Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent.

BACKGROUND AND AIM: The current focus of the treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) is lifestyle intervention with the aim of significant weight loss alongside aggressive cardiovascular risk reduction. NAFLD is tightly associated with type 2 diabetes (T2D) and obesity. In patients with T2D, glucose lowering agents that promote weight loss have shown a beneficial impact on NAFLD. However, it remains unclear as to whether glucose lowering can improve NALFD in patients with T2D, independent of weight loss. METHODS AND RESULTS: In a retrospective analysis of data from 637 people with T2D, we examined the longitudinal impact of optimizing glycaemic control with DPP-IV inhibitors, GLP-1RAs and SGLT2 inhibitors on Fatty liver index (FLI) and Fibrosis score 4 (Fib-4) adjusting for changes in BMI and choice of glucose lowering regimen over a 12-month period. Multiple linear regression analysis demonstrated a significant correlation between the change in glycated haemoglobin and change in FLI after adjustment for change in BMI, age, sex, and drug class (R = 0.467, p = 0.031). The greatest reduction in FLI was observed in patients with the largest reduction in glycated haemoglobin (p < 0.0001). The probability of improvements in FLI with optimization of glycaemic control was similar with all 3 glucose lowering agents, despite differences in weight reduction. Similar relationships were observed examining the changes in glycaemic control and Fib-4. CONCLUSIONS: Improvements in glucose control that are independent of weight loss are associated with improvement in NAFLD and should form an integral part of the management patients with co-existent NAFLD and T2D.

Changes in species diversity along the ephemeral streams in eastern Mediterranean Mountainous Ecosystem, a case study for Ahir Mountain (Kahramanmaras-Türkiye).

Ephemeral streams are important habitats that support biodiversity, especially in mountainous ecosystems in arid and semi-arid regions, and are among those that will be most affected by global climate change. This study aimed to examine the trends in plant species diversity of ephemeral stream beds and their relationship with environmental variables (aspect, elevation, soil) in the eastern Mediterranean region.For this purpose, 40 sample plots were applied in the valley cross sections of the ephemeral stream beds (valley bottom, side and ridge) on two main slopes (north and south) in 2019. The abundance values of plant species were determined and the number of individuals in each sample plot was counted. In addition, soil samples were taken at a depth of 0-30 cm and analyzed. With the data obtained, the importance value index of all species was calculated, and the diversity and species richness of the sample plots were determined.A total of 130 plant taxa were identified in the study area. The most dominant species were Astragalus kurdicus (IVI value: 25.97), Helichrysum plicatum (21.94), Taeniatherum caput-medusae subsp. crinitum (15.51), Hordeum bulbosum (15.33), Bromus erectus (15.32), and Minuartia juniperina (14.14). Both plant richness and endemism rate showed a significant relationship with increasing elevation. Plant diversity values of south-facing slopes were higher (2.23) than those of north-facing slopes (2.21). In addition, we found that phosphorus is an important factor in the distribution of plant species along the ephemeral stream beds, and as the amount of phosphorus increases, species richness and diversity also increase.

Changes of Estimated Glomerular Filtration Rate and Glycated Hemoglobin A1c in Diabetic Macular Edema Patients Treated by Ranibizumab and Aflibercept in the Tertiary Referral Hospital.

Background and Objectives: Intravitreal injections (IVI) of vascular endothelial growth factor (VEGF) inhibitors are guideline-indicated treatments for diabetic macular edema (DME). However, some recent data have suggested that IVI VEGF inhibitors might, through systemic absorption, lead to a reduction in renal function. Our study aims to compare changes in glycated hemoglobin A1c (HbA1c) and estimated glomerular filtration rate (eGFR) between patients who received IVI ranibizumab and aflibercept treatment and patients who have not received IVI treatments. Materials and Methods: There were 17,165 DME patients with documented ophthalmology visits in the China Medical University Hospital-Clinical Research Data Repository. Those with a history of ESRD or bevacizumab treatment history, and those with missing information on HbA1c or eGFR, were excluded. After matching by age (±2 years), gender, and the year of clinical visit, 154 patients with medical treatment (including ranibizumab and aflibercept) and 154 patients without medical treatment were included in the study. The difference between HbA1c and eGFR at baseline and 3 and 12 months after the index date between the two groups was assessed. Results: Mean HbA1c and eGFR decreased between baseline and 12 months after the index date in both groups (p < 0.05). Compared with the non-treatment group, the treatment group had significantly lower HbA1c 3 and 12 months after the index date. There was no significant difference in eGFR between the two groups. In the generalized estimating equations (GEE) model, HbA1c in the treatment group was lower than the non-treatment group (−0.44%, 95% CI = −0.75, −0.14), but eGFR was similar after adjusting for age, gender, and index-year. HbA1c and eGFR decreased with the time in the adjusted GEE model (p < 0.0001) in both groups. Conclusions: This study showed that eGFR decreased with age and time and was not related to IVI anti-VEGF treatments in our tertiary referral hospital. IVI anti-VEGF therapy was also associated with better HbA1c control. It is suggested that DME patients can receive intravitreal VEGF inhibitors without inducing more renal impairment.

Cytochrome c oxidase dysfunction enhances phagocytic function and osteoclast formation in macrophages.

The mitochondria-to-nucleus retrograde signaling (MtRS) pathway aids in cellular adaptation to stress. We earlier reported that the Ca2+- and calcineurin-dependent MtRS induces macrophage differentiation to bone-resorbing osteoclasts. However, mechanisms through which macrophages sense and respond to cellular stress remain unclear. Here, we induced mitochondrial stress in macrophages by knockdown (KD) of subunits IVi1 or Vb of cytochrome c oxidase (CcO). Whereas both IVi1 and Vb KD impair CcO activity, IVi1 KD cells produced higher levels of cellular and mitochondrial reactive oxygen species with increased glycolysis. Additionally, IVi1 KD induced the activation of MtRS factors NF-κB, NFAT2, and C/EBPδ as well as inflammatory cytokines, NOS 2, increased phagocytic activity, and a greater osteoclast differentiation potential at suboptimal RANK-L concentrations. The osteoclastogenesis in IVi1 KD cells was reversed fully with an IL-6 inhibitor LMT-28, whereas there was minimal rescue of the enhanced phagocytosis in these cells. In agreement with our findings in cultured macrophages, primary bone marrow-derived macrophages from MPV17-/- mice, a model for mitochondrial dysfunction, also showed higher propensity for osteoclast formation. This is the first report showing that CcO dysfunction affects inflammatory pathways, phagocytic function, and osteoclastogenesis.-Angireddy, R., Kazmi, H. R., Srinivasan, S., Sun, L., Iqbal, J., Fuchs, S. Y., Guha, M., Kijima, T., Yuen, T., Zaidi, M., Avadhani, N. G. Cytochrome c oxidase dysfunction enhances phagocytic function and osteoclast formation in macrophages.

Indirect choroidal neovascularization secondary to a posterior-segment intraocular foreign body - case report.

BACKGROUND: We reported a rare case of indirect choroidal neovascularization (CNV) secondary to a posterior-segment intraocular foreign body (IOFB) that was not located in the area of direct injury but in the fovea. After intravitreal injections (IVIs) of aflibercept, the choroidal neovascularization (CNV) lesion disappeared and vision improved. CASE PRESENTATION: A 26-year-old male patient suffered from a fast-shot metallic IOFB in his right eye. He underwent primary corneal repair, pars plana vitrectomy, IOFB removal and an IVI of antibiotics in the right eye. Two weeks later, cataract surgery was performed on the right eye for traumatic cataract after an episode of acute phacolytic glaucoma. The best-corrected visual acuity (BCVA) of the right eye improved to 20/20 5 months after the first surgery. However, the vision of the right eye worsened suddenly with metamorphopsia 1 year after the first surgery. Color fundus images showed a whitish lesion with faint retinal hemorrhage and surrounding sensory elevation. Fluorescein angiography (FA) revealed a lesion with early- and late-phase severe leakage. Optical coherence tomography (OCT) demonstrated a CNV lesion with surrounding subretinal fluid. The patient received an IVI of aflibercept every 8 weeks for 3 times. Finally, the BCVA of the right eye improved to 20/25. CONCLUSIONS: For rare cases of fovea-spared injury by a metallic IOFB, it is still necessary to pay close attention to the foveal microstructure to avoid possible CNV formation. Treatment with IVIs of anti-VEGF, aflibercept, as early as possible could provide good visual outcomes.

IoT-Based Resource Control for In-Vehicle Infotainment Services: Design and Experimentation.

A variety of in-vehicle infotainment (IVI) devices and services have been developed by many vehicle vendors and software companies, which include navigation systems, cameras, speakers, headrest displays, and heating seat. However, there has not been enough research on how to effectively control and manage numerous IVI resources (devices and contents), so as to provide users with more enhanced services. This paper proposes a framework of resource control for IVI services so as to efficiently manage the IVI resources within an automobile. Differently from conventional IVI systems, in the proposed scheme, the IVI-Master is newly introduced for overall control of IVI resources, and IVI users are divided into owner and users. In addition, the IVI resources are classified as personal resources and shared resources, which are managed by the IVI-Master using the Lightweight Machine-to-Machine (LWM2M) standard. The proposed IoT-based IVI resource control scheme was implemented and tested. The experimental results showed that the proposed scheme can be used to effectively manage IVI resources for users. Additionally, the proposed resource control scheme shows lower bandwidth usage than the existing scheme.

[Vaccinovigilance: Reports of adverse reactions in the year 2017]. / Vaccinovigilance: Gemeldete ­unerwünschte Wirkungen im Jahr 2017.

INTRODUCTION: The aim of the Vaccinovigilance system is the identification of adverse reactions and rare events after the use of immunological veterinary medicinal products. In the year 2017, 128 reports of adverse reactions following the application of various authorized vaccines were received and evaluated. The notifications were submitted primarily by marketing authorization holders (96) or veterinarians (27) and private persons (5). As in previous years, dogs were involved in most of the adverse effects (55%), followed by cattle (18%) and swine (10%). Unlike the previous years, significantly fewer reports were submitted on cats (8%). The correlation between reaction and vaccination was considered probable in 43% of the - cases.

INTRODUCTION: L'objectif du système d'annonces de vaccinovigilance est d'identifier les effets indésirables pouvant survenir à la suite de l'utilisation de médicaments vétérinaires immunologiques. En 2017, 128 notifications concernant des médicaments vétérinaires immunologiques approuvées commercialement ont été soumises. Elles ont été envoyés soit par les sociétés d'enregistrement (96), les vétérinaires praticiens (27) ou des particuliers (5). Comme les années précédentes, les effets indésirables concernent principalement les chiens (55%), suivis des bovins (18%) et des porcs (10%). Contrairement aux années précédentes, il y a beaucoup moins de rapports sur les chats (8%). Dans 43% des cas, la relation entre la réaction et le vaccin a été jugée probable.

[Vaccinovigilance: Reports of adverse reactions in the year 2016]. / Vaccinovigilance: Gemeldete unerwünschte Wirkungen im Jahr 2016.

INTRODUCTION: In the year 2016, 107 reports of adverse reactions following the application of various authorized vaccines were received and evaluated by the IVI (Institute of Virology and Immunology). The notifications were submitted primarily by marketing authorization holders (81) or veterinarians and private persons (26). The aim of the Vigilance System is the identification of rare events to assess the individual risks of the vaccine application. During the last year, the correlation between reaction and vaccination was considered probable in 34% of the cases. As in previous years, companion animals were involved in most of the adverse effects (48% dogs, 21% cats), followed by cattle (13%). In dogs, approximately half of the reports concern the combination vaccines against distemper, hepatitis, parvovirus, parainfluenza and leptospirosis. The reported symptoms, such as itching, facial edema, acute vomiting and diarrhea, usually indicated forms of hypersensitivity. In cats, apathy was most frequently observed regardless of the vaccination.

INTRODUCTION: En 2016, 107 annonces de réactions après l'utilisation de médicaments immunologiques enregistrés ont été faites et analysées à l'IVI (Institut de Virologie et d'Immunologie). Ces annonces ont été faites primairement par les firmes distribuant ces produits (81) ou par les vétérinaires praticiens et des personnes privées (26). Le but du système d'annonce est d'identifier les événements exceptionnels afin d'estimer les risques individuels de l'utilisation de vaccins. L'année dernière, 34% des cas annoncés ont été considérés comme vraisemblablement en rapport avec la vaccination. Comme les années précédentes, les effets indésirables concernaient principalement les petits animaux (chiens 48%, chats 21%) suivis par les bovins (13%). Chez le chien, il s'agissait pour environ une moitié d'annonces en relation avec des vaccins combinés contre la maladie de Carré, l'hépatite, la parvovirose, la parainfluenza et la leptospirose. Les symptômes annoncés comme des démangeaisons, un oedème de la face, des vomissements aigus ou de la diarrhée indiquaient la plupart du temps des formes d'hypersensibilité. Chez les chats, indépendamment du vaccin appliqué, c'est l'apathie qui était le plus souvent rapportée.

Multistakeholder partnerships with the Democratic Peoples' Republic of Korea to improve childhood immunisation: A perspective from global health equity and political determinants of health equity.

OBJECTIVE: To examine the current partnerships to improve the childhood immunisation programme in the Democratic Peoples' Republic of Korea (DPRK) in the context of the political determinants of health equity. METHODS: A literature search was conducted to identify public health collaborations with the DPRK government. Based on the amount of publicly accessible data and a shared approach in health system strengthening among the partners in immunisation programmes, the search focused on these partnerships. RESULTS: The efforts by WHO, UNICEF, GAVI and IVI with the DPRK government improved the delivery of childhood vaccines (e.g. pentavalent vaccines, inactivated polio vaccine, two-dose measles vaccine and Japanese encephalitis vaccine) and strengthened the DPRK health system by equipping health centres, and training all levels of public health personnel for VPD surveillance and immunisation service delivery. CONCLUSION: The VPD-focused programmatic activities in the DPRK have improved the delivery of childhood immunisation and have created dialogue and contact with the people of the DPRK. These efforts are likely to ameliorate the political isolation of the people of the DPRK and potentially improve global health equity.

Are ecologically important tree species the most useful? A case study from indigenous people in the Bolivian Amazon.

Researchers have argued that indigenous peoples preferably use the most apparent plant species, particularly for medicinal uses. However, the association between the ecological importance of a species and its usefulness remains unclear. In this paper we quantify such association for six use categories (firewood, construction, materials, food, medicines and other uses). We collected data on the uses of 58 tree species, as reported by 93 informants in 22 villages in the Tsimane' territory (Bolivian Amazon). We calculated the ecological importance of the same species by deriving their importance value index (IVI) in 48 0.1-ha old-growth forest plots. Matching both data sets, we found a positive relation between the IVI of a species and its overall use value (UV) as well as with its UV for construction and materials. We found a negative relation between IVI and UV for species that were reportedly used for medicine and food uses, and no clear pattern for the other categories. We hypothesize that species used for construction or crafting purposes because of their physical properties are more easily substitutable than species used for medicinal or edible purposes because of their chemical properties.

Dynamics of Treatment Response to Faricimab for Diabetic Macular Edema.

This study analyzes the dynamics of short-term treatment response to the first intravitreal faricimab injection in eyes with diabetic macular edema (DME). This retrospective, single-center, clinical trial was conducted at the Department of Ophthalmology, University Hospital Zurich. Patients with treatment-naïve and pretreated DME were included. Patient chart data and imaging were analyzed. Safety and efficacy (corrected visual acuity (CVA), central subfield thickness (CST), and signs of intraocular inflammation (IOI)) of the first faricimab intravitreal therapy (IVT) were evaluated weekly until 4 weeks after injection. Forty-three eyes (81% pretreated) of 31 patients were included. Four weeks after the first faricimab IVT, CVA remained stable and median CST (µm) decreased significantly (p < 0.001) from 325.0 (293.5-399.0) at baseline to 304.0 (286.5-358.0). CVA at week 4 was only associated with baseline CVA (p < 0.001). CST was the only predictive variable (p = 0.002) between baseline and week 4 CST. Weekly safety assessments did not show any sign of clinically significant IOI. This study suggests faricimab is an effective treatment for (pretreated) DME, showing structural benefit 1 month following the first injection without short-term safety signals.

Real-World Weekly Efficacy Analysis of Faricimab in Patients with Age-Related Macular Degeneration.

Objectives: This study entailed a weekly analysis of real-world data (RWD) on the safety and efficacy of intravitreal (IVT) faricimab in neovascular age-related macular degeneration (nAMD). Methods: A retrospective, single-centre clinical trial was conducted at the Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland, approved by the Cantonal Ethics Committee of Zurich, Switzerland. Patients with nAMD were included. Data from patient charts and imaging were analysed. The safety and efficacy of the first faricimab injection were evaluated weekly until 4 weeks after injection. Results: Sixty-three eyes with a complete 4-week follow-up were enrolled. Six eyes were treatment-naïve; fifty-seven eyes were switched to faricimab from another treatment. Neither group showed signs of retinal vasculitis during the 4 weeks after injection. Central subfield thickness (CST) and volume (CSV) showed a statistically significant decrease compared to the baseline in the switched group (CST: p = 0.00383; CSV: p = 0.00702) after 4 weeks. The corrected visual acuity returned to the baseline level in both groups. The macular neovascularization area decreased in both groups, but this was not statistically significant. A complete resolution of sub- and intraretinal fluid after 4 weeks was found in 40% (switched) and 75% (naïve) of the treated patients. Conclusions: The weekly follow-ups reflect the structure-function relationship beginning with a fast functional improvement within two weeks after injection followed by a return to near-baseline levels after week 3. The first faricimab injection in our cohort showed a high safety profile and a statistically significant reduction in macular oedema in switched nAMD patients.

New prefilled syringe aflibercept design. A cause of symptomatic IOP spike after aflibercept PFS?

Objective: To describe ocular hypertension cases after using a new aflibercept prefilled syringe and to assess the main characteristics of these eyes and their possible association with intraocular pressure (IOP) changes. Methods: Case series. We reported all the cases of ocular hypertension following aflibercept prefilled syringes (PFS) treatment in our department between April 2021 and December 2023. Results: A total of 4183 eyes were treated with aflibercept PSF. Thirteen transitory IOP elevations were observed immediately after injection (0.3%). Two eyes had an IOP between 30-35 mmHg, five eyes had an IOP between 36-55 mmHg and three eyes had an IOP > 56 mmHg. The mean IOP was 45.5 mmHg±11.33. Only six eyes needed anterior chamber paracentesis (37.5%). The other patients were treated conservatively (ocular massage and/or IOP-lowering drops). The mean IOP after treatment was 15.71 mmHg±7.20. Visual acuity improved after treatment in all the patients. Discussion: Compared with other injectors, reports have indicated a higher incidence of moderate and severe IOP spikes with aflibercept PSF. The European Medicine Agency (EMA) has associated this significant increase with incorrect syringe handling, leading to higher injection volumes. Although plunger misalignment seems to play a role in the IOP spikes, some other characteristics of this new injector could play a role. Factors such as syringe diameter, plunger alignment, and injection force may contribute to this issue. The reason some authors found no significant differences in IOP elevation after IVI, with aflibercept PFS, could be due to variations in patient characteristics, which may also play an important role in post-IVI pressure changes. Conclusions: Intraocular pressure spikes after aflibercept PFS can be explained by injector characteristics. The PFS of aflibercept has a domed plunger. Incorrect alignment between the base of the plunger and the black dosing line could cause an increase in the injected volume. Furthermore, the wider syringe diameter of aflibercept PFS could imply a larger injection force, increasing the risk of IOP elevation. Patient characteristics, such as previous VPP, axial length, or glaucoma history, may also play a role. Further studies are required to develop an ideal intravitreal syringe.

Identification of in-vivo induced genes of Streptococcus suis serotype 2 specially expressed in infected human.

Streptococcus suis (S. suis) serotype 2 usually cause infection in swine. Recently, two large-scale outbreaks in China with severe streptococcal toxic shock syndrome (STSS) and high mortality raised worldwide concern to human S. suis infection. To reveal the molecular pathogenesis of S. suis 2 during human infection, in-vivo induced antigen technology (IVIAT) was applied to identify the in-vivo induced genes (ivi genes) of S. suis 05ZYH33. The ivi genes are specifically expressed or up-regulated in-vivo and always associated with the in-vivo survival and pathogenicity of pathogens. In present study, convalescent sera from S. suis 05ZYH33 infected patients were pooled and fully adsorbed with in-vitro grown S. suis 05ZYH33 and Escherichia coli BL21 (DE3). Genomic expression library of 05ZYH33 was repeatedly screened with colony immunoblot assay using adsorbed sera. Finally, 19 genes were assessed as ivi genes of 05ZYH33. Fifteen of 19 genes encode proteins with biological functions in substance transport and metabolism, cell structure biogenesis, cell cycle control, replication, translation and other functions. The 4 remaining genes encode proteins with unknown functions. Of the 19 ivi genes, five (SSU05_0247, 0437, 1577, 1664 and 2144) encode proteins with no immunoreactivity to control sera from healthy individuals never exposed to 05ZYH33. The successful identification of ivi genes not only sheds light on understanding the pathogenesis of S. suis 05ZYH33 during its human infection, but also provides potential targets for the developments of new vaccines, therapeutic drugs and diagnostic reagents against human S. suis infection.

Intravenous fluid administration practice among nurses and midwives working in public hospitals of central Ethiopia: A cross-sectional study.

Intravenous fluid administration is the most common invasive procedure widely practiced in hospital settings. Globally, approximately 25 million people receive intravenous fluid therapy. Different factors affect nurse's intravenous fluid administration practices; that it may influences on the patient's outcome, increase morbidity and mortality. Previous study indicates that healthcare providers especially in developing countries have skills gap related to intravenous fluid administration. The purpose of this study was aimed to assess the intravenous fluid administration practices and its associated factors among nurses and midwives working in public hospitals of West Shewa zone, Central Ethiopia. Materials and methods: An institution-based cross-sectional study design was employed among 396 nurses and midwives in public hospitals in West Shewa zone, Central Ethiopia, from March 1 to 31, 2019. A Simple random sampling was used to select study participants using structured self-administered questionnaire, and observational checklist. The logistic regression model was used to identify association, and odds ratio was used to test the strength of the associations with outcome variable and predictor variables. Results: In this study, 59.3% (95%CI = 54.7%-64.5%) participants was had inadequate intravenous fluid administration practice. Inadequate knowledge (AOR 2.1; CI 95% = 1.36-3.36), being untrained (AOR 1.7; 95% CI = 1.04-2.86), unavailability of supervision (AOR 1.8; CI 95% = 1.14-2.99), and absence of incentives and promotion for nurses and midwives (AOR 2.1; CI 95% = 1.19-3.62) were significantly associated with outcome variable. Conclusion: Nearly seven in ten participants in the study setting were inadequate intravenous fluid practice. Inadequate knowledge, training, and absence of supervision by senior staffs, and absence of incentives and promotion for nurses and midwives were the main factors affecting intravenous fluid administration practice. Refresher courses, supervision, incentives and promotions were needed to nurses and midwives for an improvement of the intravenous fluid administration practice.

[Intravitreal injections: Guidelines, methods and medicolegal issues]. / Injections intravitréennes : principes, techniques et aspects médicolégaux.

Intravitreal injection (IVI) of a drug allows for immediate intraocular concentrations of active ingredients higher than those obtained by intravenous injection while reducing the risk of systemic side effects. Today, IVI's play a central role in the treatment of many vitreoretinal diseases. With the aging of the population and the advent of vascular endothelial growth factor (VEGF) antagonists, their indications have increased exponentially, creating structural, organizational and economic difficulties. IVI is now one of the most widely performed medical procedures in industrialized countries, and its indications are expected to expand further in the near future with the development of new molecules. Although the overall safety of this practice is proven, an IVI exposes the patient to a 0.05 % risk of endophthalmitis, the consequences of which are often dramatic. This article details the current recommendations, in particular regarding asepsis and antisepsis, and proposes a typical sequence for performing an IVI.

Identification of risk and prognostic factors for intrahepatic vascular invasion in patients with hepatocellular carcinoma: a population-based study.

Background: The aim of this study was to develop nomograms to predict the risk of intrahepatic vascular invasion (IVI) of hepatocellular carcinoma (HCC) patients and estimate the overall survival (OS) and cancer-specific survival (CSS) of HCC patients with IVI. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with HCC from 2010 to 2015. Ultimately, 1,287 HCC patients with IVI were included in this study and randomly divided into training (n=901) and validation (n=386) cohorts. Multivariate logistic regression analysis and multivariate Cox proportional hazards regression analysis were performed to construct nomograms to visually quantify the risk of IVI in patients with HCC and predict the prognosis. The prediction effect of nomograms was evaluated using Harrell's concordance index (C-index), receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA), respectively. Results: The C-index of the nomogram for risk prediction was 0.730. The C-indices based on the nomogram were 0.762 [95% confidence interval (CI): 0.745-0.779] and 0.770 (95% CI: 0.753-0.787) for OS and CSS prediction in the training cohort, respectively. In the validation cohort, the C-indices were 0.779 (95% CI: 0.752-0.806) and 0.795 (95% CI: 0.768-0.822) for OS prediction and CSS prediction, respectively. Overall, the ROC curve, calibration plots, and DCA indicated the good performance of nomograms. Conclusions: We identified the relevant risk and prognostic factors for IVI in patients with HCC. The nomograms performed well on validation and may help to facilitate clinical decision-making.

Small-fragment, high turnover: soil microenvironment fluctuation effect on tree diversity in a Neotropical montane oak forest.

Background: Soil microenvironmental variables showed an important key in α and ß-tree diversity in Neotropical montane oak forest. Thus, understanding the microenvironment fluctuation at small-fragment effects on tree diversity is crucial in maintaining the montane oak ecosystems. In this study, we hypothesized that within a relatively small-fragment (151.63 ha), tree α and ß-diversity fluctuate and specific soil microenvironmental factors could influence tree species diversity to answer three questions: Do tree α and ß-diversity differ among transects, even in a short-distance between them? Do microenvironmental variables influence tree diversity composition that occurs within a relict Neotropical montane oak forest? Is there a particular microenvironmental variable influencing tree species-specific? Methods: We established four permanent transects during a year in a relict Neotropical montane oak forest, we assessed tree diversity and specific microenvironmental variables (soil moisture, soil temperature, pH, depth litterfall and light incidence). This allowed us to evaluate how microenvironmental variables at small-fragment influence α and ß-tree diversity and tree species-specific. Results: Our results showed that α-diversity was not different among transects; however, ß-diversity of tree species was mostly explained by turnover and soil moisture, soil temperature, and light incidence were the microenvironmental variables that triggered the replacement (i.e., one species by another). Those variables also had effect on tree species-specific: Mexican beech (Fagus mexicana), Quebracho (Quercus delgadoana), Pezma (Cyathea fulva), Aguacatillo (Beilschmiedia mexicana), Pezma (Dicksonia sellowiana var. arachneosa), and Mountain magnolia (Magnolia schiedeana). Discussion: Our results confirm our hypothesis related to ß-diversity but not with α-diversity; however, the tree community structure of the diversity was similar among transects. Our study represents the first effort to evaluate and link the soil microenvironmental effect on tree α and ß-diversity, finding a high replacement in a small-fragment of Neotropical montane oak forest from eastern Mexico.

Psychometric Properties of Scales for Assessing the Vision-related Quality of Life of People with Low Vision: A Systematic Review.

OBJECTIVE: To synthesize information on the psychometric properties of scales used to assess vision-related quality of life in people with low vision. METHODS: A systematic review was conducted. The Cochrane Library, Embase, PubMed, Bireme and Epistemonikos databases were consulted in July 2020. Eligibility assessment of abstracts and full texts was performed independently by two investigators.A standardized template was used for data extraction regarding study design, scale and version, clinical condition of participants, and psychometric properties measured, using database-specific controlled vocabulary terms for low vision and keywords for vision-related quality of life and validity. Data was synthesized considering two approaches for scales validations, Classical Test Theory and Rasch Analysis. RESULTS: A total of 53 articles were included in our analysis. In total, 40 studies evaluated the NEI VFQ scale, four evaluated the IVI scale, two evaluated the VA LV VFQ instrument and seven validated the LVQOL scale. This review found that the VRQoL NEI VFQ, IVI, LVQOL and VA LV VFQ-48 scales have adequate psychometric properties, with good internal consistency, when assessed using the CTT approach. The NEI VFQ scale also showed adequate test-retest reliability and adequate construct and content validity. The NEI VFQ and LVQOL scales showed inadequate items and multidimensionality when Rasch analysis was used. The IVI scale showed potential for assessing change in HRQoL after providing interventions to patients with low vision. CONCLUSIONS: Many questionnaires exist to measure vision-related quality of life in people with low vision, but the psychometric properties of the questionnaires are variable.

An evaluating system for wetland ecological risk: Case study in coastal mainland China.

Coastal wetland degradation and fragmentation contribute to habitat and biodiversity loss. We construct wetland ecological risk assessment framework to evaluate the risk posed to 35 coastal wetland national nature reserves (NNRs) in China for the years 2000 and 2020. Our wetland ecological risk index (WRI) is based on an external hazard sub-index (EHI) and an internal vulnerability sub-index. Most NNRs have low EHI values in both 2000 and 2020. Ratios of change in EHI range from -22.76% to 52.15% (a negative value indicates a decrease, a positive value an increase), and the EHI for 20 of 35 NNRs (57.1%) decreases over time. Variation in the internal vulnerability index ranges -44.78% to 88.97%, and increases at 18 NNRs (51.4%) over time. WRI variation ranges between -48.13% and 82.91%, and increases at 19 NNRs (54.3%). Most NNRs are ranked as being at low, medium risk in both 2000 and 2020. Notably, the number of high-risk NNRs increases from 3 to 10 (for which WRI values also increase). Expansion of built-up land, cropland occupation (in 2020), road disturbance, and water quality are all significantly associated WRI. Intensified management of the 10 NNRs ranked at high risk is necessary to prevent further deterioration.