The causal relationship and potential mediators between plasma lipids and atopic dermatitis: a bidirectional two-sample, two-step mendelian randomization.

BACKGROUND: Observational studies have indicated that the plasma lipid profiles of patients with atopic dermatitis show significant differences compared to healthy individuals. However, the causal relationship between these differences remains unclear due to the inherent limitations of observational studies. Our objective was to explore the causal effects between 179 plasma lipid species and atopic dermatitis, and to investigate whether circulating inflammatory proteins serve as mediators in this causal pathway. METHODS: We utilized public genome-wide association studies data to perform a bidirectional two-sample, two-step mendelian randomization study. The inverse variance-weighted method was adopted as the primary analysis technique. MR-Egger and the weighted median were used as supplementary analysis methods. MR-PRESSO, Cochran's Q test, and MR-Egger intercept test were applied for sensitivity analyses to ensure the robustness of our findings. RESULTS: The Mendelian randomization analysis revealed that levels of Phosphatidylcholine (PC) (18:1_20:4) (OR: 0.950, 95% CI: 0.929-0.972, p = 6.65 × 10- 6), Phosphatidylethanolamine (O-18:1_20:4) (OR: 0.938, 95% CI: 0.906-0.971, p = 2.79 × 10- 4), Triacylglycerol (TAG) (56:6) (OR: 0.937, 95% CI: 0.906-0.969, p = 1.48 × 10- 4) and TAG (56:8) (OR: 0.918, 95% CI: 0.876-0.961, p = 2.72 × 10- 4) were inversely correlated with the risk of atopic dermatitis. Conversely, PC (18:1_20:2) (OR: 1.053, 95% CI: 1.028-1.079, p = 2.11 × 10- 5) and PC (O-18:1_20:3) (OR: 1.086, 95% CI: 1.039-1.135, p = 2.47 × 10- 4) were positively correlated with the risk of atopic dermatitis. The results of the reverse directional Mendelian randomization analysis indicated that atopic dermatitis exerted no significant causal influence on 179 plasma lipid species. The level of circulating IL-18R1 was identified as a mediator for the increased risk of atopic dermatitis associated with higher levels of PC (18:1_20:2), accounting for a mediation proportion of 9.07%. CONCLUSION: Our research suggests that plasma lipids can affect circulating inflammatory proteins and may serve as one of the pathogenic factors for atopic dermatitis. Targeting plasma lipid levels as a treatment for atopic dermatitis presents a potentially novel approach.

Clinical features and surgical treatments of scoliosis in neurofibromatosis type 1: a systemic review and meta-analysis.

BACKGROUND: Neurofibromatosis type 1 (NF 1) is an autosomal-dominant tumor predisposition genetic disease affecting approximately 1 in 3000 live births. The condition could present various manifestations ranging from skin abnormalities to neurological tumors. The musculoskeletal system could also be frequently affected, and scoliosis is the most common orthopedic manifestation. Characterized by the early-onset and rapid progression tendency, NF 1-related dystrophic scoliosis presented discrepancies from idiopathic scoliosis in terms of natural history, clinical features, and management outcomes and thus required special attention. In the current study, the authors conducted a systemic review to outline the body of evidence of the natural history, clinical characteristics, surgical outcomes, and surgical complications of NF 1-induced scoliosis, aiming to provide an elucidative insight into this condition. METHOD: Systemic review and meta-analysis were conducted according to the latest Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) guidelines. The search was performed in Medline, Embase, and Web of Science Core Collection up to December 27, 2022, using related keywords. Clinical features such as frequencies, segmental involvement, and hereditary information were summarized and described qualitatively. Meta-analysis was conducted using R software and the 'meta' package to yield an overall outcome of efficacy and safety of surgical management, precisely, spinal fusion procedure and growing rods procedure. Corrective rate of Cobb angle, sagittal kyphosis angle, and T1-S1 length post-operative and at the last follow-up was used to evaluate the efficacy, and the occurrence of surgery-related complications was used to evaluate the safety. RESULT: A total of 37 articles involving 1023 patients were included. Approximately 26.6% of the NF 1 patients would present with scoliosis. Patients tend to develop scoliosis at an earlier age. The thoracic part turned out to be the most affected segment. No obvious correlation between scoliosis and genotype or hereditary type was observed. Both spinal fusion and growing rod surgery have shown acceptable treatment outcomes, with spinal fusion demonstrating better performance in terms of effectiveness and safety. The growing rods technique seemed to allow a better lengthening of the spine. The mainstay post-operative complications were implant-related complications but could be managed with limited revision surgery. Severe neurological deficits were rarely reported. CONCLUSION: Scoliosis, especially the subtype characterized by dystrophic bony changes, is a significant orthopedic manifestation of NF1. It has an early onset, a tendency to persistently and rapidly progress, and is challenging to deal with. The current review outlines the available evidence from the perspective of natural history, clinical features, and the treatment efficacy and safety of the mainstay surgical options. Patients with NF1 scoliosis will benefit from a better understanding of the disease and evidence based treatment strategies.

Nf1 in heart development: a potential causative gene for congenital heart disease: a narrative review.

Congenital heart disease is the most frequent congenital disorder, affecting a significant number of live births. Gaining insights into its genetic etiology could lead to a deeper understanding of this condition. Although the Nf1 gene has been identified as a potential causative gene, its role in congenital heart disease has not been thoroughly clarified. We searched and summarized evidence from cohort-based and experimental studies on the issue of Nf1 and heart development in congenital heart diseases from various databases. Available evidence demonstrates a correlation between Nf1 and congenital heart diseases, mainly pulmonary valvar stenosis. The mechanism underlying this correlation may involve dysregulation of epithelial-mesenchymal transition (EMT). The Nf1 gene affects the EMT process via multiple pathways, including directly regulating the expression of EMT-related transcription factors and indirectly regulating the EMT process by regulating the MAPK pathway. This narrative review provides a comprehensive account of the Nf1 involvement in heart development and congenital cardiovascular diseases in terms of epidemiology and potential mechanisms. RAS signaling may contribute to congenital heart disease independently or in cooperation with other signaling pathways. Efficient management of both NF1 and cardiovascular disease patients would benefit from further research into these issues.

Targeting Mitochondria-Inflammation Circuit by ß-Hydroxybutyrate Mitigates HFpEF.

RATIONALE: Over 50% of patients with heart failure have preserved ejection fraction (HFpEF), rather than reduced ejection fraction. Complexity of its pathophysiology and the lack of animal models hamper the development of effective therapy for HFpEF. OBJECTIVE: This study was designed to investigate the metabolic mechanisms of HFpEF and test therapeutic interventions using a novel animal model. METHODS AND RESULTS: By combining the age, long-term high-fat diet, and desoxycorticosterone pivalate challenge in a mouse model, we were able to recapture the myriad features of HFpEF. In these mice, mitochondrial hyperacetylation exacerbated while increasing ketone body availability rescued the phenotypes. The HFpEF mice exhibited overproduction of IL (interleukin)-1ß/IL-18 and tissue fibrosis due to increased assembly of NLPR3 inflammasome on hyperacetylated mitochondria. Increasing ß-hydroxybutyrate level attenuated NLPR3 inflammasome formation and antagonized proinflammatory cytokine-triggered mitochondrial dysfunction and fibrosis. Moreover, ß-hydroxybutyrate downregulated the acetyl-CoA pool and mitochondrial acetylation, partially via activation of CS (citrate synthase) and inhibition of fatty acid uptake. CONCLUSIONS: Therefore, we identify the interplay of mitochondrial hyperacetylation and inflammation as a key driver in HFpEF pathogenesis, which can be ameliorated by promoting ß-hydroxybutyrate abundance.

Advancing targeted protein degradation for metabolic diseases therapy.

The development and application of traditional drugs represented by small molecule chemical drugs and biological agents, especially inhibitors, have become the mainstream drug development. In recent years, targeted protein degradation (TPD) technology has become one of the most promising methods to remove specific disease-related proteins using cell self-destruction mechanisms. Many different TPD strategies are emerging based on the ubiquitin-proteasome system (UPS) and the autophagy-lysosomal pathway (ALP), including but not limited to proteolysis-targeting chimeras (PROTAC), molecular glues (MG), lysosome targeting chimeras (LYTAC), chaperone-mediated autophagy (CMA)-targeting chimeras, autophagy-targeting chimera (AUTAC), autophagosome-tethering compound (ATTEC), and autophagy-targeting chimera (AUTOTAC). The advent of targeted degradation technology can change most protein targets in human cells from undruggable to druggable, greatly expanding the therapeutic prospect of refractory diseases such as metabolic syndrome. Here, we summarize the latest progress of major TPD technologies, especially in metabolic syndrome and look forward to providing new insights for drug discovery.

Research hotspot and trend of chronic wounds: A bibliometric analysis from 2013 to 2022.

Chronic wounds have been confirmed as a vital health problem facing people in the global population aging process. While significant progress has been achieved in the study of chronic wounds, the treatment effect should be further improved. The number of publications regarding chronic wounds has been rising rapidly. In this study, bibliometric analysis was conducted to explore the hotspots and trends in the research on chronic wounds. All relevant studies on chronic wounds between 2013 and 2022 were collected from the PubMed database of the Web of Science (WOS) and the National Center for Biotechnology Information (NCBI). The data were processed and visualised using a series of software. On that basis, more insights can be gained into hotspots and trends of this research field. Wound Repair and Regeneration has the highest academic achievement in the field of chronic wound research. The United States has been confirmed as the most productive country, and the University of California System ranks high among other institutions. Augustin, M. is the author of the most published study, and Frykberg, RG et al. published the most cited study. Furthermore, the hotspots of wound research over the last decade were identified (e.g., bandages, infection and biofilms, pathophysiology and therapy). This study will help researchers gain insights into chronic wound research's hotspots and trends accurately and quickly. Moreover, the exploration of bacterial biofilm and the pathophysiological mechanism of the chronic wound will lay a solid foundation and clear direction for treating chronic wounds.

Circ_0000566 contributes oxygen-glucose deprivation and reoxygenation (OGD/R)-induced human brain microvascular endothelial cell injury via regulating miR-18a-5p/ACVR2B axis.

Circular RNAs (circRNAs) exert regulatory roles in cerebrovascular disease. Human brain microvascular endothelial cells (HBMECs) participated in brain vascular dysfunction in ischemic stroke. Herein, the functions of circ_0000566 in oxygen-glucose deprivation and reoxygenation (OGD/R)-induced HBMECs were investigated. The expression of circ_0000566, miR-18a-5p, and Activin receptor type 2B (ACVR2B) was measured via quantitative real-time PCR (qRT-PCR). Cell Counting Kit-8 (CCK-8) and flow cytometry assays were utilized to detect cell viability and cell apoptosis. Western blot assay was employed to measure the levels of apoptotic-related proteins and ACVR2B. The secretion of IL-1ß, IL-6, and TNF-α was detected via corresponding kits. The relationship between miR-18a-5p and circ_0000566 or ACVR2B was examined via dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Circ_0000566 and ACVR2B were highly expressed, while miR-18a-5p was down-regulated in OGD/R-treated HBMECs. OGD/R treatment promoted HBMECs apoptosis and inflammation and suppressed cell viability, which could be attenuated by silencing of circ_0000566. Circ_0000566 acted as a miR-18a-5p sponge to contribute to OGD/R-induced HBMECs injury. ACVR2B served as a direct target of miR-18a-5p, and ACVR2B overexpression might abolish the inhibitory role of miR-18a-5p on OGD/R-treated HBMEC injury. Circ_0000566 sponged miR-18a-5p to regulate OGD/R-induced HBMECs injury via regulating ACVR2B expression.

Picroside III, an Active Ingredient of Picrorhiza scrophulariiflora, Ameliorates Experimental Colitis by Protecting Intestinal Barrier Integrity.

This study aims to explore the protective effects of Picroside III, an active ingredient of Picrorhiza scrophulariiflora, on the intestinal epithelial barrier in tumor necrosis factor-α (TNF-α) induced Caco-2 cells and dextran sulfate sodium (DSS) induced colitis in mice. Results show that Picroside III significantly alleviated clinical signs of colitis including body weight loss, disease activity index increase, colon shortening, and colon tissue damage. It also increased claudin-3, ZO-1 and occludin expressions and decreased claudin-2 expression in the colon tissues of mice with colitis. In vitro, Picroside III also significantly promoted wound healing, decreased the permeability of cell monolayer, upregulated the expressions of claudin-3, ZO-1 and occludin and downregulated the expression of claudin-2 in TNF-α treated Caco-2 cells. Mechanism studies show that Picroside III significantly promoted AMP-activated protein kinase (AMPK) phosphorylation in vitro and in vivo, and blockade with AMPK could significantly attenuate the upregulation of Picroside III in ZO-1 and occludin expressions and the downregulation of claudin-2 expression in TNF-α treated Caco-2 cells. In conclusion, this study demonstrates that Picroside III attenuated DSS-induced colitis by promoting colonic mucosal wound healing and epithelial barrier function recovery via the activation of AMPK.

Adversarial Auxiliary Weighted Subdomain Adaptation for Open-Set Deep Transfer Bridge Damage Diagnosis.

Deep learning models have been widely used in data-driven bridge structural damage diagnosis methods in recent years. However, these methods require training and test datasets to satisfy the same distribution, which is difficult to satisfy in practice. Domain adaptation transfer learning is an efficient method to solve this problem. Most of the current domain adaptation methods focus on close-set scenarios with the same classes in the source and target domains. However, in practical applications, new damage caused by long-term degradation often makes the target and source domains dissimilar in the class space. For such challenging open-set scenarios, existing domain adaptation methods will be powerless. To effectively solve the above problems, an adversarial auxiliary weighted subdomain adaptation algorithm is proposed for open-set scenarios. Adversarial learning is introduced to proposed an adversarial auxiliary weighting scheme to reflect the similarity of target samples with source classes. It effectively distinguishes unknown damage from known states. This paper further proposes a multi-channel multi-kernel weighted local maximum mean discrepancy metric (MCMK-WLMMD) to capture the fine-grained transferable information for conditional distribution alignment (sub-domain alignment). Extensive experiments on transfer tasks between three bridges verify the effectiveness of the algorithm in open-set scenarios.

Improved Deep Residual Shrinkage Network for Intelligent Interference Recognition with Unknown Interference.

In complex battlefield environments, flying ad-hoc network (FANET) faces challenges in manually extracting communication interference signal features, a low recognition rate in strong noise environments, and an inability to recognize unknown interference types. To solve these problems, one simple non-local correction shrinkage (SNCS) module is constructed. The SNCS module modifies the soft threshold function in the traditional denoising method and embeds it into the neural network, so that the threshold can be adjusted adaptively. Local importance-based pooling (LIP) is introduced to enhance the useful features of interference signals and reduce noise in the downsampling process. Moreover, the joint loss function is constructed by combining the cross-entropy loss and center loss to jointly train the model. To distinguish unknown class interference signals, the acceptance factor is proposed. Meanwhile, the acceptance factor-based unknown class recognition simplified non-local residual shrinkage network (AFUCR-SNRSN) model with the capacity for both known and unknown class recognition is constructed by combining AFUCR and SNRSN. Experimental results show that the recognition accuracy of the AFUCR-SNRSN model is the highest in the scenario of a low jamming to noise ratio (JNR). The accuracy is increased by approximately 4-9% compared with other methods on known class interference signal datasets, and the recognition accuracy reaches 99% when the JNR is -6 dB. At the same time, compared with other methods, the false positive rate (FPR) in recognizing unknown class interference signals drops to 9%.

Organophosphate pesticide exposure and biomarkers of liver injury/liver function.

BACKGROUND AND AIMS: There is little epidemiological evidence linking the exposure of organophosphate pesticides (OPs) to liver function or liver injury in the general population. We used data from the National Health and Nutrition Examination Survey 1999-2012 to investigate the relationship of urinary OPs with biomarkers of liver function/liver injury. METHODS: The exposures were the concentrations of urinary OP metabolites (dimethyl phosphate [DMP], dimethyl thiophosphate [DMTP], diethyl phosphate [DEP] and diethyl thiophosphate [DETP]). The health outcomes were biomarkers of liver function/liver injury. The multivariable linear regression model, restricted cubic splines (RCSs) analysis and weighted quantile sum (WQS) regression were used to evaluate the relationship between individual or overall exposure of OPs and outcomes. RESULTS: Regressions of RCSs suggested linear and positive associations of OP metabolites with aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (DMP and DEP) and fibrosis-4 (FIB-4) index (DMP, DEP and DMTP) (all p-non-linear values >.05). However, L-shaped relationships were found between OP metabolites (DMTP and DETP) and blood albumin and total protein (TP) concentrations (both p and non-linear values <.05). The positive associations of urinary DMP, DEP and DMTP with AST/ALT ratio, and with FIB-4 score were more pronounced among non-smokers than smokers, among alcohol drinkers than non-drinkers and among those with a body mass index (BMI) of ≥25 than participants with a BMI of <25. However, most of the interaction p values were more than .05, indicating no significant interactions between covariates and OPs on outcomes mainly including AST/ALT, FIB-4, ALB and TP levels. Finally, the WQS indices were positively associated with AST/ALT ratio (p = .014) and FIB-4 score (p = .002). CONCLUSIONS: Our study added novel evidence that exposures to OPs might be adversely associated with the biomarkers of liver function/liver injury. These findings indicated the potential toxic effect of OP exposures on the human liver.

Fuc-S-A New Ultrasonic Degraded Sulfated α-l-Fucooligosaccharide-Alleviates DSS-Inflicted Colitis through Reshaping Gut Microbiota and Modulating Host-Microbe Tryptophan Metabolism.

SCOPE: The dysbiosis of intestinal microecology plays an important pathogenic role in the development of inflammatory bowel disease. METHODS AND RESULTS: A polysaccharide named Fuc-S, with a molecular weight of 156 kDa, was prepared by the ultrasonic degradation of fucoidan. Monosaccharide composition, FTIR, methylation, and NMR spectral analysis indicated that Fuc-S may have a backbone consisting of →3)-α-L-Fucp-(1→, →4)-α-L-Fucp-(1→ and →3, 4)-α-D-Glcp-(1→. Moreover, male C57BL/6 mice were fed three cycles of 1.8% dextran sulfate sodium (DSS) for 5 days and then water for 7 days to induce colitis. The longitudinal microbiome alterations were evaluated using 16S amplicon sequencing. In vivo assays showed that Fuc-S significantly improved clinical manifestations, colon shortening, colon injury, and colonic inflammatory cell infiltration associated with DSS-induced chronic colitis in mice. Further studies revealed that these beneficial effects were associated with the inhibition of Akt, p-38, ERK, and JNK phosphorylation in the colon tissues, regulating the structure and abundance of the gut microbiota, and modulating the host-microbe tryptophan metabolism of the mice with chronic colitis. CONCLUSION: Our data confirmed the presence of glucose in the backbone of fucoidan and provided useful information that Fuc-S can be applied as an effective functional food and pharmaceutical candidate for IBD treatment.

Latissimus Dorsi Muscle Flap for Scalp Reconstruction and Postoperative Ulceration Management.

ABSTRACT: The latissimus dorsi muscle (LDM) flap has been widely accepted as the best choice for subtotal or total scalp reconstruction. Because of the unique anatomic and functional features of scalp, ulcerations formation would occur after reconstructive surgeries. in this study, we are presenting a patient with a large scalp defect successfully reconstructed by a latissimus dorsi muscle free flap. Ulcerations with skull exposure formed on the transplanted flap after the first surgery. They were subsequently repaired by flap recycling and tissue expansion techniques. An excellent reconstructive outcome was achieved at the 30-month follow-up after the last surgery and no further complication was found. This clinical report highlights the possibility of ulcer formation after scalp reconstructive surgeries and supports the use of recycle flaps and tissue expanders to manage postoperative ulcerations after latissimus dorsi muscle free flap transplantation.

Reconstruction of Severe Neck Scar Contracture After Electrical Injury.

ABSTRACT: High-voltage (≥1000 V) electrical injury is always related to high mortality and poor prognosis. The incidence rates of the high-voltage electrical injuries of the neck are lower than those of the other parts of the body. This article reports a case of the reconstruction of severe neck scar contracture after electrical injury. Compared with cases of scar contractures caused by nonelectrical injuries, this case had the following remarkable characteristics: extremely severe difficult airway, contracture scars involving whole layers of tissue, muscle and nerve damage, mandibular retraction, and poor occlusal relationship. The chief complaints of the patient upon admission, including forced position and continuous salivation, were greatly relieved through several operations by using different kinds of flaps and offering support to the flap from the palmar tendon and relocated mandible. However, the problem of salivation was incompletely solved. This problem might be caused by damage to related nerves and masticatory muscle function caused by high-voltage electrical injury. The patient was satisfied with the recovery of his appearance and movement function.

A Potential Role of Plant/Macrofungi/Algae-Derived Non-Starch Polysaccharide in Colitis Curing: Review of Possible Mechanisms of Action.

Multiple in vitro and in vivo model investigations have suggested a broad spectrum of potential mechanisms by which plant/macrofungi-derived non-starch polysaccharides may play a role in the treatment of inflammatory bowel disease (IBD). This article reviews the in vivo and in vitro evidence of different plant-derived polysaccharides for IBD therapy. Their underlying mechanisms, particularly the molecular mechanisms associated with protective effects in the treatment and prevention of IDB, have been well summarized, including anti-inflammatory, epithelial barrier repair, and the regulation of intestinal flora. Emerging studies have observed the potent role of probiotics in IBD, particularly its ability to modulate gut microbiota, a well-known key factor for IBD. In summary, plant/macrofungi-derived polysaccharides have the potential to be a promising agent for the adjuvant treatment and prevention of IBD and will contribute to the design of well-designed clinical intervention trials that will ultimately improve the therapy of IBD.

Risk of non-melanoma skin cancer with biological therapy in common inflammatory diseases: a systemic review and meta-analysis.

BACKGROUND: Most previous studies compared the risk for non-melanoma skin cancer (NMSC) in biologic-treated common inflammatory diseases with the general population. Whether the increased NMSC risk is caused by the disease itself, the biologics, or both remains unknown. METHODS: We systematically searched PubMed, Embase, Medline, Web of Science, and Cochrane Library from inception to May 2021. Studies were included if they assessed the risk of NMSC for rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or psoriasis patients treated with biologics compared with patients not receiving biologics. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using the fixed- or random-effects model. RESULTS: The current meta-analysis included 12 studies. Compared with patients with the inflammatory disease without biologics, patients receiving biological therapy were associated with an increased risk for NMSC (RR 1.25, 95% CI 1.14 to 1.37), especially in patients with RA (RR 1.24, 95% CI 1.13 to 1.36) and psoriasis (RR 1.28, 95% CI 1.07 to 1.52), but not in patients with IBD (RR 1.49, 95% CI 0.46 to 4.91). The risks for squamous cell skin cancer and basal cell skin cancer were both increased for patients receiving biologics. However, the risk of NMSC did not increase in patients treated with biologics less than 2 years. CONCLUSIONS: Current evidence suggests that increased risk of NMSC was identified in RA and psoriasis treated with biologics compared with patients not receiving biologics, but not in patients with IBD. The inner cause for the increased risk of NMSC in IBD patients should be further discussed.

Nasal and Oral Subunits Reconstruction of Localized Scleroderma Deformities.

ABSTRACT: Localized scleroderma is a rare soft tissue disorder characterized by a thickening of the skin from excessive collagen deposits. For patients with face involved, soft tissue depression and atrophy could cause serious facial contour deformity and adversely affect the patients' quality of social life. However, localized scleroderma cases with delicate facial aesthetic subunits defects were rarely reported to be surgically reconstructed. In this study, we present 2 patients with nasal subunits and oral subunit deformities caused by localized scleroderma respectively. The first patient with a right-side alar defect and nasal dorsum depression, forehead depression and eyebrow depression were treated through a 2-stage surgical approach, with microvascular preauricular and helical rim flap and dermofat graft transplantation. The lower lip and mandible defects of the second patient were reconstructed with a combination of submental flap and fat grafting. The transplanted dermofat graft, fat graft, the microvascular free flap, and the submental flap survived completely and maintained adequate tissue volume and facial contour during the follow-up time of 2 years. Both patients were satisfied with the overall aesthetic results. This clinical report supports the use of microsurgical flap and tissue grafts on the treatment of localized scleroderma (LS) caused facial aesthetic subunits deformities.

Pre-Expanded Latissimus Dorsi Myocutaneous Flap for Total Scalp Defect Reconstruction.

Scalp defects can be caused by various factors, and reconstruction options for scalp defects include skin grafts, local flaps, tissue expanders, and free flaps. However, currently, it is widely accepted that the use of free flaps is the most feasible method for extensive scalp defect reconstruction. While multiple flaps have been used to reconstruct scalp defects, the reconstruction of total scalp defects still remains challenging. Pre-expansion of free flaps offers several advantages, including increasing flap size and thinning of the tissue for better contour, and is particularly important in scalp reconstruction. This report describes the successful management of total scalp defect reconstruction that involved the entire frontal, parietal, occipital, and temporal regions using a pre-expanded latissimus dorsi myocutaneous flap in a 40-year-old female patient. Over 2 years of follow-up, the transplanted flap survived well and the patient eventually achieved excellent cosmetic appearance, with satisfactory durable coverage. She was able to wear a hairpiece and hat without any wound breakdown. Our report indicates that microsurgery using pre-expanded latissimus dorsi myocutaneous flap transfer is a reliable and safe choice for total scalp reconstruction, allowing reconstruction with a single-flap, an excellent aesthetic effect, and abrasive resistance.

Intelligent Reflecting Surface-Assisted Secure Multi-Input Single-Output Cognitive Radio Transmission.

Intelligent reflecting surface (IRS) is a very promising technology for the development of beyond 5G or 6G wireless communications due to its low complexity, intelligence, and green energy-efficient properties. In this paper, we combined IRS with physical layer security (PLS) to solve the security issue of cognitive radio (CR) networks. Specifically, an IRS-assisted multi-input single-output (MISO) CR wiretap channel was studied. To maximize the secrecy rate of secondary users subject to a total power constraint (TPC) for the transmitter and interference power constraint (IPC) for a single antenna primary receiver (PR) in this channel, an alternating optimization (AO) algorithm is proposed to jointly optimize the transmit covariance R at transmitter and phase shift coefficient Q at IRS by fixing the other as constant. When Q is fixed, R is globally optimized by equivalently transforming the quasi-convex sub-problem to convex one. When R is fixed, bisection search in combination with minorization-maximization (MM) algorithm was applied to optimize Q from the non-convex fractional programming sub-problem. During each iteration of MM, another bisection search algorithm is proposed, which is able to find the global optimal closed-form solution of Q given the initial point from the previous iteration of MM. The convergence of the proposed algorithm is analyzed, and an extension of applying this algorithm to multi-antenna PR case is discussed. Simulations have shown that our proposed IRS-assisted design greatly enhances the secondary user's secrecy rate compared to existing methods without IRS. Even when IPC is active, the secrecy rate returned by our algorithm increases with transmit power as if there is no IPC at all.

Immunogenicity and Safety of an F-Genotype Attenuated Mumps Vaccine in Healthy 8- to 24-Month-Old Children.

Background: Mumps vaccine immunizations have reduced the incidence of this disease. With the variation of mumps circulating strain, novel vaccine strains are always important. Methods: A 2-center parallel, randomized, double-blind noninferiority trial was performed to compare an F-genotype attenuated mumps vaccine (SP strain) to the A-genotype vaccine (S-79, Jeryl-Lynn strain) in 1080 healthy children aged 8-24 months in Hubei, China. Results: Participants were randomly assigned to receive a high or low dose of the SP or S79 vaccine and then assessed clinically at 30 minutes and 1-28 days postinoculation. No differences in local or systemic reactivity were observed. A similar incidence of severe adverse events associated with the vaccine was observed in the high-dose group and the positive control group. Based on throat swab collections, no viral shedding was present at the 4th and 10th days in any group. Neutralizing and hemagglutination-inhibiting antibody assays with the F- or A-genotype strains showed similar trends in geometric mean titers in the high-dose SP and S79 groups. Increased cytotoxic T lymphocyte responses were observed in all groups. Conclusions: The F-genotype attenuated mumps vaccine is safe, offers immunogenicity against a homologous virus, and is noninferior to the A-genotype vaccine in 8- to 24-month-old children.