A survival nomogram model for patients with resectable non-small cell lung cancer and lymph node metastasis (N1 or N2) based on the Surveillance, Epidemiology, and End Results Database and single-center data.

Background: The ability to predict survival in patients with lymph node metastasis has long been elusive. After surgery, the basis for decision-making on the combination treatment of patients is not clear. The purpose of this study was thus to build a survival nomogram model to effectively predict the overall survival (OS) of patients with non-small cell lung cancer (NSCLC) and lymph node metastasis. The number of dissected lymph nodes (NDLN), number of positive lymph nodes (NPLN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) were included in this study to determine the risk factors in patients with advanced NSCLC. Methods: The data of 5,132 patients with NSCLC and lymph node metastasis (N1 or N2) were extracted from the Surveillance, Epidemiology, and End Results (SEER) database according to inclusion and exclusion criteria and used as the training cohort. We enrolled 117 patients from the First Affiliated Hospital, Zhejiang University School of Medicine as the external validation cohort. Receiver operating characteristic (ROC) analyses were performed to determine the best cutoff values for predicting the prognosis of patients with NSCLC. Based on the risk factors affecting prognosis, a nomogram was constructed using univariate and multivariate Cox proportional hazard regression models. The discrimination ability of the nomogram was evaluated with the concordance index (C-index) and calibration curves. For the independent risk factors, survival curves were drawn using Kaplan-Meier analysis. Results: ROC curve analysis showed that the optimal NPLN cut-off value was 4, LNR was 0.26, and LODDS was -0.25, respectively. However, LNR was nonsignificant in multivariate analysis, with a P value of 0.274. The novel survival nomogram model included seven independent risk factors, among which were NPLN, LODDS, and chemotherapy. Model 4, which included N stage, NPLN, and LODDS, had a higher likelihood ratio (LR) and C-index than did the other models. The C-index was 0.648 [95% confidence interval (CI): 0.636-0.659] in the training cohort and 0.807 (95% CI: 0.751-0.863) in the external validation cohort, showing good prognostic accuracy and discrimination ability. According to the median risk score, the patients in the training cohort and external validation cohort were divided into high-risk and low-risk groups, between which significant differences in OS were found. In the training cohort, age, sex, T stage, N stage, NPLN, LODDS, and chemotherapy were significantly associated with OS (P<0.001). In the external validation cohort, T stage, NPLN, LODDS, and chemotherapy were found to be correlated with OS. Conclusions: The NPLN and LODDS nomogram is an accurate survival prediction tool for patients with N1 or N2 NSCLC. Patients with lymph node metastasis can benefit from chemotherapy, but no evidence shows that radiotherapy is necessary for patients with resectable NSCLC.

Network pharmacology analysis and experimental verification of the antithrombotic active compounds of trichosanthis pericarpium (Gualoupi) in treating coronary heart disease.

ETHNOPHARMACOLOGICAL RELEVANCE: Trichosanthis pericarpium (TP; Gualoupi, pericarps of Trichosanthes kirilowii Maxim) has been used in traditional Chinese medicine (TCM) to reduce heat, resolve phlegm, promote Qi, and clear chest congestion. It is also an essential herbal ingredient in the "Gualou Xiebai" formula first recorded by Zhang Zhongjing (from the Eastern Han Dynasty) in the famous TCM classic "Jin-Guì-Yào-Lüe" for treating chest impediments. According to its traditional description, Gualou Xiebai is indicated for symptoms of chest impediments, which correspond to coronary heart diseases (CHD). AIM OF THE STUDY: This study aimed to identify the antithrombotic compounds in Gualoupi for the treatment of CHD. MATERIALS AND METHODS: A CHD rat model was established with a combination of high-fat diet and isoproterenol hydrochloride (ISO) administration via subcutaneous multi-point injection in the back of the neck. This model was used to evaluate the antithrombotic effect of two mainstream cultivars of TP ("HaiShi GuaLou" and "WanLou") by analyzing the main components and their effects. Network pharmacology, molecular docking-based studies, and a zebrafish (Danio rerio) thrombosis model induced by phenylhydrazine was used to validate the antithrombosis components of TP. RESULTS: TP significantly reduced the body weight of the CHD rats, improved myocardial ischemia, and reduced collagen deposition and fibrosis around the infarcted tissue. It reduced thrombosis in a dose-dependent manner and significantly reduced inflammation and oxidative stress damage. Cynaroside, isoquercitrin, rutin, citrulline, and arginine were identified as candidate active TP compounds with antithrombotic effects. The key potential targets of TP in thrombosis treatment were initially identified by molecular docking-based analysis, which showed that the candidate active compounds have a strong binding affinity to the potential targets (protein kinase C alpha type [PKCα], protein kinase C beta type [PKCß], von Willebrand factor [vWF], and prostaglandin-endoperoxide synthase 1 [PTGS1], fibrinogen alpha [Fga], fibrinogen beta [Fgb], fibrinogen gamma [Fgg], coagulation factor II [F2], and coagulation factor VII [F7]). In addition, the candidate active compounds reduced thrombosis, improved oxidative stress damage, and down-regulated the expression of thrombosis-related genes (PKCα, PKCß, vWF, PTGS1, Fga, Fgb, Fgg, F2, and F7) in the zebrafish model. CONCLUSION: Cynaroside, isoquercitrin, rutin, citrulline, and arginine were identified as the active antithrombotic compounds of TP used to treat CHD. Mechanistically, the active compounds were found to be involved in oxidative stress injury, platelet activation pathway, and complement and coagulation cascade pathways.

[Risk factors for hip osteoarthritis after arthroscopy in patients with femoroacetabular impingement].

OBJECTIVE: To investigate the risk factors of hip osteoarthritis（HOA） after hip arthroscopy in patients with femoro-acetabular impingement（FAI） syndrome, and to reduce and prevent HOA. METHODS: From September 2018 to September 2020, 106 patients with FAI underwent hip arthroscopy, including 40 males and 66 females, aged from 20 to 55 years old with an average age of （33.05±10.19） years old. The mechanism of injury included 51 cases for sports injury, 36 for traffic accidents, and 19 for blunt object injury. The duration of the disease ranged from 5 to 19 days with an average of （12.02±3.69） days. All patients were followed up for 18 months. Patients were divided into HOA group （23 cases） and non-HOA group （83 cases） according to the occurrence of HOA. Multivariate Logistic regression was used to analyze the risk factors of HOA after hip arthroscopy in FAI patients. RESULTS: By univariate analysis, aged from 50 to 70 years old, female, body mass index（BMI）> 30 kg·m-2, physical labor, cam type, postoperative infection, last follow-up hip degree of motion （range of motion, ROM） （flexion, abduction, adduction, internal rotation） and Tönnis grade 1 and above of the HOA group were higher than those of the non-HOA group （P<0.05）, and the relative appendicular skeletal muscle index （RASM） was lower than that of non-HOA group（P<0.05）. By multiple Logistic regression analysis, cam type, BMI>30 kg·m-2, last follow-up hip internal rotation ROM and Tönnis grade 1 were risk factors for HOA after hip arthroscopy in FAI patients （P<0.05）. CONCLUSION: FAI classification, body mass index, hip ROM and Tönnis grade are all related to HOA after hip arthroscopy in FAI patients. Follow-up and intervention should be strengthened in high-risk FAI patients to reduce the occurrence of HOA.

Phenotypic and genotypic characterization of Marinobacterium weihaiense sp. nov. and Marinobacterium marinum sp. nov., isolated from marine sediment, and genomic properties of the genus Marinobacterium.

In this study, two novel bacterial strains were isolated from coastal sediment of Weihai, China. The two strains were Gram-stain-negative and facultatively aerobic, designated 3-1745T and A346T. Based on phenotypic, genetic and phylogenetic properties, strains 3-1745T and A346T represent two novel species of the genus Marinobacterium. The results of genome analysis revealed many central carbohydrate metabolism pathways such as gluconeogenesis, pyruvate oxidation, tricyclic acid cycle, pentose phosphate pathway and PRPP biosynthesis in the genus Marinobacterium. The ability of strains 3-1745T and A346T to utilize volatile fatty acids was experimentally confirmed. Polyhydroxyalkanoate synthases (PhaA, PhaB and PhaC) for the synthesis of polyhydroxyalkanoates were prevalent in the genus Marinobacterium. Multiple BGCs (biosynthetic gene clusters) including betalactone, ectoine, ranthipeptide, redox-cofactor, RiPPs (ribosomally synthesized post-translationally modified peptides) and T3PKS (polyketide synthases) in the genome of the genus Marinobacterium were found. Additional genome analyses suggested that the genus Marinobacterium contained diverse potential mechanisms of salt tolerance and mainly utilized oligosaccharides. This is the first report on broad genomic analyses of the genus Marinobacterium with the description of two novel species and potential ecological and biotechnological implications.

Effect and mechanism of needleless transcutaneous neuromodulation on gastrointestinal function after pancreaticoduodenectomy.

BACKGROUND: Gastrointestinal motility disorders tend to develop after pancreaticoduodenectomy (PD). The objectives of this study were: (1) to investigate the impact of needleless transcutaneous neuromodulation (TN) on the postoperative recuperation following pancreaticoduodenectomy (PD), and (2) to explore the underlying mechanisms by which TN facilitates the recovery of gastrointestinal function after PD. METHODS: A total of 41 patients scheduled for PD were randomized into two groups: the TN group (n = 21) and the Sham-TN group (n = 20). TN was performed at acupoints ST-36 and PC-6 twice daily for 1 h from the postoperative day 1 (POD1) to day 7. Sham-TN was performed at non-acupoints. Subsequent assessments incorporated both heart rate variation and dynamic electrogastrography to quantify alterations in vagal activity (HF) and gastric pacing activity. RESULTS: 1)TN significantly decreased the duration of the first passage of flatus (p < 0.001) and defecation (p < 0.01) as well as the time required to resume diet (p < 0.001) when compared to sham-TN;2)Compared with sham-TN, TN increased the proportion of regular gastric pacing activity (p < 0.01);3) From POD1 to POD7, there was a discernible augmentation in HF induced by TN stimulation(p < 0.01);4) TN significantly decreased serum IL-6 levels from POD1 to POD7 (p < 0.001);5) TN was an independent predictor of shortened hospital stay(ß = - 0.349, p = 0.035). CONCLUSION: Needleless TN accelerates the recovery of gastrointestinal function and reduces the risk of delayed gastric emptying in patients after PD by enhancing vagal activity and controlling the inflammatory response.

The disparity in hesitancy toward COVID-19 vaccination between older individuals in nursing homes and those in the community in Taizhou, China.

PURPOSE: Older individuals are priority coronavirus disease 2019 (COVID-19) vaccine recipients. Our aim was to investigate the prevalence of and factors influencing vaccine hesitancy in older individuals living in nursing homes and communities. METHODS: A self-administered COVID-19 vaccine hesitancy survey was conducted from September 2021 to December 2021 among people aged ≥ 60 years in eight nursing homes (382 participants) and the community (112 participants) in Taizhou, China. The response rate was 72.1% (382/530) for older adults in nursing homes and 68.7% (112/163) for older adults in the community. RESULTS: We found that 58.1% of the older individuals in nursing homes and 36.6% of those in the community were hesitant to receive the COVID-19 vaccine and that there was a statistically significant difference (P < 0.001). Multiple logistic regression results indicated that the main factors influencing hesitation among the older individuals in nursing homes were being male (Odds Ratio (OR) = 1.67, 95% Confidence Interval (CI): 1.01-2.76); their cognitive level, including having a high perceived risk of COVID-19 infection (OR = 3.06, 95% CI: 1.73-5.43) or the perception of low vaccine safety (OR = 3.08, 95% CI: 1.545- 6.145); anxiety (OR = 3.43, 95% CI: 1.96-5.99); and no previous influenza vaccination (OR = 1.82, 95% CI: 1.13-2.93); whereas those for older individuals in the community were comorbid chronic diseases (OR = 3.13, 95% CI: 1.11- 8.78) and community workers not recommending the vaccine (OR = 8.223, 95% CI: 1.77-38.27). CONCLUSION: The proportion of older individuals in nursing homes who were hesitant to receive the COVID-19 vaccine was significantly higher than for older individuals in the community. Targeted measures should be implemented to reduce vaccine hesitancy and improve vaccination rates in response to the special environment of nursing homes and the characteristics of this population.

Oligoagars and microbial agents show potential for Porphyra disease prevention.

Disease is a major concern in Porphyra aquaculture, particularly during the early shell-borne conchocelis (SBC) seedling stage. To explore prevention strategies for Porphyra diseases, this study explored the potential of using oligoagars (OA) and microbial agents (MA) to treat SBC of Neoporphyra haitanensis in an aquaculture environment. The impact of these treatments on the phycosphere microbial community was analyzed, and the resistance of the treated Porphyra conchocelis to the pathogenic bacterium Vibrio mediterranei 117-T6 (which causes yellow spot disease) was tested in the lab. Results showed that OA reduced α-diversity while enriching Rhodobacteriaceae, and MA increased stability and relative abundance of Bacteroidetes (including Flavobacteria). Furthermore, compared to the control group, the abundance of pathogenic microorganisms and virulence functional genes decreased while defense-related functional gene abundance increased significantly in the groups treated with OA and MA. Most importantly, the OA and MA treatments improved resistance to Vm117-T6, with survival rates of 70% (OA) and 80% (MA), compared to 15% in the control group. Overall, the findings suggest that OA and MA treatments have great potential for preventing Porphyra disease, as they improve phycosphere microorganisms and increase algae resistance to pathogenic bacteria.

Resistance Transition of Pseudomonas aeruginosa in SARS-CoV-2-Uninfected Hospitalized Patients in the Pandemic.

Objective: To investigate the impact of coronavirus disease 2019 (COVID-19) specified preventive and control measures on the distribution and resistance transition of Pseudomonas aeruginosa (P. aeruginosa) in uninfected hospitalized patients during the pandemic. Methods: This retrospective study retrieved data from 316 P. aeruginosa isolates in the year pre-COVID-19 (n=131) pandemic and the year under COVID-19 specified preventive and control (post-pandemic year, n=185), compared the general characteristics, laboratory results, and antimicrobial susceptibility tests of P. aeruginosa between the two groups. Results: Compared with the pre-pandemic year, the isolation rate of P. aeruginosa (14.35% vs 22.31%, P<0.001) increased, while the rate of drug resistant P. aeruginosa decreased significantly (29.77% vs 19.45%, P<0.001) in the post-pandemic year; Prescription of ß-Lactams (30.5% vs 50.0%, P<0.01) also increased significantly. The resistance rates of P. aeruginosa isolates to ceftazidime (P<0.01), ciprofloxacin (P<0.01), and gentamicin (P<0.001) increased, whereas the resistance rates to piperacillin/tazobactam (P<0.01) and imipenem (P<0.05) decreased significantly. Conclusion: The COVID-19 specified preventive and control measures have influenced the distribution and resistance transition of P. aeruginosa, further verifications are needed in future research.

[Clinical application of Chaihu Jia Longgu Muli Decoction based on modern pathophysiology mechanism].

Chaihu Jia Longgu Muli Decoction was firstly recorded in Treatise on Cold Damage(ZHANG Zhong-jing, Eastern Han dynasty). According to this medical classic, it is originally used in the treatment of the Shaoyang and Yangming syndrome. Based on the modern pathophysiological mechanism, this study interpreted the classic provisions of Chaihu Jia Longgu Muli Decoction. Original records of "chest fullness" "annoyance" "shock" "difficult urination" "delirium" "heavy body and failing to turn over" all have profound pathophysiological basis, involving disorders in cardiovascular, respiratory, nervous, and mental systems. This formula is widely used, which can be applied to treat epilepsy, cerebral arteriosclerosis, cerebral infarction, and other cerebrovascular diseases, hypertension, arrhythmia, and other cardiovascular diseases, insomnia, constipation, anxiety, depression, cardiac neurosis and other acute and chronic diseases as well as diseases in psychosomatic medicine. The clinical indications include Bupleuri Radix-targeted syndrome such as fullness and discomfort in chest and hypochondrium, bitter taste mouth, dry throat, and dizziness, the insomnia, anxiety, depression, susceptibility to fright, upset, dreamfulness and other psychiatric symptoms, red tongue, thick and yellow tongue coating, and wiry hard and powerful pulse. This formula was found to be used in combination with other formulas, such as Gualou Xiebai Decoction, Wendan Decoction, Zhizhu Pills, Juzhijiang Decoction, Suanzaoren Decoction, and Banxia Baizhu Tianma Decoction.

An African-Specific Variant of TP53 Reveals PADI4 as a Regulator of p53-Mediated Tumor Suppression.

TP53 is the most frequently mutated gene in cancer, yet key target genes for p53-mediated tumor suppression remain unidentified. Here, we characterize a rare, African-specific germline variant of TP53 in the DNA-binding domain Tyr107His (Y107H). Nuclear magnetic resonance and crystal structures reveal that Y107H is structurally similar to wild-type p53. Consistent with this, we find that Y107H can suppress tumor colony formation and is impaired for the transactivation of only a small subset of p53 target genes; this includes the epigenetic modifier PADI4, which deiminates arginine to the nonnatural amino acid citrulline. Surprisingly, we show that Y107H mice develop spontaneous cancers and metastases and that Y107H shows impaired tumor suppression in two other models. We show that PADI4 is itself tumor suppressive and that it requires an intact immune system for tumor suppression. We identify a p53-PADI4 gene signature that is predictive of survival and the efficacy of immune-checkpoint inhibitors. SIGNIFICANCE: We analyze the African-centric Y107H hypomorphic variant and show that it confers increased cancer risk; we use Y107H in order to identify PADI4 as a key tumor-suppressive p53 target gene that contributes to an immune modulation signature and that is predictive of cancer survival and the success of immunotherapy. See related commentary by Bhatta and Cooks, p. 1518. This article is highlighted in the In This Issue feature, p. 1501.

The relationship between exercise motivation and exercise behavior in college students: The chain-mediated role of exercise climate and exercise self-efficacy.

Objective: This study explored the relationship between college students' physical activity motivation and exercise behavior and constructed a chain mediation model through the mediating roles of exercise climate and exercise self-efficacy. Methods: By random sampling, 1,032 college students were investigated using the Exercise Motivation Scale, Physical Exercise Rating Scale, Exercise Climate Scale, and Exercise Self-Efficacy Scale. Results: (1) There was a huge positive correlation between exercise motivation and exercise behavior (r = 0.240, p < 0.01), and the immediate ways of linking exercise motivation to exercise behavior were critical (ß = 0.068, t = 0.040, p < 0.01). (2) Exercise motivation could positively predict exercise climate (ß = 0.373, t = 0.061, p < 0.01) and exercise self-efficacy (ß = 0.174, t = 0.039, p < 0.01), and exercise climate could emphatically foresee exercise behavior (ß = 0.302, t = 0.051, p < 0.01). Exercise self-efficacy could foresee exercise behavior decidedly (ß = 0.190, t = 0.048, p < 0.01). (3) Exercise climate and exercise self-efficacy play a critical intervening role between exercise motivation and exercise behavior. The intercession impact is explicitly made out of aberrant impacts created in three ways: exercise motivation → exercise climate → exercise behavior (mediating effect value: 0.113); exercise motivation → exercise self-efficacy → exercise behavior (mediating effect value: 0.033); exercise motivation → exercise climate → exercise self-efficacy → exercise behavior (mediating effect value: 0.027). Conclusion: (1) Exercise climate, exercise self-efficacy, and exercise behavior can all be significantly predicted by exercise motivation, suggesting that exercise motivation may help to enhance these variables. (2) In addition to having a direct impact on exercise behavior, exercise motivation can also have an indirect impact through the separate mediating effects of exercise climate and exercise self-efficacy as well as the chain mediating effect of exercise climate and exercise self-efficacy, which is crucial for encouraging college students to engage in physical activity.

Occlusion-Aware Instance Segmentation Via BiLayer Network Architectures.

Segmenting highly-overlapping image objects is challenging, because there is typically no distinction between real object contours and occlusion boundaries on images. Unlike previous instance segmentation methods, we model image formation as a composition of two overlapping layers, and propose Bilayer Convolutional Network (BCNet), where the top layer detects occluding objects (occluders) and the bottom layer infers partially occluded instances (occludees). The explicit modeling of occlusion relationship with bilayer structure naturally decouples the boundaries of both the occluding and occluded instances, and considers the interaction between them during mask regression. We investigate the efficacy of bilayer structure using two popular convolutional network designs, namely, Fully Convolutional Network (FCN) and Graph Convolutional Network (GCN). Further, we formulate bilayer decoupling using the vision transformer (ViT), by representing instances in the image as separate learnable occluder and occludee queries. Large and consistent improvements using one/two-stage and query-based object detectors with various backbones and network layer choices validate the generalization ability of bilayer decoupling, as shown by extensive experiments on image instance segmentation benchmarks (COCO, KINS, COCOA) and video instance segmentation benchmarks (YTVIS, OVIS, BDD100 K MOTS), especially for heavy occlusion cases.

School bullying among Chinese third to fifth grade primary school students in a cross-sectional study: The protective effect of psychological resilience.

School bullying is a major concern for school-aged youth and has great impacts on children's health and well-being, and an increasing number of school bullying cases have been reported in China. Many studies have indicated that psychological resilience may have a well-established association with school bullying. However, only a limited number of studies have explored this association, especially among primary school students. The present study aimed to investigate the relationship between school bullying and psychological resilience among primary school students from a Chinese city. The participants were 6,011 primary school students aged 7-14 years who were recruited in a cross-sectional survey in Luzhou, China. The statistical significance of differences between groups was tested using the χ2 test or t test. Binary logistic regression analyses were conducted to explore the association between psychological resilience and school bullying. The incidence rates of bullies and victims were 30.00% (1803/6011; 95% CI: 28.84%-31.16%) and 69.89% (4201/6011; 95% CI: 68.73%-71.05%), respectively. Psychological resilience was a protective factor of school bullying among primary school students (for bullying perpetrators, OR = 0.76, 95%CI:0.62-0.93, and for bully victims OR = 0.74, 95%CI:0.61-0.90), especially among female students (for bullying perpetrators, OR = 0.63, 95%CI: 0.47-0.85, and for bully victims, OR = 0.69, 95%CI: 0.53-0.90). School bullying among primary school students in Luzhou City was highly prevalent. High levels of psychological resilience might be a protective factor in preventing primary students from being involved in school bullying, especially among females.

The relationship between physical exercise and school adaptation of junior students: A chain mediating model.

Objective: This study explores the relationship between physical exercise and school adaptation of junior middle school students and constructs a chain intermediary model through the intermediary role of psychological resilience and sports learning motivation. Methods: Using the stratified cluster sampling method, 930 junior middle school students in Anhui Province were measured in group psychology by using the physical exercise rating scale, adolescent psychological resilience scale, physical learning motivation scale and school adaptation scale. The statistical software SPSS 23.0 and process plug-in were used for statistical processing, and the common method deviation test was carried out by Harman single-factor control method. Finally, the bootstrap sampling test method and process plug-in were used to test the significance of intermediary effect. Results: (1) The direct prediction effect of physical exercise on school adaptation is remarkable (t = 4.60, p < 0.01); (2) psychological resilience and sports learning motivation are the intermediary variables of the relationship between physical exercise and school adaptation; (3) psychological resilience and sports learning motivation play a chain mediation role in the relationship between physical exercise and school adaptation. The intermediary effect is composed of three indirect effects: physical exercise → psychological resilience → school adaptation (95% Cl: 0.004, 0.041), physical exercise → physical learning motivation → school adaptation (95% Cl:0.019, 0.065), physical exercise → psychological resilience → physical learning motivation → school adaptation (95% Cl:0.002, 0.021). Conclusions: Physical exercise can directly improve the school adaptation of junior middle school students, which can also affect junior middle school students' school adaptation indirectly through psychological resilience or sports learning motivation, and it can influence school adaptation through the chain mediation of psychological resilience and sports learning motivation.

The pattern of lymph node metastasis in peripheral pulmonary nodules patients and risk prediction models.

Background: For peripheral pulmonary nodules, the regularity of lymph node (LN) metastasis has not been studied. This study aimed to evaluate the metastasis pattern of intrapulmonary and relevant mediastinal lymph nodes in early-stage lung cancer, and further selected patients who were of low risk of LN metastasis as potential population to receive sub-lobectomy. Methods: This study prospectively included consecutive patients with peripheral clinical T1N0M0 disease who underwent complete resection with LN dissection or sampling from August 2014 to July 2015. The patients were followed up to 15, May 2021. Univariable or multivariable Logistic analysis was used to identify the risk factors. Models predicting LN metastasis risk were conducted. The area under the curve for the receiver operating characteristic curves was used to evaluate the diagnostic value. Disease-free survival and overall survival were compared between groups. Results: Finally, 201 patients were included in this study. For patients with negative tumor-bearing (TB) 13 and 14 station LNs, the positive rate of other lymph node stations was extremely low. Maximum CT value, pleural indentation and CEA level were risk factors for N1 station LNs metastasis. Besides, the factors above and lobulation sign were risk factors for skip metastasis beyond TB 13 and 14 station LNs. We constructed two scoring tables to predict N1 station metastasis and skip metastasis beyond TB 13 and 14 station. The AUC were 0·837 and 0·823, respectively. Based on the first table, 40·9% of patients suffered N1 station LNs metastasis and 27·3% had N2 disease in "high risk group" while the proportion was only 5·7% and 4·5% in "low risk group". For patients with negative TB13 and TB14 station LNs, based on the latter table, 11·1% of patients had N1 stations LNs metastasis and 16·7% had pN2 disease in "high risk group" while only 2·3% patients in "low risk group" suffered this kind of metastasis. Conclusion: For peripheral pulmonary nodules patients, stations 13 and 14 LNs may be the sentinel nodes. For patients with low risk of N1 metastasis and skip metastasis, sub-lobar resection might be sufficient for those who were of negative TB 13 and 14 station LNs.

The Relationship Between Exercise Intention and Exercise Behavior of Junior School Students: An Analysis of Chain Mediating Effect.

Objective: This study explores the relationship between exercise intention and exercise behavior and constructs a chain mediating model through the mediating effect of implementation intention and self-identity. Method: Through the stratified cluster sampling method, 1,573 junior school students (with an average age of 13.71 ± 0.891 years) were evaluated by the exercise intention scale, the implementation intention scale, the self-identity scale, and the physical exercise grade scale. For data analysis, the common method deviation test, Pearson correlation analysis, and Model 6 in the SPSS macro program compiled by Hayes for the chain mediating test were conducted. Results: (1) There is a marked correlation between positive exercise intention and exercise behavior (r = 0.345, p < 0.01), and exercise intention has a significant effect on the direct path of exercise behavior (ß = 0.162, t = 12.355, p < 0.01). (2) Exercise intention can positively predict implementation intention (ß = 0.219, t = 10.006, p < 0.01) and self-identity (ß = 0.160, t = 16.159, p < 0.01); implementation intention can significantly and positively predict exercise behavior (ß = 0.230, t = 12.742, p < 0.01),and self-identity can significantly and positively predict exercise behavior (ß = 0.273, t = 7.911, p < 0.01). (3) Implementation intention and self-identity play a significant mediating role between exercise intention and exercise behavior. The mediating effect consists of three indirect effects: exercise intention → implementation intention → exercise behavior (the mediating effect value is 0.050), exercise intention → self-identity → exercise behavior (the mediating effect value is 0.044), and exercise intention →implementation intention → self-identity → exercise behavior (the mediating effect value is 0.017). Conclusion: (1) Exercise intention can significantly and positively predict exercise behavior. (2) Implementation intention and self-identity exert a significant mediating effect between exercise intention and exercise behavior, including the separate mediating effect of implementation intention and self-identity, as well as the chain mediating effect of implementation intention and self-identity.

Cost-Effectiveness of Elbasvir/Grazoprevir for the Treatment of Chronic Hepatitis C: A Systematic Review.

Objective: This study aims to systematically review recent economic evaluations of elbasvir/grazoprevir (EBR/GZR) for chronic hepatitis C (CHC), to critically appraise the reporting quality and to summarize the results. Methods: A literature search was undertaken using Medline, Embase, the Cochrane Library, EconLit, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP to identify original articles containing economic evaluations of EBR/GZR for CHC published between 1 January 2000 and 31 December 2020. The Consolidated Health Economic Evaluation Reporting Standards statement was used to assess the quality of reporting of the articles. Results: Of 93 articles identified, 13 studies fulfilled the inclusion criteria. These studies were conducted in 4 countries, and 8 active interventions were assessed. The target population was patients infected with CHC genotype 1 infection in all studies. Eight out of 13 studies that compared EBR/GZR vs. other direct antiviral agents suggested that EBR/GZR was generally more cost-effective or dominant than daclatasvir/asunaprevir (DCV/ASV), sofosbuvir/velpatasvir (SOF/VEL), ledipasvir/sofosbuvir (LDV/SOF), ombitasvir/paritaprevir/ritonavir + dasabuvir (3D) but not more cost-effective than glecaprevir/pibrentasvir (GLE/PIB). Two studies from China and one study from the USA that compared EBR/GZR vs. pegylated interferon and ribavirin (PegIFN/RBV) consistently indicated that EBR/GZR was generally more cost-effective than PegIFN/RBV. One study from Italy compared EBR/GZR with SOF + PegIFN/RBV and suggested that EBR/GZR had a lower cost and higher effectiveness. One study from France and one study from the USA confirmed that compared with non-therapy for patients with chronic kidney disease, EBR/GZR was cost-effective at commonly accepted current standards. All included studies were of good quality of reporting, with an average score of 21.9 (range 19-23). Conclusion: EBR/GZR for CHC genotype 1 might be cost-effective or dominant compared with PegIFN/RBV and other direct antiviral agents (SOF/VEL, 3D, DCV/ASV, LDF/SOF) or non-therapy. However, under certain assumptions, EBR/GZR was not a cost-effective alternative for CHC patients vs. GLE/PIB.

Cost-Effectiveness of Sequential Denosumab/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China.

Objective: The primary purpose of this study was to estimate the cost-effectiveness of sequential denosumab/zoledronic acid versus zoledronic acid monotherapy for postmenopausal osteoporotic women in China. Methods: We updated and utilized a previously validated Markov microsimulation model to obtain the cost-effectiveness of two strategies for treating postmenopausal osteoporotic women. We compared the incremental cost-effectiveness ratios (ICERs) (US dollars [$] per quality-adjusted life year [QALY]) of sequential denosumab/zoledronic acid (i.e., biannual subcutaneous denosumab for 3 years followed by annual intravenous zoledronic acid for 3 years) with zoledronic acid monotherapy for 3 years in Chinese women with postmenopausal osteoporosis at ages 65, 70, 75, and 80 from the health care payer perspective. Our study's willingness-to-pay (WTP) threshold was set to three times the value of China's per capita GDP in 2020 ($31,512). Results: The ICERs of sequential denosumab/zoledronic acid versus zoledronic acid monotherapy were $59,389/QALY, $23,821/QALY, $22,710/QALY, and $14,027/QALY at age 65, 70, 75, and 80 years, respectively. One-way sensitivity analyses showed that the most impactful parameter was the persistence rate of the medications. If the persistence rate of denosumab or zoledronic acid was increased by 10%, sequential denosumab/zoledronic acid would be cost-effective at age 65. In probabilistic sensitivity analyses, the probabilities of sequential denosumab/zoledronic being cost-effective compared to zoledronic acid monotherapy were approximately 29.3%, 68.7%, 86.1%, and 99.4% for ages 65, 70, 75, and 80 years, respectively, at the WTP threshold of $31,512/QALY. Conclusion: Among Chinese postmenopausal osteoporosis women over 70 years old, sequential denosumab/zoledronic acid was cost-effective compared with zoledronic acid monotherapy at the pre-determined WTP threshold.

The Relationship Between Physical Exercise and Mobile Phone Addiction Tendency of University Students in China: A Moderated Mediation Model.

This study aims to explore the relationship between physical exercise (PE), self-control (SC), physical exercise atmosphere (PEA), and mobile phone addiction tendency (MPAT) among Chinese university students. Through the quota sampling, 1,433 students complied with the requirements were surveyed from 10 universities in China. PE, SC, PEA, and MPAT were assessed using standard scales. For data analysis, common method deviation test, mean number, standard deviation, correlation analysis and structural equation model analysis were carried out in turn. The results showed PE and MPAT were negatively related (r = -0.158, p < 0.05); PE significantly positively predicted SC (ß = 0.082, t = 3.748, p < 0.01), and SC significantly negatively predicted MPAT (ß = -0.743, t = -19.929, p < 0.01). Bootstrap method was used to test the mediating effect of SC. The results showed that 95% confidence interval did not include 0. After adding the mediating variable of SC, PE did not significantly negatively predict the tendency of MPAT (ß = -0.027, t = -1.257, p > 0.05). The interaction item PEA and SC could significantly positively predict the tendency of MPAT (ß = 0.165, t = 2.545, p < 0.05). In the high PEA group, SC had a significant negative predictive effect on the tendency of MPAT (ß = -0.665, t = -14.408, p < 0.01); However, in the low PEA group, the negative predictive effect was stronger (ß = -0.834, t = -15.015, p < 0.01). The present study shows that PE significantly negatively predicted the tendency of MPAT, and SC played a complete mediating role in the relationship between PE and MPAT; The second half of the indirect effect of PE and MPAT was regulated by the PEA. The PEA will enhance the influence of SC on MPAT, but the high PEA will increase the level of MPAT of individuals at a very high level of SC.

Cost-Effectiveness of Sequential Teriparatide/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China.

Objective: We aimed to assess the cost-effectiveness of sequential teriparatide/zoledronic acid relative to zoledronic acid monotherapy for postmenopausal osteoporotic women in China. Methods: A previously validated Markov microsimulation model was updated to examine the cost-effectiveness of daily subcutaneous teriparatide for 2 years followed by annual intravenous zoledronic acid for 3 years (sequential teriparatide/zoledronic acid), compared with zoledronic acid monotherapy for 3 years in Chinese women with postmenopausal osteoporosis at ages 65, 70, 75, and 80 from the health care payer perspective. Results: The incremental cost-effectiveness ratios (ICERs) (US dollars [$] per quality-adjusted life-year [QALY]) of sequential teriparatide/zoledronic acid vs. zoledronic acid monotherapy was $173,223/QALY at age 65 years, which was much higher than the pre-determined willingness-to-pay (WTP) threshold of $ 31,512/QALY, and the results were similar at other ages. In one-way sensitivity analyses, the two most impactful parameters were the cost of teriparatide and the residual effects of the medications included in this study. Sequential teriparatide/zoledronic acid became cost-effective at age 80 with the cost of teriparatide reduced by 50%. Without the residual effect, the ICER increased to $257,982/QALY. Probabilistic sensitivity analyses shown that the probabilities of zoledronic acid monotherapy being cost-effective were 100% at a WTP of $31,512/QALY. Conclusions: Among Chinese women with postmenopausal osteoporosis, sequential teriparatide/zoledronic acid was not cost-effective unless the cost of teriparatide was reduced by 50% only for the participants over 80 years.