Bimolecular Passivation-Dipole Bridge for Highly Efficient Inverted Perovskite Solar Cells with Low Nonradiative Recombination Loss.

Constructing charge-selective heterointerface with minimized defect state and matched energy level alignment is essential to reduce nonradiative recombination for achieving high-performance perovskite solar cells (PSCs). Herein, a bimolecular passivation-dipole bridge comprised of sodium phenylmethanesulfonate (SPM) and 2-phenylethylammonium iodide (PEAI) is carefully developed to regulate perovskite heterointerface. SPM passivates defect states and upshifts Fermi level (EF) of perovskite surface, and subsequent PEAI further induces additional negative dipole and causes the surface EF of perovskite pinning to negative polaron transport state of electron transport layer PCBM, which significantly promotes electron extraction at the perovskite electron-selective contact. These advantages are confirmed by a remarkably improved efficiency from 21.74% for control to 25.12% for treated PSC with excellent stability. Moreover, corresponding nonradiative recombination loss impressively diminishes from 123 to 70 meV, and charge transport-induced fill factor loss is only 3.00%. This work provides a promising approach via passivation-energetic synergy for engineering perovskite heterointerface toward highly efficient and stable PSCs.

Two-dimensional Janus XWZAZ' (X = S, Se, Te; A = Si, Ge; Z, Z' = N, P, As): candidates for photocatalytic water splitting and piezoelectric materials.

Due to their extraordinary properties, particularly the presence of an inherent electric field that effectively suppresses the recombination of photogenerated carriers, Janus two-dimensional (2D) materials exhibit strong light absorption and high solar-to-hydrogen conversion efficiency, making them promising candidates for photocatalytic water splitting applications. In this study, we conducted first-principles calculations to investigate the layers XWZAZ' (X = S, Se, Te; A = Si, Ge; Z, Z' = N, P, As; Z ≠ Z'). Out of 36 possible structures, 25 were found to be stable in terms of their dynamic, thermal, and mechanical properties. Among these 25 stable structures, 22 exhibit semiconductor behavior. Notably, 9 of these semiconductor structures demonstrate excellent photocatalytic and light absorption properties. These 9 photocatalysts possess remarkable light absorption rates (∼23%), high solar-to-hydrogen energy conversion efficiencies (38.447%), ultra-high carrier mobilities (101 596.37 cm2 s-1 V-1), and spontaneous hydrogen evolution reaction (HER) capabilities. Furthermore, all 22 semiconductor structures display significant piezoelectric responses both in-plane and out-of-plane, and biaxial strain has a considerable impact on the properties of the 25 stable structures. This study not only provides potential candidate materials for photocatalytic and piezoelectric applications but also offers theoretical guidance for addressing energy crises and environmental pollution challenges.

The development of a dietary nutrient density educational tool and the investigation of its acceptance by Chinese residents from Henan province.

OBJECTIVES: Helping residents select nutrient-dense foods is a strategy to improve their diet quality. However, communication based on the nutrient-dense foods as a positive attribute has not been widely used in nutritional education. This study aimed to develop an educational tool based on the picture and guidance of "Chinese food guide pagoda (2022) ", extend it with the concept of nutrient density, and investigate its acceptance by Chinese residents from Henan province. METHODS: Three examples (one-day diet with high, medium, and low nutrient-rich food (NRF) 9.2 score, an indicator for evaluating dietary nutrient density) were designed for developing a dietary nutrient density educational tool. A self-designed questionnaire was conducted to investigate the acceptance of the "dietary nutrient density educational tool" among college students from Henan province on the basis of the theory of planned behavior. RESULTS: Among the three one-day diets used in the tool, with the decrease in the NRF9.2 score, the energy intake increased from 1686 kcal to 2363 kcal, the dietary fat-to-energy ratio increased from 28 to 42%, and the mean adequacy ratio (MAR) decreased from 0.97 to 0.87. A total of 851 college students completed the acceptance questionnaire. The average score of the acceptance was 4.07, with a total score of 5. This study showed that resident's intention to use the tool was correlated with family residence, perceptual behavior control, and subjective norms. These three factors accounted for 83.5% of the variation in behavior intention. CONCLUSION: To encourage residents choosing healthier foods, a dietary nutrient density educational tool was developed to expanding the current instructional tool-the Chinese food guide pagoda (2022). The acceptance questionnaire survey revealed that residents had good acceptance of the tool, and family residence, perceptual behavior control, subjective norms may strongly contribute to their acceptance and the intention to use of the tool.

Ultrasensitive detection of H2O2 via electrochemical sensor by graphene synergized with MOF-on-MOF nanozymes.

An electrochemical sensor was developed for the detection of hydrogen peroxide (H2O2), utilizing the synergistic effects of graphene (Gr) and MOF-on-MOF nanozymes (FeCu-NZs). Initially, Fe-MOF with peroxide-like activity is synthesized using a solvothermal method. Subsequently, the organic ligand on its surface binds Cu2+, enhancing the enzyme-like activity further. The resulting FeCu-NZs exhibit a distinctive electrochemical signal in response to H2O2. Moreover, integrating FeCu-NZs with Gr significantly amplifies the electrochemical signal and effectively reduces the sensor's detection limit. The developed sensor exhibited linear ranges of 0.1-3800 µM, with a limit of detection (LOD) of 0.06 µM. Additionally, FeCu-NZs catalyze H2O2 to generate abundant •OH radicals, and colorimetric detection of H2O2 is facilitated using the color rendering principle of 3,3',5,5'-tetramethylbenzidine (TMB). Notably, this detection method was applied to determine  H2O2 concentrations in real samples, achieving a recovery exceeding 95.7%. In summary, this research provides a practical platform for the construction of traditional nanozymes and the integration of electrochemical systems, which have broad applications in food analysis, environmental monitoring, and medical diagnosis.

Application of Chlorophyll Fluorescence Analysis Technique in Studying the Response of Lettuce (Lactuca sativa L.) to Cadmium Stress.

To reveal the impact of cadmium stress on the physiological mechanism of lettuce, simultaneous determination and correlation analyses of chlorophyll content and photosynthetic function were conducted using lettuce seedlings as the research subject. The changes in relative chlorophyll content, rapid chlorophyll fluorescence induction kinetics curve, and related chlorophyll fluorescence parameters of lettuce seedling leaves under cadmium stress were detected and analyzed. Furthermore, a model for estimating relative chlorophyll content was established. The results showed that cadmium stress at 1 mg/kg and 5 mg/kg had a promoting effect on the relative chlorophyll content, while cadmium stress at 10 mg/kg and 20 mg/kg had an inhibitory effect on the relative chlorophyll content. Moreover, with the extension of time, the inhibitory effect became more pronounced. Cadmium stress affects both the donor and acceptor sides of photosystem II in lettuce seedling leaves, damaging the electron transfer chain and reducing energy transfer in the photosynthetic system. It also inhibits water photolysis and decreases electron transfer efficiency, leading to a decline in photosynthesis. However, lettuce seedling leaves can mitigate photosystem II damage caused by cadmium stress through increased thermal dissipation. The model established based on the energy captured by a reaction center for electron transfer can effectively estimate the relative chlorophyll content of leaves. This study demonstrates that chlorophyll fluorescence techniques have great potential in elucidating the physiological mechanism of cadmium stress in lettuce, as well as in achieving synchronized determination and correlation analyses of chlorophyll content and photosynthetic function.

Designing A-D-A Type Fused-Ring Electron Acceptors with a Bulky 3D Substituent at the Central Donor Core to Minimize Non-Radiative Losses and Enhance Organic Solar Cell Efficiency.

Designing and synthesizing narrow band gap acceptors that exhibit high photoluminescence quantum yield (PLQY) and strong crystallinity is a highly effective, yet challenging, approach to reducing non-radiative energy losses (▵Enr) and boosting the performance of organic solar cells (OSCs). We have successfully designed and synthesized an A-D-A type fused-ring electron acceptor, named DM-F, which features a planar molecular backbone adorned with bulky three-dimensional camphane side groups at its central core. These bulky substituents effectively hinder the formation of H-aggregates of the acceptors, promoting the formation of more J-aggregates and notably elevating the PLQY of the acceptor in the film. As anticipated, DM-F showcases pronounced near-infrared absorption coupled with impressive crystallinity. Organic solar cells (OSCs) leveraging DM-F exhibit a high EQEEL value and remarkably low ▵Enr of 0.14 eV-currently the most minimal reported value for OSCs. Moreover, the power conversion efficiency (PCE) of binary and ternary OSCs utilizing DM-F has reached 16.16 % and 20.09 %, respectively, marking a new apex in reported efficiency within the OSCs field. In conclusion, our study reveals that designing narrow band gap acceptors with high PLQY is an effective way to reduce ▵Enr and improve the PCE of OSCs.

Boosting Organic Solar Cells to Over 18% Efficiency through Dipole-Dipole Interactions in Fluorinated Nonfused Ring Electron Acceptors.

This study successfully designed and synthesized two nonfused ring electron acceptors, 412-6F and 412-6Cl, modified with fluorine and chlorine substituents, respectively. Single-crystal analysis revealed that 412-6F possesses a planar molecular backbone and exhibits pronounced dipole-dipole interactions between the fluorine atoms on the lateral phenyl groups and the carbonyl oxygen atoms on the end groups. This specific interaction promotes dense end-group stacking, leading to a reduced interlayer spacing. Improved crystallinity and coherence length are observed in the D18:412-6F blend film. Conversely, 412-6Cl adopts a more distorted configuration and lacks these interactions. As a result, the organic solar cell (OSC) based on D18:412-6F achieved a remarkable power conversion efficiency of 18.03%, surpassing the performance of the D18:412-6Cl OSC. This underscores the importance of designing novel acceptors with beneficial intermolecular interactions to enhance OSC efficiency, thus providing a new direction for organic photovoltaic advancement.

FAPI Compared with FDG PET/CT for Diagnosis of Primary and Metastatic Lung Cancer.

Background The radiotracer fluorine 18 (18F)-labeled fibroblast activation protein inhibitor (FAPI) has shown promise for visualizing several types of cancer, but the accuracy of 18F-FAPI compared with 18F-fluorodeoxyglucose (FDG) for the detection of lung cancer remains uncertain. Purpose To evaluate the effectiveness of 18F-FAPI-based PET/CT imaging for the diagnosis of primary and metastatic lung cancer lesions as compared with 18F-FDG PET/CT. Materials and Methods In this secondary analysis of a prospective trial, consecutively recruited patients from a single center with pathologically confirmed lung cancer were prospectively enrolled from December 2020 to April 2022 and underwent paired 18F-FAPI and 18F-FDG PET/CT examinations at intervals of more than 20 hours and within 7 days of each other. Histopathologic and clinical follow-up results were used as reference standards for final diagnoses. 18F-FAPI and 18F-FDG uptake were compared using the McNemar test or paired Student t test. Diagnostic accuracy was compared between the two techniques by using the McNemar χ2 test. Results Sixty-eight participants (median age, 63 years [IQR, 58-68 years; range, 42-79 years]; 46 male [68%]) were evaluated. Compared with the mean tumor-to-background ratio (TBR) for FDG uptake, TBR for FAPI uptake was lower in primary lung tumors (25.3 ± 14.0 [SD] vs 32.1 ± 21.1; P < .001) but higher in metastatic lymph nodes (7.5 ± 6.6 vs 5.9 ± 8.6; P < .001) and bone metastases (8.6 ± 5.4 vs 4.3 ± 2.3; P < .001). For diagnostic accuracy in a total of 548 lesions in 68 participants, compared with 18F-FDG PET/CT, 18F-FAPI PET/CT demonstrated a higher sensitivity (99% [392 of 397 lesions] vs 87% [346 of 397]; P < .001), specificity (93% [141 of 151 lesions] vs 79% [120 of 151]; P = .004), accuracy (97% [533 of 548 lesions] vs 85% [466 of 548]; P < .001), and negative predictive value (97% [141 of 146 lesions] vs 70% [120 of 171 lesions]; P < .001), but there was no evidence of a difference for positive predictive value (98% [392 of 402 lesions] vs 92% [346 of 377 lesions]; P = .57). Conclusion 18F-FAPI PET/CT may be superior to 18F-FDG PET/CT for detecting lung cancer. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zukotynski and Gerbaudo in this issue.

Honeycomb Electron Lattice Induced Dirac Fermion with Trigonal Warping in Bilayer Electrides.

Emergent fermions arising from the excess electrons of electrides provide a new perspective for exploring semimetal states with unique Fermi surface geometries. In this study, a class of unique two-dimensional (2D) highly anisotropic Dirac fermions is designed using a sandwich structure. Based on the structural design and first-principles calculations, 2D electride MB (M = Ca/Sr, B = Cl/Br/I) is an ideal candidate material. The excess electrons of the bilayer MB could be stably localized in the interstitial cavities, constructing a natural zigzag honeycomb electron sublattice that further forms a Dirac fermion. Compared with traditional Dirac semimetals, 2D Dirac electrides exhibited rich physical properties: i) The Fermi surface shows trigonal warping in low-energy regions. In particular, the geometry of the Fermi surface determines the high anisotropy of the Fermi velocity. ii) A pair of Dirac fermions are protected by three-fold rotational symmetry and exhibit strong robustness. iii) Electride MB possesses a lower work function that strongly correlates with the surface area of the emission channel. Based on these properties, an electron-emitting device with multifunctional applications is fabricated. Therefore, this study provides an ideal platform for studying potential entanglement between structures, electrides, and topological states.

Increased 18F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions.

OBJECTIVE: This study investigated the distribution and characteristics of various bone and joint lesions on 18F-FAPI PET/CT in lung cancer patients. METHODS: Seventy-four lung cancer patients who underwent 18F-FAPI PET/CT were reviewed. Bone and joint lesions with elevated 18F-FAPI uptake were recorded and analyzed. The distribution and maximum uptake value (SUVmax) of different benign lesions or bone metastases were presented. In addition, the SUVmax of bone metastases on 18F-FDG and 18F-FAPI-04 PET/CT were also compared. RESULTS: In 53 patients, a total of 262 lesions presented 18F-FAPI accumulation. Bone metastases were mainly in vertebrae, pelvis, and ribs, while benign lesions were in vertebral margins, alveolar bone, and shoulder joints. The SUVmax of bone metastases was significantly higher than that of benign lesions ([Formula: see text] vs. [Formula: see text], [Formula: see text]), with NSCLC cases having higher SUVmax values than SCLC cases ([Formula: see text] vs. [Formula: see text], [Formula: see text]). Among benign lesions, arthritis and periodontitis demonstrated higher SUVmax than degenerative lesions (arthritis: [Formula: see text]; periodontitis: [Formula: see text]; degenerative diseases: [Formula: see text]; [Formula: see text] and [Formula: see text], respectively). The SUVmax of bone metastases was comparable between 18F-FDG and 18F-FAPI PET/CT. However, 18F-FAPI PET/CT was found to be superior in identifying cranial metastases compared to 18F-FDG PET/CT (TBRmet/brain: [Formula: see text] vs. [Formula: see text], [Formula: see text]). CONCLUSION: This study demonstrated that 18F-FAPI PET/CT is a valuable imaging modality for detecting bone and joint lesions in lung cancer patients. The SUVmax of malignant lesions was higher than that of benign lesions, but cannot accurately distinguish benign and malignant lesions. The uptake of FAPI differs among lesions with different pathological types.

Tabersonine attenuates obesity-induced renal injury via inhibiting NF-κB-mediated inflammation.

Obesity-induced metabolic disorders can cause chronic inflammation in the whole body, activating the nuclear factor kappa B (NF-κB) pathway and inducing apoptosis. Therefore, anti-inflammatory strategies may be effective in preventing obesity-related renal injury. Tabersonine (Tab) has been used pharmacologically to alleviate inflammation-related symptoms. This study evaluated the therapeutic effect of Tab on obesity-related renal injury and explored the pharmacological mechanism. Tab (20 mg/kg) relieved HFD-induced renal structural disorder and alleviated renal functional decline in mice, including improvement of renal tissue fibrosis, reducing renal cell apoptosis and inflammation in renal tissues. Mechanistically, we demonstrated that Tab inhibited the activation of NF-κB signaling pathway both in vivo and in vitro, thereby improving the renal tissue lesions in the mice with obesity-related renal injury. In both the obese mouse model and the mouse glomerular mesangial cell model, the natural compound Tab ameliorated HFD- and saturated fatty acid-induced renal cell injury by inhibiting the activation of NF-κB signaling pathway. Our data suggest that Tab may become a potential candidate for the prevention and treatment of obesity-related renal injury.

Analysis of Cadmium Contamination in Lettuce (Lactuca sativa L.) Using Visible-Near Infrared Reflectance Spectroscopy.

In order to rapidly and accurately monitor cadmium contamination in lettuce and understand the growth conditions of lettuce under cadmium pollution, lettuce is used as the test material. Under different concentrations of cadmium stress and at different growth stages, relative chlorophyll content of lettuce leaves, the cadmium content in the leaves, and the visible-near infrared reflectance spectra are detected and analyzed. An inversion model of the cadmium content and relative chlorophyll content in the lettuce leaves is established. The results indicate that cadmium concentrations of 1 mg/kg and 5 mg/kg promote relative chlorophyll content, while concentrations of 10 mg/kg and 20 mg/kg inhibit relative chlorophyll content. The cadmium content in the leaves increases with increasing cadmium concentrations. Cadmium stress caused a "blue shift" in the red edge position only during the mature period, while the red valley position underwent a "blue shift" during the seedling and growth periods and a "red shift" during the mature period. The green peak position exhibited a "blue shift". After model validation, it was found that the model constructed using the ratio of red edge area to yellow edge area and the normalized values of red edge area and yellow edge area effectively estimated the cadmium content in lettuce leaves. The model established using the normalized vegetation index of the red edge and the ratio of the peak green value to red shoulder amplitude can effectively estimate the relative chlorophyll content in lettuce leaves. This study demonstrates that the visible-near infrared spectroscopy technique holds great potential for monitoring cadmium contamination and estimating chlorophyll content in lettuce.

High-Pressure Fabrication of Binary Organic Solar Cells with High Molecular Weight D18 Yields Record 19.65 % Efficiency.

In this work, inspired by the principles of a pressure cooker, we utilized a high-pressure method to address the processing challenges associated with high molecular weight polymers. Through this approach, we successfully dissolved high molecular weight D18 in chloroform at 100 °C within a pressure-tight vial. The increased steam pressure raised the boiling point and dissolving capacity of chloroform, enabling the creation of a hybrid film with superior properties, including more ordered molecular arrangement, increased crystallinity, extended exciton diffusion length, and improved phase morphology. Organic solar cells (OSCs) based on D18 : L8-BO prepared using this high-pressure method achieved an outstanding power conversion efficiency of 19.65 %, setting a new record for binary devices to date. Furthermore, this high-pressure method was successfully applied to fabricate OSCs based on other common systems, leading to significant enhancements in device performance. In summary, this research introduces a universal method for processing high molecular weight D18 materials, ultimately resulting in the highest performance reported for binary organic solar cells.

Strengthening the Intermolecular Interaction of Prototypical Semicrystalline Conjugated Polymer Enables Improved Photocurrent Generation at the Heterojunction.

The intra and intermolecular interactions (J- and H-type aggregation) in the conjugated polymer films are found to readily facilitate the electron and hole transport, respectively. However, how those different aggregation types influence the photocurrent generation at the heterojunction is still mysterious, especially for the newly developed semicrystalline conjugated polymers. Here, the prototypical copolymer PM6 is used to tune the relative content of aggregation types with various halogen-free processing solvents. Various measurements reveal that the toluene-processed PM6 film exhibits the increased H-aggregates and crystallinity in the π-π stacking direction compared to its o-xylene- and trimethylbenzene (TMB)-processed counterparts. This is partly resulted from the weak steric effect and good solubility in the PM6 solution prepared with toluene, which strengthens the intermolecular interaction of adjacent polymer segments. After analyzing the photovoltaic properties of PM6/Y6 bilayer devices, the faster charge carrier transport, smaller charge recombination, lower energy losses, and interfacial energetic disorder can be observed in the toluene-processed device, leading to the synergistically improved short-circuit current density (JSC ) and open-circuit voltage (VOC ). These findings indicate the control of the molecular packing structure in terms of aggregation types is a powerful strategy to promote the photocurrent generation process at the conjugated polymer-based heterojunction.

Essential role of reliable reduction quality in internal fixation of femoral neck fractures in the non-elderly patients-a propensity score matching analysis.

BACKGROUND: The rate of failure of internal fixation for femoral neck fractures has remained largely unchanged over the past 30 years. The current study attempted to identify the controllable variables influencing the failure of internal fixation of femoral neck fractures. METHODS: The study included 190 patients aged from 20 to 65 with femoral neck fracture caused by low energy violent injuries (fall from standing height), who were treated with multiple cannulated screws over the period 2005-2019 at a single centre. Kaplan-Meier (KM) survival analysis was firstly utilized to evaluate the potential interaction between each variable and cumulative rates of reoperation. If P < 0.1 in KM survival analysis, the variables would be included in subsequent Cox survival analysis to explore the influencing need for reoperation of a femoral neck fracture. Next, all of the 190 patients were divided into perfect reduction group (Garden Alignment Index I) and imperfect reduction group (Garden Alignment Index II, III, IV). Propensity score matching (PSM) analysis resulted in 39 pairs. After the baseline variables were balanced between the two groups, cox survival analysis was utilized again to explore the variables influencing the need of reoperation of a femoral neck fracture. Finally, KM survival analysis was utilized to compare the cumulative rate of reoperation between perfect reduction (Group PR) and imperfect reduction (Group IR) as a subgroup analysis. RESULTS: Before PSM analysis, the mean age was 49.96 ± 12.02 years and the total reoperation rate was 17.40%. Cox survival analysis showed that only reduction quality was interrelated with the need for reoperation before PSM analysis and after PSM analysis. Kaplan-Meier cumulative reoperation rate was higher in Group IR than in Group PR after PSM analysis. CONCLUSION: To prolong the service life of the original femoral head, it is essential to achieve a completely anatomical reduction and maintain the reduction quality until the patient fully recovers.

The function of metformin in endometrial receptivity (ER) of patients with polycyclic ovary syndrome (PCOS): a systematic review and meta-analysis.

BACKGROUND: This meta-analysis summarizes evidence from studies using metformin (Met) to improve endometrial receptivity (ER) in women with PCOS. METHODS: Following the PRISMA protocol, we conducted a comprehensive search of academic literature from various databases, including PubMed, EMbase and Cochrane libraries. Studies published in English before Jan 27, 2021, were recruited for primary screening. Data on endometrial thickness (EMT), endometrial artery resistance index (RI), clinical pregnancy rate (CPR) and miscarriage rate (MR) were extracted and analyzed. RESULTS: Sixty-two eligible studies that included 6571 patients were evaluated in this meta-analysis. Primary indicators are EMT and endometrial aetery RI; secondary indicators include the clinical pregnancy rate and miscarriage rate. Metformin significantly increased EMT (SMD = 2.04, 95% CI (0.96,3.12),P = 0.0002) and reduced endometrial artery RI compared to the non-Met group (SMD = - 2.83, 95% CI: (- 5.06, - 0.59), P = 0.01). As expected, metformin also improved CPR and reduced MR in PCOS patients as a result, clinical pregnancy rate (risk ratio [RR] = 1.26, 95% CI: 1.11-1.43, P = 0.0003), and miscarriage rate (RR = 0.73, 95% CI:0.58-0.91, P = 0.006). CONCLUSION: Metformin may improve endometrial receptivity (ER) in PCOS patients by increasing EMT and reducing endometrial artery RI. However, the level of most original studies was low, with small sample sizes. More large-scale, long-term RCTs with rigorous methodologies are needed.

Serum pepsinogen levels in different regions of China and its influencing factors: a multicenter cross-sectional study.

BACKGROUND: The aim of this study is to investigate the difference of serum pepsinogen (PG) baseline levels in different regions of China and its influencing factors. METHODS: From October 2016 to October 2018, asymptomatic health checkup people who underwent nasal endoscopy in nine health management centers in different regions of China were collected. Lifestyle questionnaires were conducted, and serum PG and gastroscopy were performed. The differences in PG levels in baseline population (OLGA-0 grade) were studied according to geographical subregions of China. SPSS software was used for statistical analysis. RESULTS: 1922 patients were included in the final analysis. Compared with the non-atrophy (OLGA-0) group, PGR levels in atrophy group (OLGA-I to IV) were significantly decreased with the atrophy degree (p < 0.05). A total of 1590 baseline people (OLGA-0) were included in the study, including 254 from South China, 574 from East China, 210 from Southwest China, 332 from Northeast China, and 220 from Central/Northern China. There were significant differences in baseline PGI levels among the five regions (p < 0.05). The PGII levels were also different among the five regions, except for Central/Northern versus Southern China. PGR (PGI/PGII ratio) levels in Southern China were higher than other four regions. Further studies were conducted on the related factors that might affect the baseline PG level, which was affected by nationality, dietary habits, smoking, Helicobacter pylori infection and other related factors. CONCLUSION: Influenced by many factors, the baseline PG levels are different in different regions of China. In the follow-up studies of PG cut-off value, different PG cut-off value based on region may be more effective in the screening of gastric cancer and precancerous lesions in China.

More metalwork removals in patients with olecranon fracture treated by tension band wiring than plate fixation-a propensity score matching analysis.

BACKGROUND: Traditional tension band wiring and plate fixation represent the commonest methods for treating olecranon fractures. However, there is no agreement on which method provides the best outcome. The aim of this retrospective study is to compare the outcomes of tension band wiring (TBW) and plate fixation (PF) for treating displaced olecranon fractures. This is the first study to use propensity score matching analysis to compare treatment methods for olecranon fracture. METHOD: A total of 107 patients aged between 18 and 85 had acute isolated and displaced olecranon fractures. The patients were divided into either TBW (n = 49) or PF (n = 58) groups. To conduct propensity score matching for the treatment method (TBW versus PF), 58 patients were analyzed by logistic regression (29 patients in each group). Various demographic and treatment-related variables were examined and analyzed to determine their correlation. RESULTS: Functional effects between two groups are similar (in terms of Mayo Elbow Performance Score (MEPS), the patients' range of elbow motion (ROM) and forearm rotation (RFR), the time return to work (RTW)). The total adverse events rate and metalwork removal events rate are higher in TBW than that in PF. After propensity score matching analysis, similar primary treatment efficacy (indicated by MEPS> 90) in 2 groups and more primary adverse events (indicated by metalwork removal) were perceived in TBW than that in PF. Logistic regression analysis revealed that fracture type was an independent factor that affected the efficacy of a treatment (regression coefficient = - 1.24 < 0, P = 0.03), indicating that fracture severity was inversely proportional to the efficacy of a treatment for olecranon fracture. Furthermore, logistic regression analysis demonstrated that the treatment method was an independent factor that affected metalwork removal of olecranon fracture (regression coefficient 2.38 > 0, OR = 10.77, P < 0.01), indicating that the risk of metalwork removal in the TBW Group was 10.77 times that in the PF Group. CONCLUSION: When initially discussing the surgical approach with patients, physicians should fully weigh the possibility that TBW may lead to a second surgery due to the higher risk of internal fixation removal and that TBW won't yield better functional outcomes than PF .

Reducing decompression levels by diffusion tensor imaging and conventional magnetic resonance imaging in degenerative lumbar spinal stenosis.

BACKGROUND: The selection of a correct level in lumbar spinal stenosis (LSS) remains a common problem and is critically important to the effectiveness of this surgical treatment. Surgery is invasive, and extended laminectomy may lead to secondary surgical complications. The application of diffuse tensor imagining (DTI) and paraspinal mapping (PM) in addition to conventional magnetic resonance imaging (cMRI) may be helpful in this respect. However, the superiority of cMRI + DTI over cMRI+ (DTI or PM) in reducing decompression has not yet been established. METHODS: We compared the surgical levels, determined by cMRI + DTI and cMRI+ (DTI or PM) (self-control). Treatment outcome measurements were performed at two weeks, three months, six months, and twelve months postoperatively. RESULTS: The surgical levels determined by cMRI ± DTI showed less than that determined by cMRI± (DTI or PM) with statistically significant differences (p value = 0.0199) and cMRI ± PM with no statistically significant differences (p value = 0.5503). CONCLUSIONS: The effectiveness of cMRI ± DTI in the reduction of the surgical levels in degenerative lumbar spinal stenosis is superior than that of cMRI± (DTI or PM).

Heterogeneous components of lung adenocarcinomas confer distinct EGFR mutation and PD-L1 expression.

BACKGROUND: Lung adenocarcinoma (LAC) is composed of lepidic, papillary, mucinous, micropapillary and solid components in its parenchyma. Complex responses to therapeutics result from intratumoral heterogeneity. However, it remains confused that what components in a mixed LAC tumor are responsible to the heterogeneous EGFR mutation and PD-L1 expression. METHODS: We investigated EGFR status via laser microdissection to capture spatially separated cancer cell subpopulations and digital droplet PCR to determine the abundance of EGFR sensitizing mutation and naïve T790M. Whilst, PD-L1 expression level via tumor proportion score (TPS) was evaluated by Ventana immunohistochemistry using SP263 antibody. PD-L1 expression levels were tiered in < 1, 1-49% and > =50% groups. RESULTS: EGFR mutation harbored in 154 (59%) of 261 LAC patients and more frequently occurred in papillary, lepidic and micropapillary constituents. Higher levels of PD-L1 were found in LACs at stage III and IV (68.3%) versus those at stage I and II (31.7%) (P = 0.04). Solid predominant LACs (41.3%) expressed PD-L1 with TPS > =50%, versus mucinous and lepidic LACs (P < 0.01). LACs with solid constituents also had more positive proportion of PD-L1 protein. Cut-offs < 1, 1-49% or > =50% were associated with patients' progression-free survival and longer in the < 1% group (22.9 month, 95% CI 17.6-28.2) (P < 0.05). LACs consisting of two constituents with PD-L1 TPS < 1% had a better prognosis than the groups with single component and more than two components (P < 0.05). Eighteen LACs (6.9%) had concomitantly deletion in exon 19 or L858R and naïve T790M mutation. The abundance of T790M varied diversely with sensitizing mutation. PD-L1 expression was not concordant in same components and usually negative in the EGFR-mutated constituents. Heterogeneous PD-L1 expression occurred in the vicinity of stromal tissues. 58.8, 29.4 and 11.8% in ALK positive LACs (N = 17) were found PD-L1 expression via cutoffs of < 1, 1-49% and > =50%, respectively (P > 0.05). CONCLUSION: Intratumoral genetic heterogeneity of LACs was demonstrated associated with histological patterns. Heterogeneous PD-L1 expression in higher level usually occurred in solid component both in EGFR mutated and EGFR wild-typed LACs. EGFR mutated LACs heterogeneously had sensitizing and resistant mutation and was accompanied with PD-L1 expression, but discordant among histological constituents. Immune checkpoint inhibitor combined with third generation EGFR tyrosine kinase inhibitor should be more effective to these LACs.