Association of frailty with adverse outcomes in surgically treated geriatric patients with hip fracture: A meta-analysis and trial sequential analysis.

OBJECTIVE: Some studies have associated frailty and prognostic outcomes in geriatric hip fracture patients, but whether frailty can predict postoperative outcomes remains controversial. This review aims to assess the relationship between frailty and adverse postoperative outcomes in geriatric patients with hip fracture. METHODS: Based on electronic databases, including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang Data, we systematically searched for studies that investigated the association between frailty and adverse outcomes among patients aged 60 or over after hip fracture surgery. Stata 17.0 and Trial Sequential Analysis viewer software were used to obtain pooled estimates and verify whether the sample size was sufficient and the evidence robust. RESULTS: Twenty-one studies involving 49,196 patients were included for quantitative analysis. Compared with nonfrail patients, frail patients had a higher risk of inpatient mortality (risk ratio [RR] = 1.93, 95% confidence interval [CI]: 1.66-2.23), 30-day mortality (RR = 2.13, 95% CI: 1.23-3.70), and 1-year mortality (RR = 2.44, 95% CI: 1.47-4.04). Frailty can significantly predict postoperative complications (RR = 1.76, 95% CI: 1.38-2.23), including delirium, pneumonia, cardiac complications, urinary tract infection, and surgical site infection; the association between frailty and deep venous thrombosis/pulmonary embolism and acute kidney injury needs further analysis. Trial sequential analysis showed that the findings regarding mortality were reliable and robust. CONCLUSION: This meta-analysis provides detailed information indicating that frailty is a substantial predictor of mortality and selected postoperative complications.

MOF-derived low Ru-loaded high entropy alloy as an efficient and durable self-supporting electrode in rechargeable liquid/flexible Zn-air batteries.

Exploiting the high-entropy alloy (HEA) electrocatalysts with the synergistic effect of multi-metal components is an effective approach to address the slow kinetics and undesirable stability of the oxygen evolution reaction (OER) in Zn-air batteries (ZABs), but still faces many challenges. In this study, a multimetallic Metal-organic framework (MOF)-derived HEA catalyst was successfully fabricated on carbon fiber as a flexible self-supporting electrode (denoted as CC@FeCoNiMoRu-HEA/C) for high-performance liquid/flexible ZABs using a facile and cost-effective strategy. The three-dimensional (3D) highly open network framework and hierarchical porous structure accelerate the mass transport of OH-/O2 and charge transfer. The electronic structure adjustment, lattice defects and high entropy effects enable the CC@FeCoNiMoRu-HEA/C catalysts to perform high OER catalytic activity and strong durability while reducing the Ru content and lowering the economic cost. In situ Raman spectra and XPS results reveal the generation of metal-OOH intermediates on the HEA surface during the OER process. In a practical demonstration, the liquid ZAB assembled with CC@FeCoNiMoRu-HEA/C + Pt/C as the air electrode offers stable open-circuit voltage, large power density, excellent specific capacity and satisfactory cycle life, outperforming the commercial RuO2 + Pt/C-based reference ZAB. More attractively, the flexible solid-state ZAB also achieves fast dynamic response, high peak power density, robust cycling stability as well as favorable mechanical flexibility, indicating a promising application prospect in future flexible electronics and wearable devices. This work provides a viable pathway to develop low precious metal-loaded HEAs as advanced OER self-supporting electrocatalysts and realize high-performance flexible energy storage devices.

Development and validation of models for predicting mortality in intertrochanteric fracture surgery patients with perioperative blood transfusion: a prospective multicenter cohort study.

BACKGROUND: The association between allogenic blood transfusions (ABT) and all-cause mortality in surgically treated hip fracture patients with perioperative transfusion (STHFPT) remained unknown. We aim to introduce transfusion-related factors, new variables to develop and validate models to predict mortality in these patients. METHODS: A prospective multicenter cohort study was conducted with STHFPT hospitalized during Jan. 2018 and Jun. 2021. The database was divided into training cohort and validation cohort in a ratio of 70% to 30% using the randomization method. All participants received a minimum of 2-year follow-up and all participants' overall and eight time-specific survival status were recorded. Prediction models were developed using multivariate logistic regression and Cox regression for variable selection. Model performance was measured by determining discrimination, calibration, overall model performance or precision, and utility. Sensitivity analyses were performed to test robustness of the results. RESULTS: A total of 7074 consecutive patients were prospectively screened and assessed for eligibility to participate. Finally, 2490 patients met our inclusion and exclusion criteria and 1743 (70%) patients were randomized to the training cohort and 747 (30%) to the validation cohort. The median duration of follow-up was 38.4 months (IQR 28.0-62.0). Our novel models highlight that preoperative transfusion is of significance for short-term mortality while mid-term outcomes are predominantly determined by severe complications, pulmonary complications, and advanced age. Our models showed high discriminative power, good calibration and precision for mortality prediction in both training and validation cohorts, especially in short-term mortality prediction. CONCLUSIONS: We introduce transfusion-related factors, new variables to develop and validate models to predict mortality with STHFPT. The models can be further tested and updated with the ultimate goal of assisting in optimizing individual transfusion strategy.

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study.

BACKGROUND: Optimal treatment strategy for nonagenarians and centenarians with hip fractures (NCHF) remained unknown. The authors aimed to compare the outcomes of surgical and conservative management in NCHF. METHODS: A prospective cohort study was conducted based on CPMHF database with NCHF patients hospitalized during 2014-2020. Comorbidities were evaluated by mECM score and restricted cubic spline was utilized to visually assess the dose-effect relationship between the mECM and outcomes. Propensity score matching was performed to balance baseline characteristics between nonsurgical and surgical groups. Multivariate logistic regression, Cox proportional hazard analysis, and survival analysis were employed for unfavorable outcomes (UFO) evaluation. Competing risk of death were analyzed based on Fine and Gray's hazard model and then constructed nomogram models for predicting survival rates. Subgroup analyses were used to determine potential population heterogeneity and sensitivity analyses were performed to test robustness of the results. RESULTS: The authors found increasing trends for UFO with the increase in the mECM score, and that high mECM score (HMS, ≥3) was independently associated with a 2.42-fold (95% CI: 2.07-3.54; P =0.024) increased risk of UFO, which remained significant after considering the competing role of death and were more pronounced in nonsurgical treatment, women, no insurance, and patients with spouse (all P for interaction <0.05). Surgical intervention was identified to be significant protective factors for UFO (RR, 0.59; 95% CI: 0.46-0.75; P <0.001) and severe complications (RR, 0.63; 95% CI: 0.41-0.96; P =0.033) after propensity score matching, as well as survival (HR, 0.40, 95% CI: 0.28-0.58; P <0.001), which remained significant after considering the competing role of death and in all sensitivity analyses and were more pronounced in HMS participants ( P for interaction=0.006). Subgroup analyses revealed surgical patients with HMS had a significantly higher UFO rate (excluding death, P <0.001) while nonsurgical patients with HMS had higher mortality rate as compared to the others ( P =0.005). CONCLUSION: Surgical treatment for NCHF yields better outcomes compared to conservative treatment.

Construction of a knowledge graph for breast cancer diagnosis based on Chinese electronic medical records: development and usability study.

BACKGROUND: Electronic medical records (EMRs) contain a wealth of information related to breast cancer diagnosis and treatment. Extracting relevant features from these medical records and constructing a knowledge graph can significantly contribute to an efficient data analysis and decision support system for breast cancer diagnosis. METHODS: An approach was proposed to develop a workflow for effectively extracting breast cancer-related features from Chinese breast cancer mammography reports and constructing a knowledge graph for breast cancer diagnosis. Firstly, the concept layer of the knowledge graph for breast cancer diagnosis was constructed based on breast cancer diagnosis and treatment guidelines, along with insights from clinical experts. .Next, a BiLSTM-Highway-CRF model was designed to extract the mammography features, which formed the data layer of the knowledge graph. Finally, the knowledge graph was constructed by combining the concept layer and the data layer in a Neo4j graph data platform, and then applied in visualization analysis, semantic query and computer assisted diagnosis. RESULTS: Mammographic features were extracted from a total of 1171 mammography examination reports. The overall extraction performance of the model achieved an accuracy rate of 97.16%, a recall rate of 98.06%, and a F1 score of 97.61%. Additionally, 47,660 relationships between entities were identified based on the four different types of relationships defined in the concept layer. The knowledge graph for breast cancer diagnosis was constructed after inputting mammographic features and relationships into the Neo4j graph data platform. The model was assessed from the concept layer, data layer, and application layer perspectives, and showed promising results. CONCLUSIONS: The proposed workflow is applicable for constructing knowledge graphs for breast cancer diagnosis based on Chinese EMRs. This study serves as a reference for the rapid design, construction, and application of knowledge graphs for diagnosis and treatment of other diseases. Furthermore, it offers a potential solution to address the issues of limited data sharing and format inconsistencies present in Chinese EMR data.

Application of piezoelectric materials in the field of bone: a bibliometric analysis.

In the past 4 decades, many articles have reported on the effects of the piezoelectric effect on bone formation and the research progress of piezoelectric biomaterials in orthopedics. The purpose of this study is to comprehensively evaluate all existing research and latest developments in the field of bone piezoelectricity, and to explore potential research directions in this area. To assess the overall trend in this field over the past 40 years, this study comprehensively collected literature reviews in this field using a literature retrieval program, applied bibliometric methods and visual analysis using CiteSpace and R language, and identified and investigated publications based on publication year (1984-2022), type of literature, language, country, institution, author, journal, keywords, and citation counts. The results show that the most productive countries in this field are China, the United States, and Italy. The journal with the most publications in the field of bone piezoelectricity is the International Journal of Oral & Maxillofacial Implants, followed by Implant Dentistry. The most productive authors are Lanceros-Méndez S, followed by Sohn D.S. Further research on the results obtained leads to the conclusion that the research direction of this field mainly includes piezoelectric surgery, piezoelectric bone tissue engineering scaffold, manufacturing artificial cochleae for hearing loss patients, among which the piezoelectric bone tissue engineering scaffold is the main research direction in this field. The piezoelectric materials involved in this direction mainly include polyhydroxybutyrate valerate, PVDF, and BaTiO3.

The efficacy of different interventions in the treatment of sarcopenia in middle-aged and elderly people: A network meta-analysis.

BACKGROUND: In this study, a meta-analysis system was used to evaluate the effects of 7 methods of treating sarcopenia, including resistance exercise, aerobic exercise, mixed exercise, nutrition, resistance combined with nutrition, mixed exercise combined with nutrition, and electric stimulation combined with nutrition, and their effects on physical function. METHODS: According to the PRISMA guidelines, PubMed, Web of Science, Embase, and other foreign databases, as well as Chinese databases such as China National Knowledge Infrastructure and Wan Fang, the literatures of randomized controlled trials with different intervention measures were searched. ADDIS software was used to compare and rank the results of the network meta-analysis. RESULTS: A total of 2485 patients were included in the 30 randomized controlled trial items. According to the clinical manifestations of sarcopenia, 7 different forms of exercise and nutrition interventions can improve muscle strength, muscle mass, and physical function; in terms of improving muscle strength, resistance exercise has the most significant effect on improving grip strength (MD = 2.58, 95% confidence interval [CI] [1.06-4.07]); resistance exercise combined with nutrition lifting performed best in chair standing test (MD = -2.37, 95% CI [-4.73 to -0.33]). For muscle mass gains, resistance training increased appendicular skeletal muscle mass significantly (MD = 0.90, 95% CI [0.11-1.73]), while resistance exercise combined with nutrition significantly increased fat-free mass (MD = 5.15, 95% CI [0.91-9.43]). For physical activity, resistance training improved walk speed best (MD = 0.28, 95% CI [0.15-0.41]), and resistance exercise combined with nutrition in the best results were seen in the timed up and go test (MD = -2.31, 95% CI [-4.26 to -0.38]). CONCLUSION: Compared with aerobic exercise, mixed exercise, nutrition, resistance combined with nutrition, mixed exercise combined with nutrition, and electric stimulation combined with nutrition, resistance exercise has more advantages in improving muscle mass, strength, and physical function performance. The clinical treatment of sarcopenia with resistance exercise intervention has a better curative effect.

Exploration and Practice of the "One Combination, Two Highlights, Three Combinations, Four in One" Innovative Talents Training Mode in Forensic Medicine.

Talent is one of the basic and strategic supports for building a modern socialist country in all aspects. Since the 1980s, the establishment of forensic medicine major and the cultivation of innovative talents in forensic medicine have become hot topics in higher education in forensic medicine. Over the past 43 years, the forensic medicine team of Shanxi Medical University has adhered to the joint education of public security and colleges, and made collaborative innovation, forming a training mode of "One Combination, Two Highlights, Three Combinations, Four in One" for innovative talents in forensic medicine. It has carried out "5+3/X" integrated reform, and formed a relatively complete talent training innovation mode and management system in teaching, scientific research, identification, major, discipline, team, platform and cultural construction. It has made a historic contribution to China's higher forensic education, accumulated valuable experience for the construction of first-class major and first-class discipline of forensic medicine, and provided strong support for the construction of the national new forensic talent training system. The popularization of this training mode is conducive to the rapid and sustainable development of forensic science, and provides more excellent forensic talents for national building, regional social development and the discipline construction of forensic science.

Prenatal and postnatal diagnosis of Phelan-McDermid syndrome: A report of 21 cases from a medical center and review of the literature.

Background: Phelan-McDermid syndrome (PMS), caused by deletions at 22q13.3 and pathogenic variants in the SHANK3 gene, is a rare developmental disorder characterized by hypotonia, developmental delay (DD), intellectual disability (ID), autism spectrum disorder (ASD), dysmorphic features, absence of or delayed language, and other features. Methods: Conventional karyotyping, chromosomal microarray analysis (CMA), and whole exome sequencing (WES) have been used to detect genetic defects causing PMS. We summarized the genetic and clinical findings from prenatal to postnatal stages of detected cases of PMS and mapped potential candidate haploinsufficient genes for deletions of 22q13. This study aimed to summarize the laboratory findings, genetic defects, and genotype-phenotype correlations for Chinese patients with PMS. Results: Seven prenatal cases and fourteen postnatal cases were diagnosed with PMS in our center. Thirteen cases had a deletion ranging in size from 69 to 9.06 Mb at 22q13.2-q13.33, and five cases had a pathogenic variant or an intragenic deletion in the SHANK3 gene. Three familial cases with a parental carrier of a balanced translocation were noted. A review of the literature noted another case series of 29 cases and a report of five cases of PMS in China. Genotype-phenotype correlations confirmed haploinsufficiency of the SHANK3 gene for PMS and suggested other candidate haploinsufficient genes TNFRSFI3C and NFAM1 genes for immunological features and TCF20, SULT4A1, PARVB, SCO2, and UPK3A genes for intellectual impairment and behavioral abnormality, neurological features, macrocephaly/hypotonia, oculopathy, and renal adysplasia, respectively. Conclusion: Indications for prenatal diagnosis of PMS are not specific, and approximately 85% prenatally diagnosed PMS elected termination of pregnancies after genetic counseling. For postnatal cases, 62.5% were caused by a deletion at 22q13 and 37.5% were caused by a pathogenic variant or an intragenic deletion in the SHANK3 gene. Approximately 6.7% of cases with a deletion were familial, and almost all pathogenic variants were de novo. Combined karyotype, CMA, and WES should be performed to increase the diagnostic yield. The identification of other candidate haploinsufficient genes in deletions of 22q13.2-q13.33 could relate to more severe dysmorphic features, neurologic defects, and immune deficiency. These results provided evidence for diagnostic interpretation, genetic counseling, and clinical management for the Chinese cases of PMS.

Risk of cardiovascular disease among cancer survivors: Protocol of a pooled analysis of population-based cohort studies.

Introduction: Cancer and cardiovascular disease remain leading causes of death and disability worldwide, which places a heavy burden on public health systems and causes widespread suffering. Because these entities have highly overlapping risk factors, including hyperlipidemia, hypertension, diabetes, obesity, smoking and other lifestyle factors, many studies have reported that they have similar etiological mechanisms. Accumulating evidence indicates that there is an increased risk of cardiovascular disease among cancer survivors compared with the general population. However, whether cancer is associated with an increased risk of cardiovascular disease remains controversial. Methods and analysis: We will conduct and report the meta-analysis strictly based on the Cochrane Handbook for Systematic Reviews and the Meta-analysis of Observational Studies in Epidemiology guidelines combined with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISM-P). This meta-analysis was registered with PROSPERO (registration number CRD42022307056). We will search for studies published from database inception to December 1, 2021, regardless of language or date, in three electronic databases (PubMed, EMBASE, and Cochrane Library) to identify and appraise cohort studies examining the relationship between cancer and subsequent cardiovascular disease risk. The literature screening, inclusion and data extraction will be conducted independently by two investigators using pre-designed standardized data extraction forms. A senior investigator will be consulted in cases of disagreement. We will assess risk of bias in the included cohort studies using the Newcastle-Ottawa Scale (NOS). Quantitative synthesis will be conducted using a random-effects model. To explore potential sources of heterogeneity, we will carry out multiple sensitivity analysis, meta-regression and subgroup analysis according to baseline characteristics. Publication bias will be evaluated through visual inspection of funnel plot asymmetry as well as by Begg's rank correlation test and Egger's weighted linear regression test.

Novel recombinant human thyroid-stimulating hormone in aiding postoperative assessment of patients with differentiated thyroid cancer-phase I/II study.

PURPOSE: Thyroid hormone withdrawal (THW) inevitably induced hypothyroidism in patients with differentiated thyroid cancer (DTC), and we aimed to evaluate the safety and efficacy of a novel recombinant human thyroid-stimulating hormone (rhTSH, ZGrhTSH) as an alternative of THW in China. METHODS: Totally, 64 DTC patients were enrolled with 24 in the dose-escalation cohort equally grouped into 0.9 mg × 1 day, 0.9 mg × 2 day, 1.8 mg × 1 day, and 1.8 mg × 2 day dosage, and 40 further enrolled into 0.9 mg × 2 day dose-expansion cohort. All patients underwent both ZGrhTSH phase and levothyroxine (L-T4) withdrawal phase for self-comparison in terms of TSH levels, the radioactive iodine (RAI) uptake, stimulated thyroglobulin level, and the quality of life (QoL). RESULTS: In ZGrhTSH phase, no major serious adverse events were observed, and mild symptoms of headache were observed in 6.3%, lethargy in 4.7%, and asthenia in 3.1% of the patients, and mostly resolved spontaneously within 2 days. Concordant RAI uptake was noticed in 89.1% (57/64) of the patients between ZGrhTSH and L-T4 withdrawal phases. The concordant thyroglobulin level with a cut-off of 1 µg/L was noticed in 84.7% (50/59) of the patients without the interference of anti-thyroglobulin antibody. The QoL was far better during ZGrhTSH phase than L-T4 withdrawal phase, with lower Billewicz (- 51.30 ± 4.70 vs. - 39.10 ± 16.61, P < 0.001) and POMS (91.70 ± 16.70 vs. 100.40 ± 22.11, P = 0.011) scores which indicate the lower the better. Serum TSH level rose from basal 0.11 ± 0.12 mU/L to a peak of 122.11 ± 42.44 mU/L 24 h after the last dose of ZGrhTSH. In L-T4 withdrawal phase, a median of 23 days after L-T4 withdrawal was needed, with the mean TSH level of 82.20 ± 31.37 mU/L. The half-life for ZGrhTSH clearance was about 20 h. CONCLUSION: The ZGrhTSH held the promise to be a safe and effective modality in facilitating RAI uptake and serum thyroglobulin stimulation, with better QoL of patients with DTC compared with L-T4 withdrawal.

Upregulation of Runt related transcription factor 1 (RUNX1) contributes to tendon-bone healing after anterior cruciate ligament reconstruction using bone mesenchymal stem cells.

BACKGROUND: Anterior cruciate ligament (ACL) injury could lead to functional impairment along with disabilities. ACL reconstruction often fails owing to the regeneration failure of tendon-bone interface. Herein, we aimed to investigate the effects of Runt related transcription factor 1 (RUNX1) on tendon-bone healing after ACL reconstruction using bone mesenchymal stem cells (BMSCs). METHODS: BMSCs were isolated from the marrow cavity of rat femur, followed by the modification of RUNX1 with lentiviral system. Then, an ACL reconstruction model of rats was established with autografts. RESULTS: Results of flow cytometry exhibited positive-antigen CD44 and CD90, as well as negative-antigen CD34 and CD45 of the BMSCs. Then, we found that RUNX1-upregulated BMSCs elevated the decreased biomechanical strength of the tendon grafts after ACL reconstruction. Moreover, based on the histological observation, upregulation of RUNX1 was linked with better recovery around the bone tunnel, a tighter tendon-bone interface, and more collagen fibers compared to the group of BMSCs infected with LV-NC. Next, RUNX1-upregulated BMSCs promoted osteogenesis after ACL reconstruction, as evidenced by the mitigation of severe loss and erosion of the cartilage and bone in the tibial and femur area, as well as the increased number of osteoblasts identified by the upregulation of alkaline phosphatase, osteocalcin, and osteopontin in the tendon-bone interface. CONCLUSION: Elevated expression of RUNX1 contributed to tendon-bone healing after ACL reconstruction using BMSCs.

Efficacy and Safety of Low-Dose Nab-Paclitaxel Plus Tislelizumab in Elderly Patients With Previously Treated Metastatic Non-Small Cell Lung Cancer.

The combination of immunotherapy and chemotherapy has a synergic effect in non-small cell lung cancer (NSCLC). However, the elderly are often excluded from clinical trails due to their poor health status and more comorbidities. We sought to assess the efficacy and safety of low-dose nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus tislelizumab (an anti-PD-1 antibody) in elderly patients with advanced NSCLC. In this phase 2 clinical trail, eligible patients were those aged ≥65 years with metastatic NSCLC who had disease progression after treatment with ≥1 line of chemotherapy or targeted therapy. Patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) variations were eligible if they demonstrated disease progression after treatment with ≥1 corresponding inhibitor. Primary endpoints were progression-free survival and safety/tolerability. Secondary endpoints included objective response rate and overall survival. Among 29 patients enrolled from May 2019 through August 2020, 21 (72.4%) had adenocarcinoma, 17 (58.6%) had a performance status of 2, 8 (27.6%) had asymptomatic brain metastases, and 13 (44.8%) had EGFR/ALK variations. As of the data cutoff point on April 1, 2021, median progression-free survival and overall survival were 9.5 months and 16.5 months, respectively. Ten patients achieved a partial response (objective response rate of 34.5%). Seventeen (58.6%) patients had ≥1 treatment-related adverse event, with grade 3 events seen in 3 patients (10.3%). The most common adverse events were fatigue (20.7%), fever (17.2%), abnormal liver function (17.2%), and rash (17.2%). These results suggest that low-dose nab-paclitaxel plus tislelizumab is well tolerated and effective in elderly patients with advanced NSCLC, including those with EGFR/ALK variations.

Effects of different exercise methods of calf muscles on the hemodynamics of lower extremity vein.

OBJECTIVE: To compare the effects of active and passive calf muscle contraction on the hemodynamics of the lower extremity vein. METHODS: 30 females were selected by convenient sampling. The hemodynamic indexes of the common femoral vein were measured by Duplex ultrasound during the active ankle pump exercise, active circular exercise, passive ankle pump exercise, passive circular exercise, and massage the calf muscles. RESULTS: There was no significant difference in the velocity of common femoral vein when the subjects do active ankle pump exercise, active circular exercise, and massage the calf muscles (p > .05), but the velocity of common femoral vein was faster than that of passive ankle pump exercise and passive circular exercise (p < .01). CONCLUSION: The effects of active ankle exercise and massage on promoting venous blood return of lower extremity are better than that of passive ankle exercise.

Epidemiological status and risk factors of deep vein thrombosis in patients with femoral neck fracture.

OBJECTIVES: The purpose of this study was to investigate the incidence of deep vein thrombosis (DVT) and clarify the risk factors of DVT in patients with femoral neck fracture. METHODS: A self-designed questionnaire was used to collect the clinical data of 1209 patients with femoral neck fracture in our hospital from January 2019 to December 2019. The content of the questionnaire mainly includes general information, past medical history, history of present illness, operation related information, occurrence of DVT. The collected data were entered into Excel to analyze the incidence and risk factors of DVT in patients with femoral neck fracture. Chi square test and binary logistic regression model was used to screen the risk factors of DVT. RESULTS: 1209 cases of femoral neck fracture were included in this study. The incidence of DVT was 28.0% (339 patients). Among them, 71.7% (243 patients) were preoperative DVT and 28.3% (96 patients) were postoperative DVT. For the risk-factor analysis, gender, age, time from injury to hospitalization, operative method, anesthesia method and intraoperative blood loss were independent risk factors for DVT. CONCLUSION: The incidence of DVT in patients with femoral neck fracture is relatively high, and there are many related risk factors.

Multi-Component Nanofiber Composite Membrane Enabled High PM0.3 Removal Efficiency and Oil/Water Separation Performance in Complex Environment.

Currently, industrial waste gas and oily wastewater are usually at high temperature and contain corrosive components (e.g., acid, alkali, oxidant, or high salt, etc.), presenting great challenges on filtration/separation materials. Here, a multi-purpose Poly(m-phenylene isophthalamide)/polyacrylonitrile/silica (PMIA/PAN/SiO2) nanofiber composite membrane with a high yield was prepared simply via electrospinning to satisfy the demands of air filtration and oil/water separation in complex environments. Under the synergy of PMIA, PAN and SiO2, the composite membrane possesses high PM0.3 removal capacity of 99.69%, robust purification ability against real smoke PM2.5, effective oil/water separation performance of > 99.6%, superior high temperature stability (about 250 °C) and excellent chemical resistance, showing the potential application in filtration/separation process under complex conditions. Moreover, the influence mechanism of SiO2 NPs on mechanical properties and filtration performance was systematically investigated through experiments and simulations, paving the way for future intensive research. This study provides an option for the facile and effective preparation of high-performance filtration/separation membranes applied in the field of dust filtration and oily wastewater separation, even in harsh environments.

Epidemiologic Features and Influencing Factors of Norovirus Outbreaks in the City of Wuxi, China from 2014 to 2018.

The study investigated the genotypic changes and epidemiologic features of norovirus outbreaks and factors influencing the attack rate and outbreak duration in Wuxi from 2014 to 2018. Norovirus outbreaks, monitored through surveillance system, were investigated. The norovirus-positive specimens from outbreaks were collected and genotyped using a dual polymerase-capsid genotyping protocol based on a one-step polymerase chain reaction (PCR) amplicon. The genotypes were analyzed by Norovirus Typing Tool Version 2.0. A total of 74 norovirus outbreaks were reported in Wuxi from 2014 to 2018. Most (93.2%) norovirus outbreaks were caused by GII genotypes. The predominant norovirus genotypes in outbreaks have changed from GII.17 (20.3%) in 2014-2015 to GII.P16/GII.2 (40.5%) in 2017-2018. GII.P16/GII.2 in 2017-2018 season were more prevalent than GII.17 in 2014-2015 season (χ2 = 4.741, P = 0.029). 56.7% of the outbreaks occurred in primary schools. The re-outbreak rate was 16.2%. 66.7% of re-outbreaks were caused by norovirus variants different from previous genotypes. Outbreaks in nonprimary school settings (odds ratio [OR]: 4.007; 95% CI: 1.247-12.876) and those leading to temporary school or institution closure (OR: 20.510; 95% CI: 1.806-232.937) were reported with a higher attack rate. The outbreaks in primary schools (OR: 4.248; 95% CI: 1.211-14.903), re-outbreaks (OR: 6.433; 95% CI: 1.103-37.534) and longer report timing (OR: 8.380; 95% CI: 2.259-31.089) declared a significantly longer duration. It is of great importance that the monitoring of norovirus outbreaks for the emergence of novel strains, along with responsive prevention and control intervention should be strengthened in adults and school-age population, especially in primary students and preschool children.

[Effects of long-term nitrogen addition on the nitrogen pools in a meadow steppe ecosystem]. / é•¿æœŸæ°®æ·»åŠ å¯¹è‰ç”¸è‰åŽŸç”Ÿæ€ç³»ç»Ÿæ°®åº“çš„å½±å“.

Increasing atmospheric nitrogen (N) deposition greatly affects species diversity, productivity, and stability of ecosystems. It is thus of the great importance to understand how grassland N pools respond to the increased atmospheric N deposition. This study was conducted in a meadow steppe in Erguna, Inner Mongolia, China. There were six levels of N addition (i.e., 0, 2, 5, 10, 20 and 50 g·m-2·a-1) and two levels of mowing (i.e., mowing and unmown). Samples of aboveground tissues of dominant plant, root, aboveground litter, and soil to the depth of 100 cm were collected in the seventh year after treatments. The N content was measured and the N pool was calculated. The results showed that N addition significantly increased the N content of aboveground plant tissues and litter, as well as N pools of Leymus chinensis, plant community, litter and ecosystem. Mowing significantly increased the N content of L. chinensis leaf and litter, but reduced N pools of L. chinensis, plant community and litter, and did not affect their responses to N addition. There was a significant interactive effect between mowing and N addition on plant community N pool. High levels of N addition in the unmown treatment led to more N stored in the litter pool, with the saturation threshold for the plant community N pool occurred at 10 g·m-2·a-1. Under mowing treatment, the plant community N pool increased with the increasing N addition, and more N stored in plant community N pool after mowing. Mowing could alleviate the negative impacts of increasing N deposition on biodiversity and ecosystem stability, and extended postponing the occurrence of ecosystem N saturation induced by increasing N deposition.

SHP-1 acts as a tumor suppressor by interacting with EGFR and predicts the prognosis of human breast cancer.

OBJECTIVE: The aims of this study were to examine the prognostic value of SHP-1 in breast cancer, its roles in the regulation of breast cancer cell growth and metastasis, and the underlying mechanisms. METHODS: Tumor specimens from 160 patients with breast cancer and 160 noncancerous tissues were used to examine the expression of SHP-1 and to analyze its association with overall survival through Kaplan-Meier and multivariate Cox regression analyses. RNA sequencing data and the expression and clinical importance of SHP-1 in breast cancer were evaluated with data from The Cancer Genome Atlas. In vitro and in vivo assays were performed to elucidate the effects of SHP-1 on breast cancer cell proliferation and invasion. Confocal immunofluorescence and GST pulldown assays were used to demonstrate the interaction between SHP-1 and epidermal growth factor receptor, as well as its downstream pathways. Immunohistochemistry and The Cancer Genome Atlas database were used to investigate the clinical association between SHP-1 and EGFR in human breast cancer. RESULTS: SHP-1 expression was associated with better survival in patients with breast cancer, whereas SHP-1 expression was negatively correlated with EGFR in human breast cancer. Ectopic SHP-1 expression significantly suppressed breast cancer cell proliferation, migration, and invasion. SHP-1 knockdown induced a more invasive phenotype and accelerated cell growth. Mechanistically, EGFR, a protein directly interacting with SHP-1, mediates the SHP-1-induced inactivation of Ras/Erk/GSK3ß signaling and its downstream effectors. CONCLUSIONS: SHP-1 is an important prognostic biomarker in patients with breast cancer, and the SHP-1-EGFR axis is a promising target for treatment.

MOF-Embedded Bifunctional Composite Nanofiber Membranes with a Tunable Hierarchical Structure for High-Efficiency PM0.3 Purification and Oil/Water Separation.

Herein, a unique hierarchically structured composite nanofiber membrane, consisting of a zeolitic imidazolate framework-8-embedded polyethersulfone (PES@ZIF8) fiber layer and a polysulfonamide/polyethersulfone (PSA/PES) fiber layer, was successfully developed to cope with the complex environments during the actual filtration/separation process and overcome the conflict between high filtration efficiency and low air pressure resistance. Due to the advantages of the synergistic effect of multicomponents and the bi-layer hierarchical structure, the integrated PES@ZIF8-PSA/PES filter possesses an extremely high air filtration efficiency (up to 99.986%) under a very low pressure drop (only 15 Pa), superior PM0.3 purification capacity (close to 99.95%), long-term recycling ability for purifying real smoke PM2.5 from >800 to <10 µg/m3, extremely high temperature resistance (exceed 200 °C), flame retardancy, good chemical stability, satisfactory transmittance, and robust self-cleaning ability. Apart from these, it achieves effective separation of oil-water mixtures and oil-water emulsions as a result of selective wettability including hydrophobicity and superoleophilicity. In particular, the PES@ZIF8-PSA/PES nanofiber membranes maintain outstanding air filtration and oil/water separation properties under the high temperature or strong acid/alkali conditions. This special comprehensive performance gives the PES@ZIF8-PSA/PES-based filtration/separation membranes a wider application prospect ranging from environmental governance to individual protection and industrial security.