Associations of overweight/obesity with patient-reported outcome measures after oblique lumbar interbody fusion.

Background: Oblique lateral interbody fusion (OLIF) combined with transpedicular screw fixation has been practiced for degenerative spinal diseases of elderly patients for years. However, overweight patients have been shown to have longer operative times and more complications from surgery. The effect on clinical outcome is still uncertified. The objective of this study was to determine is overweight a risk factor to clinical outcome of OLIF combined with transpedicular screw fixation technique. Material and methods: A retrospective study in patients submitted to OLIF combined with transpedicular screw fixation from January 2018 to August 2019 was conducted. VAS score, ODI score and EQ5D were measured before the operation and one year after the operation. Results: A total of 111 patients were included with 48 patients in the non-obese group and 55 patients in the overweight/obese group. There was no significant difference between the two groups in gender, age, smoking history, hypertension, chronic kidney disease and diabetes mellitus. Overweight/obese group has higher BMI (28.4 vs. 22.7, p < 0.001) than non-obese group. There was no difference between the two groups in pre-operative VAS score, ODI score and EQ5D score. However, the healthy weight group improved much more than the overweight score in VAS score, ODI score and EQ5D score. Conclusion: The overweight/obese patient group had clinical outcomes worse than the non-obese group in terms of pain relief and life functions.

Cobalt-Catalyzed Enantioselective Reductive Arylation, Heteroarylation, and Alkenylation of Michael Acceptors via an Elementary Mechanism of 1,4-Addition.

Cobalt complexes with chiral quinox ligands effectively promote the enantioselective conjugate addition of enones using aryl, heteroaryl, and alkenyl halides and sulfonates. Additionally, a cobalt complex with a strongly donating diphosphine, BenzP*, successfully catalyzes the asymmetric reductive arylation and alkenylation of α,ß-unsaturated amides. Both catalytic systems show broad scopes and tolerance of sensitive functional groups. Both reactions can be scaled up with low loadings of cobalt catalysts. Experimental results and density functional theory (DFT) calculations suggest a new mechanism of elementary 1,4-addition of aryl cobalt(I) complexes.

Accuracy of FreeStyle Libre flash glucose monitoring in patients with type 2 diabetes who migrated from highlands to plains.

BACKGROUND: The FreeStyle Libre flash glucose monitoring (FGM) system entered the Chinese market in 2017 to complement the self-monitoring of blood glucose. Due to its increased usage in clinics, the number of studies investigating its accuracy has increased. However, its accuracy has not been investigated in highland popu-lations in China. AIM: To evaluate measurements recorded using the FreeStyle Libre FGM system compared with capillary blood glucose measured using the enzyme electrode method in patients with type 2 diabetes (T2D) who had migrated within 3 mo from highlands to plains. METHODS: Overall, 68 patients with T2D, selected from those who had recently migrated from highlands to plains (within 3 mo), were hospitalized at the Department of Endocrinology from August to October 2017 and underwent continuous glucose monitoring (CGM) with the FreeStyle Libre FGM system for 14 d. Throughout the study period, fingertip capillary blood glucose was measured daily using the enzyme electrode method (Super GL, China), and blood glucose levels were read from the scanning probe during fasting and 2 h after all three meals. Moreover, the time interval between reading the data from the scanning probe and collecting fingertip capillary blood was controlled to < 5 min. The accuracy of the FGM system was evaluated according to the CGM guidelines. Subsequently, the factors influencing the mean absolute relative difference (MARD) of this system were analyzed by a multiple linear regression method. RESULTS: Pearson's correlation analysis showed that the fingertip and scanned glucose levels were positively correlated (R = 0.86, P = 0.00). The aggregated MARD of scanned glucose was 14.28 ± 13.40%. Parker's error analysis showed that 99.30% of the data pairs were located in areas A and B. According to the probe wear time of the FreeStyle Libre FGM system, MARD1 d and MARD2-14 d were 16.55% and 14.35%, respectively (t = 1.23, P = 0.22). Multiple stepwise regression analysis showed that MARD did not correlate with blood glucose when the largest amplitude of glycemic excursion (LAGE) was < 5.80 mmol/L but negatively correlated with blood glucose when the LAGE was ≥ 5.80 mmol/L. CONCLUSION: The FreeStyle Libre FGM system has good accuracy in patients with T2D who had recently migrated from highlands to plains. This system might be ideal for avoiding the effects of high hematocrit on blood glucose monitoring in populations that recently migrated to plains. MARD is mainly influenced by glucose levels and fluctuations, and the accuracy of the system is higher when the blood glucose fluctuation is small. In case of higher blood glucose level fluctuations, deviation in the scanned glucose levels is the highest at extremely low blood glucose levels.

New look at the power of zero coronary artery calcium (CAC) in Asian population: a systemic review and meta-analysis.

Background: Numerous studies have validated a 5-year warranty period for heart health in Western populations with a coronary artery calcium (CAC) score of zero. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. This meta-analysis aimed to clarify the uncertainty surrounding the prevalence, warranty period, and prognostic implications of zero CAC scores in Asian populations. It also examined the impact of sex on subclinical CAC progression. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. The study aimed to shed light on these issues by exploring the specificities of subclinical CAC progression in the Asian context. Methods: Our systematic literature search, from the study's inception to October 2023, targeted studies on subclinical CAC progression in the Asian population with a zero CAC score. We searched the Cochrane Library, and PubMed. The search terms included "zero score", "coronary calcification", "zero CAC score", and "CAC scan". Results: We evaluated seven published studies through a meta-analysis and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). In this meta-analysis of three observational studies addressing zero CAC prevalence (n=7,661), the pooled prevalence of zero CAC scores in the Asian population was 18.2% [95% confidence interval (CI): 12.5-25.9%]. A significant difference in follow-up warranty period was observed between the CAC zero group and subclinical CAC progression group (mean difference, 1.26 years; 95% CI: 0.94-1.58; P<0.001). Furthermore, the conversion rate of subclinical CAC progression differed significantly between males and females (risk ratio, 2.37; 95% CI: 1.98-2.84; P<0.001). Analysis of four studies revealed a notable discrepancy in the major adverse cardiovascular event (MACE) rate between the CAC (-) and CAC (+) groups (risk ratio, 4.78; 95% CI: 2.21-10.36; P<0.001). Conclusions: The meta-analysis of zero CAC scores in Asian populations suggested an 18.2% prevalence. A 5-year warranty period was noted, with heightened subclinical CAC progression likelihood after this duration. Additionally, sex-based differences were observed in subclinical CAC progression rates. These findings will provide clinical cardiovascular risk stratification for guiding gender-specific clinical decision-making in asymptomatic in Asian individuals.

Sterile Diet Causes Gut Microbiome Collapse of Cancer Patients Post Hematopoietic Cell Transplantation, But Normal Diet Recovers Them.

Though sterile diet, post-transplantation surgery is a clinical strategy for patient care to prevent the infiltration of gut pathogens, less is known about its effects on the gut microbiome. Here, the gut microbiome dynamics of leukemia patients following a 120-day "sterile-normal" diet strategy posthematopoietic cell transplantation are examined. In contrast to the traditional idea, a sterile diet leads to the lowest gut microbiota diversity (p < 0.05) and short-chain fatty acids, promoted the proliferation of potential pathogens such as Streptococcus (up by 16.93%) and Lactobacillus (up by 40.30%), and 43.32% reduction in nodes and an 85.33% reduction in edges within the microbial interaction's network. Interestingly, a normal diet allows the gut microbiome recovery and significantly promotes the abundance of beneficial bacteria. These results indicate that a sterile diet leads to a collapse of the patient's gut microbiome and promoted the proliferation of potential pathogens. This assay is a starting point for a more sophisticated assessment of the effects of a sterile diet. The work also suggests a basic principle for the re-establishment of microbial equilibrium that supplementation of microbial taxa may be the key to the restoration of the degraded ecosystem.

Experimental study on the mechanical properties of desert sand improved by the combination of additives and bio-cement.

Bio-cement is a green and energy-saving building material that has attracted much attention in the field of ecological environment and geotechnical engineering in recent years. The aim of this study is to investigate the use of bio-cement (enzyme-induced calcium carbonate precipitation-EICP) in combination with admixtures for the improvement of desert sands, which can effectively improve the mechanical properties of desert sands and is particularly suitable for sand-rich countries. In addition, the suitability of tap water in bio-cement was elucidated and the optimum ratio of each influencing factor when tap water is used as a solvent was derived. The results showed that peak values of unconfined compressive strength (maximum increase of about 130 times), shear strength (increase of 27.09%), calcium carbonate precipitation value (increase of about 4.39 times), and permeability (decrease of about 93.72 times) were obtained in the specimens modified by EICP combined with admixture as compared to the specimens modified by EICP only. The incorporation of skimmed milk powder, though significantly increasing the strength, is not conducive to cost control. The microscopic tests show that the incorporation of admixtures can provide nucleation sites for EICP, thus improving the properties of desert sand. This work can provide new research ideas for cross-fertilization between the disciplines of bio-engineering, ecology, and civil engineering.

Non-insulin-based insulin resistance indices predict early neurological deterioration in elderly and middle-aged acute ischemic stroke patients in Northeast China.

Insulin resistance (IR) has a strong association with acute ischemic stroke (AIS) occurrence and poor prognosis of afflicted patients. However, the relation between early neurological deterioration (END) risk and IR in elderly and middle-aged patients remains to be thoroughly studied. Here, we investigated the relationship between four indicators of IR and the risk of END in middle-aged patients patients with AIS. The study retrospectively analyzed 1696 elderly and middle-aged patients having AIS between January 2019 and June 2023. Within 7 days of admission, the patients were then stratified relying upon alternations in the National Institutes of Health Stroke Scale. Subsequently, we employed logistic regression analyses for assessing each index correlation with END on the basis of the tertiles of TyG index (TyGI), triglyceride to high-density lipoprotein ratio (TG/HDL), TyG-BMI, alongside IR metabolic score (METS-IR). These four indicators were significantly heightened in the END group (n = 680) in comparison to the non-END group (n = 1016). When grouping using tertiles, the four aforementioned indicators emerged as independent risk factors for END occurrence, whether or not adjusted for confounding factors. The results revealed a progressive elevation in END occurrence risk with the rise in the tertile of each indicator. Finally, we utilized receiver operating characteristic (ROC) curves for assessing the indicators' predictive power. TyG-BMI, TyGI, TG/HDL, and METS-IRs' area under the curve (AUC) were, respectively, 0.736 (95% CI: 0.712-0.761; P < 0.001), 0. 694 (95% CI: 0.668-0.721; P < 0.001), 0.684 (95% CI: 0.658-0.711; P < 0.001), and 0.722 (95% CI: 0.697-0.747; P < 0.001). IR is associated with END risk in middle-aged AIS patients. TyG-BMI, TyGI, TG/HDL, and METS-IR are independent risk factors of END in elderly and middle-aged AIS patients. Simultaneously, these four IR indicators have significant predictive power for END.

Toxic effects of trace metal(loid) mixtures on aquatic organisms.

The co-occurrence of metal (loid)s in realistic aquatic environments necessitates the evaluation of their combined effects. However, the generality of the additive effect hypothesis is contentious, particularly due to metal(loid)-metal(loid) interactions. The absence of systematic evaluation approaches restricts our ability to draw overall conclusions and make reliable predictions. In this study, we reviewed 1473 effect sizes from 38 publications, and classified all responses into seven main categories (from molecular to individual levels) according to their toxicological significance. Our meta-analysis revealed that metal(loid) mixtures had significant effects on aquatic organisms (33 %, 95 % CI 28 %-39 %, P < 0.05), along with significant response heterogeneity (Qt = 690,319.62, P < 0.0001; I2 = 99.95 %). Concurrently, we developed a Random Forest machine learning model to predict adverse effects and identify key variables. These two methods demonstrated that the toxicity of metal(loid) mixtures is primarily linked to the choice of toxicity endpoints, and the characteristics of metal(loid) mixtures. Our findings underscore the potential of combining meta-analysis with machine learning, a more systematic approach, to enhance the understanding and prediction of the adverse effects of metal(loid) mixtures, and they offer guidance for risk assessment and policy-making in complex environmental scenarios.

A novel PROTAC molecule dBET1 alleviates pathogenesis of experimental autoimmune encephalomyelitis in mice by degrading BRD4.

Neuroinflammation and neurodegeneration are hallmarks of multiple sclerosis (MS). Bromodomain-containing protein 4 (BRD4), a bromodomain and extra-terminal domain (BET) protein family member, is indispensable for the transcription of pro-inflammatory genes. Therefore, inhibiting BRD4 may be a prospective therapeutic approach for modulating the inflammatory response and regulating the course of MS. dBET1, a newly synthesized proteolysis-targeting chimera (PROTAC), exhibits effectively degrades of BRD4. However, the precise effects of dBET1 on MS require further investigation. Therefore, we assessed the effect of dBET1 in experimental autoimmune encephalomyelitis (EAE), a typical MS experimental model. Our findings revealed that BRD4 is mainly expressed in astrocytes and neurons of the spinal cords, and is up-regulated in the spinal cords of EAE mice. The dBET1 attenuated lipopolysaccharide-induced expression of astrocytic pro-inflammatory mediators and inhibited deleterious molecular activity in astrocytes. Correspondingly, dBET1, used in preventive and therapeutic settings, alleviated the behavioral symptoms in EAE mice, as demonstrated by decreased demyelination, alleviated leukocyte infiltration, reduced microglial and astrocyte activation, and diminished inflammatory mediator levels. In addition, dBET1 corrected the imbalance in peripheral T cells and protected blood-brain barrier integrity in EAE mice. The underlying mechanism involved suppressing the phosphoinositide-3-kinase/protein kinase B, mitogen-activated protein kinase /extracellular signal-regulated kinase, and nuclear factor kappa B pathways. In summary, our data strongly suggests that dBET1 is a promising treatment option for MS.

[Clinical efficacy of nusinersen sodium in the treatment of children with spinal muscular atrophy]. / è¯ºè¥¿é‚£ç”Ÿé’ æ²»ç–—è„Šé«“æ€§è‚ŒèŽç¼©ç—‡å„¿ç«¥çš„ä¸´åºŠåˆ†æž.

OBJECTIVES: To investigate the efficacy and safety of nusinersen sodium in the treatment of children with spinal muscular atrophy (SMA). METHODS: A retrospective analysis was conducted on the clinical data of 50 children with 5q SMA who received nusinersen sodium treatment and multidisciplinary treatment management in Shanxi Children's Hospital from February 2022 to February 2024. RESULTS: Compared with the baseline data, 67% (8/12), 74% (35/47), and 74% (35/47) of the SMA children had a clinically significant improvement in the scores of Philadelphia Infant Test of Neuromuscular Disorders, Hammersmith Functional Motor Scale Expanded, and Revised Upper Limb Module, respectively, and the distance of 6-minute walking test increased from 207.00 (179.00, 281.50) meters to 233.00 (205.25, 287.50) meters (P<0.05) after nusinersen sodium treatment. Of all 50 children with SMA, 24 (48%) showed good tolerability after administration, with no significant or persistent abnormalities observed in 2 034 laboratory test results, and furthermore, there were no serious or immunological adverse events related to the treatment. After treatment, there was a significant change in forced vital capacity as a percentage of the predicted value in 27 children with restrictive ventilatory dysfunction, as well as a significant change in the level of 25-(OH) vitamin D in 15 children with vitamin D deficiency (P<0.05). CONCLUSIONS: For children with SMA, treatment with nusinersen sodium can continuously improve the response rates of motor function scales, with good tolerability and safety.

Exosomal Thomsen-Friedenreich Glycoantigen: A New Liquid Biopsy Biomarker for Lung and Breast Cancer Diagnosis.

Exosomes are nanosized extracellular vesicles released by cells to transport biomolecules such as proteins and RNAs for intercellular communication. Exosomes play important roles in cancer development and metastasis; therefore, they have emerged as potential liquid biopsy biomarkers for cancer screening, diagnosis and management. Many exosome cargos, including proteins, RNAs and lipids, have been extensively investigated as biomarkers for cancer liquid biopsy. However, carbohydrates, an important type of biomolecules, have not yet been explored for this purpose. In this study, we reported a new exosomal carbohydrate biomarker, i.e., alpha-linked Thomsen-Friedenreich glycoantigen (TF-Ag-α; Galß1-3GalNAc alpha). To transform our discovery for clinical applications, we developed a surface plasmon resonance (SPR)-based assay which utilized a unique monoclonal antibody, JAA-F11, with high specificity to TF-Ag-α to measure the levels of exosomal TF-Ag-α in blood. To our knowledge, we are the first to demonstrate that exosomes carry TF-Ag-α. We detected exosomal TF-Ag-α in as low as 10 µL serum samples from cancer patients but in contrast, levels were negligible from normal controls. With a total of 233 cancer patients and normal controls, we showed that exosomal TF-Ag-α detected lung cancer (n=60) and breast cancer (n=95) from normal controls (n=78) with ≥95% and ≥97% accuracy, respectively. These results demonstrated that exosomal TF-Ag-α is a potential liquid biopsy biomarker for cancer diagnosis.

Efficacy and safety of first-line regimens for advanced HER2-positive breast cancer: A Bayesian network meta-analysis.

Background: The current standard of care for advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer is pertuzumab plus trastuzumab and docetaxel as first-line therapy. However, with the development of newer treatment regimens, there is a lack of evidence regarding which is the optimal treatment strategy. The aim of this network meta-analysis was to evaluate the efficacy and safety of first-line regimens for advanced HER2-positive breast cancer by indirect comparisons. Methods: A systematic review and Bayesian network meta-analysis were conducted. The PubMed, EMBASE, and Cochrane Library databases were searched for relevant articles published through to December 2023. The hazard ratio (HR) and 95% credible interval (CrI) were used to compare progression-free survival (PFS) between treatments, and the odds ratio and 95% CrI were used to compare the objective response rate (ORR) and safety. Results: Twenty randomized clinical trials that included 15 regimens and 7094 patients were analyzed. Compared with the traditional trastuzumab and docetaxel regimen, PFS was longer on the pyrotinib and trastuzumab plus docetaxel regimen (HR: 0.41, 95% CrI: 0.22-0.75) and the pertuzumab and trastuzumab plus docetaxel regimen (HR: 0.65, 95% CrI: 0.43-0.98). Consistent with the results for PFS, the ORR was better on the pyrotinib and trastuzumab plus docetaxel regimen and the pertuzumab and trastuzumab plus docetaxel regimen than on the traditional trastuzumab and docetaxel regimen. The surface under the cumulative ranking curve indicated that the pyrotinib and trastuzumab plus docetaxel regimen was most likely to rank first in achieving the best PFS and ORR. Comparable results were found for grade ≥3 AE rates of ≥10%. Conclusions: Our results suggest that the pyrotinib and trastuzumab plus docetaxel regimen is most likely to be the optimal first-line therapy for patients with HER2-positive breast cancer.

The first discovery of Polypedatesteraiensis (Dubois, 1987) (Rhacophoridae, Anura) in China.

Background: The genus of Polypedates Tschudi, 1838 currently comprises 25 recognised species with four of these species reported in Yunnan, China. Dubois (1987) speculated the distribution of P.teraiensis in China; however, there was no study carried out to confirm its distribution in the region. New information: We herein describe P.teraiensis as a new national record, based on a specimen collected from Yunnan border region. Phylogenetically, our sequence clustered with the sequences of recognised P.teraiensis specimens from Bangladesh, Myanmar and India. The uncorrected pairwise distances between the specimens from China and other P.teraiensis localities was small, ranging from 0.0-0.7%, based on 16S rRNA gene. Therefore, we report P.teraiensis as a new species record for China.

Prediction of the stage shift growth of early-stage lung adenocarcinomas by volume-doubling time.

Background: Prediction of subsolid nodule (SSN) interval growth is crucial for clinical management and decision making in lung cancer screening program. To the best of our knowledge, no study has investigated whether volume doubling time (VDT) is an independent factor for predicting SSN interval growth, or whether its predictive power is better than that of traditional semantic methods, such as nodular diameter or type. This study aimed to investigate whether VDT could provide added value in predicting the long-term natural course of SSNs (<3 cm) regarding stage shift. Methods: This retrospective study enrolled 132 patients with spectrum lesions of lung adenocarcinoma who underwent two consecutive computed tomography (CT) examinations before surgical tissue proofing between 2012 and 2021 in Kaohsiung Veterans General Hospital. The VDTs were manually calculated from the volumetric segmentation using Schwartz's approximation formula. We utilized logistic regression to identify predictors associated with stage shift progression based on the VDT parameter. Results: The average duration of follow-up period was 3.629 years. A VDT-based nomogram model (model 2) based on CT semantic features, clinical characteristics, and the VDT parameter yielded an area under the curve (AUC) of 0.877 [95% confidence interval (CI): 0.807-0.928]. Compared with model 1 (CT semantic features and clinical characteristics), model 2 exhibited the better predictive performance for stage shift (AUC model 1: 0.833 versus AUC model 2: 0.877, P=0.047). In model 2, significant predictors of stage shift growth included initial nodule size [odds ratio (OR) =4.074, 95% CI: 1.368-12.135; P=0.012], SSN classification (OR =0.042; 95% CI: 0.006-0.288; P=0.001), follow-up period (OR =1.692, 95% CI: 1.337-2.140; P<0.001), and VDT classification (OR =2.327, 95% CI: 1.368-3.958; P=0.002). For the stage shift, the mean progression time for the VDT (>400 d) group was 7.595 years, and median progression time was 7.430 years. Additionally, a VDT ≤400 d is an important prognostic factor associated with aggressive growth behavior with a stage shift. Conclusions: VDT is crucial for predicting SSN stage shift growth irrespective of clinical and CT semantic features. This highlights its significance in informing follow-up protocols and surgical planning, emphasizing its prognostic value in predicting SSN growth.

Combined activation of artificial and natural ion channels for disrupting mitochondrial ion homeostasis towards effective postoperative tumor recurrence and metastasis suppression.

Rationale: Pharmacological targeting of mitochondrial ion channels is developing as a new direction in cancer therapy. The opening or closing of these channels can impact mitochondrial function and structure by interfering with intracellular ion homeostasis, thereby regulating cell fate. Nevertheless, their abnormal expression or regulation poses challenges in eliminating cancer cells, and further contributes to metastasis, recurrence, and drug resistance. Methods: We developed an engineered mitochondrial targeted delivery system with self-reinforcing potassium ion (K+) influx via amphiphilic mitochondrial targeting polymer (TMP) as carriers to co-deliver natural K+ channel agonists (Dinitrogen oxide, DZX) and artificial K+ channel molecules (5F8). Results: Using this method, DZX specifically activated natural K+ channels, whereas 5F8 assembled artificial K+ channels on the mitochondrial membrane, leading to mitochondrial K+ influx, as well as oxidative stress and activation of the mitochondrial apoptotic pathway. Conclusion: The synergistic effect of 5F8 and DZX presents greater effectiveness in killing cancer cells than DZX alone, and effectively inhibited tumor recurrence and lung metastasis following surgical resection of breast cancer tumors in animal models. This strategy innovatively integrates antihypertensive drugs with artificial ion channel molecules for the first time to effectively inhibit tumor recurrence and metastasis by disrupting intracellular ion homeostasis, which will provide a novel perspective for postoperative tumor therapy.

The efficacy, safety, and beneficiary population of angiogenesis inhibitor apatinib plus chemotherapy in recurrent platinum-resistant ovarian cancer patients: A comparative cohort study.

AIM: Angiogenesis inhibitor apatinib targets vascular endothelial growth factor receptors and improves the outcomes of patients with gynecologic malignancy. This study aimed to evaluate the efficacy and safety of angiogenesis inhibitor apatinib plus chemotherapy in recurrent platinum-resistant ovarian cancer (RPR-OC) patients. METHODS: This study retrieved 67 RPR-OC patients who received apatinib plus chemotherapy or chemotherapy alone and divided them into apatinib + chemo (N = 30) and chemo alone (N = 37) groups according to the actual medication. RESULTS: Objective response rate (36.7% vs. 16.2%, p = 0.056) and disease control rate (80.0% vs. 59.5%, p = 0.072) showed an increased trend in apatinib + chemo group versus chemo alone group. The progression-free survival (PFS) (p = 0.010) and overall survival (OS) (p = 0.042) were prolonged in apatinib + chemo group versus chemo alone group. The median (95%confidence interval [CI]) PFS was 5.9 (5.5-6.3) months in apatinib + chemo group and 3.8 (2.0-5.6) months in chemo alone group. The median (95%CI) OS was 20.5 (16.5-24.5) months in apatinib + chemo group and 13.6 (8.6-18.6) months in chemo alone group. Apatinib plus chemotherapy was independently related with better PFS (hazard ratio [HR]: 0.354, p < 0.001) and OS (HR: 0.116, p < 0.001). Subgroup analyses indicated that patients with a more serious disease condition might benefit more from apatinib plus chemotherapy. No difference was found in adverse events of all grade or grade ≥3 between the two groups (all p > 0.05). CONCLUSION: Angiogenesis inhibitor apatinib plus chemotherapy shows better treatment efficacy than chemotherapy alone with controllable safety profile in RPR-OC patients.

Facilitation of coke gasification by coking wastewater and its degradation properties in thermochemical reactions.

The thermochemical reaction between coking wastewater and gasification-coke is a new way to achieve efficient and clean use of coal and solve the problem of coking wastewater treatment in the Gansu Longdong region. To further investigate the thermochemical reaction characteristics of coking wastewater and gasification-coke, this paper explores the effect of coking wastewater on syngas production from coke gasification at 1000 °C, the degradation effect of organic pollutants in coking wastewater, the thermochemical reactivity of gasification-coke, and the reasons why wastewater promotes coke gasification and wastewater degradation. The results showed that the thermochemical reaction of coking wastewater with gasification-coke not only facilitates the improvement of syngas yield and low-level calorific value but also improves the thermochemical reactivity of gasification-coke. Notably, phenol in coking wastewater plays a major role in promoting the gasification of gasification-coke. During the thermochemical reaction, the organic pollutants in the wastewater were effectively degraded, the degradation rate of CODCr reached more than 85%, and the degradation of organic pollutants reached more than 75%. Phenol water and coking wastewater can not only improve the dispersion of the ash phase on the surface of gasification-coke, effectively inhibiting the sintering and agglomeration of the ash phase in gasification-coke, but also change the type and number of organic functional groups in gasification-coke. Therefore, coking wastewater can promote the gasification of coke. The thermochemical reaction between coke wastewater and gasification-coke can simultaneously promote coke gasification and the degradation of coke wastewater and achieve the resourceful use of coke wastewater.

FDB-Net: Fusion double branch network combining CNN and transformer for medical image segmentation.

BACKGROUND: The rapid development of deep learning techniques has greatly improved the performance of medical image segmentation, and medical image segmentation networks based on convolutional neural networks and Transformer have been widely used in this field. However, due to the limitation of the restricted receptive field of convolutional operation and the lack of local fine information extraction ability of the self-attention mechanism in Transformer, the current neural networks with pure convolutional or Transformer structure as the backbone still perform poorly in medical image segmentation. METHODS: In this paper, we propose FDB-Net (Fusion Double Branch Network, FDB-Net), a double branch medical image segmentation network combining CNN and Transformer, by using a CNN containing gnConv blocks and a Transformer containing Varied-Size Window Attention (VWA) blocks as the feature extraction backbone network, the dual-path encoder ensures that the network has a global receptive field as well as access to the target local detail features. We also propose a new feature fusion module (Deep Feature Fusion, DFF), which helps the image to simultaneously fuse features from two different structural encoders during the encoding process, ensuring the effective fusion of global and local information of the image. CONCLUSION: Our model achieves advanced results in all three typical tasks of medical image segmentation, which fully validates the effectiveness of FDB-Net.

Tracing the possible evolutionary trends of Morganella morganii: insights from molecular epidemiology and phylogenetic analysis.

Morganella morganii, encompassing two subspecies, subsp. morganii and subsp. sibonii, is a common opportunistic pathogen, notable for intrinsic resistance to multiple antimicrobial agents. Despite its clinical significance, research into the potential evolutionary dynamics of M. morganii remains limited. This study involved the analysis of genome sequences from 431 M. morganii isolates, comprising 206 isolates that cause host infections, obtained from this study and 225 from the NCBI genome data sets. A diverse array of antimicrobial resistance genes (ARGs) was identified in M. morganii isolates, including mcr-1, tet(X4), tmexCD-toprJ, and various carbapenemase genes. In addition, a novel blaKPC-2-bearing plasmid with demonstrated conjugative capability was discovered in M. morganii. The majority of virulence-related genes (VRGs), except for the hlyCABD gene cluster, were found in almost all M. morganii. Three novel genospecies of M. morganii were identified, designated as M. chanii, M. variant1, and M. variant2. Compared to M. sibonii, M. chanii genospecies possessed a greater number of flagellar-related genes, typically located within mobile genetic elements (MGEs), suggesting potential for better environmental adaptability. Phylogenetic analysis further disclosed that M. morganii was divided into 12 sequence clusters (SCs). Particularly, SC9 harbored an elevated abundance of ARGs and VRGs, mainly toxin-related genes, and was associated with a higher presence of MGEs compared to non-SC9 strains. The collective findings suggest that M. morganii undergoes evolution driven by the influence of MGEs, thereby significantly enhancing its adaptability to selective pressures of environmental changes and clinical antimicrobial agents.IMPORTANCEThe growing clinical significance of Morganella morganii arises from its abundant virulence factors and antimicrobial resistance genes, resulting in elevated infection rates and increased clinical scrutiny. However, research on the molecular epidemiology and evolutionary trends of M. morganii has been scarce. Our study established a list of virulence-related genes (VRGs) for M. morganii and conducted a large-scale epidemiological investigation into these VRGs. Based on genomic classification, three novel genotypes of M. morganii were identified, representing evolutionary adaptations and responses to environmental challenges. Furthermore, we discovered the emergence of a sequence cluster enriched with antimicrobial resistance genes, VRGs, and mobile genetic elements, attributed to the selective pressure of antimicrobial agents. In addition, we identified a novel conjugative plasmid harboring the blaKPC-2 gene. These findings hold significance in monitoring and comprehending the epidemiology of M. morganii.