The thylakoid phosphatase TEF8 is involved in state transition and high light stress resistance in Chlamydomonas.

The sophisticated regulation of state transition is required to maintain optimal photosynthetic performance under fluctuating light condition, through balancing the absorbed light energy between photosystem II and photosystem I. This exquisite process incorporates phosphorylation and dephosphorylation of light-harvesting complexes and PSII core subunits, accomplished by thylakoid membrane-localized kinases and phosphatases that have not been fully identified. In this study, one Chlamydomonas high light response gene, THYLAKOID ENRICHED FRACTION 8 (TEF8), was characterized. The Chlamydomonas tef8 mutant showed high light sensitivity and defective state transition. The enzymatic activity assays showed that TEF8 is a bona fide phosphatase localized in thylakoid membranes. Biochemical assays, including BN-PAGE, pull-down, and phosphopeptide mass spectrometry, proved that TEF8 associates with photosystem II and is involved in the dephosphorylation of D2 and CP29 subunits during state 2 to state 1 transition. Taken together, our results identified TEF8 as a thylakoid phosphatase with multiple dephosphorylation targets on photosystem II, and provide new insight into the regulatory mechanism of state transition and high light resistance in Chlamydomonas.

Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture.

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant-Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p < 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p < 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p < 0.001). Both groups had similarly excellent Constant-Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.

Control of grain size and weight by the RNA-binding protein EOG1 in rice and wheat.

Grain size is one of the important yield traits in crops. Understanding the molecular and genetic mechanisms of grain-size control is important for yield improvement. Here, we report that the enhancer of GS2AA (EOG1) encodes an RNA-binding protein, which can bind mRNAs of several grain-size genes and influence their abundance. The eog1-1 mutant produces large and heavy grains by promoting cell proliferation in the spikelet hull. OsGSK3 physically interacts with and phosphorylates EOG1, thereby influencing the stability of EOG1. Genetic analyses support that EOG1 and OsGSK3 share overlapped function in grain size and weight control but does so independently of GS2. Notably, genome editing of wheat homologs TaEOG1A/B/D causes large and heavy grains. Thus, our findings identify a genetic and molecular mechanism whereby the OsGSK3-EOG1 module regulates grain size and weight in rice, suggesting that this pathway has the potential for grain-size improvement in key crops.

Phase 2 dose-ranging study to evaluate the efficacy and safety of liposomal irinotecan (LY01610) as a second-line treatment for patients with relapsed small cell lung cancer.

Background: This was a multicenter, single-arm dose-ranging phase 2 study aimed to assess the efficacy and safety of LY01610, a liposomal irinotecan, at various doses for patients with relapsed small cell lung cancer (SCLC). Methods: This study (NCT04381910) enrolled patients with relapsed SCLC at 10 hospitals across China, who have failed with previous platinum-based treatments. LY01610 was administered at doses of 60 mg/m2, 80 mg/m2, and 100 mg/m2. Primary endpoints were investigator-assessed objective response rate (ORR) and investigator-assessed duration of response (DoR). Secondary endpoints included investigator-assessed disease control rate (DCR), investigator-assessed progression-free survival (PFS), overall survival (OS), and safety. Findings: From September 3, 2020 to March 3, 2022, a total of 66 patients were enrolled, with 6, 30, and 30 allocated to the 60 mg/m2, 80 mg/m2, and 100 mg/m2 dose groups, respectively, with 68% (45/66) having a chemotherapy-free interval <90 days. In all 66 patients, the ORR was 32% (21/66, 95% confidence interval [CI], 21-44), with a median DoR of 5.2 months (95% CI, 3.0-8.3). Median PFS and OS were 4.0 (95% CI, 2.9-5.5) and 9.7 (95% CI, 7.2-12.3) months, respectively. The ORR of 60 mg/m2, 80 mg/m2, and 100 mg/m2 dose group were 33% (2/6), 33% (10/30), and 30% (9/30), respectively. The median DoR of 60 mg/m2, 80 mg/m2, and 100 mg/m2 dose group were 4.2 (95% CI, 2.8-not reached), 6.9 (95% CI, 2.5-9.9), and 4.0 (95% CI, 2.7-6.8) months, respectively. The incidence of ≥ grade 3 treatment-related adverse events (TRAEs) in the 60 mg/m2, 80 mg/m2, and 100 mg/m2 dose group were 33% (2/6), 47% (14/30), and 50% (15/30), respectively. The most common ≥ grade 3 TRAEs of all 66 patients were neutropenia (27%), leukopenia (24%) and anemia (15%). Interpretation: LY01610 exhibited promising clinical efficacy and manageable safety profiles in patients with relapsed SCLC, the 80 mg/m2 dose group had the best benefit-risk ratio. Funding: This study was supported by Luye Pharma Group Ltd.

The affective factors of depression symptoms in hypertensive patients and the protective effect of physical activity.

OBJECTIVE: To investigate the potential affective factors of depressive symptoms in patients with hypertension and explore the protective effects of physical activity. METHODS: 211 hypertensive patients aged over 18 years were consecutively recruited. All patients completed a self-designed questionnaire and the Hospital Anxiety and Depression Scale (HADS) to assess the coexistence of depressive symptoms, and psychiatrists were invited to diagnose depression when necessary. Full-night polysomnography was performed to detect the sleep pattern. The association between sleep structure and depressive symptoms was tested by using logistic regression analysis, and contributing factors as well as the effect of physical activity were assessed among patients with and without depressive symptoms. RESULTS: Of the 211 subjects, 33.6% of cases were coexistent with depressive symptoms. Female gender [OR (95%CI): 2.83 (1.44-5.57), P = 0.003) and the greater percentage of REM stage [OR (95%CI): 1.09 (1.01-1.18), P = 0.024] were the risk factors of depressive symptoms, while doing physical activity showed as the protective factor. Patients with REM stage ≥ 20% showed a higher score on HADS-D than those with REM stage < 20% [(4.9 ± 3.8) vs. (3.7 ± 3.1), P = 0.018]. Compared to individuals who never did physical activity, those who did physical activity 1-2 times per week and ≥ 3 times per week had a 52% and 62% risk reduction in depressive symptoms respectively. Patients who did physical activity had lower levels of high-sensitivity C-reactive protein (hs-CRP) compared to those who never did physical activity. CONCLUSION: Female gender and a higher percentage of REM stage are risk factors for depressive symptoms in hypertension, while physical activity may benefit depressive symptoms by reducing serum levels of hs-CRP.

Omega-3 fatty acids prevent gestational diabetes mellitus via modulation of lipid metabolism.

The incidence rate of gestational diabetes mellitus (GDM) remains high among pregnant women in the second trimester of pregnancy. However, the main clinical approach to alleviate the symptoms of GDM is to control the diet. Our study explored the therapeutic effects of omega-3 fatty acids (ω-3 FAs) on GDM at the cellular and animal levels. We found that ω-3 FAs can promote the transformation of M0 macrophages into anti-inflammatory M2 macrophages. The transformed M2 macrophages promoted ß-oxidation and reduced hepatocyte lipid synthesis (P < 0.05), thereby promoting hepatic function and preventing the excessive accumulation of lipid droplets in the hepatocyte cell line HepG2. Supplementation of ω-3 FAs in pregnant GDM mice significantly reduced fasting blood glucose levels, glucose tolerance test, and insulin tolerance test indices, and lipid accumulation in the liver and effectively prevented the occurrence of liver fibrosis (P < 0.05). These therapeutic effects may be mediated through the anti-inflammatory effects of ω-3 FAs (P < 0.05). ω-3 FAs also had positive effects on the offspring of pregnant GDM mice, as demonstrated by reduced birth mortality and improved glycemic stabilization (P < 0.05). In conclusion, this study provides a possible translational medicine strategy for the treatment of GDM.

BRASSINOSTEROID-SIGNALING KINASE 1 modulates OPEN STOMATA 1 phosphorylation and contributes to stomatal closure and plant immunity.

Stomatal movement plays a critical role in plant immunity by limiting the entry of pathogens. OPEN STOMATA 1 (OST1) is a key component that mediates stomatal closure in plants, however, how OST1 functions in response to pathogens is not well understood. RECEPTOR-LIKE KINASE 902 (RLK902) phosphorylates BRASSINOSTEROID-SIGNALING KINASE 1 (BSK1) and positively modulates plant resistance. In this study, by a genome-wide phosphorylation analysis, we found that the phosphorylation of BSK1 and OST1 was missing in the rlk902 mutant compared with the wild-type plants, indicating a potential connection between the RLK902-BSK1 module and OST1-mediated stomatal closure. We showed that RLK902 and BSK1 contribute to stomatal immunity, as the stomatal closure induced by the bacterial pathogen Pto DC3000 was impaired in rlk902 and bsk1-1 mutants. Stomatal immunity mediated by RLK902 was dependent on BSK1 phosphorylation at Ser230, a key phosphorylation site for BSK1 functions. Several phosphorylation sites of OST1 were important for RLK902- and BSK1-mediated stomatal immunity. Interestingly, the phosphorylation of Ser171 and Ser175 in OST1 contributed to the stomatal immunity mediated by RLK902 but not by BSK1, while phosphorylation of OST1 at Ser29 and Thr176 residues was critical for BSK1-mediated stomatal immunity. Taken together, these results indicate that RLK902 and BSK1 contribute to disease resistance via OST1-mediated stomatal closure. This work revealed a new function of BSK1 in activating stomatal immunity, and the role of RLK902-BSK1 and OST1 module in regulating pathogen-induced stomatal movement.

Tim-4 alleviates acute hepatic injury by modulating homeostasis and function of NKT cells.

T-cell immunoglobulin and mucin domain-containing molecule 4 (Tim-4) is an immune checkpoint molecule, which involves in numerous inflammatory diseases. Tim-4 is mainly expressed on antigen-presenting cells. However, increasing evidence has shown that Tim-4 is also expressed on natural killer T (NKT) cells. The role of Tim-4 in maintaining NKT cell homeostasis and function remains unknown. In this study, we explored the effect of Tim-4 on NKT cells in acute liver injury. This study found that Tim-4 expression on hepatic NKT cells was elevated during acute liver injury. Tim-4 deficiency enhanced IFN-γ, TNF-α expression while impaired IL-4 production in NKT cells. Loss of Tim-4 drove NKT-cell effector lineages to be skewed to NKT1 subset. Furthermore, Tim-4 KO mice were more susceptible to α-Galactosylceramide (α-GalCer) challenge. In conclusion, our findings indicate that Tim-4 plays an important role in regulating homeostasis and function of NKT cells in acute liver injury. Therefore, Tim-4 might become a new regulator of NKT cells and a potential target for the therapy of acute hepatitis.

Development and Implementation of a Dynamically Updated Big Data Intelligence Platform Using Electronic Medical Records for Secondary Hypertension.

Background: The accurate identification and diagnosis of secondary hypertension is critical,especially while cardiovascular heart disease continues to be the leading cause of death. To develop a big data intelligence platform for secondary hypertension using electronic medical records to contribute to future basic and clinical research. Methods: Using hospital data, the platform, named Hypertension DATAbase at Urumchi (UHDATA), included patients diagnosed with hypertension at the People's Hospital of Xinjiang Uygur Autonomous Region since December 2004. The electronic data acquisition system, the database synchronization technology, and data warehouse technology (extract-transform-load, ETL) for the scientific research big data platform were used to synchronize and extract the data from each business system in the hospital. Standard data elements were established for the platform, including demographic and medical information. To facilitate the research, the database was also linked to the sample database system, which includes blood samples, urine specimens, and tissue specimens. Results: From December 17, 2004, to August 31, 2022, a total of 295,297 hypertensive patients were added to the platform, with 53.76% being males, with a mean age of 59 years, and 14% with secondary hypertension. However, 75,802 patients visited the Hypertension Center at our hospital, with 43% (32,595 patients) being successfully diagnosed with secondary hypertension. The database contains 1458 elements, with an average fill rate of 90%. The database can continuously include the data for new hypertensive patients and add new data for existing hypertensive patients, including post-discharge follow-up information, and the database updates every 2 weeks. Presently, some studies that are based on the platform have been published. Conclusions: Using computer information technology, we developed and implemented a big database of dynamically updating electronic medical records for patients with hypertension, which is helpful in promoting future research on secondary hypertension.

Novel Dynamic Event-Triggered Consensus Control of Multiagent Systems With Markovian Switching Topologies Under DoS Attacks.

This article focuses on the issue of novel dynamic event-triggered consensus control of multiagent systems (MASs) with denial-of-service (DoS) attacks. Different from the conventional Markovian switching topologies, the generally uncertain semi-Markovian (GUSM) switching topologies with partially unknown elements and time-dependent uncertainties are constructed for the leader-following MASs by considering the equipment performance and external uncertain environment influence. To save communication resources, the novel dynamic memory event-triggered strategy (DMETS) is presented to decrease the frequency of communication between agents. Some secure consensus control criteria are established for the MASs with GUSM switching topologies and DoS attacks due to the potential system communication disruption caused by attackers. Finally, two physical system examples are designed to prove the effectiveness of the presented method.

Wnt/Wingless signaling promotes lipid mobilization through signal-induced transcriptional repression.

The Wnt/Wingless signaling pathway plays critical roles in metazoan development and energy metabolism, but its role in regulating lipid homeostasis remains not fully understood. Here, we report that the activation of canonical Wnt/Wg signaling promotes lipolysis while concurrently inhibiting lipogenesis and fatty acid ß-oxidation in both larval and adult adipocytes, as well as cultured S2R+ cells, in Drosophila. Using RNA-sequencing and CUT&RUN (Cleavage Under Targets & Release Using Nuclease) assays, we identified a set of Wnt target genes responsible for intracellular lipid homeostasis. Notably, active Wnt signaling directly represses the transcription of these genes, resulting in decreased de novo lipogenesis and fatty acid ß-oxidation, but increased lipolysis. These changes lead to elevated free fatty acids and reduced triglyceride (TG) accumulation in adipocytes with active Wnt signaling. Conversely, downregulation of Wnt signaling in the fat body promotes TG accumulation in both larval and adult adipocytes. The attenuation of Wnt signaling also increases the expression of specific lipid metabolism-related genes in larval adipocytes, wing discs, and adult intestines. Taken together, these findings suggest that Wnt signaling-induced transcriptional repression plays an important role in regulating lipid homeostasis by enhancing lipolysis while simultaneously suppressing lipogenesis and fatty acid ß-oxidation.

Denosumab ameliorates osteoarthritis by protecting cartilage against degradation and modulating subchondral bone remodeling.

Osteoarthritis (OA) is the most prevalent degenerative joint disease worldwide. Effective management for early-stage OA is crucial. Denosumab (DS) has been widely used to treat osteoporosis (OP) and rheumatoid arthritis, but its potential for managing OA remains clear. We assessed the effects of DS on osteoclast activity and chondrocyte apoptosis using tartrate-resistant acid phosphatase (TRAP) assay, quantitative real-time polymerase chain reaction (qRT-PCR), flow cytometry, and TUNEL staining. To assess the impact of DS on the NF-κB pathway, we performed Western blot and immunofluorescence staining. Additionally, we used an OA model to explore the influence of DS on subchondral bone remodeling and cartilage degeneration in vivo. We found that DS hindered receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclastogenesis by inhibiting the activity of the NF-κB pathway. Besides, DS alleviated reactive oxygen species (ROS)-induced apoptosis in chondrocytes by regulating the expression of genes related to apoptosis. Moreover, we observed an attenuation of OA-related subchondral bone remodeling and cartilage degeneration in vivo. Our findings indicate that DS could effectively suppress osteoclast activity and chondrocyte apoptosis, thereby mitigating OA-related subchondral bone remodeling and cartilage degeneration. These results provide a mechanistic basis for using DS to treat OA.

Data Quality-Aware Mixed-Precision Quantization via Hybrid Reinforcement Learning.

Mixed-precision quantization mostly predetermines the model bit-width settings before actual training due to the non-differential bit-width sampling process, obtaining suboptimal performance. Worse still, the conventional static quality-consistent training setting, i.e., all data is assumed to be of the same quality across training and inference, overlooks data quality changes in real-world applications which may lead to poor robustness of the quantized models. In this article, we propose a novel data quality-aware mixed-precision quantization framework, dubbed DQMQ, to dynamically adapt quantization bit-widths to different data qualities. The adaption is based on a bit-width decision policy that can be learned jointly with the quantization training. Concretely, DQMQ is modeled as a hybrid reinforcement learning (RL) task that combines model-based policy optimization with supervised quantization training. By relaxing the discrete bit-width sampling to a continuous probability distribution that is encoded with few learnable parameters, DQMQ is differentiable and can be directly optimized end-to-end with a hybrid optimization target considering both task performance and quantization benefits. Trained on mixed-quality image datasets, DQMQ can implicitly select the most proper bit-width for each layer when facing uneven input qualities. Extensive experiments on various benchmark datasets and networks demonstrate the superiority of DQMQ against existing fixed/mixed-precision quantization methods.

Policy Iteration Q -Learning for Linear Itô Stochastic Systems With Markovian Jumps and Its Application to Power Systems.

This article addresses the solution of continuous-time linear Itô stochastic systems with Markovian jumps using an online policy iteration (PI) approach grounded in Q -learning. Initially, a model-dependent offline algorithm, structured according to traditional optimal control strategies, is designed to solve the algebraic Riccati equation (ARE). Employing Lyapunov theory, we rigorously derive the convergence of the offline PI algorithm and the admissibility of the iterative control law through mathematical analysis. This article represents the first attempt to tackle these technical challenges. Subsequently, to address the limitations inherent in the offline algorithm, we introduce a novel online Q -learning algorithm tailored for Itô stochastic systems with Markovian jumps. The proposed Q -learning algorithm obviates the need for transition probabilities and system matrices. We provide a thorough stability analysis of the closed-loop system. Finally, the effectiveness and applicability of the proposed algorithms are demonstrated through a simulation example, underpinned by the theorems established herein.

Clinical characteristics and risk factors for poor outcomes of invasive pneumococcal disease in pediatric patients in China.

BACKGROUND: Invasive pneumococcal disease (IPD) is a significant health concern in children worldwide. In this study, we aimed to analyze the clinical features, antibiotic resistance, and risk variables for poor outcomes in patients with IPD in Hangzhou. METHODS: A retrospective single-centre study was performed using the pediatric intensive care (PIC) database from 2010 to 2018. The clinical characteristics, laboratory data, antimicrobial resistance, and risk factors for in-hospital mortality and sepsis in patients with IPD in intensive care units (ICUs) were analyzed systematically. RESULTS: A total of 178 IPD patients were included in the study. The majority of the IPD children were 2-10 years old. Antimicrobial resistance tests of S. pneumoniae isolates revealed high resistance to erythromycin, tetracycline and compound sulfamethoxazole (SMZ-Co). All the isolates were sensitive to vancomycin, linezolid, moxifloxacin, telithromycin, ofloxacin, and levofloxacin. IPD patients may experience poor outcomes, including death and sepsis. The in-hospital mortality was 3.93%, and 34.27% of patients suffered from sepsis. Temperature (OR 3.80, 95% CI 1.62-8.87; P = 0.0021), Partial Pressure of Oxygen in Arterial Blood (PaO2) (OR 0.99, 95% CI 0.98-1.00; P = 0.0266), and albumin (OR 0.89, 95% CI 0.80-0.99; P = 0.0329) were found to be independent risk factors for sepsis in children with IPD. CONCLUSION: Pediatric IPD deserves attention in China. Appropriate surveillance and antibiotic selection are crucial in managing resistant strains. Early identification of high-risk individuals with risk factors contributes to the development of appropriate treatment strategies.

Glycosyltransferase Slr1064 regulates carbon metabolism by modulating the levels of UDP-GlcNAc in Synechocystis sp. PCC 6803.

Glycosyltransferases (GTs) are enzymes that transfer sugars to various targets. They play important roles in diverse biological processes, including photosynthesis, cell motility, exopolysaccharide biosynthesis, and lipid metabolism; however, their involvement in regulating carbon metabolism in Synechocystis sp. PCC 6803 has not been reported. We identified a novel GT protein, Slr1064, involved in carbon metabolism. The effect of slr1064 deletion on the growth of Synechocystis cells and functional mechanisms of Slr1064 on carbon metabolism were thoroughly investigated through physiological, biochemistry, proteomic, and metabolic analyses. We found that this GT, which is mainly distributed in the membrane compartment, is essential for the growth of Synechocystis under heterotrophic and mixotrophic conditions, but not under autotrophic conditions. The deletion of slr1064 hampers the turnover rate of Gap2 under mixotrophic conditions and disrupts the assembly of the PRK/GAPDH/CP12 complex under dark culture conditions. Additionally, UDP-GlcNAc, the pivotal metabolite responsible for the O-GlcNAc modification of GAPDH, is downregulated in the Δslr1064. Our work provides new insights into the role of GTs in carbon metabolism in Synechocystis and elucidate the mechanism by which carbon metabolism is regulated in this important model organism.

Cryo-electron tomography reveals the packaging pattern of RuBisCOs in Synechococcus ß-carboxysome.

Carboxysomes are large self-assembled microcompartments that serve as the central machinery of a CO2-concentrating mechanism (CCM). Biogenesis of carboxysome requires the fine organization of thousands of individual proteins; however, the packaging pattern of internal RuBisCOs remains largely unknown. Here we purified the intact ß-carboxysomes from Synechococcus elongatus PCC 7942 and identified the protein components by mass spectrometry. Cryo-electron tomography combined with subtomogram averaging revealed the general organization pattern of internal RuBisCOs, in which the adjacent RuBisCOs are mainly arranged in three distinct manners: head-to-head, head-to-side, and side-by-side. The RuBisCOs in the outermost layer are regularly aligned along the shell, the majority of which directly interact with the shell. Moreover, statistical analysis enabled us to propose an ideal packaging model of RuBisCOs in the ß-carboxysome. These results provide new insights into the biogenesis of ß-carboxysomes and also advance our understanding of the efficient carbon fixation functionality of carboxysomes.

From Pixels to Principles: A Decade of Progress and Landscape in Trustworthy Computer Vision.

The rapid development of computer vision technologies and applications has brought forth a range of social and ethical challenges. Due to the unique characteristics of visual technology in terms of data modalities and application scenarios, computer vision poses specific ethical issues. However, the majority of existing literature either addresses artificial intelligence as a whole or pays particular attention to natural language processing, leaving a gap in specialized research on ethical issues and systematic solutions in the field of computer vision. This paper utilizes bibliometrics and text-mining techniques to quantitatively analyze papers from prominent academic conferences in computer vision over the past decade. It first reveals the developing trends and specific distribution of attention regarding trustworthy aspects in the computer vision field, as well as the inherent connections between ethical dimensions and different stages of visual model development. A life-cycle framework regarding trustworthy computer vision is then presented by making the relevant trustworthy issues, the operation pipeline of AI models, and viable technical solutions interconnected, providing researchers and policymakers with references and guidance for achieving trustworthy CV. Finally, it discusses particular motivations for conducting trustworthy practices and underscores the consistency and ambivalence among various trustworthy principles and technical attributes.

Application of Carbon Nanoparticles in Transoral Endoscopic Thyroidectomy Vestibular Approach for Unilateral Papillary Thyroid Cancer.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is newly applied technology. Carbon nanoparticles (CNs) are novel lymph node tracers that have been widely used in China to help remove central lymph nodes (CLNs) and protect the parathyroid glands (PGs) in open thyroid cancer surgery. This study is to evaluate the effectiveness and safety of CNs in TOETVA. MATERIALS AND METHODS: A total of 158 patients who underwent TOETVA with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2022. The participants were divided into a CNs group (n=88) and a control group (n=70), based on whether they received a intraoperative injection of CNs or not. Meanwhile, the CNs group were additionally divided into 2 subgroups, leakage subgroup (n=26) and standard subgroup (n=62). The 2 groups and subgroups were compared in terms of patient characteristics, perioperative clinical results, and postoperative outcomes. RESULTS: All common metrics had no significant differences were found between the CNs group and the control group ( P >0.05). The standard subgroup of CNs group had advantage over the control group on PGs identification (59/62 vs. 59/70 for superior PG, 56/62 vs. 52/70 for inferior PG, P <0.05). Moreover, the standard subgroup harvested more CLNs than the control group (8.97±2.96 vs. 7.47±2.93, P <0.05). More operation time was spent on the leakage subgroup of CNs group than the control group (160.00±17.61 vs. 140.00±13.32, P <0.05). Meanwhile, the leakage subgroup had disadvantage on intraoperative hemorrhage (26.15±10.80 vs. 21.21±7.09, P <0.05) and hospital durations (4.96±0.72 vs. 4.57±0.69, P <0.05). Furthermore, the leakage group identified fewer inferior PG than the control group (7/26 vs. 52/70, P <0.05). Contrary to the standard subgroup, the CLNs of the leakage subgroup was also unsatisfactory compared with the control group (4.96±1.84 vs. 7.47±2.93, P <0.05). CONCLUSIONS: The application of CNs suspension tracing technology has a definite effect in TOETVA. It can improve the thoroughness of lymph node dissection in the central region and enhance recognition of the PG. However, refined extracapsular anatomy is indispensable to prevent CN leakage. Leaked CNs will also be counterproductive to the operation.

Protein profile of circulating extracellular vesicles reveals biomarker candidates for diagnosis of post-traumatic deep vein thrombosis.

BACKGROUND AND OBJECTIVE: Deep vein thrombosis (DVT) is a common complication after trauma and mostly without specific symptoms. Timely diagnosis and early appropriate treatment measures can prevent further development of thrombosis for patients with traumatic lower extremity fractures. Although extracellular vesicles (EVs) are confirmed as promising disease biomarkers, little is known about the role of altered levels and composition in the diagnosis of post-traumatic DVT. METHOD: The levels of circulating EVs subgroups were measured using flow cytometry. Isolated EVs were characterized and subjected to proteomics analysis to screen for differentially expressed proteins (DEPs) between DVT and non-DVT patients. Regularized logistic regression analysis based on L2 penalty terms using R's caret package was applied to build a model for DVT diagnosis. RESULTS: Compared to non-DVT patients, DVT patients had higher circulating hepatocyte-derived EVs (hEVs) with good predictive value for post-traumatic DVT diagnosis. The results of the proteomic analysis showed that differentially expressed proteins (DEPs) of circulating EVs between the DVT group and non-DVT group were enriched in the complement and coagulation cascade. Finally, an integrated model of five biomarkers including SERPING1, C8G, CFH, FIX, and hEVs level was established for post-traumatic DVT diagnosis with robust identification of the traumatic patients with and without DVT (AUC 0.972). CONCLUSION: Post-traumatic DVT patients had changed levels and composition of circulating EVs compared to non-DVT patients and healthy controls. Circulating EVs may acquire pathological protein signatures and become potential biomarkers for identifying subjects' post-traumatic DVT.