Precise lymph node biopsy for endometrial cancer confined to the uterus: Analysis of 43 clinical cases.

OBJECTIVE: To explore a precise association between tumor location and lymph node (LN) biopsy algorithm in uterine confined endometrial cancer (EC). MATERIALS AND METHODS: Patients with EC treated in the Department of Obstetrics and Gynecology, South Branch of Fujian Provincial Hospital were included in this observational retrospective study. Based on the procedure of treatment, patients were separated to stage I (2015.07-2019.09) and stage II (2019.09-2021.9). In each stage, patients were separated to high and low-risk group by the predicted results. Patients in the high-risk group received systematic lymphadenectomy in stage I and sentinel lymph node (SLN) dissection in stage II. The efficiency of lymph node metastasis (LNM) detection rates was compared between stage I and stage II cases. Precise lymph node biopsy algorithm was also constructed based on the outcomes of stage II. RESULTS: Overall, 43 patients, 28 in stage I and 15 in stage II, were included in the study. No recurrence or death cases had been found within follow-up terms. Based on the difference in the detection efficiency of LNM (p > 0.05), there was no difference between two stages. Thus, systematic lymphadenectomy and SLN biopsy provided similar success rates. The location of tumor site was also important for deciding whether pelvic or para-aortic SLN should be sampled for LNM. CONCLUSIONS: Precise SLN biopsy for EC confined to the uterus showed comparable LNM detection rate as systematic lymphadenectomy. EC location may be used to determine whether pelvic or para-aortic SLN sampling should be conducted for treatment.

Del nido versus conventional blood cardioplegia in patients with obstructive hypertrophic cardiomyopathy.

BACKGROUND: Myocardial protection is essential in cardiac surgery with cardiopulmonary bypass The Del Nido cardioplegia which was initially used in pediatric cardiac surgery, has been increasingly used in adult cardiac surgery recently. However, no literature has reported the efficacy of DNC in hypertrophic obstructive cardiomyopathy. METHODS: This retrospective study involved elective patients who underwent extended surgical myectomy with or without concomitant cardiac surgical procedures between September 2017 and June 2022. Patients were distributed into two groups, the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels at the 0, 1, and 2 postoperative days. The secondary outcomes contained: intraoperative LVEF, return to spontaneous rhythm; postoperative myocardial infarction, worsening or deteriorating of EF, mechanical circulatory support; new-onset atrial fibrillation; mechanical ventilation duration; intensive care unit hours; in-hospital days. RESULTS: Fifty-nine patients were included and divided into the CBC (n = 15) and the DNC group (n = 44). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [21.93(18.36,26.07) vs. 25.68(23.17,37.12), p = 0.012] and infusion times [1(1,1) vs. 2(2,3), p = 0.000] were less and the incidence of return to spontaneous rhythm after declamping was higher in the DNC group [97.7% vs. 73.3%, p = 0.013]. Postoperative hs-TnI and CK-MB levels were comparable between the two groups. A longer DNC infusion interval was associated with higher levels of CK-MB on postoperative day 1 and day 2 (p = 0.009 and p = 0.011, respectively). CONCLUSIONS: The use of DNC in extended surgical myectomy procedure was as safe and effective as CBC. However, DNC infusion interval over 60 minutes was associated with increased postoperative CK-MB levels.

Laparoscopic surgeries for uterine fibroids and ovarian cysts reduce ovarian reserve via age- and surgical type-manner.

Aim: Diminished ovarian reserve can be characterized by poor response to ovulation and low number of eggs. The risk factors include endometriosis, receiving cancer treatment, luteal phase deficiency and gynecologic surgery. Uterine fibroids and ovarian cysts are the most common benign gynecological diseases in women globally. This prospective study evaluated the influence of laparoscopic surgery treating benign gynecological diseases on ovarian reserve. Methods: A total of 121 patients with uterine fibroids or benign ovarian cysts who received laparoscopic surgeries (41 with hysterectomy, 36 with myomectomy, 18 with adnexectomy, and 26 with ovarian cystectomy) were included. The ovarian reserve status defined as serum anti-Mullerian hormone concentration was assessed at 1 month before and after surgery, respectively. Results: The anti-Mullerian hormone reduction level was 22.34% in cystectomy, 44.1% in adnexectomy, 24.92% in myomectomy, and 47.61% in hysterectomy (p < 0.001). Multivariate analysis showed that adnexectomy had significantly high risk of high serum anti-Mullerian hormone reduction level (adjusted odds ratio (aOR): 14.90, 95% confidence interval (CI): 2.56-86.93, p = 0.003). Conclusions: These 4 laparoscopic surgeries all reduced the AMH levels 1 month after the procedure. Further prospective studies with longer follow-up are necessary to know the real impact on the ovarian reserve. Adnexectomy was an independent factor of reduced ovarian reserve in 1 month after surgery.

Significant enhancement of scintillation performance by inducing oxygen vacancies in alkali metal ion (A+ = Li+, Na+, K+)-incorporated (Lu, Sc)BO3:Ce.

The incorporation of Sc3+ can stabilize calcite-phase LuBO3:Ce3+ to grow large-sized single crystals but leads to the significant degradation of scintillation performance. In the present work, alkali metal ion (A+ = Li+, Na+, K+)-incorporated (Lu, A, Sc)BO3:Ce was rapidly synthesized in batches via a high-throughput sol-gel method. The aliovalent substitution of Lu3+ with A+ is balanced by the generation of oxygen vacancies by forming complexes. Thanks to the increased oxygen vacancies, the luminescence and XEL intensity of (Lu, Li, Sc)BO3:Ce are significantly enhanced by 2.2 times and 1.9 times, respectively. Further, the incorporation of A+ is attributed to the improved transition efficiency of charge carriers. The prepared scintillation screen fabricated with LASBO:Ce and PMMA shows that the spatial resolution can reach 8.6 lp mm-1, indicating its potential application in efficient and low-cost non-destructive X-ray detection. This work is of great significance in improving the luminescence and scintillation performance of (Lu, Sc)BO3:Ce single crystals and thin films and their application in the scintillation field.

Therapeutic efficacy of combined active and passive immunization in ART-suppressed, SHIV-infected rhesus macaques.

The latent viral reservoir is the critical barrier for developing an HIV-1 cure. Previous studies have shown that therapeutic vaccination or broadly neutralizing antibody (bNAb) administration, together with a Toll-like receptor 7 (TLR7) agonist, enhanced virologic control or delayed viral rebound, respectively, following discontinuation of antiretroviral therapy (ART) in SIV- or SHIV-infected rhesus macaques. Here we show that the combination of active and passive immunization with vesatolimod may lead to higher rates of post-ART virologic control compared to either approach alone. Therapeutic Ad26/MVA vaccination and PGT121 administration together with TLR7 stimulation with vesatolimod resulted in 70% post-ART virologic control in SHIV-SF162P3-infected rhesus macaques. These data suggest the potential of combining active and passive immunization targeting different immunologic mechanisms as an HIV-1 cure strategy.

Therapeutic efficacy of an Ad26/MVA vaccine with SIV gp140 protein and vesatolimod in ART-suppressed rhesus macaques.

Developing an intervention that results in virologic control following discontinuation of antiretroviral therapy (ART) is a major objective of HIV-1 cure research. In this study, we investigated the therapeutic efficacy of a vaccine consisting of adenovirus serotype 26 (Ad26) and modified vaccinia Ankara (MVA) with or without an SIV Envelope (Env) gp140 protein with alum adjuvant in combination with the TLR7 agonist vesatolimod (GS-9620) in 36 ART-suppressed, SIVmac251-infected rhesus macaques. Ad26/MVA therapeutic vaccination led to robust humoral and cellular immune responses, and the Env protein boost increased antibody responses. Following discontinuation of ART, virologic control was observed in 5/12 animals in each vaccine group, compared with 0/12 animals in the sham control group. These data demonstrate therapeutic efficacy of Ad26/MVA vaccination with vesatolimod but no clear additional benefit of adding an Env protein boost. SIV-specific cellular immune responses correlated with virologic control. Our findings show partial efficacy of therapeutic vaccination following ART discontinuation in SIV-infected rhesus macaques.

Confinement of all-inorganic perovskite quantum dots assembled in metal-organic frameworks for ultrafast scintillator application.

Nucleation and growth of quantum dots (QDs) are thermodynamic processes driven by the total Gibbs free energy change (ΔG). We discuss the nucleation and growth theory of perovskite quantum dots (PeQDs) inside a metal-organic framework (MOF) as a strong constraint framework, which can effectively confine the size of QDs below 3 nm and achieve a scintillator with an ultra-fast transient lifetime of fluorescence. Therefore, based on the requirements for the optical properties of ultra-fast scintillation materials, two kinds of suitable MOFs (UiO-67-bpy and MIL-101(Cr)) were selected for synthesis. The method of 'ship-in-bottle' was adopted to embed perovskite quantum dots CsPbBrCl2 into MOF cages to form PeQDs@MOF composite materials, which is different from the one-pot method. In order to further improve the stability of PeQDs@MOF, polystyrene was used to cure the composite scintillator, which can resist exposure to UV light and withstand the ISO level 4 test, with the fastest transient lifetime of 2.13 ns and a fluorescence emission wavelength of 445 nm.

A Comparison of Oxygenation Efficacy between High-Flow Nasal Cannulas and Standard Facemasks during Elective Tracheal Intubation for Patients with Obesity: A Randomized Controlled Trial.

Obese patients are predisposed to rapid oxygen desaturation during tracheal intubation. We aimed to compare the risk of desaturation between high-flow nasal oxygenation (HFNO) and classical facemask oxygenation (FMO) during rapid sequence intubation for elective surgery in obese patients. Adults with a body mass index ≥30 kg·m−2 undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into the HFNO group (n = 40) and FMO group (n = 40). In the HFNO group, patients used a high-flow nasal cannula to receive 30 to 50 L·min−1 flow of heated and humidified 100% oxygen. In the FMO group, patients received a fitting facemask with 15 L·min−1 flow of 100% oxygen. After 5-min preoxygenation, rapid sequence intubation was performed. The primary outcome was arterial desaturation during intubation, defined as a peripheral capillary oxygen saturation (SpO2) <92%. The risk of peri-intubation desaturation was significantly lower in the HFNO group compared to the FMO group; absolute risk reduction: 0.20 (95% confidence interval: 0.05−0.35, p = 0.0122); number needed to treat: 5. The lowest SpO2 during intubation was significantly increased by HFNO (median 99%, interquartile range: 97−100) compared to FMO (96, 92−100, p = 0.0150). HFNO achieved a higher partial pressure of arterial oxygen (PaO2) compared to FMO, with medians of 476 mmHg (interquartile range: 390−541) and 397 (351−456, p = 0.0010), respectively. There was no difference in patients' comfort level between groups. Compared with standard FMO, HFNO with apneic oxygenation reduced arterial desaturation during tracheal intubation and enhanced PaO2 among patients with obesity.

Multiple Color Emission of Mechanoluminescence and Photoluminescence from SrZnSO: Bi3+ for Multimode Anticounterfeiting.

Mechanoluminescence materials that emit light under mechanical stimulation have attracted widespread attention in sensing, anticounterfeiting, and imaging applications. In this study, a series of Sr1-xBixZnSO (0.001 ≤ x ≤ 0.1) samples was synthesized by the method of high temperature solid-state reaction. It is worth noting that the distortion degree of the SrO3S3 octahedron was increased with increasing Bi3+ concentration, and the color manipulated Sr1-xBixZnSO which can emit different photoluminescence (blue to dark blue and finally red) and mechanoluminescence (orange to red) colors is obtained. Moreover, the deep traps can stably store and provide electronic supplements in shallow traps released under mechanical stimulation. Therefore, devices made of SrZnSO:Bi3+ phosphor and polydimethylsiloxane (PDMS) can be used as thermo-mechano-opto three-mode anticounterfeiting. The ML intensity is linear to the external load and can be utilized for stress sensing or imaging.

Efficient energy transfer from Bi3+ to Mn2+ in CaZnOS for WLED application.

A series of Bi3+ and Mn2+ co-doped CaZnOS phosphors with a tunable emission color have been synthesized by a high temperature solid-state reaction method. Their crystal structure, spectroscopic properties, energy transfer and thermal quenching have been investigated systematically. An intense blue-green emission band at 485 nm and a red emission band at 616 nm were observed at an excitation wavelength of 375 nm, owing to the 3P1,0→1S0 transition of Bi3+ and the 4T1(4G) →6A1(6S) transition of Mn2+, respectively. The tunable color from blue-green, white light to red light can be obtained by varying the Mn2+ ion concentration from 0.005 to 0.015 in CaZnOS:Bi3+. The decay time decreased from 642 to 273 ns with the Mn2+ ion concentration x increasing from 0.005 to 0.015, and the energy transfer efficiency ηT can reach up to 65% in the CaZnOS:Bi3+,0.015Mn2+ phosphor. As the temperature increases from 300 to 420 K, the emission intensity is maintained at 67%, and the activation energy Ea is estimated to be 0.28 eV. An LED fabricated using CaZnOS:Bi3+,0.01Mn2+ exhibited the chromaticity coordinates and corrected color temperature (CCT) of (0.338, 0.364) and 4655 K, respectively. These results validate the promising applications of the CaZnOS:Bi3+,Mn2+ phosphor in UV white LEDs.

Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial.

Obesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients. Adults with a body mass index ≥ 30 kg·m-2 undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into four groups: sevoflurane or desflurane anesthesia with or without M-Entropy guidance on anesthetic depth in a ratio of 1:1:1:1. In the M-Entropy guidance groups, the dosage of sevoflurane and desflurane was adjusted to achieve response and state entropy values between 40 and 60 during surgery. In the non-M-Entropy guidance groups, the dosage of anesthetics was titrated according to clinical signs. Primary outcome was time to spontaneous eye opening. A total of 80 participants were randomized. Compared to sevoflurane, desflurane anesthesia significantly reduced the time to spontaneous eye opening [mean difference (MD): -129 s; 95% confidence interval (CI): -211, -46], obeying commands (-160; -243, -77), tracheal extubation (-172; -266, -78), and leaving operating room (-148; -243, -54). M-Entropy guidance further reduced time to eye opening (MD: -142 s; 99.2% CI: -276, -8), tracheal extubation (-199; -379, -19), and leaving operating room (-190; -358, -23) in the desflurane but not the sevoflurane group. M-Entropy guidance significantly reduced the risk of agitation during emergence, i.e., risk difference: -0.275 (95% CI: -0.464, -0.086); and number needed to treat: 4. Compared to sevoflurane, using desflurane to maintain general anesthesia accelerated the return of consciousness in obese patients. M-Entropy guidance further hastened awakening in patients using desflurane and prevented emergence agitation.

One Stone, Two Birds: pH- and Temperature-Sensitive Nitrogen-Doped Carbon Dots for Multiple Anticounterfeiting and Multiple Cell Imaging.

Carbon dots (CDs) as new fluorescent materials with excellent fluorescence properties have shown enormous potential applications, especially in anticounterfeiting and cell imaging. Herein, nitrogen-doped CDs (NCDs) with excellent biocompatibility were prepared by a simple thermal sintering method. An extremely large red shift (∼130 nm) of the emission peak was observed when the excitation wavelength changes from 355 to 550 nm, indicating that NCDs are excellent fluorescent labeling materials for multiple cell imaging. On the other hand, NCDs showed obvious changes of emission intensity and peak position when the temperature increased from 223 to 323 K and the pH values changed from 1 to 13, respectively, which has been demonstrated by the "horse" pattern printed with NCD water-soluble fluorescent inks. The nontoxic NCDs dispersed in a multiple matrix are highly sensitive to excitation wavelength, temperature, and pH, indicating their great potential application in multiple anticounterfeiting and multiple cell imaging.