Upcycling crab shell waste into biochar for treatment of palm oil mill effluent via microwave pyrolysis and activation.

The escalating consumer demand for crabs results in a growing amount of waste, including shells, claws, and other non-edible parts. The resulting crab shell waste (CSW) is disposed of via incineration or landfills which causes environmental pollution. CSW represents a potential biological resource that can be transformed into valuable resources via pyrolysis technique. In this study, microwave pyrolysis of CSW using self-purging, vacuum, and steam activation techniques was examined to determine the biochar production yield and its performance in treating palm oil mill effluent (POME). The biochar produced through microwave pyrolysis exhibits yields ranging from 50 to 61 wt%, showing a hard texture, low volatile matter content (≤34.1 wt%), and high fixed carbon content (≥58.3 wt%). The KOH-activated biochar demonstrated a surface area of up to 177 m2/g that is predominantly composed of mesopores, providing a good amount of adsorption sites for use as adsorbent. The biochar activated with steam removed 8.3 mg/g of BOD and 42 mg/g of COD from POME. The results demonstrate that microwave pyrolysis of CSW is a promising technology to produce high-quality biochar as an adsorbent for POME treatment.

Extraction methods optimization of available heavy metals and the health risk assessment of the suburb soil in China.

Heavy metal pollution has attracted increasing concern due to its high toxicity and persistence. A suitable extraction procedure for available heavy metals in soil is necessary for assessing the ecological risk. In this work, the single extraction methods aided by shaking and microwaves were investigated and analyzed for their ability to extract available heavy metals from soil samples, and a total of 42 soil samples were collected from suburbs of Zhengzhou city in China. The extraction efficiency of Cu, Zn, As, and Cd in the certified fluvo-aquic soil was compared using eight different types of solutions: CaCl2, CH3COONH4, NH4NO3, CH3COOH, Na2EDTA, DTPA, HNO3, and NH4H2PO4. Results indicated that the shaking-assisted method that utilized Na2EDTA as an extractant demonstrated satisfactory efficiency and was chosen for further optimization and that the optimal conditions were obtained using 0.05 M Na2EDTA at pH 7, soil-liquid ratio 1:20, and extraction duration 2 h, which gained the perfect extraction efficiency ranging from 85.8 to 109.5%. The proposed approach has been applied to extract available Cu, Zn, As, and Cd in soils of Zhengzhou suburbs, where the mean values varied from 0.129 to 6.881 mg/kg. The bioavailability of different heavy metals in the soil varies greatly, with Cd having the highest activity in the survey region. Significant (p < 0.01) positive relationships were observed between the available state and the total amount of all the heavy metals. The assessment of health risks associated with heavy metals indicated that there was no risk for chronic non-carcinogenic effects. Even though the total amount of metal elements in suburban soil of Zhengzhou is 1.6% with high carcinogenic risk, the risk of available elements is still within the acceptable range, which verified that the risk grade obtained by the total amount is higher than the actual risk.

CA125 over-release behavior following a 75-g oral glucose test as a predictive biomarker of multidrug resistance in patients with ovarian cancer.

Multidrug resistance is a major cause of death in patients with ovarian cancer. To improve patient survival, we developed a novel, noninvasive and convenient tool, the 75-gram oral glucose (75gOG)-stimulated CA125 test, to monitor cancer chemoresistance in real time. Our in vitro proof-of-principal experiments revealed that post-75gOG glucose and insulin peaks can synergistically increase cancer-derived CA125 levels, and the increase in CA125 secretion (ΔCA125) is correlated with the overactivation of the insulin receptor (IR)-PI3K-Akt axis and increases (ΔIC50 s) in cisplatin/taxol IC50 s. Correspondingly, among the 93 patients enrolled, post-75gOG CA125 over-release (i.e., enhanced ΔCA125) behavior was associated with overexpression of the IR-PI3K-Akt pathway and its downstream components, namely, IR, pAkt, pS6 and GLUT4, in cancer specimens. Furthermore, both pre- and postsurgical 75gOG CA125 tests demonstrated that CA125 over-release showed excellent prediction efficacy on the chemoresistance potential of ovarian cancer; notably, the former indicated the need for an optimal debulking surgery, and the latter suggested the use of IR-PI3K-Akt inhibitors. Both test results possess independent prognostic significance for the 2-year progression-free survival (PFS) and overall survival (OS) of patients. The odds ratios and corresponding 95% confidence intervals (95% CIs) were 2.680 (95% CI: 1.393-5.156) for patients with CA125 over-release behavior evidenced by a presurgical 75gOG CA125 test or 3.822 (95% CI: 1.942-7.522) for that evidenced by a postsurgical test in PFS; and 3.320 (95% CI: 1.508-7.309) for patients with CA125 over-release behavior evidenced by a presurgical test or 5.212 (95% CI: 2.241-12.121) for that evidenced by a postsurgical test in OS.

Convolutional neural network to predict the local recurrence of giant cell tumor of bone after curettage based on pre-surgery magnetic resonance images.

OBJECTIVE: To predict the local recurrence of giant cell bone tumors (GCTB) on MR features and the clinical characteristics after curettage using a deep convolutional neural network (CNN). METHODS: MR images were collected from 56 patients with histopathologically confirmed GCTB after curettage who were followed up for 5.8 years (range, 2.0 to 9.5 years). The inception v3 CNN architecture was fine-tuned by two categories of the MR datasets (recurrent and non-recurrent GCTB) obtained through data augmentation and was validated using fourfold cross-validation to evaluate its generalization ability. Twenty-eight cases (50%) were chosen as the training dataset for the CNN and four radiologists, while the remaining 28 cases (50%) were used as the test dataset. A binary logistic regression model was established to predict recurrent GCTB by combining the CNN prediction and patient features (age and tumor location). Accuracy and sensitivity were used to evaluate the prediction performance. RESULTS: When comparing the CNN, CNN regression, and radiologists, the accuracies of the CNN and CNN regression models were 75.5% (95% CI 55.1 to 89.3%) and 78.6% (59.0 to 91.7%), respectively, which were higher than the 64.3% (44.1 to 81.4%) accuracy of the radiologists. The sensitivities were 85.7% (42.1 to 99.6%) and 87.5% (47.3 to 99.7%), respectively, which were higher than the 58.3% (27.7 to 84.8%) sensitivity of the radiologists (p < 0.05). CONCLUSION: The CNN has the potential to predict recurrent GCTB after curettage. A binary regression model combined with patient characteristics improves its prediction accuracy. KEY POINTS: • Convolutional neural network (CNN) can be trained successfully on a limited number of pre-surgery MR images, by fine-tuning a pre-trained CNN architecture. • CNN has an accuracy of 75.5% to predict post-surgery recurrence of giant cell tumors of bone, which surpasses the 64.3% accuracy of human observation. • A binary logistic regression model combining CNN prediction rate, patient age, and tumor location improves the accuracy to predict post-surgery recurrence of giant cell bone tumors to 78.6%.

Long non-coding RNA 00607 as a tumor suppressor by modulating NF-κB p65/p53 signaling axis in hepatocellular carcinoma.

Accumulating evidence suggests that long non-coding RNA (lncRNA) plays important roles in some malignant tumors. However, the mechanism underlying how lncRNA regulates hepatocellular carcinoma (HCC) process remains largely unknown. In this study, we explored the potential role of lncRNA 00607 as a novel tumor suppressor in HCC. In this study, we examined the regulation of lncRNA 00607 by the important inflammatory cytokine tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). We also determined the expression of LINC000607 in 159 HCC tumors and paired adjacent tissues. Effects of LINC000607 in HCC proliferation and apoptosis were examined in vitro in HCC cell lines and in vivo tumor xenografts. Furthermore, we also examine underlying mechanism by which lncRNA 00607 regulates NF-κB p65 and how LIN00607 exerts its tumor suppressor role in HCC. We found that lncRNA 00607 expression level is lower in HCC tumors compared with matched normal liver tissue, and its low expression predicts worse prognosis in HCC. Functionally, lncRNA 00607 overexpression leads to decreased HCC cell proliferation in vitro and in vivo, enhanced apoptosis and chemotherapeutic drug sensitivity. Mechanistically, lncRNA 00607 inhibits the p65 transcription by binding to the p65 promoter region, therefore contributing to increased p53 levels in HCC. Taken together, the findings of this study show that the TNF-α/IL-6-lncRNA 00607-NF-κB p65/p53 signaling axis represents a novel therapeutic avenue in cancer chemotherapy.

Matrix metalloproteinase-9 expression of GCTSC in peripheral tissue and central tissue of GCTB.

Giant cell tumor stromal cell (GCTSC) is the tumor cell of giant cell tumor of bone (GCTB). The biomarkers characterization of GCTSC is critical for the selection of GCTB targeting drugs. We believe the main functions of GCTSC in different part of tumor should be different for different environment. Then the biological behavior and molecular biomarkers of GCTSC should be different as well. Based on this idea, we focused on GCTSC which located in central tissue, peripheral tissue and took MMP-9 as the breakthrough point to carry out research. The results showed MMP-9 staining grade of GCTSC which located in central tissue was slight, whereas multinucleated giant cell staining grade was high. The peripheral tissue was consisted by almost GCTSC with high MMP-9 staining degree and mRNA expression. This study also provided clues and inspiration for reducing GCTB recurrence rate after intralesional curettage with MMP-9 targeted therapy which were aimed at the residual peripheral tissue.

Postprandial increase in serum CA125 as a surrogate biomarker for early diagnosis of ovarian cancer.

BACKGROUND: CA125 is a prevalently used serum biomarker for detecting ovarian cancer over the last three decades. However, it has a significant deficiency in screening for early-stage cancer. With the purpose of exploring an effective approach to improve its performance in early diagnosis, we investigated the postprandial fluctuation pattern of cancer-derived CA125 and the underlying mechanism. METHODS: In two medical centers, 551 patients sonographically diagnosed with ovarian (adnexal) cysts (< 5 cm in diameter) were enrolled and divided into five disease groups (pelvic inflammatory cysts, retention cysts, endometrioma, benign/borderline cystadenoma and malignant cysts). The subtle differences in 1-h postprandial serum CA125 increases were compared between disease groups. A support vector machine (SVM)-based algorithm was used for refining the performance of CA125 postprandial increment. Ovarian cancer xenograft animal and cancer cell models were used to recapitulate the clinical findings and reveal the molecular basis of postprandial blood glucose and insulin in invoking the synthesis/secretion/re-absorption of CA125. RESULTS: Patients with ovarian cancer presented the highest postprandial increment 13.3 ± 0.7% (mean ± standard deviation) among the five disease groups. Using a CA125 increment ≥ 10% criterion, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) reached 83.3, 96.3, 61.1 and 98.8%, respectively, for early-stage ovarian cancer. This performance was further improved by the SVM-based CA125-increment algorithm, which exhibited 91.7% sensitivity, 99.2% specificity, 89.2% PPV and 99.4% NPV. Both modalities manifested diagnostic advantages over the traditional CA125 test (75.0% sensitivity, 25.4% specificity, 6.6% PPV and 93.6% NPV at the cut-off of 35 U/mL). Regarding the molecular basis, the postprandial blood glucose and insulin-invoked overexpression of Mucin 16 (encoding CA125) were demonstrated in animal and cancer cell models, which were mediated by the PI3K-Akt pathway. Nevertheless, a Mesothelin-based CA125 re-absorption behavior was noted in the treated cancer cells, which contributed to the over-drop following the postprandial peak of serum CA125. CONCLUSIONS: Cancer-derived serum CA125 possesses a unique and distinctive postprandial pattern, that distinguishes it from the common CA125 elevation in a benign disease condition. The dynamic measurement/assessment strategy can achieve a discriminatory power superior to that of a static test.

Prognosis of local recurrence in giant cell tumour of bone: what can we do?

Giant cell tumour of bone (GCTB) is classified as an intermediate tumour with rare metastasis, but is challenged by local recurrence. This review focuses on the role of radiological evaluation in terms of prognosis of local recurrence in GCTB. We hope to highlight the value of radiological evaluation by integrating studies on the impact of surgical treatments and non-surgical factors on local recurrence of GCTB and the current statuses of genetic and molecular prognostic factors of GCTB. Radiological evaluation can provide diverse information on tumours. As a non-invasive method, magnetic resonance imaging (MRI) is especially valuable for the diagnosis and evaluation of bone tumours due to its heightened sensitivity to soft tissue disease and multiplanar image acquisition. Imaging findings should be integrated with clinical characteristics, pathology and genetic and molecular prognostic factors to direct clinical approach and reduce the local recurrence of GCTB. Therefore, it is necessary to establish a multi-perspective evaluation system by which prognostic factors can be reliably determined. We further advocate more large-scale prospective studies. With the help of radiological evaluation, the clinic treatment of GCTB can be guided and local recurrence might be reduced; additionally, MR imaging can identify local recurrence of GCTB after surgical treatment in the early stage.

A prospective study on predicting local recurrence of giant cell tumour of bone by evaluating preoperative imaging features of the tumour around the knee joint.

PURPOSE: To evaluate the role of medical imaging in predicting local recurrence of giant cell tumour of bone (GCTB) by assessing the preoperative imaging features of GCTB around the knee. METHODS: Forty-eight consecutive GCTBs in the proximal tibia and distal femur treated with curettage were prospectively enrolled. Patients were grouped in terms of their imaging features on radiography, computed tomography (CT) and magnetic resonance imaging (MRI). All patients were followed up for at least two years after surgery. The association between preoperative imaging features and local recurrence was investigated. Imaging features were retrospectively studied by correlation analysis. The differences between rates were tested by the Chi square and Fisher exact tests; independent factors were determined by multivariate logistic regression analysis. RESULTS: Cystic change and adjacent soft tissue invasion were associated with a higher rate of local recurrence compared to the negative groups (P < 0.05). Cystic change was identified as an independent risk factor for local recurrence of GCTB (P < 0.05). Expansibility was correlated with the "soap bubble" sign and the fluid-fluid level (P < 0.05); the "soap bubble" sign was correlated with osteosclerosis and the fluid-fluid level (P < 0.05); cortical bone involvement was correlated with adjacent soft tissue invasion (P < 0.05); and cystic change was correlated with the fluid-fluid level (P < 0.05). CONCLUSION: Cystic change was an independent risk factor for local recurrence of GCTB. Adjacent soft tissue invasion might indirectly relate to local relapse. A cluster of association relationships between imaging features was revealed.

Naive Treg-like CCR7(+) mononuclear cells indicate unfavorable prognosis in hepatocellular carcinoma.

Chemokine receptor-like 1 (CCRL1) has the potential in creating a low level of CCL19 and CCL21 to hinder CCR7(+) cell tracking to tumor tissue. Previously, we found a tumor suppressive role of CCRL1 by impairing CCR7-related chemotaxis of tumor cells in human hepatocellular carcinoma (HCC). Here, we reported a contribution of CCR7(+) mononuclear cells in the tumor microenvironment to the progression of disease. Immunohistochemistry was used to investigate the distribution and clinical significance of CCR7(+) cells in a cohort of 240 HCC patients. Furthermore, the phenotype, composition, and functional status of CCR7(+) cells were determined by flow cytometry, immunofluorescence, and in vitro co-culture assays. We found that CCR7(+) mononuclear cells were dispersed around tumor tissue and negatively related to tumoral expression of CCRL1 (P < 0.001, r = 0.391). High density of CCR7(+) mononuclear cells positively correlated with the absence of tumor capsule, vascular invasion, and poor differentiation (P < 0.05). Survival analyses revealed that increased number of CCR7(+) mononuclear cells was significantly associated with worse survival and increased recurrence. We found that CCR7(+) mononuclear cells featured a naive Treg-like phenotype (CD45RA(+)CD25(+)FOXP3(+)) and possessed tumor-promoting potential by producing TGF-ß1. Moreover, CCR7(+) cells were also composed of several immunocytes, a third of which were CD8(+) T cells. CCR7(+) Treg-like cells facilitate tumor growth and indicate unfavorable prognosis in HCC patients, but fortunately, their tracking to tumor tissue is under the control of CCRL1.

Tunable Yb:CaF2-SrF2 laser and femtosecond mode-locked performance based on semiconductor saturable absorber mirrors.

We experimentally demonstrate an effective continuous-wave tunable operation and femtosecond passively mode-locked pulse from a Yb:CaF2-SrF2 mixed crystal laser for the first time. Pumped by a 977 nm fiber-coupled laser diode, a continuous-wave mode-locked pulse as short as 634 fs was generated. The shortest pulse operated under a repetition rate of 87 MHz at the central wavelength of 1047 nm. The calculated time-bandwidth product was 0.503, which was 1.6 times the Fourier transform-limited sech2-shaped pulses.

[The Role of Leptin in Cognitive Development During Aging].

Brain aging is accompanied by alternations of brain structure, functions and the cognitive impairment. With respect to cognitive decline, the elderly population is far from homogeneous, as well as heterogeneous, which presents successful aging, normal aging, mild cognitive impairment and Alzheimer's disease. Studies demonstrated that higher serum leptin levels are associated with normal cognition in older adults without significant neurological conditions, while it is lower in most mild cognitive impairment patients. Leptin can improve cognitive disorders and referred to as a potential cognitive enhancer. Therefore, low level of leptin plays an significant role in cognitive impairment development in elderly people.

Diagnosis of 25 genotypes of human papillomaviruses for their physical statuses in cervical precancerous/cancerous lesions: a comparison of E2/E6E7 ratio-based vs. multiple E1-L1/E6E7 ratio-based detection techniques.

BACKGROUND: Cervical lesions caused by integrated human papillomavirus (HPV) infection are highly dangerous because they can quickly develop into invasive cancers. However, clinicians are currently hampered by the lack of a quick, convenient and precise technique to detect integrated/mixed infections of various genotypes of HPVs in the cervix. This study aimed to develop a practical tool to determine the physical status of different HPVs and evaluate its clinical significance. METHODS: The target population comprised 1162 women with an HPV infection history of > six months and an abnormal cervical cytological finding. The multiple E1-L1/E6E7 ratio analysis, a novel technique, was developed based on determining the ratios of E1/E6E7, E2/E6E7, E4E5/E6E7, L2/E6E7 and L1/E6E7 within the viral genome. Any imbalanced ratios indicate integration. Its diagnostic and predictive performances were compared with those of E2/E6E7 ratio analysis. The detection accuracy of both techniques was evaluated using the gold-standard technique "detection of integrated papillomavirus sequences" (DIPS). To realize a multigenotypic detection goal, a primer and probe library was established. RESULTS: The integration rate of a particular genotype of HPV was correlated with its tumorigenic potential and women with higher lesion grades often carried lower viral loads. The E1-L1/E6E7 ratio analysis achieved 92.7% sensitivity and 99.0% specificity in detecting HPV integration, while the E2/E6E7 ratio analysis showed a much lower sensitivity (75.6%) and a similar specificity (99.3%). Interference due to episomal copies was observed in both techniques, leading to false-negative results. However, some positive results of E1-L1/E6E7 ratio analysis were missed by DIPS due to its stochastic detection nature. The E1-L1/E6E7 ratio analysis is more efficient than E2/E6E7 ratio analysis and DIPS in predicting precancerous/cancerous lesions, in which both positive predictive values (36.7%-82.3%) and negative predictive values (75.9%-100%) were highest (based on the results of three rounds of biopsies). CONCLUSIONS: The multiple E1-L1/E6E7 ratio analysis is more sensitive and predictive than E2/E6E7 ratio analysis as a triage test for detecting HPV integration. It can effectively narrow the range of candidates for colposcopic examination and cervical biopsy, thereby lowering the expense of cervical cancer prevention.

Association between cytochrome P450 2C9 gene polymorphisms and colorectal cancer susceptibility: evidence from 16 case-control studies.

Previous epidemiological studies have evaluated the association between common variations of cytochrome P450 (CYP)2C9 (430C>T and 1075A>C) and the risk of colorectal cancer (CRC) with conflicting results. To derive a more precise estimation of the relationship between these CYP2C9 polymorphisms and CRC, a meta-analysis was performed. PubMed, Embase, CNKI, and Web of Science databases were searched. A total of 16 studies including 9,463 cases and 11,416 controls were identified. Potential sources of heterogeneity including ethnicity, sample size of study, genotyping method, diagnostic criteria, and outcome were systematically assessed. Overall, the summary odds ratio of 430T variant for CRC was 0.92 (95% confidence interval (CI) 0.86-0.98; P = 0.012) and 1.39 (95% CI 1.07-1.81; P = 0.013) for colorectal adenomas (CRAs). As for CYP2C9 1075A>C polymorphism, no significant results were observed in overall and subgroup analysis. There was no evidence of publication bias. In conclusion, there is evidence to indicate a significant association between CYP2C9 430C>T polymorphism and CRC/CRA risk.

Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a retrospective cohort study.

BACKGROUND: The number of cesarean scar pregnancy (CSP) has significantly increased in the recent decade. Although uterine artery embolization (UAE) has been adopted to minimize the blood loss during uterine curettage removing of CSP, massive bleeding and uterine rupture can still be frequently encountered. The aim of this study was to compare the efficacy and safety of a novel combined laparoscopy and hysteroscopy technique with the traditional curettage in removing the conceptus and repairing the incision defect following the UAE management of CSP. METHODS: The CSP patients (n = 58) diagnosed between March 1, 2005 and March 1, 2010 were enrolled in three medical centers in Shanghai, China. All of these patients have undergone intra-arterial methotrexate, UAE and one of the following treatments: combined laparoscopy and hysteroscopy (study group, n = 25) and uterine curettage (control group, n = 33). Their medical records and 2-year outcomes were reviewed. The CSP removal rate, amount of blood loss during the treatment, incision repair rate (note: the post-curettage healing process of the incision defect was seen as a form of natural incision repairing, i.e., the self-repair mode), hospital stay, ß-hCG regression time and postoperative sequelae were compared between two groups. RESULTS: The CSP removal rate in the study group (100%) was significantly higher than that (79%) in the control group (p = 0.024). The average blood loss was 78.0 mL in the study group, which was much less than the 258.5 mL (p = 0.004) in the control group. A satisfactory incision repair rate (96%) was achieved in the study group, while it was 25% (p < 0.001) in the control group. Moreover, the study group had significantly shorter hospital stays (p = 0.043) and ß-hCG regression times (p = 0.033), lower rates of postoperative abdominal pain (p = 0.035) and menstruation abnormalities (p = 0.043). CONCLUSIONS: Combined laparoscopy and hysteroscopy is much safer and more effective than uterine curettage as a supplementary measure to remove the conceptus and repair the cesarean incision following the UAE management of CSP.

Driving sustainable circular economy in electronics: A comprehensive review on environmental life cycle assessment of e-waste recycling.

E-waste, encompassing discarded materials from outdated electronic equipment, often ends up intermixed with municipal solid waste, leading to improper disposal through burial and incineration. This improper handling releases hazardous substances into water, soil, and air, posing significant risks to ecosystems and human health, ultimately entering the food chain and water supply. Formal e-waste recycling, guided by circular economy models and zero-discharge principles, offers potential solutions to this critical challenge. However, implementing a circular economy for e-waste management due to chemical and energy consumption may cause environmental impacts. Consequently, advanced sustainability assessment tools, such as Life Cycle Assessment (LCA), have been applied to investigate e-waste management strategies. While LCA is a standardized methodology, researchers have employed various routes for environmental assessment of different e-waste management methods. However, to the authors' knowledge, there lacks a comprehensive study focusing on LCA studies to discern the opportunities and limitations of this method in formal e-waste management strategies. Hence, this review aims to survey the existing literature on the LCA of e-waste management under a circular economy, shedding light on the current state of research, identifying research gaps, and proposing future research directions. It first explains various methods of managing e-waste in the circular economy. This review then evaluates and scrutinizes the LCA approach in implementing the circular bioeconomy for e-waste management. Finally, it proposes frameworks and procedures to enhance the applicability of the LCA method to future e-waste management research. The literature on the LCA of e-waste management reveals a wide variation in implementing LCA in formal e-waste management, resulting in diverse results and findings in this field. This paper underscores that LCA can pinpoint the environmental hotspots for various pathways of formal e-waste recycling, particularly focusing on metals. It can help address these concerns and achieve greater sustainability in e-waste recycling, especially in pyrometallurgical and hydrometallurgical pathways. The recovery of high-value metals is more environmentally justified compared to other metals. However, biometallurgical pathways remain limited in terms of environmental studies. Despite the potential for recycling e-waste into plastic or glass, there is a dearth of robust background in LCA studies within this sector. This review concludes that LCA can offer valuable insights for decision-making and policy processes on e-waste management, promoting environmentally sound e-waste recycling practices. However, the accuracy of LCA results in e-waste recycling, owing to data requirements, subjectivity, impact category weighting, and other factors, remains debatable, emphasizing the need for more uncertainty analysis in this field.

Serial circulating tumor DNA profiling predicts tumor recurrence after liver transplantation for liver cancer.

BACKGROUND: Minimal residual disease (MRD) is proposed to be responsible for tumor recurrence. The role of circulating tumor DNA (ctDNA) to detect MRD, monitor recurrence, and predict prognosis in liver cancer patients undergoing liver transplantation (LT) remains unrevealed. METHODS: Serial blood samples were collected to profile ctDNA mutational changes. Baseline ctDNA mutational profiles were compared with those of matched tumor tissues. Correlations between ctDNA status and recurrence rate (RR) and recurrence-free survival (RFS) were analyzed, respectively. Dynamic change of ctDNA was monitored to predict tumor recurrence. RESULTS: Baseline mutational profiles of ctDNA were highly concordant with those of tumor tissues (median, 89.85%; range 46.2-100%) in the 74 patients. Before LT, positive ctDNA status was associated with higher RR (31.7% vs 11.5%; p = 0.001) and shorter RFS than negative ctDNA status (17.8 vs 19.4 months; p = 0.019). After LT, the percentage of ctDNA positivity decreased (17.6% vs 47.0%; p < 0.001) and patients with positive ctDNA status had higher RR (46.2% vs 21.3%; p < 0.001) and shorter RFS (17.2 vs 19.2 months; p = 0.010). Serial ctDNA profiling demonstrated patients with decreased or constant negative ctDNA status had lower RR (33.3% vs 50.0%; p = 0.015) and favorable RFS (18.2 vs 15.0 months, p = 0.003) than those with increased or constant positive ctDNA status. Serial ctDNA profiling predicted recurrence months ahead of imaging evidence and serum tumor biomarkers. CONCLUSIONS: ctDNA could effectively detect MRD and predict tumor recurrence in liver cancer patients undergone LT.

T2* MRI of minimal hepatic encephalopathy and cognitive correlates in vivo.

PURPOSE: To evaluate regional brain iron deposition in minimal hepatic encephalopathy (MHE) patients using T2*-weighted gradient-echo imaging and to explore the relationship between T2* MR changes and cognitive performance. MATERIALS AND METHODS: Forty hepatitis-B virus (HBV)-related cirrhotic patients and 22 age-, sex-, and education-matched healthy controls were included in this study. Of the patients, twenty eight patients were diagnosed with MHE. All subjects were administered Number Connection Test-A (NCT-A), Letter Digit Substitution Test (LDST), Rey-Osterrieth Complex Figure Test (RCFT), and the Mini-Mental State Examination (MMSE). T2*-weighted gradient-echo images were acquired using 3 Tesla MRI. Phase values (putative iron levels) in the frontal-basal ganglia-thalamocortical circuits were measured. Spearman correlation and multiple linear regression analysis were performed. RESULTS: MHE patients exhibited significantly prolonged NCT-A time and decreased LDST, RCFT immediate and delayed recall scores. Significant decreases of phase values in the bilateral putamen were detected in MHE patients compared to without MHE patients and controls. Multiple linear regression analysis confirmed significant correlations between the phase values in the putamen and right frontal white matter and cognitive performances by MHE patients. CONCLUSION: Decreased phase values in the frontal cortical-basal ganglial circuits independently contribute to cognitive impairments in MHE patients.

[Risk of cervical cancer and precancerous diseases in the oral HPV carriers].

OBJECTIVE: To evaluate the risk of the occurrence of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer in the oral HPV carriers through a population-based investigation in Shanghai. METHODS: A total of 1200 cases of outpatients who attended the annual cervical examination and 50 preoperational cases of inpatients with CINIII or invasive cervical cancer were enrolled from three clinical centers in Shanghai. The oral HPV infection was determined by real-time PCR. In 1200-case cross-sectional study, the incidence rate of CIN was compared between the oral HPV positive and negative cohort. In 1250-case case-control study, the positive rate of oral HPV DNA test was compared among normal control group, CINI-III, and invasive cancer case groups, and all odds ratio (OR) values were calculated, respectively. The HPV transmission-related demographic and behavioral characters of the oral HPV carriers were also analyzed. RESULTS: The oral HPV carriers accounted for 5.9% (71/1200) of the investigated outpatients. The oral HPV DNA positive rates were gradually increased with the cervical disease grades, which were 5.8% (68/1182, normal), 2/13 (CIN I), 1/5 (CINII), 31.4% (11/35, CINIII) and 5/15 (invasive cancer). In cross-sectional cohort studies, the relative risks (RR) of CINI,II were 2.9 and 4.0 for oral HPV carriers, respectively. In case-control study, the OR values for CINI-III and invasive cervical cancer were 3.1(95%CI: 1.6-10.1), 4.2(95%CI: 1.7-28.4), 7.1(95%CI: 4.8-19.8) and 10.1(95%CI: 3.2-32.1), respectively. The oral sex and multi-sexual partner were two major risk factors for the oral and cervical HPV co-infection, HPV-related cervical cancer and precancerous diseases according to behavioral analysis. CONCLUSIONS: There are complicated transmission pathways between oral and cervical HPV. Oral HPV carriers should be intensively followed up and their oral HPV infection and HPV-related cervical diseases should be treated together.