Pt-Decorated Gold Nanoflares for High-Fidelity Phototheranostics: Reducing Side-Effects and Enhancing Cytotoxicity toward Target Cells.

Functionalized with the Au-S bond, gold nanoflares have emerged as promising candidates for theranostics. However, the presence of intracellular abundantly biothiols compromises the conventional Au-S bond, leading to the unintended release of cargoes and associated side-effects on non-target cells. Additionally, the hypoxic microenvironment in diseased regions limits treatment efficacy, especially in photodynamic therapy. To address these challenges, high-fidelity photodynamic nanoflares constructed on Pt-coated gold nanoparticles (Au@Pt PDNF) were communicated to avoid false-positive therapeutic signals and side-effects caused by biothiol perturbation. Compared with conventional photodynamic gold nanoflares (AuNP PDNF), the Au@Pt PDNF were selectively activated by cancer biomarkers and exhibited high-fidelity phototheranostics while reducing side-effects. Furthermore, the ultrathin Pt-shell catalysis was confirmed to generate oxygen which alleviated hypoxia-related photodynamic resistance and enhanced the antitumor effect. This design might open a new venue to advance theranostics performance and is adaptable to other theranostic nanomaterials by simply adding a Pt shell.

Screening candidate microRNA-mRNA network for predicting the response to chemoresistance in osteosarcoma by bioinformatics analysis.

The search for biomarkers is important for providing more targeted treatments for osteosarcoma patients with chemoresistance. In this study, differentially expressed microRNAs (miRNAs) were identified from miRNA expression profiles. And the target messenger RNAs (mRNAs) of miRNA were obtained from two websites in public domains. Analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway by these miRNA targets suggests that they may have potential links to osteosarcoma chemoresistance. In the protein-protein interaction (PPI) network, we screened three subnetworks and 10 hub RNAs, and analyzed through KEGG pathway and searched the PubMed database, indicating that they were significantly associated with drug resistance. Then we found 12 key mRNAs by analyzing the mRNA expression profile. Survival analyses showed that most of the 10 hub mRNAs and 12 key mRNAs had a significant influence on the prognosis of patients with chemoresistance osteosarcoma. A miRNA-mRNA network is constructed by integrating mRNAs and miRNAs information. The network biomarkers in this study have an advantage over traditional single-molecule biomarkers in terms of predictive power. And the mRNAs in this network biomarkers are supported by survival analysis or by existing theories. These results will contribute to the choice of chemotherapy before treatment and the prediction of patient prognosis.

Effects of antithrombotic therapy on bleeding after endoscopic submucosal dissection.

BACKGROUND AND AIMS: Bleeding is the most common adverse event after endoscopic submucosal dissection (ESD). Although several studies have reported on the use of antithrombotic agents and post-ESD bleeding, many issues remain controversial. We conducted a meta-analysis and systematic review to evaluate the effects of antithrombotic therapy on post-ESD bleeding. METHODS: The published literature was searched on online databases, and all studies were included up to January 2017. Standard forms were used to extract data by 2 independent reviewers. The Newcastle-Ottawa Scale score was used to assess the quality of studies. The pooled odds ratio (OR) was computed for the effect of antithrombotic agents. Publication bias was assessed by funnel plots. Heterogeneity was assessed by the Cochran Q test and I2 statistic. RESULTS: Sixteen retrospective articles were included. Regardless of discontinuation (OR, 1.66; 95% confidence interval [CI], 1.15-2.39; P = .007) or continuation (OR, 8.39; 95% CI, 4.64-15.17; P < .00001), antithrombotic therapy was significantly associated with post-ESD bleeding, particularly for delayed bleeding (OR, 2.66; 95% CI, 1.42-4.98; P = .002). The bleeding rate was higher in the discontinued multiple antithrombotics group (OR, 5.17; 95% CI, 3.13-8.54; P < .00001) than in the discontinued a single antithrombotic group (OR, 2.23; 95% CI, 1.29-3.85; P = .004) and single antiplatelet group (OR, 2.08; 95% CI, 0.93-4.63; P = .07). In the subgroup analysis, resuming antithrombotics within 1 week (OR, 2.46; 95% CI, 1.54-3.93; P = .0002) and using heparin replacement (OR, 4.20; 95% CI, 1.94-9.09; P= .0003) significantly increased post-ESD bleeding risk. Continued use of low-dose aspirin (OR, 1.22; 95% CI, 0.17-8.61; P = .84) did not significantly increase the bleeding risk. CONCLUSIONS: Antithrombotic therapy is a risk factor for post-ESD bleeding, especially for delayed bleeding. Using multiple antithrombotic drugs, resuming antithrombotics within 1 week, and heparin replacement were significantly associated with post-ESD bleeding; but continuous low-dose aspirin was not. However, much larger prospective studies are required.

Management of Islet Cell Tumours: A Single Hospital Experience.

BACKGROUND/AIMS: Islet cell tumours (ICTs) are uncommon tumours in clinical practice. Surgical resection is the treatment of choice for ICTs, but localisation of these lesions can be challenging. The aim of this study was to analyse the clinical diagnosis and treatment for ICTs. METHODOLOGY: Thirty-one patients with ICTs who were diagnosed and who underwent surgical treatment in the affiliate hospital of Luzhou Medical College from 1 January 2000 to 31 July 2013 were enrolled. The clinical data of these patients were retrospectively reviewed. RESULTS: Among 31 patients (6 males, 25 females), 15 cases (48.39%) had non-functional ICTs and 16 (51.61%) cases were insulinoma: The mean age of patients with non-functional ICTs was 42.73 ± 12.34 years and of those with insulinoma was 48.88 ± 13 years. Non-functional ICTs had a non-specific presentation. Insulinoma makes different clinical presentations mostly with symptoms of hypoglycaemia. CONCLUSIONS: Preoperative and/or intra-operative localisation is needed for ICTs; CT scan or MRI is used routinely as the first choice. If the lesion is very small, DSA is also good for localisation before operation. IOUS is a reliable technique in exactly localising insulinoma. ICTs are considered to be cured with successful surgical removal.

Management of Islet Cell Tumours: A Single Hospital Experience.

BACKGROUND/AIMS: Islet cell tumours (ICTs) are uncommon tumours in clinical practice. Surgical resection is the treatment of choice for ICTs, but localisation of these lesions can be challenging. The aim of this study was to analyse the clinical diagnosis and treatment for ICTs. METHODS: Thirty-one patients with ICTs who were diagnosed and who underwent surgical treatment in the affiliate hospital of Luzhou Medical College from 1 January 2000 to 31 July 2013 were enrolled. The clinical data of these patients were retrospectively reviewed. RESULTS: Among 31 patients (6 males, 25 females), 15 cases (48.39%) had non-functional ICTs and 16 (51.61%) cases were insulinoma. The mean age of patients with non-functional ICTs was 42.73 ± 12.34 years and of those with insulinoma was 48.88 ± 13 years. Non-functional ICTs had a non-specific presentation. Insulinoma makes different clinical presentations mostly with symptoms of hypoglycaemia. CONCLUSIONS: Preoperative and/or intra-operative localisation is needed for ICTs; CT scan or MRI is used routinely as the first choice. If the lesion is very small, DSA is also good for localisation before operation. IOUS is a reliable technique in exactly localising insulinoma. ICTs are considered to be cured with successful surgical removal.

Enhancement of ovarian cancer chemotherapy by delivery of multidrug-resistance gene small interfering RNA using tumor targeting Salmonella.

AIM: The aim of this study was to observe the effect of attenuated Salmonella typhi as a tumor-targeting delivery vector for multidrug-resistance gene (MDR1) small interfering RNA (siRNA). MATERIAL AND METHODS: The cisplatin (DDP)-resistant ovarian cancer cell line SKOV-3/DDP was established by treatment with gradually increasing concentrations of cisplatin. MDR1 siRNA expression plasmid containing short hairpin RNA (shRNA) of MDR1 gene was constructed and transformed into attenuated Salmonella typhi strain  SL7207. SKOV-3/DDP cells were incubated with recombinant Salmonella and then subjected to analysis of MDR1 expression by real-time polymerase chain reaction and Western blot. SKOV-3/DDP tumor-bearing mice were established by subcutaneously injecting BALB/c nude mice with SKOV-3/DDP cells, and were orally inoculated with Salmonella carrying MDR1 siRNA plasmid and simultaneously injected intraperitoneally with cisplatin. Tumor growth and mouse survival were observed. RESULTS: Compared with parental cell line, the DDP-resistant SKOV-3/DDP cells expressed a much higher level of MDR1. The expression of MDR1 in SKOV-3/DDP cells infected with the Salmonella strain bearing MDR1 siRNA plasmid in vitro was detected to be downregulated and DDP tolerance of these cells was reversed. Tumor-bearing nude mice that were orally receiving recombinant Salmonella experienced a slow tumor growth and became more sensitive to DDP. CONCLUSION: Attenuated Salmonella typhi may represent a promising vector for in vivo administration of RNA interference therapy against malignant tumors.

Effects of different exercise interventions on executive function in children with autism spectrum disorder: a network meta-analysis.

Background: A large body of research has identified the positive effects of physical activity on children with autism spectrum disorders (ASD). However, the specific benefits of different types of sports on executive functioning in children with ASD remain unclear. The aim of this study was to further analyze the effects of different sports on executive functioning in children with ASD using reticulated meta-analysis and to establish their effectiveness ranking. Methods: This study conducted a comprehensive online search in Web of Science, PubMed, Cochrane, Embase, and CNKI databases. It included randomized controlled trials and quasi-experimental studies, and synthesized the data using a Bayesian framework. Results: Several relevant studies were included. The results showed that physical activity significantly improved all three dimensions of executive functioning (inhibitory control, cognitive flexibility, and working memory) in children with ASD. The improvement in cognitive flexibility and inhibitory control both reached a medium effect size. However, the improvement in inhibitory control was better than that in cognitive flexibility, while the improvement in working memory did not reach the level of a medium effect. Mini Basketball was effective in improving inhibitory control and cognitive flexibility, but not working memory. Ping Pong was more effective in cognitive flexibility and working memory, but weaker in inhibitory control. Fixed Bicycle was less effective in all three dimensions. Among other interventions, Learning Bicycles, Animal-assisted therapy, and Exergaming performed better in cognitive flexibility. SPARK, Neiyang Gong, and Martial Arts were also effective in improving inhibitory control. However, SPARK and Fixed Bicycle were not significant in improving working memory. Conclusion: Physical activity as an intervention can significantly improve the executive function of children with ASD. The intervention effects of different sports on different dimensions of executive function vary. Mini Basketball was outstanding in improving inhibitory control and cognitive flexibility. Ping Pong was effective in improving cognitive flexibility and working memory. Fixed Bicycle was not effective in any dimension.

The impact of exercise intervention on social interaction in children with autism: a network meta-analysis.

Background: Extensive research has documented the positive impacts of physical activity on children and adolescents with Autism Spectrum Disorders (ASD). However, the specific benefits of various sports on the social functioning of children with ASD remain ambiguous. This study aims to employ a network meta-analysis to investigate the effects of different sports on the social functioning of children and adolescents with ASD and to establish a ranking of their effectiveness. Methods: This study conducted a comprehensive online search across Web of Science, PubMed, Cochrane, and Embase databases for randomized controlled trials and quasi-experimental studies focusing on social functioning outcomes. Data were synthesized using a Bayesian framework. Results: Sixteen relevant studies encompassing 560 participants were included. According to Cohen's classification, mini-basketball (SMD = 0.84, 95% CI: 0.46, 1.20), SPARK (SMD = 0.88, 95% CI: 0.06, 1.70), and Karate (SMD = 1.10, 95% CI: 0.27, 2.00) demonstrated high effect sizes, with Karate identified as the most effective intervention. Conversely, Combined Exercise and Nei Yang Gong interventions exhibited the least significant effects, falling below small effect sizes. Conclusion: Physical activity interventions have been shown to enhance social functioning in children and adolescents with ASD to varying extents, with Karate emerging as the most efficacious.

II-Scheme Heterojunction Frameworks Based on Covalent Organic Frameworks and HKUST-1 for Boosting Photocatalytic Hydrogen Evolution.

Covalent organic frameworks (COFs) are one type of promising polymer semiconductors in solar-driven hydrogen production, but majority of COFs-based photocatalytic systems show low photocatalytic efficiency owing to lack of metal active sites. Herein, we reported II-Scheme heterojunction frameworks based on COF (TpPa-1) and metal-organic framework (HKUST-1) for highly efficient hydrogen production. The coordination bonding directed self-assembly of HKUST-1 on the surface of TpPa-1 endows the heterojunction frameworks (HKUST-1/TpPa-1) with strong interface interaction, optimized electronic structures and abundant redox active sites, thus remarkably boosting photocatalytic hydrogen evolution. The hydrogen evolution rate for optimal HKUST-1/TpPa-1 is as high as 10.50 mmol g-1 h-1, which is significantly enhanced when compared with that of their physical mixture (4.13 mmol g-1 h-1), TpPa-1 (0.013 mmol g-1 h-1) and Pt-based counterpart (6.70 mmol g-1 h-1). This work offers a facile approach to the construction of noble-metal-free II-Scheme heterojunctions based on framework materials for efficient solar energy conversion.

Fabrication of High-Performance Densified Wood via High-Pressure Steam Treatment and Hot-Pressing.

The fabrication of sustainable structural materials with high physical properties to replace engineering plastics is a major challenge for modern industry, and wood, as the most abundant sustainable natural raw material on the planet, has received a great deal of attention from researchers. Researchers have made efforts to enhance the physical properties of wood in order to replace plastics. However, it is also difficult to meet practical demands at a low cost. Herein, we report a simple and efficient top-down strategy to transform bulk natural basswood into a high-performance structural material. This three-step strategy involves partial removal of hemicellulose and lignin via treating basswood by boiling an aqueous mixture of NaOH and Na2SO3, and a high-pressure steam treatment (HPST) was applied to delignified wood followed by hot-pressing, which allowed the wood to absorb moisture uniformly and quickly. HPST-treated dense delignified wood (HDDW) has a tensile strength of ~420 MPa, which is 6.5 times better than natural basswood (~65 MPa). We systematically investigated the various factors affecting the tensile strength of this wood material and explored the reasons why these factors affect the tensile strength, as well as the intrinsic connection between the moisture absorbed through HPST and the increased tensile strength of HDDW. Through our experiments, we realized the enhancement mechanism of HDDW and the optimal experimental conditions for the fabrication of HDDW.

Exercise, weight maintenance, and nonalcoholic fatty liver disease risk: a Chinese cohort study.

Background: Exercise has been reported to be associated with a reduced risk of nonalcoholic fatty liver disease (NAFLD), but there is no consensus on the role of weight changes in this association. This study aims to investigate whether the impact of exercise on NAFLD is mainly dependent on weight changes or is inherent to exercise itself. Methods: The study recruited 1671 Chinese NAFLD-free adults in 2019, and collected their exercise habits as well as 3 years of medical examination data including anthropometric measurements, blood biochemistry parameters, and liver ultrasound results. Univariate and multivariate logistic regression models were employed to examine the impact of exercise habits on NAFLD risk, with mediation analysis utilized to estimate the magnitude of the role of weight maintenance in the association between exercise and NAFLD. Results: After adjusting for confounders, moderate to high-intensity exercisers were 1.56 times (95% CIs = 1.09-2.22) more likely to successfully control their body weight, and therefore the weight-controlled group had a lower NAFLD risk of 34.9% (95% CIs = 21.8%-56.0%) compared to the weight-gain group. Mediation analysis reveals that exercise can significantly reduce the risk of NAFLD both through weight maintenance (37.1%) and independent of weight maintenance (62.9%). Conclusion: It might be more crucial to emphasize the adoption of regular moderate to high-intensity exercise for preventing NAFLD in the general population, rather than solely focusing on weight maintenance.

Social anxiety and bullying victimization: A three-level meta-analysis of cross-sectional and longitudinal studies.

BACKGROUND: Numerous studies have explored the association between social anxiety and bullying victimization. However, inconsistency are found regarding the strength and the direction of this relationship. Moreover, it remains unclear how different subtypes of bullying victimization associate with social anxiety. OBJECTIVE: The purpose of this study was to conduct a meta-analysis to systematically investigate the cross-sectional and longitudinal relationships between social anxiety and bullying victimization. PARTICIPANTS AND SETTING: Individuals experiencing social anxiety and bullying victimization. METHODS: The present study employed three-level random effects model to combine the correlation coefficients r to indicate the strength of the cross-sectional association between social anxiety and bullying victimization. Cross-lagged regressions were utilized to examine the prospective relationship between both variables. RESULTS: A total of 133 cross-sectional studies reporting 220 effect sizes were included in the meta-analysis, and the results showed a significant moderate association between social anxiety and bullying victimization (r = 0.268, 95 % CI [0.244, 0.292]). Nineteen longitudinal studies were also identified, revealing that social anxiety at Time 1 significantly predicted bullying victimization at Time 2 (ß = 0.067, 95 % CI [0.038, 0.096]). However, bullying victimization did not significantly predict subsequent social anxiety (ß = 0.012, 95 % CI [-0.026, 0.049]). Subgroup analyses revealed that social anxiety had the strongest association with relational victimization (r = 0.382, 95 % CI [0.335, 0.430]), followed by reputational victimization (r = 0.254, 95 % CI [-0.171, 0.337]), physical victimization (r = 0.226, 95 % CI [0.144, 0.308]) and overt victimization (r = 0.202, 95 % CI [0.146, 0.257]). Social anxiety was significantly more associated with traditional bullying victimization (r = 0.281, 95 % CI [0.233, 0.328]) than cyberbullying victimization (r = 0.177, 95 % CI [0.137, 0.218]; p < 0.001). CONCLUSIONS: Social anxiety was found to be moderately associated with and prospectively predict bullying victimization. Future research and interventions could focus on reducing social anxiety to prevent bullying victimization.

p38α deficiency ameliorates psoriasis development by downregulating STAT3-mediated keratinocyte proliferation and cytokine production.

Psoriasis is characterized by keratinocyte (KC) hyperproliferation and inflammatory cell infiltration, but the mechanisms remain unclear. In an imiquimod-induced mouse psoriasiform model, p38 activity is significantly elevated in KCs and p38α specific deletion in KCs ameliorates skin inflammation. p38α signaling promotes KC proliferation and psoriasis-related proinflammatory gene expression during psoriasis development. Mechanistically, p38α enhances KC proliferation and production of inflammatory cytokines and chemokines by activating STAT3. While p38α signaling in KCs does not affect the expression of IL-23 and IL-17, it substantially amplifies the IL-23/IL-17 pathogenic axis in psoriasis. The therapeutic effect of IL-17 neutralization is associated with decreased p38 and STAT3 activities in KCs and targeting the p38α-STAT3 axis in KCs ameliorates the severity of psoriasis. As IL-17 also highly activates p38 and STAT3 in KCs, our findings reveal a sustained signaling circuit important for psoriasis development, highlighting p38α-STAT3 axis as an important target for psoriasis treatment.

The relationship between child maltreatment and social anxiety: A meta-analysis.

BACKGROUND: Globally, child maltreatment has become a serious problem, affecting individuals' physical and mental health. This meta-analysis aimed to explore the association between child maltreatment and social anxiety. METHODS: MEDLINE, PsycINFO, EMBASE, Scopus, and Web of Science were searched for articles published by October 2021. Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of studies. Maltreatment type, sample setting, age, country and measurement instruments were analyzed as moderators. RESULTS: Twenty-nine studies met the inclusion criteria. Child maltreatment was positively correlated with social anxiety (r = 0.201, 95 % CI [0.171, 0.230]). The moderating effect of maltreatment subtypes was significant whether divided into three types (Qb = 12.152, p = .002), or five types (Qb = 11.574, p = .021). Specifically, emotional maltreatment (r = 0.251, 95 % CI [0.201, 0.298]) had a stronger relationship with social anxiety than physical (r = 0.138, 95 % CI [0.085, 0.191]; Qb = 9.312, p = .002) and sexual maltreatment (r = 0.153, 95 % CI [0.108, 0.197]; Qb = 9.197, p = .002). However, there was no significant difference in the effect size between physical and sexual maltreatment (Qb = 0.096, p = .757). Other variables (age, sample setting and country) were not significant moderators. LIMITATIONS: Only twenty-nine studies were included, and there was high heterogeneity among the studies, the interpretation of the results should be cautious. CONCLUSIONS: This meta-analysis confirmed the relationship between child maltreatment and social anxiety, especially highlight the harmfulness of emotional maltreatment.

Staging liver fibrosis in patients with chronic hepatitis B using two-dimensional shear wave elastography based on histopathological findings: a prospective multicenter study.

Background: With the rapid development of shear wave elastography technology, the clinical application prospect of two-dimensional shear wave elastography (2D SWE) for non-invasive monitoring of liver fibrosis is extremely promising. This study aimed to evaluate the diagnostic performance of ElastQ, a noval 2D SWE method, in the staging of liver fibrosis in patients with chronic hepatitis B with histopathological results as the reference standard. Methods: Between August 2020 and December 2021, a prospective multicenter study of 602 consecutive patients with chronic hepatitis B was conducted in 14 hospitals. All patients underwent liver biopsy and 2D SWE examination. The patients were divided into a training cohort and a validation cohort. The area under the receiver operating characteristic curve (AUROC) was calculated, and the optimal cut-off values for ElastQ were obtained. Results: Overall, 2D SWE values showed a strong correlation with fibrosis stage (r=0.71, P<0.001). In the training cohort, the AUROCs of ElastQ for diagnosing fibrosis stages ≥S1, ≥S2, ≥S3, and S4 were 0.817 [95% confidence interval (CI): 0.777-0.853), 0.887 (95% CI: 0.852-0.915), 0.912 (95% CI: 0.881-0.937), and 0.832 (95% CI: 0.793-0.866)], respectively. In the validation cohort, the AUROCs of ElastQ for diagnosing fibrosis stages ≥S1, ≥S2, ≥S3, and S4 were 0.807 (95% CI: 0.742-0.861), 0.868 (95% CI: 0.810-0.914), 0.855 (95% CI: 0.796-0.903), and 0.851 (95% CI: 0.791-0.900), respectively. The optimal liver stiffness cut-off values for the identification of fibrosis stages ≥S1, ≥S2, ≥S3, and S4 were 5.72 kPa (sensitivity: 78%, specificity: 70%), 6.85 kPa (sensitivity: 77%, specificity: 86%), 7.43 kPa (sensitivity: 80%, specificity: 86%), and 8.03 kPa (sensitivity: 81%, specificity: 73%), respectively. Conclusions: Two-dimensional SWE can accurately stage liver fibrosis in patients with chronic hepatitis B.

Medical English anxiety patterns among medical students in Sichuan, China.

This study adapts a Medical English Language Anxiety Scale (MELAS) based on Horwitz's Foreign Language Classroom Anxiety Scale (FLCAS) and examines students' anxiety in medical English vocabulary, listening and speaking, communication, literature reading, and academic paper writing. The biographical factors related to medical English language anxiety (MELA) were also tested. The questionnaire sets including five dimensions were distributed to the students from a medical university in Sichuan, China, and were statistically analyzed by using SPSS 22.0 and AMOS 21.0. By employing the adapted MELAS, it was found that 85.2% of the medical students surveyed suffered moderate and higher anxiety. Among all dimensions, students with listening and speaking anxiety recorded the highest (89.3%), followed by literature reading anxiety (86.6%), English academic writing anxiety (85.9%), communication anxiety (81.9%), and vocabulary learning anxiety (81.2%). We also found that the anxiety of rural medical students in each dimension was higher than that of urban medical students. This study suggests that English teachers should be fully aware of their students' language anxiety situation, design interesting class activities, and create a relaxed English learning atmosphere in classroom teaching to make students less nervous when learning medical English in class.

Case Report: A Case of a Child With Facial Foreign Body Abscess and Facial Artery Pseudoaneurysm.

Facial artery pseudoaneurysms are rare and mostly a result of blunt injury. Since the facial arteries are well protected by facial soft tissue and the lumen of the facial artery is thin and small in diameter, a sharp injury usually leads to complete transection rather than partial laceration of the blood vessel. As a non-invasive method, ultrasound does not involve radiation and sedation. Diagnosis of facial artery pseudoaneurysms is most commonly made with ultrasound, and Doppler ultrasound is essential. On grayscale imaging, facial artery pseudoaneurysms often appearanced of a fluid collection, Color Doppler imaging often show a well-defined swirl pattern named "yin and yang sign," the Spectral Doppler showed a diagnostic "to and fro" two-phase bidirectional arterial blood flow spectrum. It's particularly for the examination of facial artery pseudoaneurysms in children. Here, we report a case of facial foreign body abscess and facial artery pseudoaneurysm in a 19-month-old child 1 week after a sharpness injury that was diagnosed by ultrasound.

Two-dimensional germanium islands with Dirac signature on Ag2Ge surface alloy.

Two-dimensional (2D) Dirac materials have attracted intense research efforts due to their promise for applications ranging from field-effect transistors and low-power electronics to fault-tolerant quantum computation. One key challenge is to fabricate 2D Dirac materials hosting Dirac electrons. Here, monolayer germanene is successfully fabricated on a Ag2Ge surface alloy. Scanning tunneling spectroscopy measurements revealed a linear energy dispersion relation. The latter was supported by density functional theory calculations. These results demonstrate that monolayer germanene can be realistically fabricated on a Ag2Ge surface alloy. The finding opens the door to exploration and study of 2D Dirac material physics and device applications.

Predictive value of CONUT score combined with serum CA199 levels in postoperative survival of patients with pancreatic ductal adenocarcinoma: a retrospective study.

BACKGROUND: The preoperative controlling nutritional status (CONUT) score and serum carbohydrate antigen 199 (CA199) levels are individually correlated with the prognosis of pancreatic ductal adenocarcinoma (PDAC). The objective of this study aimed to investigate the efficacy of CONUT score and CA199 (CONUT-CA199) combination in predicting the prognosis of PDAC patients undergoing radical surgery. METHODS: We retrospectively analyzed the preoperative CONUT scores and serum CA199 levels of 294 patients with PDAC who underwent radical resection at the Affiliated Hospital of Southwest Medical University between March 2012 and July 2019. Patients were divided into four groups on the basis of their preoperative CONUT scores and serum CA199 levels: CONUTlow/CA199low (1), CONUTlow/CA199high (2), CONUThigh/CA199low (3) and CONUThigh/CA199high (4). The prognostic effects were compared among the groups. RESULTS: CONUThigh was more frequent in patients with positive peripancreatic infiltration and Clavien-Dindo classification of ≥IIIa (P < 0.001). Kaplan-Meier analysis revealed obvious difference in overall survival (OS) and recurrence-free survival (RFS) among patients with PDAC having CONUT-CA199 scores of 1, 2, 3 and 4 (P < 0.001). Peripancreatic infiltration, lymph node metastasis, pTNM stage, CONUT score, serum CA199 levels and CONUT-CA199 classification were found to be the independent prognostic factors for OS and RFS in multivariate analyses. In time-dependent receiver operating characteristic (ROC) analyses, the area of the CONUT-CA199 score under the ROC curve (AUC) was higher than that of the preoperative CONUT score or serum CA199 levels for the prediction of OS and RFS. CONCLUSION: CONUT-CA199 classification may be more effective in predicting the postoperative prognosis of PDAC patients.