Radiomics-based ultrasound models for thyroid nodule differentiation in Hashimoto's thyroiditis.

Background: Previous models for differentiating benign and malignant thyroid nodules(TN) have predominantly focused on the characteristics of the nodules themselves, without considering the specific features of the thyroid gland(TG) in patients with Hashimoto's thyroiditis(HT). In this study, we analyzed the clinical and ultrasound radiomics(USR) features of TN in patients with HT and constructed a model for differentiating benign and malignant nodules specifically in this population. Methods: We retrospectively collected clinical and ultrasound data from 227 patients with TN and concomitant HT(161 for training, 66 for testing). Two experienced sonographers delineated the TG and TN regions, and USR features were extracted using Python. Lasso regression and logistic analysis were employed to select relevant USR features and clinical data to construct the model for differentiating benign and malignant TN. The performance of the model was evaluated using area under the curve(AUC), calibration curves, and decision curve analysis(DCA). Results: A total of 1,162 USR features were extracted from TN and the TG in the 227 patients with HT. Lasso regression identified 14 features, which were used to construct the TN score, TG score, and TN+TG score. Univariate analysis identified six clinical predictors: TI-RADS, echoic type, aspect ratio, boundary, calcification, and thyroid function. Multivariable analysis revealed that incorporating USR scores improved the performance of the model for differentiating benign and malignant TN in patients with HT. Specifically, the TN+TG score resulted in the highest increase in AUC(from 0.83 to 0.94) in the clinical prediction model. Calibration curves and DCA demonstrated higher accuracy and net benefit for the TN+TG+clinical model. Conclusion: USR features of both the TG and TN can be utilized for differentiating benign and malignant TN in patients with HT. These findings highlight the importance of considering the entire TG in the evaluation of TN in HT patients, providing valuable insights for clinical decision-making in this population.

Effect of pretreatment with a P2Y12 inhibitor in patients with non-ST-elevation acute coronary syndrome: a systematic review and network meta-analysis.

Background: This study aimed to systematically evaluate the effects of different types and doses of pretreatment with P2Y12 inhibitors in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Methods: Electronic databases were searched for studies comparing pretreatment with different types and doses of P2Y12 inhibitors or comparison between P2Y12 inhibitor pretreatment and nonpretreatment. Electronic databases included the Cochrane Library, PubMed, EMBASE, and Web of Science. Literature was obtained from the establishment of each database until June 2022. The patients included in the study had pretreatment with P2Y12 inhibitors with long-term oral or loading doses, or conventional aspirin treatment (non-pretreatment). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs) during follow-up within 30 days after PCI, which included determining the composite endpoints of cardiac death, myocardial infarction, ischemia-driven revascularization, and stroke. The safety endpoint was a major bleeding event. Results: A total of 119,014 patients from 21 studies were enrolled, including 13 RCTs and eight observational studies. A total of six types of interventions were included-nonpretreatment (placebo), clopidogrel pretreatment, ticagrelor pretreatment, prasugrel pretreatment, double loading pretreatment (double loading dose of clopidogrel, ticagrelor, prasugrel) and P2Y12 inhibitors pretreatment (the included studies did not distinguish the types of P2Y12 inhibitors, including clopidogrel, ticagrelor, and prasugrel). The network meta-analysis results showed that compared to patients without pretreatment, patients receiving clopidogrel pretreatment (RR = 0.78, 95% CI:0.66, 0.91, P < 0.05) and double-loading pretreatment (RR = 0.62, 95% CI:0.41, 0.95, P < 0.05) had a lower incidence of MACCEs. There was no statistically significant difference in the incidence of major bleeding events among the six pretreatments (P > 0.05). Conclusions: In patients with NSTE-ACS, pretreatment with P2Y12 inhibitors before percutaneous intervention reduced the incidence of recurrent ischemic events without increasing the risk of major bleeding after PCI compared with nonpretreatment. Clopidogrel or double loading dose P2Y12 inhibitors can be considered for the selection of pretreatment drugs.

A novel de-escalation antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention.

To investigate the effect of different DAPTs in patients with ACS undergoing PCI, and to identify the most efficient DAPT to reduce the risk of ischemia and bleeding after PCI. Between March 2017 and December 2021, 1598 patients with ACS who underwent PCI were included in the study. The DAPT protocol included the clopidogrel group (aspirin 100 mg + clopidogrel 75 mg), ticagrelor group (aspirin 100 mg + ticagrelor 90 mg), de-escalation Group 1 (reduced dose of ticagrelor [from 90 mg to 60 mg]) after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]), and de-escalation Group 2 (switched from ticagrelor to clopidogrel after 3 months of oral DAPT [aspirin 100 mg + ticagrelor 90 mg]). All patients received a 12-month follow-up. The primary endpoint was net adverse clinical events (NACEs) that included the composite endpoints of cardiac death, myocardial infarction, ischemia-driven revascularization, stroke, and bleeding events. There were 2 secondary endpoints, major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding. No statistically significant difference was found in the incidence of NACEs between the 4 groups at the average 12-month follow-up (15.7% vs 19.2% vs 16.7% vs 20.4%). Cox regression analysis revealed that DAPT ticagrelor group regimen (hazard ratio [HR] 0.547; 95% confidence interval [CI]: 0.334-0.896; P  = .017) were associated with a lower risk of MACCEs. Age (HR 1.024; 95% CI: 1.003-1.046; P  = .022). DAPT de-escalation Group 2 regimen (HR 1.665; 95% CI: 1.001-2.767; P  = .049) were marginally associated with a higher risk of MACCEs. Ticagrelor group regimen (HR 1.856; 95% CI: 1.376-2.504; P  < .001) was associated with higher risk of bleeding events. Ticagrelor group regimen (HR 1.606; 95% CI: 1.179-2.187; P  = .003) were associated with a higher risk of minor bleeding events. For patients with ACS underwent PCI, there were no significant difference in the incidence of NACEs between 3 and 12 months after PCI between de-escalation and non-de-escalation therapies. Compared with ticagrelor-based 12-month DAPT, there was no significant difference in MACCEs and bleeding events in patients receiving de-escalation treatment (ticagrelor reduction from 90 to 60 mg, 3 months after PCI).

An aminocaproic acid-grafted chitosan derivative with superior antibacterial and hemostatic properties for the prevention of secondary bleeding.

Uncontrolled bleeding is one of the leading causes of human mortality. Existing hemostatic materials or techniques cannot meet the clinical requirements for safe and effective hemostasis. The development of novel hemostatic materials has always been of great interest. Chitosan hydrochloride (CSH), a derivative of chitin, is extensively used on wounds as an antibacterial and hemostatic agent. However, the formation of intra- or intermolecular hydrogen bonds between hydroxyl and amino groups limits its water solubility and dissolution rate and affects its effectiveness in promoting coagulation. Herein, we covalently grafted aminocaproic acid (AA) to the hydroxyl and amino groups of CSH via ester and amide bonds, respectively. The solubility of CSH in water (25 °C) was 11.39 ± 0.98 % (w/v), whereas the AA-grafted CSH (CSH-AA) reached 32.34 ± 1.23 % (w/v). Moreover, the dissolution rate of CSH-AA in water was 6.46 times higher than that of CSH. Subsequent studies proved that CSH-AA is non-toxic, biodegradable, and has superior antibacterial and hemostatic properties to CSH. Additionally, anti-plasmin activity can be exerted by the dissociated AA from the CSH-AA backbone, which can help to lessen secondary bleeding.

Effectiveness of dual antiplatelet de-escalation therapy on the prognosis of patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention.

AIM: To investigate the effectiveness of de-escalation of ticagrelor (from ticagrelor 90 mg to clopidogrel 75 mg or ticagrelor 60 mg) on the prognosis of patients with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) after 3 months of oral dual antiplatelet therapy (DAPT). METHODS: From March 2017 to August 2021, 1056 patients with STEMI in a single centre, through retrospective investigation and analysis, were divided into intensive (ticagrelor 90 mg), standard (clopidogrel 75 mg after PCI) and de-escalation groups (clopidogrel 75 mg or ticagrelor 60 mg after 3 months of treatment with 90 mg ticagrelor) based on the type and dose of P2Y12 inhibitor 3 months after PCI, and the patients had a ≥ 12-month history of oral DAPT. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs) during the 12-month follow-up period, including composite end points of cardiac death, myocardial infarction, ischaemia-driven revascularization and stroke. The major safety endpoint was bleeding events. RESULTS: The results showed that during the follow-up period, there was no statistically significant difference in the incidence of MACCEs between the intensive and de-escalation groups (P > 0.05). The incidence of MACCEs in the standard treatment group was higher than that in the intensive treatment group (P = 0.014), but the incidence of bleeding events in the de-escalation group was significantly lower than that in the standard group (9.3% vs. 18.4%, χ²=7.191, P = 0.027). The Cox regression analysis showed that increases in haemoglobin (HGB) (HR = 0.986) and estimated glomerular filtration rate (eGFR) (HR = 0.983) could reduce the incidence of MACCEs, while old myocardial infarction (OMI) (P = 0.023) and hypertension (P = 0.013) were independent predictors of MACCEs. CONCLUSION: For STEMI patients undergoing PCI, the de-escalation scheme of ticagrelor to clopidogrel 75 mg or ticagrelor 60 mg at 3 months after PCI was related to the reduction of bleeding events, especially minor bleeding events, without an increase in ischaemic events.

High-value utilization of the waste hydrolysate of Dioscorea zingiberensis for docosahexaenoic acid production in Schizochytrium sp.

The starch saccharification liquid of Dioscorea zingiberensis tubers (SSLD) is a glucose-rich agro-industrial waste. Herein, SSLD was used as a novel potential carbon source for the biosynthesis of docosahexaenoic acid (DHA) in Schizochytrium sp. to achieve waste recycling and high-value utilization. Component analysis showed that SSLD contains abundant nutrients, such as glucose, amino acids, phenolics and flavonoids. When the total sugar concentration in SSLD was optimized to 90 g/L, the biomass and DHA yield reached 44.85 and 6.60 g/L, respectively, which were 32.1% and 36.92% higher than that at pure glucose culture condition. Fermentation characteristics and gene expression analysis showed that SSLD could remarkably improve cell antioxidant capacity, which is beneficial to scavenge intracellular reactive oxygen species and increase the gene expression of antioxidant enzymes in Schizochytrium sp. Hence, SSLD is an effective and economic carbon source for DHA production in Schizochytrium sp.

Gene mutation profiling in Chinese colorectal cancer patients and its association with clinicopathological characteristics and prognosis.

BACKGROUND: Gene mutations may play an important role in the development, response to treatment and prognosis of colorectal cancer (CRC). This retrospective study aimed to investigate the mutation profiling of Chinese patients with CRC, and its correlation with clinicopathological features and prognosis. METHODS: This study included 1190 Chinese CRC patients who were diagnosed between May 1998 and December 2018 and received clinical genetic testing. The OncoCarta Panel was used to test a total of 238 possible mutations in 19 common oncogenes. RESULTS: Five hundred and eighty-two (48.9%) cases were detected with gene mutations. Of the 582 cases, there were 111 cases (19.7%) with two concurrent mutations, and six cases (1.0%) with three concurrent mutations. KRAS was the most common gene mutation that occurred in all cases (429, 36.1%), followed by PIK3CA (121, 10.2%), NRAS (47, 3.9%), BRAF (35, 2.9%), HRAS (11, 0.9%) and epidermal growth factor receptor (EGFR) (11, 0.9%). AKT1, KIT, FGFR1, FGFR3, FLT3, CDK, ERBB2, ABL1, MET, RET and PDGFRA mutations were also detected in several cases. When it came to prognosis, we found that KRAS/NRAS/PIK3CA/BRAF mutation was not associated with prognosis. But BRAF mutation was associated with poor prognosis in patients who accepted anti-EGFR therapy. CONCLUSIONS: The molecular testing offered the clinical data and mutation profile of Chinese CRC patients. The information of these mutated genes may help to find out the correlation between mutated genes and the development or prognosis of CRC.

The application of moist dressings in wound care for tracheostomy patients: A meta-analysis.

AIM: To evaluate the clinical application of moist wound dressings in wound care for patients with the tracheostomy. BACKGROUND: Tracheostomy patients may suffer from many complications. Moist dressings have been proposed to lower complication rates for patients with the tracheostomy. DESIGN: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist-guided meta-analysis of randomised and controlled clinical trials. METHOD: In this meta-analysis, two reviewers independently searched PubMed, EMBASE, Cochrane Library, Web of Science, CNKI and Wanfang databases for controlled clinical trials (CCTs) comparing the use of moist dressings and gauze for tracheostomy patients. The reviewers screened studies according to the inclusion criteria and extracted data from published reports independently. The outcome of site infection and pressure ulcer incidence, the frequency of dressing changes and wound closing time were evaluated by random-effects or fixed-effects meta-analysis. RESULTS: After the screening, ten studies including 1,220 participants were eligible for analysis. The result showed that the incidence of site infection and pressure ulcer was significantly reduced in the moist dressings group compared with the gauze group. Moist dressings were also associated with significant reductions in the frequency of dressing changes and wound closing time. These results were assessed as moderate- to low-quality evidence. CONCLUSION: Moist dressings seem to be beneficial to tracheostomy patients, giving a lower incidence of site infection and pressure ulcers as well as shorter wound closing times and lower dressing change frequency. More high-quality trials are needed to support this finding. RELEVANCE TO CLINICAL PRACTICE: The findings offer clinicians an assessment of and evidence for the efficacy of moist dressings, which may be a superior option for patients with a tracheotomy.

Preparation of micro-electrolysis material from flotation waste of copper slag and its application for degradation of organic contaminants in water.

Flotation waste of copper slag (FWCS) was used as a raw material for the preparation of a micro-electrolysis material (MEM) through a carbothermal reduction process. The performance of MEM was evaluated for the degradation of organic contaminants in water. The effects of preparation conditions on the performance of MEM were investigated. Results showed that the MEM prepared under the conditions of calcination temperature of 1100 °C, calcination time of 60 min, and coal dosage of 25% presented the best performance for degrading methyl orange (MO). The decolorization process was enhanced by increasing the MEM dosage, decreasing the initial pH of the solution, and raising the solution temperature. Moreover, the MEM presented good capability for the degradation of methylene blue, eosin Y, and acid fuchsin. X-ray diffraction (XRD) analysis showed that increasing the roasting temperature was beneficial to the formation of zero-valent iron (ZVI). Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) showed that micro-sized ZVI particles were formed in the MEM, and they contained a small amount of copper element. Meanwhile, the mechanism analysis showed that a redox reaction of the MEM and MO occurred, the azo bond of MO was destroyed, and sulfanilic acid was generated.

Effects of massage on newborn infants with jaundice: A meta-analysis.

OBJECTIVE: This meta-analysis aims to systematically evaluate the effects of massage on infants with jaundice. METHODS: Multiple electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science, China Biology Medicine (CBM), Wan Fang Data, VIP Database for Chinese Technical Periodicals and China National Knowledge Infrastructure (CNKI), were used to search for studies on the effects of massage on infants with jaundice. Data were analysed by Rev Man 5.3. RESULTS: A total of 14 randomised controlled trials with 1889 patients were included. Statistically significant difference in percutaneous bilirubin [MD = -1.21, 95% CI (-1.90, -0.52), P < 0.05; MD = -2.00, 95% CI (-2.68, -1.32), P < 0.05; MD = -2.00, 95% CI (2.56, -1.44), P < 0.05; MD = -1.93, 95% CI (-2.44, -1.43), P < 0.05] was found between two groups at 48, 72, 96 and 168 h. Studies on the serum total bilirubin level were divided into two subgroups according to sample size, and the results of subgroup analysis showed that the serum total bilirubin level in the intervention group was significantly lower than that in the control group [MD = -52.06, 95% CI (-57.76, -46.36), P < 0.05 and MD = -10.65, 95% CI (-14.66, -6.63), P < 0.05]. Statistically significant difference in defecation frequency was observed between the two groups at 48 h after birth[SMD = 0.44, 95%CI (0.02, 0.87), P < 0.05]. CONCLUSION: Massage can decrease serum total bilirubin and percutaneous bilirubin levels and increasing defecation frequency. However, due to heterogeneity among studies, numerous multi-centre, large-sample and high-quality randomised controlled trials are needed to verify the effects of massage.

The effect of Tai Chi exercise on motor function and sleep quality in patients with stroke: A meta-analysis.

OBJECTIVE: The meta-analysis is to objectively evaluate the efficacy of Tai Chi exercise for motor function and sleep quality in patients with stroke. METHODS: Randomized controlled trials(RCTs) about the effects of Tai Chi versus a non-exercise or conventional rehabilitation exercise control group on motor function and sleep quality in patients with stroke were searched from multiple electronic databases(PubMed, Web of Science, the Cochrane Library, EMBASE, AMED, CBM, CNKI, Wanfang and VIP) until August 2016. Two investigators independently screened eligible studies, extracted data, and assessed the methodological quality by using the quality evaluation criteria for RCTs recommended by Cochrane Handbook. Then meta-analysis was performed by RevMan5.3 software. RESULTS: A total of 17 RCTs with 1209 participants were included. The meta-analysis indicated that there was a significant difference on improving the balance function(P < 0.001) and ability of daily activity (P = 0.0003) of patients with stroke between Tai Chi group and control group. However, no significant effect was found on Tai Chi for walking function and sleep quality(P > 0.05). CONCLUSION: Tai Chi exercise can significantly improve the balance function and ability of daily activities of patients with stroke, and there are no significant differences in walking function and sleep quality. Therefore, lots of multicenter, large-sample, higher quality randomized controlled trials are needed to verify the effects of Tai Chi exercise in improving walking function and sleep quality for patients with stroke.