Emerging trends of invasive yeast infections and azole resistance in Beijing intensive care units.

BACKGROUND: Invasive fungal infections pose a substantial threat to patients in healthcare settings globally. Recent changes in the prevalence of fungal species and challenges in conducting reference antifungal susceptibility testing emphasize the importance of monitoring fungi and their antifungal resistance. METHODS: A two-phase surveillance project was conducted in Beijing, China, involving 37 centres across 12 districts, from January 2012 to December 2013 and from January 2016 to December 2017. FINDINGS: We found that the proportion of Candida albicans in intensive care units (ICUs) during 2016-2017 exhibited a significant decline compared with the 2012-2013 period, although it remained the most predominant pathogen. In contrast, the prevalence of Nakaseomyces glabratus (formerly Candida glabrata) and Candida tropicalis notably increased during the two-phase surveillance. The high prevalence of C. tropicalis and its resistance to azole drugs posed a serious threat to patients in ICUs. The pathogens causing invasive fungal infections in Beijing were relatively sensitive to echinocandins. While C. albicans continued to exhibit susceptibility to azoles, the resistance and growth rates of C. tropicalis towards azoles were particularly prominent. Concerns were raised due to the emergence of multiple, short-term isolates of Clavispora lusitaniae and Candida parapsilosis complex in neonatal ICUs, given their similarity in antifungal susceptibilities. Such occurrences point towards the potential for transmission and persisting presence of these pathogens within the ICU environment. CONCLUSIONS: Our study complements existing data on the epidemiology of invasive fungal infections. It is imperative to exercise cautious medication management for ICU patients in Beijing, paying particular attention to azole resistance in C. tropicalis.

Research and Application Progress of Laser-Processing Technology in Diamond Micro-Fabrication.

Laser-processing technology has been widely used in the ultra-precision machining of diamond materials. It has the advantages of high precision and high efficiency, especially in the field of super-hard materials and high-precision parts manufacturing. This paper explains the fundamental principles of diamond laser processing, introduces the interaction mechanisms between various types of lasers and diamond materials, focuses on analyzing the current development status of various modes of laser processing of diamond, briefly discusses the relevant applications in diamond cutting, micro-hole forming, and micro-groove machining, etc., and finally discusses the issues, challenges, and potential future advancements of laser technology in the field of diamond processing at this point.

Migration-inducing gene-7 promotes glioma cell proliferation and invasiveness via activating the MAPK signaling pathway.

Glioma is a highly aggressive primary malignant tumor. Migration-inducing gene-7 (Mig-7) is closely related to tumor invasion and metastasis. However, the detailed molecular mechanism of Mig-7-mediated promotion of glioma cell invasion requires further investigation. Therefore, this study aimed to investigate the molecular mechanism by which Mig-7 promotes invasion and growth of glioma tumor cells. After collecting 65 glioma tissues and 16 non-tumor tissues, the expression difference of Mig-7 between tumor tissues and non-tumor tissues was analyzed. The molecular mechanism of Mig-7 in tumor cells was investigated by knockdown or overexpression of Mig-7 in U87MG cells. Specifically, the expression levels of mitogen-activated protein kinase (MAPK) signaling pathway-related molecules were detected in cells that knocked down Mig-7. MTT, Transwell, and three-dimensional cell culture assays were used to detect the survival, migration, invasion, and tube formation of U87MG cells that overexpressed Mig-7 were treated with the MAPK signaling pathway inhibitors (SP600125, SCH772984, and SB202190). The effect of Mig-7 on the tumorigenic ability of U87MG cells was investigated by subcutaneous tumorigenic experiment in nude mice. The corresponding results indicated that Mig-7 expression was significantly higher in glioma tissues and cell lines compared to that in non-neoplastic brain tissues and normal glial cell lines. In U87MG cells, downregulation or overexpression of Mig-7 inhibited or promoted the expression of MMP-2, MMP-9, LAMC2, EphA2, and VE-cadherin, and phosphorylation levels of ERK1/2, JNK, and p38. Mig-7 overexpression promoted migration, invasion, cell viability, and tube formation, which were reversed by the MAPK signaling pathway inhibitors. Mig-7 overexpression promoted subcutaneous tumor growth in mice and upregulated the phosphorylation levels of ERK1/2, JNK, and p38 and the expression of Ki-67. These effects of Mig-7 overexpression were reversed by MAPK pathway inhibitors. Overall, these results suggest that Mig-7 may be a novel biomarker and potential therapeutic target for glioma, with the MAPK pathway playing a key role in the corresponding Mig-7 mechanism of action.

Modifying a D-A-π-A-D HTM system for higher hole mobility by the meta-substitution strategy to weaken the electron-donating ability of the donor unit: a DFT study.

Tuning the electron-donating ability (EDA) of the donor units of hole transporting materials (HTMs) is an efficient strategy to modulate the optoelectronic properties of HTMs. Based on this strategy, we first theoretically investigated the effects of the EDA of donor units on D-A-π-A-D architectural HTMs. The results show that the enhanced EDA of the donor unit leads to larger hole reorganization energy and poorer molecular stability of HTMs. In contrast, meta-substitution of side groups is an effective strategy to reduce the EDA of the donor unit. We found that the application of the meta-substitution strategy in the D-A-π-A-D system not only successfully improves the molecular stability, but also achieves higher hole mobility by promoting the electronic coupling between the molecular dimers and decreasing the hole reorganization energies simultaneously. Studies on interfacial properties indicate that intermolecular coupling also synergistically enhances the interfacial charge extraction performance and reduces carrier recombination. In conclusion, by utilizing the meta-substitution strategy to reduce the EDA of donor units on D-A-π-A-D architectural HTMs, we successfully designed four superior performance HTMs mD1, mD2, mD3, and mD4.

Analysis of white-light imaging-based features predictive for determination of lesion depths of superficial flat esophageal squamous cell carcinoma: a retrospective multicenter study from China.

OBJECTIVES: Endoscopic diagnosis of invasion depth of superficial esophageal squamous cell carcinoma (SESCC) by white-light imaging (WLI) modality remains difficult. This study aims to clarify WLI-based features which are predictive for invasion depth of SESCC. METHODS: A two-phase study was performed by enrolling 1288 patients with 1396 SESCC lesions. Endoscopic appearances, clinical characteristics and post-operative pathological outcomes were collected and reviewed. The association between lesion features and invasion depth were analyzed. A predictive nomogram was constructed for prediction of invasion depth. RESULTS: Among 1396 lesions in derivation and validation cohort, 1139 (81.6%), 194 (13.9%) and 63 (4.5%) lesions were diagnosed as lesions confined into the intraepithelium or the lamina propria mucosa (T1a-EP/LPM), lesions invading the muscularis mucosa (T1a-MM) or superficial submucosa (T1b-SM1) and tumor with moderate invasion into the submucosa or deeper submucosal invasion (≥ T1b-SM2), respectively. Lesion length > 2 cm (p < 0.001), wider circumferential extension (p < 0.001, 0.002 and 0.048 for > 3/4, 1/2-3/4 and 1/4-1/2 circumferential extension, respectively), surface unevenness (p < 0.001 for both type 0-IIa/0-IIc lesions and mixed type lesions), spontaneous bleeding (p < 0.001), granularity (p < 0.001) and nodules (p < 0.001) were identified as significant factors predictive for lesion depth. A nomogram based on these factors was constructed and the values of area under the Receiver Operating Characteristics curve were 0.89 and 0.90 in the internal and external patient cohort. CONCLUSIONS: Our study provides six WLI-based morphological features predicting for lesion depth of SESCC. Our findings will make endoscopic evaluation of invasion depth for SESCC more convenient by assessing these profiles.

Artificial intelligence assisted detection of superficial esophageal squamous cell carcinoma in white-light endoscopic images by using a generalized system.

BACKGROUND: The use of artificial intelligence (AI) assisted white light imaging (WLI) detection systems for superficial esophageal squamous cell carcinoma (SESCC) is limited by training with images from one specific endoscopy platform. METHODS: In this study, we developed an AI system with a convolutional neural network (CNN) model using WLI images from Olympus and Fujifilm endoscopy platforms. The training dataset consisted of 5892 WLI images from 1283 patients, and the validation dataset included 4529 images from 1224 patients. We assessed the diagnostic performance of the AI system and compared it with that of endoscopists. We analyzed the system's ability to identify cancerous imaging characteristics and investigated the efficacy of the AI system as an assistant in diagnosis. RESULTS: In the internal validation set, the AI system's per-image analysis had a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 96.64%, 95.35%, 91.75%, 90.91%, and 98.33%, respectively. In patient-based analysis, these values were 90.17%, 94.34%, 88.38%, 89.50%, and 94.72%, respectively. The diagnostic results in the external validation set were also favorable. The CNN model's diagnostic performance in recognizing cancerous imaging characteristics was comparable to that of expert endoscopists and significantly higher than that of mid-level and junior endoscopists. This model was competent in localizing SESCC lesions. Manual diagnostic performances were significantly improved with the assistance by AI system, especially in terms of accuracy (75.12% vs. 84.95%, p = 0.008), specificity (63.29% vs. 76.59%, p = 0.017) and PPV (64.95% vs. 75.23%, p = 0.006). CONCLUSIONS: The results of this study demonstrate that the developed AI system is highly effective in automatically recognizing SESCC, displaying impressive diagnostic performance, and exhibiting strong generalizability. Furthermore, when used as an assistant in the diagnosis process, the system improved manual diagnostic performance.

Comprehensive analysis of prediction of the EGFR mutation and subtypes based on the spinal metastasis from primary lung adenocarcinoma.

Purpose: To investigate the use of multiparameter MRI-based radiomics in the in-depth prediction of epidermal growth factor receptor (EGFR) mutation and subtypes based on the spinal metastasis in patients with primary lung adenocarcinoma. Methods: A primary cohort was conducted with 257 patients who pathologically confirmed spinal bone metastasis from the first center between Feb. 2016 and Oct. 2020. An external cohort was developed with 42 patients from the second center between Apr. 2017 and Jun. 2021. All patients underwent sagittal T1-weighted imaging (T1W) and sagittal fat-suppressed T2-weight imaging (T2FS) MRI imaging. Radiomics features were extracted and selected to build radiomics signatures (RSs). Machine learning classify with 5-fold cross-validation were used to establish radiomics models for predicting the EGFR mutation and subtypes. Clinical characteristics were analyzed with Mann-Whitney U and Chi-Square tests to identify the most important factors. Nomogram models were developed integrating the RSs and important clinical factors. Results: The RSs derived from T1W showed better performance for predicting the EGFR mutation and subtypes compared with those from T2FS in terms of AUC, accuracy and specificity. The nomogram models integrating RSs from combination of the two MRI sequences and important clinical factors achieved the best prediction capabilities in the training (AUCs, EGFR vs. Exon 19 vs. Exon 21, 0.829 vs. 0.885 vs.0.919), internal validation (AUCs, EGFR vs. Exon 19 vs. Exon 21, 0.760 vs. 0.777 vs.0.811), external validation (AUCs, EGFR vs. Exon 19 vs. Exon 21, 0.780 vs. 0.846 vs.0.818). DCA curves indicated potential clinical values of the radiomics models. Conclusions: This study indicated potentials of multi-parametric MRI-based radiomics to assess the EGFR mutation and subtypes. The proposed clinical-radiomics nomogram models can be considered as non-invasive tools to assist clinicians in making individual treatment plans.

Ferromagnetic vanadium disulfide VS2 monolayers with high Curie temperature and high spin polarization.

The structural, electronic, and magnetic properties of vanadium disulfide VS2 monolayers were investigated using first-principles calculations and Monte Carlo (MC) simulations. The results of molecular dynamics simulations and phonon dispersion showed that the VS2 monolayer has good dynamic and thermodynamic stabilities. Based on the results of the band structure, we also explore the effect of carrier concentrations on the spin gap, spin polarization and the direction of the easy magnetic axis. Our results demonstrated that doping an appropriate amount of holes can cause the reversal of the easy magnetic axis and maintain nearly 100% spin polarization, which greatly improves the application possibility of the VS2 monolayer as a spintronic device. The contribution of different orbits to the spin-orbit coupling (SOC) effect is given in magnetocrystalline anisotropy energy, which provides a theoretical basis for explaining the origin of magnetic crystal anisotropy. Based on the MC simulations, we also showed the influences of different parameters (carrier concentrations, magnetic field and crystal field) on the magnetothermal properties of the VS2 monolayer. It is found that the increase of hole doping concentrations can promote the increase of the Curie temperature, while the increase of electron doping concentrations will greatly weaken the Curie temperature. Furthermore, according to the influences of different parameters on the Curie temperature and spin polarization, we conclude that a suitably enhanced magnetic field and appropriate hole concentrations will not only make the system maintain high spin polarization, but also make the system exhibit ferromagnetic properties above room temperature.

Aspiration versus stent retriever for posterior circulation stroke: A meta-analysis.

AIMS: New thrombectomy strategies have emerged recently. Differences between posterior circulation stroke management via aspiration and stent retriever remain to be evaluated. We compared the safety and efficacy of aspiration and stent retriever in treating posterior circulation stroke. METHODS: Three databases (PubMed, Embase, and Cochrane Library) were systematically searched for studies comparing aspiration and stent retriever in patients with posterior circulation stroke. The modified Newcastle-Ottawa scale was used to assess the risk of bias. A random-effects model was used. RESULTS: Fifteen cohort studies with 1451 patients were included. Pooled results showed a significant difference in total complication (odds ratio [OR] 0.48, 95% confidence interval [CI] [0.30, 0.76], p = 0.002). successful recanalization (1.85, [1.30, 2.64], p = 0.0006), favorable outcome (1.30, [1.02, 1.67], p = 0.04), procedure duration (-22.10, [-43.32, -0.88], p = 0.04), complete recanalization (4.96, [1.06, 23.16], p = 0.009), and first-pass effect (2.59, [1.55, 4.32], p = 0.0003) between the aspiration and stent retriever groups, and in favor of aspiration. There was no significant difference in the outcomes of rescue therapy (1.42, [0.66, 3.05], p = 0.37) between the two groups. CONCLUSION: Patients with posterior circulation stroke receiving treatment with aspiration achieved better recanalization, first-pass effect, and shorter procedure time. Aspiration may be more secure than a stent retriever.

A first-principles study on the electronic, piezoelectric, and optical properties and strain-dependent carrier mobility of Janus TiXY (X ≠ Y, X/Y = Cl, Br, I) monolayers.

Janus transition metal dichalcogenide monolayers (TMDs) have attracted wide attention due to their unique physical and chemical properties since the successful synthesis of the MoSSe monolayer. However, the related studies of Janus monolayers of transition metal halides (TMHs) with similar structures have rarely been reported. In this article, we systematically investigate the electronic properties, piezoelectric properties, optical properties, and carrier mobility of new Janus TiXY (X ≠ Y, X/Y = Cl, Br, I) monolayers using first principles calculations for the first time. These Janus TiXY monolayers are thermally, dynamically, and mechanically stable, and their energy bands near the Fermi level (EF) are almost entirely contributed by the central Ti atom. Besides, the Janus TiXY monolayers exhibit excellent in-plane and out-of-plane piezoelectric effects, especially with an in-plane piezoelectric coefficient of ∼4.58 pm V-1 for the TiBrI monolayer and an out-of-plane piezoelectric coefficient of ∼1.63 pm V-1 for the TiClI monolayer, suggesting their promising applications in piezoelectric sensors and energy storage applications. The absorption spectra of Janus TiXY monolayers are mainly distributed in the visible and infrared regions, implying that they are fantastic candidates for photoelectric and photovoltaic applications. The obtained carrier mobilities revealed that TiXY monolayers are hole-type semiconductors. Under uniaxial compressive strain, the hole mobilities of these monolayers are gradually improved, indicating that TiXY monolayers have potential applications in the field of flexible electronic devices.

Electronic and thermoelectric properties of semiconducting Bi2SSe2 and Bi2S2Se monolayers with high optical absorption.

Bismuth telluride (Bi2Te3) and its derivatives are often focused on as thermoelectric materials around room temperature. In this work, we theoretically predicted two new types of Bi2Te3-based two-dimensional materials Bi2SSe2 and Bi2S2Se using density functional theory (DFT) combined with Boltzmann transport theory. The thermal, dynamic, and mechanical stabilities of Bi2SSe2 and Bi2S2Se monolayers are confirmed using ab initio molecular dynamics (AIMD) simulations, phonon dispersion, and elastic constant calculations. The phonon transport properties, including lattice thermal conductivity, group velocity, Grüneisen parameter, converged scattering rate, and phonon lifetimes contributed by different branches, are systematically investigated. The electronic and thermoelectric properties, including carrier mobility (µ), Seebeck coefficient (S), electrical conductivity (σ), power factors, and figure of merit (zT) along the zigzag and armchair directions as a function of carrier concentration at different temperatures, are also investigated. It is found that the Bi2SSe2 and Bi2S2Se monolayers have moderate indirect band gaps (0.92 eV and 1.08 eV at the PBE level, respectively) and low lattice thermal conductivities (4.35 and 5.37 W m-1 K-1 at 300 K, respectively). The largest zT values of Bi2SSe2 and Bi2S2Se monolayers are 0.50 and 0.28 at 300 K and 1.39 and 0.93 at 700 K for p-doping types, respectively. The Bi2SSe2 and Bi2S2Se monolayers are predicted to show high optical absorption peaks at 8 × 105 cm-1 in the visible and near-UV light region, respectively. Our results indicate that both Bi2SSe2 and Bi2S2Se could be promising candidates in energy conversion, solar cells, and optoelectronic devices.

Study protocol for artificial intelligence-assisted sponge cytology as pre-endoscopy screening for early esophegeal squmaous epithelial lesions in China.

BACKGROUND: Endoscopic screening is the widely accepted screening strategy for esophageal squmaous cell carcinoma (ESCC). However, massive endoscopic screening is expensive and not cost-efficient, and novel pre-endoscopy detection used as a preliminary screening method arouses new concerns. We are planning to launch an artificial intelligence (AI) assisted sponge cytology for detecting esophageal squmaous high-grade intraepithelial neoplasia (HGIN) and above lesions. The aim of this trail is to investigate the efficiency of AI-assisted sponge cytology in population-based screening of early esophageal squmaous epithelial lesions. METHODS: The study will be prospectively conducted in five regions with a high prevalence of ESCC. AI-assisted sponge cytology and endoscopic examination will be sequentially performed. Based on our previous data, at least 864 patients with esophageal HGIN and above lesions are needed to achieve enough statistical power. And, a calculated 112,500 individuals with high risks of ESCC will be recruited. In the first stage, each 24,000 participants who meet the inclusion criteria will be recruited on a voluntary basis. Setting pathological results as standard reference, diagnostic threshold and according performance of AI-assisted detection will be evaluated. A prediction model will be constructed by co-analyzing cytological results and relevant risk factors. Then, an external validation cohort will be used for validation of the model efficiency. Also, cost-efficiency analysis will be performed. This study protocol was registered on chineseclinicaltrial.gov (ChiCTR1900028524). DISCUSSION: Our study will determine whether this AI-assisted sponge cytology can be used as an effective pre-endoscopy detection tool for large-scale screening for ESCC in high-risk areas.

An Efficient Dopant for Introducing Magnetism into Topological Insulator Bi2Se3.

In this work, we obtained an effective way to introduce magnetism into topological insulators, and successfully fabricated single crystal C-Bi2Se3. The structural, electrical and magnetic properties of non-magnetic element X (B, C and N) doped at Bi, Se1, Se2 and VDW gap sites of Bi2Se3 were studied by the first principles. It is shown that the impurity bands formed inside the bulk inverted energy gap near the Fermi level with C doping Bi2Se3. Due to spin-polarized ferromagnetic coupling, the time inversion symmetry of Bi2Se3 is destroyed. Remarkably, C is the most effective dopant because of the magnetic moment produced by doping at all positions. The experiment confirmed that the remnant ferromagnetism Mr is related to the C concentration. Theoretical calculations and experiments confirmed that carbon-doped Bi2Se3 is ferromagnetic, which provides a plan for manipulating topological properties and exploring spintronic applications.

LncRNA NONRATT009773.2 promotes bone cancer pain progression through the miR-708-5p/CXCL13 axis.

Bone cancer pain (BCP) is the most frequently observed chronic cancer pain, and its development remains largely unexplored. Dysregulation of non-coding RNAs greatly contributes to the pathogenesis of BCP. In the present study, we found a new long noncoding RNA (lncRNA), NONRATT009773.2, and investigated its role in the spinal cord of BCP rats. Our results showed that NONRATT009773.2 was significantly up-regulated in BCP model rats, whereas depletion of NONRATT009773.2 attenuated BCP. In contrast, overexpression of NONRATT009773.2 triggered pain-like symptoms in normal animals. Moreover, NONRATT009773.2 functioned as a microRNA (miRNA) sponge to absorb miR-708-5p and up-regulated miRNA downstream target CXCL13, which plays fundamental roles in the initiation and maintenance of neuroinflammation and hyperalgesia. Collectively, our current findings indicated that NONRATT009773.2 could be employed as a new therapeutic target for BCP.

Sterols and triterpenoids from Ganoderma lucidum and their reversal activities of tumor multidrug resistance.

Two sterols and seven triterpenoids were isolated and identified from Ganoderma lucidum by silica gel column chromatography, preparative high-performance liquid chromatography and spectra analysis. Then, the multidrug resistance reversal activities of these compounds were assessed using MTT assay. Among these compounds, ganoderol B (3), ganoderone A (4), ganodermanondiol (6) and ganoderiol F (8) were shown to reverse the resistance of human oral epidermoid carcinoma cell line KBv200 to doxorubicin, and the reversal folds were 6.59, 4.70, 4.01 and 7.09, respectively. Ganoderiol F could increase the intracellular accumulation of doxorubicin in KBv200 cells through inhibiting P-glycoprotein transport function. Further mechanistic investigation found that ganoderiol F did not alter P-glycoprotein expression. In conclusion, ganoderiol F has potent effect in reversing P-glycoprotein mediated tumor multidrug resistance. Potential reversal agents against multidrug resistance in tumor may be found in triterpenoids from Ganoderma lucidum.[Formula: see text].

MRI-Based Radiomics Nomogram as a Potential Biomarker to Predict the EGFR Mutations in Exon 19 and 21 Based on Thoracic Spinal Metastases in Lung Adenocarcinoma.

RATIONALE AND OBJECTIVES: Preoperative identifications of epidermal growth factor receptor (EGFR) mutation subtypes based on the MRI image of spinal metastases are needed to provide individualized therapy, but has not been previously investigated. This study aims to develop and evaluate an MRI-based radiomics nomogram for differentiating the exon 19 and 21 in EGFR mutation from spinal bone metastases in patients with primary lung adenocarcinoma. MATERIALS AND METHODS: A total of 76 patients underwent T1-weighted and T2-weighted fat-suppressed MRI scans were enrolled in this study, 38 were positive for EGFR mutation in exon 19 and 38 were in exon 21.MRI imaging features were extracted and selected from each MRI pulse sequence, and used to form the radiomics signature. A radiomics nomogram was developed integrating the radiomics signature and important clinical factors with receiver operating characteristic, calibration and decision curve analysis to assess the nomogram. Clinical characteristics were analyzed with Mann-Whitney U and Chi-Square tests to identify the most important factors. RESULTS: A total of 6 features were selected as the most discriminative predictors from the two MRI pulse sequences. The nomogram integrating the combined radiomics signature, age and CEA level generated good prediction performance in the training (AUCs, nomogram vs. combined radiomics signature vs. clinical model, 0.90 vs. 0.87 vs. 0.59) and validation (AUCs, nomogram vs. combined radiomics signature vs. clinical model, 0.88 vs. 0.86 vs. 0.72) cohort. DCA analysis confirmed the potential clinical utility of the nomogram. CONCLUSION: This study demonstrated that MRI features from spinal bone metastases can be used to prognosticate EGFR mutation subtypes in exon 19 and 21. The developed pre-treatment nomogram can potentially guide treatments for lung adenocarcinoma patients.

The peripheral Epac1/p-Cav-1 pathway underlies the disruption of the vascular endothelial barrier following skin/muscle incision and retraction-induced chronic postsurgical pain.

Background: Vascular endothelial barrier disruption is pivotal in the development of acute and chronic pain. Here, we demonstrate a previously unidentified molecular mechanism in which activation of the peripheral Epac1/p-Cav-1 pathway accelerated the disruption of the vascular endothelial barrier, thereby promoting chronic postsurgical pain (CPSP). Methods: We established a rat model of CPSP induced by skin/muscle incision and retraction (SMIR). Pain behaviors were assessed by the mechanical withdrawal threshold (MWT) at different times. Local muscle tissues around the incision were isolated to detect the vascular permeability and the expression of Epac1 and Cav-1. They were assessed by western blot and immunofluorescence staining. Results: SMIR increased vascular endothelial permeability and the number of macrophages and endothelial cells in the muscle tissues around the incision. The peripheral upregulation of Epac1 was macrophage-derived, whereas that of p-Cav-1 was both macrophage and endothelial cell-derived in the SMIR model. Moreover, the Epac1 agonist 8-pCPT could induce mechanical sensitivity, increase the expression of p-Cav-1, and disrupt vascular endothelial barrier in normal rats. The Epac1 inhibitor CE3F4 attenuated established SMIR-induced mechanical hyperalgesia, the upregulation of p-Cav-1 and vascular endothelial barrier. Finally, we showed that intrathecal injection of Cav-1siRNA relieved SMIR-induced mechanical allodynia, but had no effects of the expression of Epac1. Conclusions: Collectively, these results revealed a molecular mechanism for modulating CPSP through the peripheral Epac1/Cav-1 pathway. Importantly, targeting Epac1/Cav-1 signaling might be a potential treatment for CPSP.

[Risk factors of carbapenem resistant Acinetobacter baumannii infection in intensive care unit].

Objective: This study will analyze the clinical characteristics and risk factors that may be related to the 30-day mortality of patients infected with CRAB in intensive care unit (ICU), and explore the resistance of CRAB and its influence on mortality. Methods: From December 2012 to February 2021, 173 ICU patients with CRAB infection in the Fifth Medical Center of PLA General Hospital were selected as the research objects, and the relevant data were collected for retrospective analysis. There were 119 cases (68.8%) in survival group and 54 cases (31.2%) in the non-survival group. Patients with CRAB infection were (52.9±13.5) years old, including 140 males (80.9%) and 33 females (19.1%).The first detected CRAB was collected, and antibiotic sensitivity test was conducted after the strain was resuscitated to analyze the antibiotic resistance. Univariate and multivariate Cox models were used to analyze independent risk factors associated with 30-day mortality in patients with CRAB infection. Results: Univariate and multivariate Cox analysis showed that acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ)(HR=1.058, 95%CI:1.012-1.106, P=0.013) and septic shock (HR=6.240, 95%CI:2.227-17.483, P<0.001) were independent risk factors related to 30-day mortality in ICU patients with CRAB. Treatment with ß-lactamase inhibitor (HR=0.496, 95%CI: 0.275-0.893, P<0.019) can reduce the 30-day mortality of patients with CRAB infection in ICU. The resistance rate of CRAB to cephalosporins, carbapenems, aminoglycosides and quinolones were more than 80%. The survival rate of patients infected by aminoglycoside resistant CRAB is low(χ²=4.012,P<0.05). Conclusion: The APACHE Ⅱ score, septic shock and use of ß-lactamase inhibitors were independent factors associated with the 30-day mortality in ICU patients with CRAB infection.

Role of caveolin-1 in chronic postsurgical pain in rats.

Chronic postsurgical pain (CPSP) has a high incidence, but the underlying mechanisms remain elusive. Previous studies have indicated that caveolin-1 (Cav-1) plays a notable role in pain modulation. To study the role of Cav-1 in CPSP in the present study, a rat model of skin/muscle incision and retraction (SMIR) was established. Under anesthesia, skin and superficial muscle of the medial thigh were incised and a small pair of retractors inserted. It was revealed that SMIR increased the expression of Cav-1 in the dorsal root ganglion (DRG) and the injured tissue around the incision. Furthermore, the infiltration of endothelial cells and macrophages in the injured tissue around the incision increased constantly, and the vascular permeability increased due to the destruction of the vascular endothelial barrier function around the injured tissue. Cav-1 was mainly expressed by CD68-positive macrophages and CD34-positive endothelial cells in the injured tissues around the incision, while it was also primarily localized in the medium and large neurofilament 200-positive neurons and a small number of calcitonin gene-related peptide- and isolectin B4-positive small and medium-sized neurons in the DRG. The results demonstrated that the sustained high expression levels of Cav-1 in the injured tissue around the incision could lead to the dysfunction of the vascular endothelial barrier and, thus, could induce the inflammatory response through the lipoprotein transport of endothelial cells, thereby resulting in peripheral sensitization. In addition, the sustained high expression levels of Cav-1 in the DRG could sensitize large-sized neurons and change the transmission mode of noxious stimuli. The findings of the present study indicated that a Cav-1-mediated process could participate in neuronal transmission pathways associated with pain modulation.

Radiomic Evaluations of the Diagnostic Performance of DM, DBT, DCE MRI, DWI, and Their Combination for the Diagnosisof Breast Cancer.

OBJECTIVES: This study aims to evaluate digital mammography (DM), digital breast tomosynthesis (DBT), dynamic contrast-enhanced (DCE), and diffusion-weighted (DW) MRI, individually and combined, for the values in the diagnosis of breast cancer, and propose a visualized clinical-radiomics nomogram for potential clinical uses. METHODS: A total of 120 patients were enrolled between September 2017 and July 2018, all underwent preoperative DM, DBT, DCE, and DWI scans. Radiomics features were extracted and selected using the least absolute shrinkage and selection operator (LASSO) regression. A radiomics nomogram was constructed integrating the radiomics signature and important clinical predictors, and assessed with the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS: The radiomics signature derived from DBT plus DM generated a lower area under the ROC curve (AUC) and sensitivity, but a higher specificity compared with that from DCE plus DWI. The nomogram integrating the combined radiomics signature, age, and menstruation status achieved the best diagnostic performance in the training (AUCs, nomogram vs. combined radiomics signature vs. clinical model, 0.975 vs. 0.964 vs. 0.782) and validation (AUCs, nomogram vs. combined radiomics signature vs. clinical model, 0.983 vs. 0.978 vs. 0.680) cohorts. DCA confirmed the potential clinical usefulness of the nomogram. CONCLUSIONS: The DBT plus DM provided a lower AUC and sensitivity, but a higher specificity than DCE plus DWI for detecting breast cancer. The proposed clinical-radiomics nomogram has diagnostic advantages over each modality, and can be considered as an efficient tool for breast cancer screening.