Prediction of non-muscle invasive bladder cancer recurrence using deep learning of pathology image.

We aimed to build a deep learning-based pathomics model to predict the early recurrence of non-muscle-infiltrating bladder cancer (NMIBC) in this work. A total of 147 patients from Xuzhou Central Hospital were enrolled as the training cohort, and 63 patients from Suqian Affiliated Hospital of Xuzhou Medical University were enrolled as the test cohort. Based on two consecutive phases of patch level prediction and WSI-level predictione, we built a pathomics model, with the initial model developed in the training cohort and subjected to transfer learning, and then the test cohort was validated for generalization. The features extracted from the visualization model were used for model interpretation. After migration learning, the area under the receiver operating characteristic curve for the deep learning-based pathomics model in the test cohort was 0.860 (95% CI 0.752-0.969), with good agreement between the migration training cohort and the test cohort in predicting recurrence, and the predicted values matched well with the observed values, with p values of 0.667766 and 0.140233 for the Hosmer-Lemeshow test, respectively. The good clinical application was observed using a decision curve analysis method. We developed a deep learning-based pathomics model showed promising performance in predicting recurrence within one year in NMIBC patients. Including 10 state prediction NMIBC recurrence group pathology features be visualized, which may be used to facilitate personalized management of NMIBC patients to avoid ineffective or unnecessary treatment for the benefit of patients.

IL-33 Suppresses the Progression of Atherosclerosis via the ERK1/2-IRF1-VCAM-1 Pathway.

PURPOSE: This study was designed to explore the effects of interleukin 33 (IL-33) on the progression of atherosclerosis and the possible mechanism. METHODS: The adhesion assay was performed on isolated peripheral blood mononuclear cells (PBMCs) and human umbilical vein endothelial cells (HUVEC). The expression of proteins and messenger RNA (mRNA) were detected by western blot and quantitative real-time polymerase chain reaction (PCR), including intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and P-selectin. The effect of IL-33 on the interaction of growth stimulation expressed gene 2 (ST2) with myeloid differentiation factor 88 (MyD88) and interleukin-1 receptor-associated kinase (IRAK) 1/4 were investigated using co-immunoprecipitation assay. An apolipoprotein (Apo) E-/- mice model was used to confirm the effect of IL-33 on atherosclerosis progression. Area of plaques was recorded by hematoxylin-eosin (H&E) staining. The severity of atherosclerosis plaque was evaluated using immunohistochemistry assay, and lipid accumulation was measured by an oil red O staining. In contrast, western blot was performed to detect the expression levels of VCAM-1, extracellular signal-regulated kinase (ERK) 1/2, and interferon regulatory factor 1 (IRF1). RESULTS: Our study observed that IL-33 suppressed cell adhesion and the expression of VCAM-1 in tumor necrosis factor-α (TNF-α) exposed HUVEC. Moreover, the addition of IL-33 significantly inhibited the expression of IRF1 and the binding level of IRF1 to VCAM-1 and also promoted the phosphorylation level of IRAK1/4 and ERK1/2 compared to TNF-α-stimulated HUVEC. The ST2 neutralizing antibody or ERK pathway inhibitor SCH772984 reversed the regulatory effects of IL-33 on HUVEC, suggesting that IL-33 suppressed IRF1 and VCAM-1 dependent on binding to ST2 and activating the ERK1/2 signaling pathway. Further investigation in vivo confirmed that IL-33 decreased the expressions of IRF1 and VCAM-1 by activating the phosphorylation of ERK1/2 in the thoracic aorta of Apo E-/- mice. CONCLUSION: In conclusion, our results demonstrated that IL-33 plays a protective role in the progression of atherosclerosis by inhibiting cell adhesion via the ERK1/2-IRF1-VCAM-1 pathway. This study may provide a potential therapeutic way to prevent the development of atherosclerosis.

Artificial Downregulation of Ribosomal Protein L34 Restricts the Proliferation and Metastasis of Colorectal Cancer by Suppressing the JAK2/STAT3 Signaling Pathway.

The highly conserved ribosomal protein L34 (RPL34) has been reported to play an essential role in the progression of diverse malignancies. RPL34 is aberrantly expressed in multiple cancers, although its significant in colorectal cancer (CRC) is currently unclear. Here, we demonstrated that RPL34 expression was higher in CRC tissues than in normal tissues. Upon RPL34 overexpression, the ability of proliferation, migration, invasion, and metastasis of CRC cells were significantly enhanced in vitro and in vivo. Furthermore, high expression of RPL34 accelerated cell cycle progression, activated the JAK2/STAT3 signaling pathway, and induced the epithelial-to-mesenchymal transition (EMT) program. Conversely, RPL34 silencing inhibited the CRC malignant progression. Utilizing immunoprecipitation assays, we identified the RPL34 interactor, the cullin-associated NEDD8-dissociated protein 1 (CAND1), which is a negative regulator of cullin-RING ligases. CAND1 overexpression reduced the ubiquitin level of RPL34 and stabilized RPL34 protein. CAND1 silencing in CRC cells resulted in a decrease in the ability of proliferation, migration, and invasion. CAND1 overexpression promoted CRC malignant phenotypes and induced EMT, and RPL34 knockdown rescued CAND1-induced CRC progression. In summary, our study indicates that RPL34 acts as a mediator, is stabilized by CAND1, and promotes proliferation and metastasis, in part, through the activation of the JAK2/STAT3 signaling pathway and induction of EMT in CRC.

The relationship between exercise motivation and exercise behavior in college students: The chain-mediated role of exercise climate and exercise self-efficacy.

Objective: This study explored the relationship between college students' physical activity motivation and exercise behavior and constructed a chain mediation model through the mediating roles of exercise climate and exercise self-efficacy. Methods: By random sampling, 1,032 college students were investigated using the Exercise Motivation Scale, Physical Exercise Rating Scale, Exercise Climate Scale, and Exercise Self-Efficacy Scale. Results: (1) There was a huge positive correlation between exercise motivation and exercise behavior (r = 0.240, p < 0.01), and the immediate ways of linking exercise motivation to exercise behavior were critical (ß = 0.068, t = 0.040, p < 0.01). (2) Exercise motivation could positively predict exercise climate (ß = 0.373, t = 0.061, p < 0.01) and exercise self-efficacy (ß = 0.174, t = 0.039, p < 0.01), and exercise climate could emphatically foresee exercise behavior (ß = 0.302, t = 0.051, p < 0.01). Exercise self-efficacy could foresee exercise behavior decidedly (ß = 0.190, t = 0.048, p < 0.01). (3) Exercise climate and exercise self-efficacy play a critical intervening role between exercise motivation and exercise behavior. The intercession impact is explicitly made out of aberrant impacts created in three ways: exercise motivation → exercise climate → exercise behavior (mediating effect value: 0.113); exercise motivation → exercise self-efficacy → exercise behavior (mediating effect value: 0.033); exercise motivation → exercise climate → exercise self-efficacy → exercise behavior (mediating effect value: 0.027). Conclusion: (1) Exercise climate, exercise self-efficacy, and exercise behavior can all be significantly predicted by exercise motivation, suggesting that exercise motivation may help to enhance these variables. (2) In addition to having a direct impact on exercise behavior, exercise motivation can also have an indirect impact through the separate mediating effects of exercise climate and exercise self-efficacy as well as the chain mediating effect of exercise climate and exercise self-efficacy, which is crucial for encouraging college students to engage in physical activity.

Self-inflicted intravesical insertion of 83 magnetic balls in a 10-year-old boy: a case report and literature review.

BACKGROUND: A magnetic ball is a toy for children that can cause physical injury when used improperly. The injury of urethra and bladder caused by magnetic ball is rarely reported. CASE: Here we present a case of self-inflicted intravesical insertion of 83 magnetic balls by a 10-year-old boy. Preliminary diagnosis was made by a plain radiograph of the pelvis and ultrasonic examination of bladder and all the magnetic balls were removed under cystoscopy successfully. CONCLUSIONS: For children with recurrent bladder irritation, the possibility of bladder foreign body should be considered. Surgery is an effective method. For patients without serious complications, cystoscopy is the gold standard for diagnosis and treatment.

Epigenetic Regulations in Autoimmunity and Cancer: from Basic Science to Translational Medicine.

Epigenetics, as a discipline that aims to explain the differential expression of phenotypes arising from the same gene sequence and the heritability of epigenetic expression, has received much attention in medicine. Epigenetic mechanisms are constantly being discovered, including DNA methylation, histone modifications, noncoding RNAs and m6A. The immune system mainly achieves an immune response through the differentiation and functional expression of immune cells, in which epigenetic modification will have an important impact. Because of immune infiltration in the tumor microenvironment, immunotherapy has become a research hotspot in tumor therapy. Epigenetics plays an important role in autoimmune diseases and cancers through immunology. An increasing number of drugs targeting epigenetic mechanisms, such as DNA methyltransferase inhibitors, histone deacetylase inhibitors, and drug combinations, are being evaluated in clinical trials for the treatment of various cancers (including leukemia and osteosarcoma) and autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis). This review summarizes the progress of epigenetic regulation for cancers and autoimmune diseases to date, shedding light on potential therapeutic strategies.

Duodenal Dieulafoy lesion: a rare pathogeny of gastrointestinal bleeding in children.

BACKGROUND: Dieulafoy lesion is a calibre persistent submucosal artery associated with a minuter mucosal defect. Dieulafoy lesion has been reported to account for 1-5.8% of acute nonvariceal upper gastrointestinal bleeding in adults, but it is rarely reported in children. CASE: Here we report a case of duodenal Dieulafoy lesion in a 13-year-old boy. After endoscopy and laparotomy, he still had no definite diagnosis and effective treatment. The duodenal Dieulafoy lesion was finally identified by selective angiography and was effectively treated by intravascular embolization. CONCLUSIONS: For unexplained upper gastrointestinal bleeding, the possibility of duodenal Dieulafoy lesion should be considered. A combination of multiple diagnosis and treatment methods can improve the success rate of diagnosis and treatment when a single test or treatment method cannot provide definitive diagnosis or effective treatment.

Pediatric unicystic cystic partially differentiated nephroblastoma: The first case report.

Cases of patients with cystic partially differentiated nephroblastoma (CPDN) have been reported to date, which presented as polycystic renal tumor in all of them. It is a special pathological type of nephroblastoma. Here, we report the first case of a unicystic CPDN in a child. The patient was diagnosed with a simple renal cyst and underwent laparoscopic decortication. The naive nephron was found in the pathological section, and the diagnosis of CPDN was confirmed. The patient then underwent a radical nephrectomy and six cycles of postoperative chemotherapy. There was no recurrence or metastasis after 2 years of follow-up. Pediatric CPDN presenting as a unicystic renal tumor poses a new challenge to the diagnosis, differential diagnosis, and treatment of unicystic renal tumor.

Identification and analysis of microRNA editing events in recurrent bladder cancer based on RNA sequencing: MicroRNA editing level is a potential novel biomarker.

Background: With the continued advancement of RNA-seq (RNA-sequencing), microRNA (miRNA) editing events have been demonstrated to play an important role in different malignancies. However, there is yet no description of the miRNA editing events in recurrent bladder cancer. Objective: To identify and compare miRNA editing events in primary and recurrent bladder cancer, as well as to investigate the potential molecular mechanism and its impact on patient prognosis. Methods: We examined the mRNA and miRNA transcriptomes of 12 recurrent bladder cancer cases and 13 primary bladder cancer cases. The differentially expressed mRNA sequences were analyzed. Furthermore, we identified the differentially expressed genes (DEGs) in recurrent bladder cancer. The Gene Ontology (GO) functional enrichment analyses on DEGs and gene set enrichment analysis were performed. The consensus molecular subtype (CMS) classification of bladder cancer was identified using the Consensus MIBC package in R (4.1.0); miRNA sequences were then further subjected to differentially expressed analysis and pathway enrichment analysis. MiRNA editing events were identified using miRge3.0. miRDB and TargetScanHuman were used to predict the downstream targets of specific differentially edited or expressed miRNAs. The expression levels of miR-154-5p and ADAR were validated by RT-qPCR. Finally, survival and co-expression studies were performed on the TCGA-BLCA cohort. Results: First, the mRNA expression levels in recurrent bladder cancer changed significantly, supporting progression via related molecular signal pathways. Second, significantly altered miRNAs in recurrent bladder cancer were identified, with miR-154-5p showing the highest level of editing in recurrent bladder cancer and may up-regulate the expression levels of downstream targets HS3ST3A1, AQP9, MYLK, and RAB23. The survival analysis results of TCGA data revealed that highly expressed HS3ST3A1 and RAB23 exhibited poor prognosis. In addition, miR-154 editing events were found to be significant to CMS classification. Conclusion: MiRNA editing in recurrent bladder cancer was detected and linked with poor patient prognosis, providing a reference for further uncovering the intricate molecular mechanism in recurrent bladder cancer. Therefore, inhibiting A-to-I editing of miRNA may be a viable target for bladder cancer treatment, allowing current treatment choices to be expanded and individualized.

2D MXene Nanomaterials as Electrocatalysts for Hydrogen Evolution Reaction (HER): A Review.

MXenes, a novel family of 2D transition metal carbide, nitride and carbonitride materials, have been gaining tremendous interest in recent days as potential electrocatalysts for various electrochemical reactions, including hydrogen evolution reaction (HER). MXenes are characterized by their etchable metal layers, excellent structural stability, versatility for heteroatoms doping, excellent electronic conductivity, unique surface functional groups and admirable surface area, suitable for the role of electrocatalyst/support in electrochemical reactions, such as HER. In this review article, we summarized recent developments in MXene-based electrocatalysts synthesis and HER performance in terms of the theoretical and experimental point of view. We systematically evaluated the superiority of the MXene-based catalysts over traditional Pt/C catalysts in terms of HER kinetics, Tafel slope, overpotential and stability, both in acidic and alkaline electrolytic environments. We also pointed out the motives behind the electro catalytic enhancements, the effect of synthesis conditions, heteroatom doping, the effect of surface terminations on the electrocatalytic active sites of various MXenes families. At the end, various possible approaches were recommended for a deeper understanding of the active sites and catalytic improvement of MXenes catalysts for HER.

Development and validation of an immune-related prognosis signature associated with hypoxia and ferroptosis in hepatocellular carcinoma.

BACKGROUND: Hypoxia and ferroptosis are crucial in the occurrence and development of hepatocellular carcinoma (HCC), and they both affect the immune status of the tumor microenvironment. Previous studies have also shown a link between hypoxia and ferroptosis. PATIENTS AND METHODS: In all, 814 HCC cases from The Cancer Genome Atlas and Gene Expression Omnibus databases were used as the discovery cohort, and 230 HCC cases from the International Cancer Genome Consortium database were used as the validation cohort. Hypoxia subtypes and ferroptosis subtypes were identified by consensus cluster analysis according to 174 hypoxia-related genes and 193 ferroptosis-related genes. The prognostic signature was constructed using the Cox and LASSO regression analyses, and two risk groups were identified. A comprehensive analysis of the clinical and immune characteristics between the two risk groups was further performed. RESULTS: Two hypoxia subtypes and two ferroptosis subtypes were distinguished and verified; subsequently, a five-gene prognostic signature was constructed and the risk score could be acquired by the following formula: risk score = 0.0604*Expression (CA9)-0.0714*Expression (ANXA10) + 0.1501*Expression (CDC20)-0.0853*Expression (CYP7A1) + 0.0530*Expression (SPP1). Compared with the low-risk group, the high-risk group had a worse prognosis. The high-risk group also showed a higher level of immune infiltration than the low-risk group, and immune checkpoints were generally upregulated in the high-risk group. The antigen presentation ability of the low-risk group was poor, which may be related to the immune escape mechanism. Drug sensitivity analysis indicated that the high- and low-risk groups were sensitive to tyrosine kinase inhibitors and chemotherapeutic drugs, respectively. CONCLUSION: The hypoxia-, ferroptosis-, and immune-associated prognostic signature we constructed could stratify patients with HCC and guide precise treatment.

Assessing the performance of sustainable entrepreneurship and environmental corporate social responsibility: revisited environmental nexus from business firms.

Society is currently contemplating sustainable growth strategies, which have become somewhat apprehensive by associating entrepreneurship, innovation, and sustainable development. In this perspective, this article's objective is to connect sustainable development to environmentally sensitive entrepreneurship via scientific proof of developing nations. Therefore, this research objective is to confirm the hypothesis of corporate social responsibility (CSR) to confirm that Pakistan achieves its objectives for sustainable development. The combined average estimator and pooled mean group (PMG) model of the self-release lag model determines a lengthy-term combination of factors and environmental analysis in the Kuznets. We can see the U-shaped ecological arcs in Pakistan. Further results show that the pooled mean group autoregressive distributed lag (PMG-ARDL) estimator has a long-term relationship. This indicates that a 1% rise in per-capita income at some stage of industrial growth will reduce environmental emissions by 2.88%, 4.54%, and 2.48%. The results show that (1) CSR has a substantial and robust link to the two factors of organizational success (employee engagement and credibility); (ii) respectively socio-cultural and ecological CSR make a positive contribution to the success of Pakistani companies; (iii) the ecological dimensions of CSR being the essential relevance to Pakistani companies' credibility and engagement of employees. This research attempts to include additional analytical information on the contribution of CSR to profitable growth. This also has academic and empirical ramifications, showing how domestic and international companies in developing countries can do CSR. This research is expected to give guidance to policymakers.

Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA.

Objectives: To investigate the predictive factors for successful recanalization based on digital subtraction angiography and three-dimensional T1W sampling perfection with application-optimized contrasts using different flip angle evolutions (3D T1-SPACE) high-resolution magnetic resonance imaging (MRI) signal features. Methods: Consecutive internal carotid artery occlusion cases with ipsilateral ischemic stroke refractory to therapy who visited our institution between February 2017 and August 2020 were retrospectively analyzed. Epidemiology, symptomatology, imaging morphology on angiography and MRI, peri-procedural complications, technical success rate, and follow-up results were summarized. Factors related to technical success were analyzed using univariate and multivariate analyses. Results: In total, 75 cases (53 men, mean age 57.51 ± 9.71 years) were included. The total successful recanalization rate was 72.00% (54/75), with a complication rate of 13.33% (9/75). Through multivariate analysis, first ischemic stroke in <3 months (OR: 2.57; 95% CI: 1.13-4.58), tapered stump (OR: 4.31; 95% CI: 1.37-13.55), reversed flow of the ophthalmic artery (OR: 2.99; 95% CI: 1.06-8.49), high intraluminal signal on unenhanced T1-SPACE sequence (OR: 16.15; 95% CI: 3.40-76.72), no vessel wall collapse (OR: 17.00; 95% CI: 3.57-81.02), short occlusion length (OR: 9.87; 95% CI: 2.09-46.64), and primary occlusion site at the cervical internal carotid artery (OR: 8.42; 95% CI: 1.04-68.19) were associated with successful recanalization. Conclusion: Besides traditional features such as short ischemic event time, tapered stump, and distal ICA reconstitution by the ophthalmic artery, our study demonstrates that luminal and mural changes determined by 3D SPACE high-resolution MRI could also predict successful endovascular recanalization. Endovascular recanalization for non-acute internal carotid artery occlusion is feasible, but prudent case selection is mandatory considering the high periprocedural complication rate.

On-line weight estimation of broiler carcass and cuts by a computer vision system.

In a broiler carcass production conveyor system, inspection, monitoring, and grading carcass and cuts based on computer vision techniques are challenging due to cuts segmentation and ambient light conditions issues. This study presents a depth image-based broiler carcass weight prediction system. An Active Shape Model was developed to segment the carcass into 4 cuts (drumsticks, breasts, wings, and head and neck). Five regression models were developed based on the image features for each weight estimation (carcass and its cuts). The Bayesian-ANN model outperformed all other regression models at 0.9981 R2 and 0.9847 R2 in the whole carcass and head and neck weight estimation. The RBF-SVR model surpassed all the other drumstick, breast, and wings weight prediction models at 0.9129 R2, 0.9352 R2, and 0.9896 R2, respectively. This proposed technique can be applied as a nondestructive, nonintrusive, and accurate on-line broiler carcass production system in the automation of chicken carcass and cuts weight estimation.

Epidemiology and factors predicting survival of amyotrophic lateral sclerosis in a large Chinese cohort.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder associated with loss of motor neurons. Our objective was to explore the epidemiology, clinical features, and survival factors of 1809 patients with ALS. METHODS: We analyzed 1809 ALS patients, who were recruited from the Peking University Third Hospital from January 2005 to December 2015. Demographic data and disease-related parameters were collected. Kaplan-Meier curves were used to compare survival time. Cox proportional hazards function and the hazard ratio were used to identify adjusted prognostic predictors. RESULTS: The results showed that the average annual incidence in Beijing alone was 0.38 cases/100,000 person-years and the mean age of onset was 48.88 ±â€Š11.35 (95% confidence interval [CI]: 48.17-49.85) years. The median survival time from onset to death/tracheostomy was 58.89 ±â€Š33.03 (95% CI: 51.46-63.84) months. In the adjusted Cox proportional hazard model, age of onset, diagnosis delay, rate of disease progression (Amyotrophic Lateral Sclerosis Functional Rating Scale Revised decline [points/month]), and body mass index all had an independent effect on survival in ALS. CONCLUSIONS: Our study provides information on epidemiology, clinical features, and survival factors of patients with ALS in China. These results can be helpful in clinical practice, clinical trial design, and validation of new tools to predict disease progression.

Reflections on the aconitine poisoning.

Aconitine is a natural toxic substance belonging to the family of aconitum alkaloids, which is used in small doses by Traditional Chinese practitioners. We present a case of accidental death due to acute aconitine poisoning. A 65-year-old Chinese man presented to a medical clinic with fever and shoulder pain. Soon after administration of intravenous ceftriaxone, a bottle of Chinese medicinal wine was administered. The man rapidly experienced headache, hearing loss and tinnitus, nausea, diarrhea, numbness of the lips, tongue, face, and the upper and lower extremities, cold sweat, fall of blood pressure, and discomfort of the entire body, and he died on the same day. Postmortem examination showed cyanosis of the nail beds, severe congestion in lungs and other organs, bilateral pleural effusions, and infiltration of basophils in the intestinal submucosa. No significant increase of IgE was found in the blood. Toxicological analysis detected aconitine in the medicinal wine, blood, and stomach contents by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Aconitine was quantified in cardiac blood as 16.4 ng/ml, and in stomach contents (63.8 ng/ml) and wine sample (10.1 ug/ml). The cause of death was aconitine poisoning. This case report highlights the danger of aconitine. LC-MS/MS has the advantages of high analytic speed, sensitivity, and accuracy. It would be desirable for the government to control the use of aconitine-containing herbal extracts.

Corrigendum: A Matrine Derivative M54 Suppresses Osteoclastogenesis and Prevents Ovariectomy-Induced Bone Loss by Targeting Ribosomal Protein S5.

[This corrects the article DOI: 10.3389/fphar.2018.00022.].

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China.

BACKGROUND: Whether regional lymphadenectomy (RL) should be routinely performed in patients with T1b gallbladder cancer (GBC) remains a subject of debate. AIM: To investigate whether RL can improve the prognosis of patients with T1b GBC. METHODS: We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China. The log-rank test and Cox proportional hazards model were used to compare the overall survival (OS) of patients who underwent cholecystectomy (Ch) + RL and those who underwent Ch only. To investigate whether combined hepatectomy (Hep) improved OS in T1b patients, we studied patients who underwent Ch + RL to compare the OS of patients who underwent combined Hep and patients who did not. RESULTS: Of the 121 patients (aged 61.9 ± 10.1 years), 77 (63.6%) underwent Ch + RL, and 44 (36.4%) underwent Ch only. Seven (9.1%) patients in the Ch + RL group had lymph node metastasis. The 5-year OS rate was significantly higher in the Ch + RL group than in the Ch group (76.3% vs 56.8%, P = 0.036). Multivariate analysis showed that Ch + RL was significantly associated with improved OS (hazard ratio: 0.51; 95% confidence interval: 0.26-0.99). Among the 77 patients who underwent Ch + RL, no survival improvement was found in patients who underwent combined Hep (5-year OS rate: 79.5% for combined Hep and 76.1% for no Hep; P = 0.50). CONCLUSION: T1b GBC patients who underwent Ch + RL had a better prognosis than those who underwent Ch. Hep + Ch showed no improvement in prognosis in T1b GBC patients. Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines, RL was only performed in 63.6% of T1b GBC patients. Routine Ch + RL should be advised in T1b GBC.

Dynamically controllable multi-switch and slow light based on a pyramid-shaped monolayer graphene metamaterial.

Graphene, a new two-dimensional (2D) material, has attracted considerable attention in recent years because of the metallic characteristics at terahertz frequencies. The phase coupling of multilayer graphene-coupled grating structures is normally used to realize multiple plasmon-induced transparency (PIT) spectral responses. However, the device becomes more complicated with the increase in the number of graphene layers. In this work, we propose a five-step-coupled pyramid-shaped monolayer graphene metamaterial and predict a dynamically controllable PIT with four transparency peaks for the first time in the monolayer graphene metamaterial. A tunable multi-switch and good slow light effect is predicted over the wide PIT window, and the maximum modulation depth is high up to 16.89 dB, which corresponds to 97.95%, while the time delay of the induced transparent window is as high as 0.488 ps, where the corresponding group refractive index is 586. The electric field distributions and quantum level theory are used to explain the physical mechanism of the PIT with four transparency peaks. The coupled mode theory (CMT) is employed to establish the mathematical model of the PIT with four transparency peaks, and the consistency between the simulated and the calculated results is nearly perfect. We believe that the pyramid-shaped monolayer graphene metamaterial could be useful in efficient filters, switches, and slow light devices.

The state of nursing research from 2000 to 2019: A global analysis.

AIM: This study aims to present a general bibliometric overview of the development status of global nursing research from 2000 to 2019. DESIGN: A longitudinal bibliometric analysis of nursing research was conducted. METHODS: Nursing research publications (N = 88,665) were obtained from Web of Science. Bibliometric method was used to map the output and citation impact trends of countries/regions, institutions, disciplines, and journals and analyse the research collaboration among countries/regions and institutions. RESULTS: The global paper output in nursing research increased steadily over the past two decades and it varied in different countries/regions with the USA being far ahead of the others. The paper output and cross-border collaboration are mainly distributed in several developed countries like the USA, the UK, Australia, and Canada. The University of Pennsylvania, Harvard University, University of Toronto, and University of North Carolina at Chapel Hill have high academic influence in the field of nursing. Increasing attention from academic fields has been paid to research on nursing. Journal of Advanced Nursing is the most prolific and most cited journal in nursing field. CONCLUSION: Nursing research has developed steadily over the last two decades. Both the scientific output and research collaboration are disproportionally distributed between high-income countries/regions and low- and middle-income countries/regions. Most research and collaboration have taken place in a few developed countries across North America, Europe, and Oceania. IMPACT: The study highlighted the need for policy makers and funding agencies, especially those from low- and middle-income countries/regions, to allocate research funding that supports the nursing higher education and international cooperation so as to promote the development of high-quality nursing research in those countries/regions. At the same time, researchers from non-English-speaking countries/regions should attach more importance to publishing papers in English, strengthening the academic exchanges with international nursing colleagues and better integrating into the international academic community.