMCs from patients with T. marneffei infection and healthy individuals were stimulated with IFN-γ and anti-CD3/CD28 beads, and the levels of STAT1 and STAT3 phosphorylation were detected by Western blot.Results: The M1-reactive CD8+ T cells that expressed IFN-γ+ TNF-α+ of healthy controls were clearly reduced in serum with high-titer anti-IFN-γ autoantibodies. In addition, the CD4+ T cell response, designated by the expression of IFN-γ, against T. marneffei in PBMCs of patients were significantly decreased when cultured in high-titer anti-IFN-γ autoantibody serum culture, compared to the healthy compartments. Moreover, the release of the cytokines IFN-γ, TNF-α and IL-2 was significantly decreased, while IL-10 was significantly increased. There was no significant difference in the phosphorylation levels of STAT1 and STAT3 protein between patients and healthy controls after IFN-γ or anti-CD3/CD28 beads stimulation.Conclusion: Anti-IFN-γ autoantibodies presence in the serum inhibited CD4+ Th1 and CD8+ T cell immune responses. There was no congenital dysfunction of STAT1 and STAT3 in anti-IFN-γ autoantibody-positive patients with T. marneffei infection. These results suggest that the production of anti-IFN-γ autoAbs impair T-lymphocyte responses.Keywords: anti-interferon-γ autoantibody, T lymphocyte, Talaromyces marneffei, signal transducer and activator of transcription 1, signal transducer and activator of transcription 3

Ling-Yao Qi, Han-Xiong Liu, Lian-Chao Cheng, Yan Luo, Si-Qi Yang, Xu Chen, Lin Cai Department of Cardiology, The Third People’s Hospital of Chengdu Affiliated Hospital of Southwest Jiaotong University, Chengdu, People’s Republic of ChinaCorrespondence: Lin Cai, Department of Cardiology, The Third People’s Hospital of Chengdu Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong St, Chengdu, Sichuan, People’s Republic of China, Tel/Fax +86 28-67575956, Email clin63@hotmail.comPurpose: The leuko-glycaemic index (LGI) is an index that combines white blood cell count and blood glucose and could be a marker of systemic inflammatory response syndrome. The prognostic value of the LGI in acute myocardial infarction (AMI) is still unclear. We aimed to investigate the prognostic value of the LGI for short- and long-term prognosis in AMI patients with different diabetic status.Patients and Methods: This was an observational, multicenter study involving 1256 AMI patients admitted in 11 hospitals between March 2014 and June 2019 in Chengdu. White blood cell count and blood glucose were measured on admission. The LGI was calculated by multiplying both values and dividing them by a thousand. Logistic regression was used to explore the predictive value of LGI in in-hospital mortality. Receiver operating characteristic curve was used to determine the optimal cut-off values of the LGI to predict in-hospital mortality. The patients were classified into diabetic and non-diabetic groups and further divided into higher and lower LGI subgroups according to the optimal cut-off values. The endpoints were all-cause mortality during the hospitalization and major adverse cardiovascular and cerebrovascular events (MACCE) during follow-up, including all-cause mortality, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke.Results: LGI was an independent predictor of all-cause mortality during the hospitalization in non-diabetics, but not in diabetics. The optimal cut-off values of diabetics and non-diabetics were 3593 mg/dl. mm3 and 1402 mg/dl. mm3, respectively. Whether diabetics or not, in-hospital mortality was higher in the higher LGI subgroup (p-value < 0.001). And in the follow-up of 15 months (9 months, 22 months), we observed 99 (8.6%), 6 (0.5%), 54 (4.7%) and 29 (2.5%) cases of death, non-fatal MI, revascularization and non-fatal stroke, respectively. The cumulative incidence of MACCE during follow-up was higher in the higher LGI subgroup, both in the diabetics and non-diabetics (p-value < 0.05). In non-diabetics, higher LGI was an independent predictor of MACCE.Conclusion: LGI was an independent predictor for short- and long-term prognosis in AMI patients without diabetes, but had no prognostic value for short- and long-term prognosis of AMI patients with diabetes.Keywords: acute myocardial infarction, prediction, leuko-glycemic index, in-hospital mortality, long-term prognosis