[Socio-ecological risk analysis framework coupled with ecosystem services]. / 耦合生态系统服务的社会生态风险分析框架.

The strong coupling between society and ecosystem makes socio-ecological risks become the main object of risk management. As the link between ecological and social processes, ecosystem services (ESs) are the core variable in deconstructing the social-ecological risks and the crucial point in resolving the risks. We explored the concept and the internal formation mechanisms of socio-ecological risk combining ESs, and further put the cascade logic and evolution process of "real risk-risk perception-risk behavior". Based on driver-pressure-state-impact-response framework (DPSIR), we proposed a framework for analyzing socio-ecological risk, and expanded the content and methodology system of research and management practices related to socio-ecological risks. We proposed that socio-ecological risk research coupled with ESs should focus on: 1) exploring the transmission mechanism between ecosystem processes, ecosystem services, and human well-being; 2) exploring the response mechanism of social subject behavior and its impacts on ecosystem services and human well-being; 3) construction of a multi-scale assessment model for social ecological risks coupled with ESs. The socio-ecological risk analysis framework for coupled ecosystem services was based on the mutual feedback between human and nature to explore the logic of risk formation, evolution, and governance, which could provide ideas for clarifying the deep meaning of ecological problems and selecting pathways to resolve socio-ecological risks.

Petrocodonliboensis (Gesneriaceae), a new species from Guizhou, China.

Petrocodonliboensis Sheng H.Tang & Jia W.Yang is a new species of Gesneriaceae from Guizhou, southwestern China. The new taxon has a pale-yellow corolla and is most similar to P.luteoflorus. However, it differs from the latter by having a urceolate (vs. cannulate) corolla tube, an abaxial corolla lip 0.8-1.1 mm (vs. 2-2.2 mm) long, and filaments 1.5-1.7 mm (vs. ca. 7 mm) long that are straight (vs. S-shaped or geniculate near the middle). The new taxon is assessed as "Data Deficient" (DD) according to the IUCN standards.

The consistent anti-cancer effect of a simple exercise (Ou MC decrescendo phenomenon exercise) may hold promise for low-cost cancer prevention.

The causal relationship between physical activity and anti-cancer effect are not proved by the current studies. However, Ou MC decrescendo phenomenon treatment (OuDPt), a simple exercise treatment, has shown consistent anti-cancer effects, which evinces the consequent anti-cancer effect by physical activity. The anti-cancer effects through OuDPt in the context of physical activity and human body anatomical axes showed to induce apoptosis, restore apical-basal polarity of cancer cells and mitigate epithelial-mesenchymal transition (EMT) with concomitant clinical regression of uterine endometrial cancer, suppression of ovarian and pancreatic cancer growth, regression of early suspicious pancreatic cancer, enhancement of chemotherapy effect of pancreatic cancer and cessation of cancer-related bleeding, which underlines the most important anti-cancer mechanisms. Although such anti-cancer effects by OuDPt show insufficient efficacy for advanced cancer in long-term treatment, OuDPt may be availed as an Ou MC decrescendo phenomenon exercise for cancer prevention. Further study is warranted.

The Causal Relationship of Anti-Cancer Effect with Physical Activity Evinced by the Consistent Anti-Cancer Effect of the Ou MC Decrescendo Phenomenon.

A causal relationship between physical activity and cancer prevention has not been firmly established in the medical literature. The Ou MC decrescendo phenomenon treatment (OuDPt) is a self-administered protocol in which placing the contralateral hand on or near the affected area of the body produces a zone of decreased pain or inflammation. OuDPt has also been shown to elicit an anti-cancer effect that consistently induces tumor regression in several cancer types, including uterine, ovarian, and pancreatic cancer, with documented apoptosis and squamous metaplasia in uterine endometrial cancer. The anti-cancer effects of OuDPt are associated with factors such as the frequency, duration, and intensity of treatment, as well as the accessibility and susceptibility of the tumor. This relationship mirrors the dynamics between antibiotics and bacterial infections, where similar factors come into play. Given that OuDPt is self-administered and easy to perform, and produces consistent anti-cancer effects, this procedure could be potentially harnessed for cancer prevention. Further study of the use of OuDPt for cancer prevention is warranted.

Multiple Field-of-View Based Attention Driven Network for Weakly Supervised Common Bile Duct Stone Detection.

OBJECTIVE: Common bile duct (CBD) stones caused diseases are life-threatening. Because CBD stones locate in the distal part of the CBD and have relatively small sizes, detecting CBD stones from CT scans is a challenging issue in the medical domain. METHODS AND PROCEDURES: We propose a deep learning based weakly-supervised method called multiple field-of-view based attention driven network (MFADNet) to detect CBD stones from CT scans based on image-level labels. Three dominant modules including a multiple field-of-view encoder, an attention driven decoder and a classification network are collaborated in the network. The encoder learns the feature of multi-scale contextual information while the decoder with the classification network is applied to locate the CBD stones based on spatial-channel attentions. To drive the learning of the whole network in a weakly-supervised and end-to-end trainable manner, four losses including the foreground loss, background loss, consistency loss and classification loss are proposed. RESULTS: Compared with state-of-the-art weakly-supervised methods in the experiments, the proposed method can accurately classify and locate CBD stones based on the quantitative and qualitative results. CONCLUSION: We propose a novel multiple field-of-view based attention driven network for a new medical application of CBD stone detection from CT scans while only image-levels are required to reduce the burdens of labeling and help physicians automatically diagnose CBD stones. The source code is available at https://github.com/nchucvml/MFADNet after acceptance. CLINICAL IMPACT: Our deep learning method can help physicians localize relatively small CBD stones for effectively diagnosing CBD stone caused diseases.

The role of different macrophages-derived conditioned media in dental pulp tissue regeneration.

Macrophages have been reported to play important roles in tissue repair and regeneration. While it is known that macrophages are present in the dental pulp, their role in dental pulp regeneration is not fully understood. In the present study, we investigated the effects of different phenotype macrophages conditioned medium on the cellular behaviors of hDPSCs and their extracellular matrix (cell sheets) in vitro. Moreover, twenty-four root fragments inserted with cell sheets cultured with different conditioned media were placed into the back subcutaneous space of 6-8-week-old male BALB/c nude mouse. The regenerated tissues in the root fragments were assessed via histologic analysis after 8 weeks of transplantation. M2 macrophages could promote the proliferation, migration, and osteogenic differentiation of hDPSCs. Dental pulp-like tissue with an odontoblast-like layer lining the dentinal surface and well-arranged collagen fibers was harvested in root fragment combined with M2 conditioned medium cultured cell sheet, whereas a large amount of calcium salt deposition and disorganization of collagen fibers were observed in root fragments combined with M1 conditioned medium cultured cell sheet. Therefore, promoting the transformation of M1 into M2 macrophage in dental pulp tissue regeneration may be a potential way for dental pulp regeneration via functional healing.

Safety and Efficacy of Drug-Eluting Beads Trans-Arterial Chemoembolization for Hepatocellular Carcinoma in Taiwan (SERENADE-T).

Purpose: The aim of this retrospective study was to evaluate the safety and efficacy of patients with hepatocellular carcinoma treated with drug-eluting bead with doxorubicin transarterial chemoembolization (DEBDOX-TACE) in Taiwan. Patients and Methods: We retrospectively investigated 630 hepatocellular carcinoma patients who underwent DEBDOX-TACE in multiple institutions from 2011 to 2016 in Taiwan. Tumor response was assessed per modified response evaluation criteria in solid tumors, overall survival, and safety. Results: This study included 630 patients who underwent DEBDOX-TACE, participants' mean age was 66 years, 68.1% males and 15.6% females. The mean doxorubicin dose administered via DEBDOX-TACE was 56 mg. Complete and partial response rates were 14.6% and 49.2%, respectively, with a disease control rate of 84.6%. The median overall survival was 29.2 months. The most common post-embolization symptom was abdominal pain (22.4%). No hepatic encephalopathy and no procedure-related death were found. Conclusion: Real-world data from Taiwan demonstrated that DEBDOX-TACE for hepatocellular carcinoma can achieve high tumor response rate with low adverse events.

The pelvic area - A central hypogastric area for abdominal palpation for women with abdominal pain: A narrative review.

The pelvic area is a central hypogastric area which is conformed with the pelvic inlet to reduce overlapping of the non-pelvic area and is more sensitive and specific in diagnosing female abdominal emergencies than the traditional four quadrants and nine regions methods for abdominal palpation. The purpose of this narrative review is to assess the principle and mechanism of formation of the pelvic area for abdominal palpation for women with abdominal pain. By classifying the abdominal area as inside or outside the pelvic area, abdominal pain can be located inside or outside the pelvic cavity, thereby distinguishing pelvic diseases from non-pelvic diseases. When the examiner divides the patient's pelvic area along the pelvic ring using his/her hand on the patient's contralateral abdomen, there can be a reduced pain zone under the hand and alleviate pain in the non-diseased area. It allows patients with poor perception of tenderness or abdominal pain with guarding to easily recognize pelvic or non-pelvic pain. Partitioning the pelvic area which conforms with pelvic cavity inlet can reduce confusing pelvic and non-pelvic diseases when using traditional four quadrants or nine regions method. The division of the pelvic area on the patient's contralateral side can induce a reduced pain zone under the hand and alleviate pain in the non-diseased area, which can help the patient distinguish between pelvic and non-pelvic pain. Pain is a subjective feeling to the patient, and correct patient perception of pain are the basis for a correct diagnosis.

Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography.

BACKGROUND: The current guideline recommends patients who meet high probability criteria for choledocholithiasis to receive endoscopic retrograde cholangiopancreatography (ERCP). However, adverse events can occur during ERCP. Our goal is to determine whether endoscopic ultrasound (EUS) before ERCP can avoid unnecessary ERCP complications, especially in patients with a negative CT scan. METHODS: A total of 604 patients with high probability of choledocholithiasis were screened and 104 patients were prospectively enrolled. Patients with malignant biliary obstruction, altered GI anatomy, and choledocholithiasis on CT scan were excluded. Among them, 44 patients received EUS first, and ERCP if choledocholithiasis present (EUS-first group). The other 60 patients received ERCP directly (ERCP-first group). The baseline characteristics, presence of choledocholithiasis, and complications were compared between groups. All patients were followed for 3 months to determine the difference in recurrent biliary event rate. Cost-effectiveness was compared between the two strategies. RESULTS: There was no marked difference in age, sex, laboratory data, presenting with pancreatitis, and risk factors for choledocholithiasis. Overall, 51 patients (49.0%) had choledocholithiasis, which did not justify the risk of direct ERCP. In the EUS-first group, 27 (61.4%) ERCP procedures were prevented. The overall complication rate was significantly lower in the EUS-first group compared to the ERCP-fist group (6.8% vs. 21.7%, P = 0.04). The number-needed-to-treat to avoid one unnecessary adverse event was 6.71. After a 3-month follow-up, the cumulative recurrence biliary event rates were similar (13.6% vs. 15.0%, P = 0.803). EUS-first strategy was more cost-effective than the ERCP-first strategy (mean cost 2322.89$ vs. 3175.63$, P = 0.002). CONCLUSIONS: In high-probability choledocholithiasis patients with a negative CT, the EUS-first strategy is cost-effective, which can prevent unnecessary ERCP procedures and their complications.

Primary intracranial papillary meningioma: Analysis of factors of prognosis and systematic review.

OBJECTIVE: Papillary meningioma is rare and displays an aggressive clinical behavior with poor prognosis. Therefore, we performed an extensive literature review to evaluate the adverse factors and treatment strategy of survival. METHOD: We performed Ovid, Medline, Embase, Pubmed, Web of Science and Cochrane database queries for articles published between 1938 and 2019 with the search term "WHO grade III meningioma" or "papillary meningioma" and "central nervous system", "cerebral", or "intracranial". RESULTS: After a careful evaluation, a total of 19 studies were included. The entire cohort included the 67 patients, 34 (50.7%) were male and 33 (49.3%) were female with a mean age of 32.6 ± 2.1 years ranging from 4.5 months to 74 years. Gross total resection was achieved in 48 (71.6%) cases, and 29 (51.8%) patients received postoperative radiation. The mean follow-up period was 42.3 ± 4.4 months (range, 2-197 months). Thirty-six (53.7%) patients happened to recurrences, 11 (16.4%) patients happened to extracranial metastasis and 25 (37.3%) patients died. Univariate analysis revealed that the MIB > 5% trended toward a shorter time to recurrence (p = 0.084). Gross total resection was associated with favorable progression-free survival (p = 0.007) and overall survival (p = 0.001). Postoperative radiation was associated with favorable progression-free survival (p = 0.001). CONCLUSIONS: Gross total resection and adjuvant radiation were recommended as the initial treatment option for patients with papillary meningioma.

The Role of Small Extracellular Vesicles Derived from Lipopolysaccharide-preconditioned Human Dental Pulp Stem Cells in Dental Pulp Regeneration.

INTRODUCTION: Regenerative endodontics has created a desirable shift in the treatment paradigm despite current limitations of regenerative outcomes. Mesenchymal stem cells (MSCs) facilitate tissue regeneration and repair in a mild inflammatory environment. Small extracellular vesicles (sEVs) derived from MSCs play an imperative role in the paracrine modulation of regenerative responses modulated by MSCs. However, it remains unknown whether MSCs enhance dental pulp regeneration or whether this enhancement is mediated by sEVs in a mild inflammatory environment. The present study aimed to elucidate the effects of sEVs originated from lipopolysaccharide (LPS)-preconditioned human dental pulp stem cells (hDPSCs) on dental pulp regeneration. METHODS: All sEVs were isolated from hDPSCs cultured with or without LPS (ie, N-sEVs and L-sEVs, respectively). The effect of N-sEVs and L-sEVs on proliferation, migration, angiogenesis, and differentiation of rat bone marrow MSCs was identified in vitro. Moreover, N-sEVs or L-sEVs were implanted into rat pulpless root canal models, and the regenerated tissue in root canals was assessed via hematoxylin-eosin staining, Masson staining, and immunohistochemistry after 30 days of transplantation. RESULTS: Both N-sEVs and L-sEVs could modulate BMSC proliferation, migration, angiogenesis, and differentiation. Both kinds of sEVs enhanced the structure of the regenerated tissue closer to that of a normal dental pulp in vivo. L-sEVs had a more significant effect than N-sEVs. CONCLUSIONS: sEVs released by hDPSCs in a mild inflammatory microenvironment are capable of facilitating the regeneration of dental pulp through functional healing instead of scar healing, which has potential applications in regenerative endodontics.

Safety and effectiveness of new embolization microspheres SCBRM for intermediate-stage hepatocellular carcinoma: A feasibility study.

Transarterial chemoembolization (TACE) is, currently, the recommended treatment for hepatocellular carcinoma (HCC). However, long-term chemoembolization triggers the inflammatory response and may lead to postembolization syndrome (PES). Although several types of degradable microspheres have been developed to reduce drug toxicity and PES incidence, the clinical outcomes remain unsatisfactory. Previously, we have developed a new type of spherical, calibrated, biodegradable, radiopaque microspheres (SCBRM) and demonstrated their safety and efficacy in a pig model. Thus, the goal of this feasibility study was to determine the clinical safety and efficacy of the new SCBRM in intermediate-stage HCC patients. In this study, 12 intermediate-stage HCC patients underwent TACE using SCBRM with a calibrated size of 100-250 µm. The disease control rates at 1 month and 3 months after TACE-SCBRM treatment were 100% and 75.0%, respectively. The objective response rates at 1 month and 3 months after treatment were 66.7% and 58.3%, respectively. Very few adverse events were observed with one patient developing nausea. One day after the treatment, alanine aminotransferase, alanine aminotransferase, and total bilirubin levels were slightly elevated in the patients, but all returned to baseline on day 7. The median and mean overall survival times were 33 months (interquartile range, 12.8-42.0) and 29.2 ± 14.3 months, respectively. The 1-year and 2-year survival rates were 91.7% and 58.3%, respectively. In conclusion, TACE with the new SCBRM microspheres is clinically safe and effective, and it represents a promising approach in the management of intermediate-stage HCC.

A Systematic Review and Meta-analysis of the Therapeutic Effect of Acupuncture on Migraine.

Background: Migraine is an intractable headache disorder, manifesting as periodic attacks. It is highly burdensome for patients and society. Acupuncture treatment can be beneficial as a supplementary and preventive therapy for migraine. Objectives: This systematic review and meta-analysis aimed to investigate the efficacy and safety of acupuncture for migraine, and to examine transcranial doppler changes after acupuncture. Methods: Reports, conference, and academic papers published before March 15, 2019 in databases including PubMed, Cochrane library, Embase, China National Knowledge Infrastructure, WANFANG Database, Chinese journal of Science and Technology, and China Biomedical were searched. Randomized controlled trials (RCTs) involving acupuncture, sham acupuncture, and medication in migraine were included. The Cochrane Collaboration software, RevMan 5.3, was used for data processing and migration risk analysis. Results: Twenty-eight RCTs were included. 15 RCTs included medication only, 10 RCTs included sham acupuncture only, and 3 RCTs included both. The study included 2874 patients, split into 3 groups: acupuncture treatment group (n = 1396), medication control group (n = 865), and sham acupuncture control group (n = 613). The results showed that treatment was more effective in the acupuncture group than in the sham acupuncture group (MD = 1.88, 95% CI [1.61, 2.20], P < 0.00001) and medication group (MD = 1.16, 95% CI [1.12, 1.21], P < 0.00001). Improvement in visual analog scale (VAS) score was greater in the acupuncture group than in the sham acupuncture group (MD = -1.00, 95% CI [-1.27,-0.46], P < 0.00001; MD = -0.59, 95% CI [-0.81,-0.38], P < 0.00001), and their adverse reaction rate was lower than that of the medication group (RR = 0.16, 95% CI [0.05, 0.52], P = 0.002). The improvement of intracranial blood flow velocity by acupuncture is better than that by medication, but the heterogeneity makes the result unreliable. Conclusions: Acupuncture reduced the frequency of migraine attacks, lowered VAS scores, and increased therapeutic efficiency compared with sham acupuncture. Compared with medication, acupuncture showed higher effectiveness with less adverse reactions and improved intracranial blood circulation. However, owing to inter-study heterogeneity, a prospective, multicenter RCT with a large sample is required to verify these results.

The ubiquitinase ZFP91 promotes tumor cell survival and confers chemoresistance through FOXA1 destabilization.

The forkhead box A1 (FOXA1), one of the forkhead class of DNA-binding proteins, functions as a transcription factor and plays a vital role in cellular control of embryonic development and cancer progression. Downregulation of FOXA1 has reported in several types of cancer, which contributes to cancer cell survival and chemoresistance. However, the mechanism for FOXA1 downregulation in cancer remains unclear. Here, we report that the ubiquitination enzyme zinc finger protein 91 (ZFP91) ubiquitinates and destabilizes FOXA1, which promotes cancer cell growth. High level of ZFP91 expression correlates with low level of FOXA1 protein in human gastric cancer (GC) cell lines and patient samples. Furthermore, ZFP91 knockdown reduces FOXA1 polyubiquitination, which decreases FOXA1 turnover and enhances cellular sensitivity to chemotherapy. Taken together, our findings reveal ZFP91-FOXA1 axis plays an important role in promoting GC progression and provides us a potential therapeutic intervention in the treatment of GC.

Comparison of the Efficacy of Two Microsphere Embolic Agents for Transcatheter Arterial Chemoembolization in Hepatocellular Carcinoma Patients.

PURPOSE: Transarterial chemoembolization (TACE) delivers cytotoxic drugs intra-arterially and induces ischemic necrosis by arterial embolization. Embolization is achieved using a variety of agents that differ widely in particle size and range, deformation, and in vivo arterial distribution. The clinical significance of these differences has not been thoroughly characterized. The present study is to compare the efficacy of Embosphere and Embozene microspheres in TACE therapy for hepatocellular carcinoma. MATERIALS AND METHODS: This retrospective study includes 108 hepatocellular carcinoma (HCC) patients who received TACE/doxorubicin with Embozene (70 patients) or Embosphere (38 patients) at a single medical center. Patient outcomes, including liver function, tumor size, tumor response, and complications after treatment, were analyzed. The change in total target lesion size and tumor response was evaluated according to embolization agent and clinical characteristics. RESULTS: The postoperative glutamate oxaloacetate transaminase (mean, 194.5 vs. 147.5; p=0.032) and bilirubin (mean, 1.11 mg/dL vs. 0.73 mg/dL; p=0.016) were higher among patients treated with Embozene, the decrease in the number (55.86±25.55% vs. 41.81±38.51%, p=0.027) and size (56.37±25.91 mm vs. 43.44±37.89 mm, p=0.001) of liver tumors relative to baseline was greater in these patients than in those treated with Embosphere. These greater antitumor effects were achieved using lower doses of doxorubicin than for treatment with Embozene. Minor complications were more common among patients treated with Embosphere than with Embozene. CONCLUSION: These results suggest that Embozene is more efficacious than Embosphere for HCC treatment using TACE/doxorubicin.

Epigastralgia in a middle-aged woman with acquired immunodeficiency syndrome.

Lin and colleagues presented an unusual case of AIDS-related cholecystopathy with an enlarged gallbladder and thickened wall. Cholecystopathy is a rare condition characterized by biliary abnormalities in AIDS patients, and the mechanism remains unclear. The authors aimed to heighten awareness of this entity in patients with advanced AIDS disease status.

Temporal and spatial surveys of polybromodiphenyl ethers (PBDEs) contamination of soil near a factory using PBDEs in northern Taiwan.

Polybrominated diphenyl ethers (PBDEs), previously commonly used as flame retardants, should be monitored in the environment since some are listed as persistent organic pollutants. A contaminated site near a northern Taiwan factory using decabrominated diphenyl ether (deca-BDE) was identified based on a vegetable PBDEs monitoring project in 2013. The subsequent spatial and temporal survey of that contaminated site shows the contamination ingredients in soils were close to ones used by the factory, indicating that contamination was from the factory, possibly through an exhaust vent. The average concentration of deca-BDE in the main contaminated soil was 615 µg/kg d. w. (dry weight) soil in 2015, slightly decreasing to 604 µg/kg d. w. soil in 2016, increasing to 844 µg/kg d. w. soil in 2017, and then slightly decreasing to 670 µg/kg d. w. soil in 2018. The slight change of deca-BDE and the minor change in low brominated congener level indicate a low degradation rate. The contamination of peripheral sites was around 5000 µg/kg d. w. soil for one PBDEs sampling site that was higher than those around or within the main contaminated farm, indicating serious pollution. Concentrations of PBDEs in different soil depths show that depth 2-15 cm accounted for the greatest PBDEs accumulation, indicating that deca-BDE pollution had been present over time and transported into deeper soil. There can be PBDEs uptake by crops consumed by humans, as shown in our previous studies, so continuous monitoring of PBDEs in this site is important and treatments should be established urgently.

Depression is a major risk factor for the development of dementia in people with lower urinary tract symptoms: A nationwide population-based study.

BACKGROUND/OBJECTIVES: Studies have shown a strong relationship between depression and dementia. Lower urinary tract symptoms (LUTS) were reported to be independently associated with depression and dementia. However, the relationship between depression and cognitive dysfunction in patients with LUTS is not well characterized. METHOD: We conducted a matched cohort study by using a one-million population-based dataset in Taiwan. A total of 15,944 patients with LUTS aged 50 or older were included from 2001 to 2005 and followed up until their death or the end of 2012. During the follow-up period, 1958 cases developed depression subsequently and were defined as the study group. 7832 patients without depression were then identified as control group, matching by age, gender, insurance premium, status of catastrophic illness certificate, and the index year in a 1:4 ratio. The primary outcome was the onset of dementia. LUTS, depression, dementia, and other comorbidities were defined by the International Classification of Disease, 9th Revision, Clinical Modification coding system. Cox hazards models and Aalen Johansen curves were applied to measure the influence of depression on the risk of dementia in patients with LUTS. RESULTS: The crude incidence of depression among people with LUTS was 12.3%. The incidence of dementia in the depression group was significantly higher than that in the control group (12.2% versus 8.9%; P < 0.001). Depression was associated with a significantly greater risk of subsequent dementia after adjusted for socioeconomic status, number of outpatient visits and multiple comorbidities (adjusted hazard ratio: 1.32; 95% confidence interval: 1.13-1.54). CONCLUSIONS: Depression is a major risk factor for the onset of subsequent dementia in patients with LUTS. Early screening and interventions for depression in patients with LUTS may be important to maintain cognitive function.