Loss of USP10 promotes hepatocellular carcinoma proliferation by regulating the serine synthesis pathway through inhibition of LKB1 activity.

Metabolic dysregulation is emerging as a critical factor in tumorigenesis, and reprogramming of serine metabolism has been identified as an essential factor in the progression of hepatocellular carcinoma (HCC). Studies have shown that LKB1 deficiency can activate mTOR to upregulate the serine synthesis pathway (SSP) and promote tumor progression. Our team discovered that ubiquitin-specific protease 10 (USP10) can inhibit HCC proliferation through mTOR, but its relationship with SSP needs further investigation. The metabolite assays revealed a significant increase in serine content in HCC tissues. Through the LKB1/mTOR/activating transcription factor 4 (ATF4) axis, loss of USP10 may increase serine biosynthesis and promote the proliferation of HCC in vitro and in vivo. Furthermore, it was found that USP10 could activate LKB1 through deubiquitination. Analyzing clinical HCC tissues revealed a positive correlation between USP10 and LKB1. Additionally, those with high expression of USP10 in HCC tissues showed a better degree of tumor differentiation and longer overall survival time. Moreover, we found increased expression of both serine and its synthase in liver tumor tissues of USP10 liver-specific KO mice. Loss of USP10 inhibits the activity of LKB1, contributing to the stimulation of the mTOR/ATF4 axis and SSP and then promoting the proliferation of HCC. This work presents a novel approach for serine-targeted treatment in HCC.

Injectable Hydrogels Including Magnetic Nanosheets for Multidisciplinary Treatment of Hepatocellular Carcinoma via Magnetic Hyperthermia.

Relapse and unresectability have become the main obstacle for further improving hepatocellular carcinoma (HCC) treatment effect. Currently, single therapy for HCC in clinical practice is limited by postoperative recurrence, intraoperative blood loss and poor patient outcomes. Multidisciplinary therapy has been recognized as the key to improving the long-term survival rate for HCC. However, the clinical application of HCC synthetic therapy is restricted by single functional biomaterials. In this study, a magnetic nanocomposite hydrogel (CG-IM) with iron oxide nanoparticle-loaded mica nanosheets (Iron oxide nanoparticles@Mica, IM) is reported. This biocompatible magnetic hydrogel integrated high injectability, magnetocaloric property, mechanical robustness, wet adhesion, and hemostasis, leading to efficient HCC multidisciplinary therapies including postoperative tumor margin treatment and percutaneous locoregional ablation. After minimally invasive hepatectomy of HCC, the CG-IM hydrogel can facilely seal the bleeding hepatic margin, followed by magnetic hyperthermia ablation to effectively prevent recurrence. In addition, CG-IM hydrogel can inhibit unresectable HCC by magnetic hyperthermia through the percutaneous intervention under ultrasound guidance.

Formin-like 2 promotes angiogenesis and metastasis of colorectal cancer by regulating the EGFL6/CKAP4/ERK axis.

Increasing evidence indicates that angiogenesis plays a pivotal role in tumor progression. Formin-like 2 (FMNL2) is well-known for promoting metastasis; however, the molecular mechanisms by which FMNL2 promotes angiogenesis in colorectal cancer (CRC) remain unclear. Here, we found that FMNL2 promotes angiogenesis and metastasis of CRC in vitro and in vivo. The GDB/FH3 domain of FMNL2 directly interacts with epidermal growth factor-like protein 6 (EGFL6). Formin-like 2 promotes EGFL6 paracrine signaling by exosomes to regulate angiogenesis in CRC. Cytoskeleton associated protein 4 (CKAP4) is a downstream target of EGFL6 and is involved in CRC angiogenesis. Epidermal growth factor-like protein 6 binds to the N-terminus of CKAP4 to promote the migration of HUVECs by activating the ERK/MMP pathway. These findings suggest that FMNL2 promotes the migration of HUVECs and enhances angiogenesis and tumorigenesis in CRC by regulating the EGFL6/CKAP4/ERK axis. Therefore, the EGFL6/CKAP4/ERK axis could be a candidate therapeutic target for CRC treatment.

The formation process and mechanism of gastrointestinal anastomosis after retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy: a preclinical study.

BACKGROUND AND AIMS: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a promising method of treating gastric outlet obstruction. However, no study has investigated gastrointestinal anastomosis formation after EUS-GE. We aimed to evaluate the formation of gastrointestinal anastomosis after EUS-GE in a porcine model. METHODS: Retrieval anchor-assisted EUS-GE was performed on 15 Bama mini pigs. Five pigs each were randomly euthanized 3, 7, and 14 days postoperatively to evaluate the formation of gastrointestinal anastomosis and measure the anastomotic distance. The expression of transforming growth factor-ß1(TGF-ß1) and Smad3 in the anastomosis site were examined by immunohistochemistry. RESULTS: EUS-GE was successfully performed in all 15 pigs. The mean procedure time was 29.2 ± 6.0 (range 18-40) minutes. The anastomotic distance was 34.0 ± 3.6 cm in 14 pigs. The site of gastroenterostomy of one pig was at the ileum. For pigs euthanized 3 days postoperatively, the structure was mechanically maintained by a stent. For pigs euthanized 7 or 14 days postoperatively, the stomach and small intestine were anastomosed to form a stable structure. The level of TGF-ß1 and Smad3 in the anastomosis site gradually increased from 3 to 14 days after EUS-GE. TGF-ß1 and Smad3 expression had a significant difference between 3 days, 7 days, and 14 days after EUS-GE (P < 0.05). CONCLUSIONS: For EUS-GE, the stomach and small intestine were initially linked together mechanically and spontaneously anastomosed to form a stable structure 7 days postoperatively. TGF-ß1 and Smad3 play an important role in the formation of a stable structure of gastrointestinal anastomosis.

Line-Features-Based Pose Estimation Method for the Disc Cutter Holder of Shield Machine.

To achieve automatic disc cutter replacement of shield machines, measuring the accurate pose of the disc cutter holder by machine vision is crucial. However, under polluted and restricted illumination conditions, achieving pose estimation by vision is a great challenge. This paper proposes a line-features-based pose estimation method for the disc cutter holder of the shield machine by using a monocular camera. For the blurring effect of rounded corners on the image edge, a rounded edge model is established to obtain edge points that better match the 3D model of the workpiece. To obtain the edge search box corresponding to each edge, a contour separation method based on an adaptive threshold region growing method is proposed. By preprocesses on the edge points of each edge, the efficiency and the accuracy of RANSAC linear fitting are improved. The experimental result shows that the proposed pose estimation method is highly reliable and can meet the measurement accuracy requirements in practical engineering applications.

COMMD10 inhibits HIF1α/CP loop to enhance ferroptosis and radiosensitivity by disrupting Cu-Fe balance in hepatocellular carcinoma.

BACKGROUND & AIMS: Copper (Cu) is an essential trace element whose serum levels have been reported to act as an effective indicator of the efficacy of radiotherapy. However, little is known about the role of Cu in radiotherapy. In this study we aimed to determine this role and investigate the precise mechanism by which Cu or Cu-related proteins regulate the radiosensitivity of hepatocellular carcinoma (HCC). METHODS: The expression and function of Cu and copper metabolism MURR1 domain 10 (COMMD10) were assessed via a Cu detection assay, immunostaining, real-time PCR, western blot, a radiation clonogenic assay and a 5-ethynyl-2'-deoxyuridine assay. Ferroptosis was determined by detecting glutathione, lipid peroxidation, malondialdehyde and ferrous ion (Fe) levels. The in vivo effects of Cu and COMMD10 were examined with Cu/Cu chelator treatment or lentivirus modification of COMMD10 expression in radiated mouse models. RESULTS: We identified a novel role of Cu in promoting the radioresistance of HCC cells. Ionizing radiation (IR) induced a reduction of COMMD10, which increased intracellular Cu and led to radioresistance of HCC. COMMD10 enhanced ferroptosis and radiosensitivity in vitro and in vivo. Mechanistically, low expression of COMMD10 induced by IR inhibited the ubiquitin degradation of HIF1α (by inducing Cu accumulation) and simultaneously impaired its combination with HIF1α, promoting HIF1α nuclear translocation and the transcription of ceruloplasmin (CP) and SLC7A11, which jointly inhibited ferroptosis in HCC cells. In addition, elevated CP promoted HIF1α expression by reducing Fe, forming a positive feedback loop. CONCLUSIONS: COMMD10 inhibits the HIF1α/CP loop to enhance ferroptosis and radiosensitivity by disrupting Cu-Fe homeostasis in HCC. This work provides new targets and treatment strategies for overcoming radioresistance in HCC. LAY SUMMARY: Radiotherapy benefits patients with unresectable or advanced hepatocellular carcinoma (HCC), but its effectiveness is hampered by radioresistance. Herein, we uncovered a novel role for copper in promoting the radioresistance of HCCs. This work has revealed new targets and potential treatment strategies that could be used to sensitize HCC to radiotherapy.

Rice stripe virus suppresses jasmonic acid-mediated resistance by hijacking brassinosteroid signaling pathway in rice.

Rice stripe virus (RSV) is one of the most destructive viral diseases affecting rice production. However, so far, only one RSV resistance gene has been cloned, the molecular mechanisms underlying host-RSV interaction are still poorly understood. Here, we show that increasing levels or signaling of brassinosteroids (BR) and jasmonic acid (JA) can significantly enhance the resistance against RSV. On the contrary, plants impaired in BR or JA signaling are more susceptible to RSV. Moreover, the enhancement of RSV resistance conferred by BR is impaired in OsMYC2 (a key positive regulator of JA response) knockout plants, suggesting that BR-mediated RSV resistance requires active JA pathway. In addition, we found that RSV infection suppresses the endogenous BR levels to increase the accumulation of OsGSK2, a key negative regulator of BR signaling. OsGSK2 physically interacts with OsMYC2, resulting in the degradation of OsMYC2 by phosphorylation and reduces JA-mediated defense to facilitate virus infection. These findings not only reveal a novel molecular mechanism mediating the crosstalk between BR and JA in response to virus infection and deepen our understanding about the interaction of virus and plants, but also suggest new effective means of breeding RSV resistant crops using genetic engineering.

SSThe coexistence and diversity of Candidatus methylomirabilis oxyfera-like and anammox bacteria in sediments of an urban eutrophic lake.

Tangxun Lake is the largest urban lake in China, which is polluted by multiple wastewaters, and now is severely eutrophic. We detected diversity, abundance, and the coexistence of Candidatus Methylomirabilis oxyfera-like and anammox bacteria in different horizontal and vertical directions of the lake sediments through qPCR and clone library. Phylogenetic tree analysis showed that the Ca. Methylomirabilis oxyfera-like and anammox bacteria exhibited high diversity, and they belonged to group B-E and Ca. Brocadia genus, respectively. These two bacteria displayed higher diversity in polluted area than in other areas. Furthermore, they had great spatial variation of abundance both horizontally and vertically. The abundance of anammox bacteria was significantly higher than that of Ca. Methylomirabilis oxyfera-like bacteria. The stronger the human interference were, the higher abundances these two bacteria exhibited horizontally, whereas both their abundances and the ratio of anammox to Ca. Methylomirabilis oxyfera-like bacteria decreased with the increasing depth. Redundancy analysis indicated that nitrate was the most influential environmental factor to the abundance of these two bacteria. Ammonia, nitrite, total nitrogen, and organic matters were in positive correlation with the abundance of these two bacteria. Nitrate was slightly negatively correlated with the abundance of Ca. Methylomirabilis oxyfera-like bacteria, while it was positively correlated with that of anammox bacteria. Our results provided an insight into the effects of environmental factors such as ammonia, nitrite, and nitrate on the diversity and abundances of these two bacteria and theoretical basis for restoration of water.

The necessarity of treatment for small gastric subepithelial tumors (1-2 cm) originating from muscularis propria: an analysis of 972 tumors.

BACKGROUND AND OBJECTIVES: Up till now, there are still controversies about the specific indication of endoscopic resection for small gastric subepithelial tumors (gSETs) originating from muscularis propria. We aimed to investigate the safety of endoscopic resection and postoperative pathology analysis. METHOD: The patients with primary small gSETs originating from muscularis propria, treated by endoscopic resection in the endoscopic center of Shengjing Hospital between January, 2011 and September, 2019 were enrolled. The complete resection rate, adverse events and clinicopathological features were recorded. RESULT: A total of 936 patients with 972 gastric SETs ≤ 2 cm originating from muscularis propria were included in our study. All the lesions were successfully treated by endoscopic resection. Nearly half of lesions were proved to be gastrointestinal stromal tumor (GIST) [n = 411 (42.3%)] according to postoperative pathology. All the objects were further subdivided into 2 groups, ≤ 1 cm, > 1 and ≤ 2 cm gSETs. The risk of gastric GIST of intermediate/high risk in the group (> 1 and ≤ 2 cm gSETs) is 8.41 times as that of gastric GIST in the group (the size of gastric ≤ 1 cm gSETs) (P < 0.05). CONCLUSION: Endoscopic resection is a safe and effective treatment for small gSETs. gSETs (1-2 cm) is more risky than gSETs (≤ 1 cm) and should be resected. This should be evaluated by further studies.

A Syntax-enhanced model based on category keywords for biomedical relation extraction.

Certain categories in multi-category biomedical relationship extraction have linguistic similarities to some extent. Keywords related to categories and syntax structures of samples between these categories have some notable features, which are very useful in biomedical relation extraction. The pre-trained model has been widely used and has achieved great success in biomedical relationship extraction, but it is still incapable of mining this kind of information accurately. To solve the problem, we present a syntax-enhanced model based on category keywords. First, we prune syntactic dependency trees in terms of category keywords obtained by the chi-square test. It reduces noisy information caused by current syntactic parsing tools and retains useful information related to categories. Next, to encode category-related syntactic dependency trees, a syntactic transformer is presented, which enhances the ability of the pre-trained model to capture syntax structures and to distinguish multiple categories. We evaluate our method on three biomedical datasets. Compared with state-of-the-art models, our method performs better on these datasets. We conduct further analysis to verify the effectiveness of our method.

Injectable magnetic montmorillonite colloidal gel for the postoperative treatment of hepatocellular carcinoma.

Bioactive materials have been extensively developed for the adjuvant therapy of cancer. However, few materials can meet the requirements for the postoperative resection of hepatocellular carcinoma (HCC) due to massive bleeding and high recurrence. In particular, combination therapy for HCC has been highly recommended in clinical practice, including surgical resection, interventional therapy, ablation therapy and chemotherapy. Herein, an injectable magnetic colloidal gel (MCG) was developed by controllable electrostatic attraction between clinically available magnetic montmorillonites and amphoteric gelatin nanoparticles. The optimized MCG exhibited an effective magnetic heating effect, remarkable rheological properties, and high gel network stability, realizing the synergistic treatment of postoperative HCC by stimuli-responsive drug delivery, hemostasis and magnetic hyperthermia. Furthermore, a minimal invasive MCG-induced interventional magnetic hyperthermia therapy (MHT) under ultrasound guidance was realized on hepatic tumor rabbits, providing an alternative therapeutics to treat the postoperative recurrence. Overall, MCG is a clinically available injectable formulation for adjuvant therapy after HCC surgical resection.

Pose Determination of the Disc Cutter Holder of Shield Machine Based on Monocular Vision.

The visual measurement system plays a vital role in the disc cutter changing robot of the shield machine, and its accuracy directly determines the success rate of the disc cutter grasping. However, the actual industrial environment with strong noise brings a great challenge to the pose measurement methods. The existing methods are difficult to meet the required accuracy of pose measurement based on machine vision under the disc cutter changing conditions. To solve this problem, we propose a monocular visual pose measurement method consisting of the high precision optimal solution to the PnP problem (OPnP) method and the highly robust distance matching (DM) method. First, the OPnP method is used to calculate the rough pose of the shield machine's cutter holder, and then the DM method is used to measure its pose accurately. Simulation results show that the proposed monocular measurement method has better accuracy and robustness than the several mainstream PnP methods. The experimental results also show that the maximum error of the proposed method is 0.28° in the direction of rotation and 0.32 mm in the direction of translation, which can meet the measurement accuracy requirement of the vision system of the disc cutter changing robot in practical engineering application.

Comparison between the widely used magnetically controlled capsule gastroscopy and conventional gastroscopy: a meta-analysis.

OBJECTIVES: We systematically evaluated the difference in diagnostic accuracy, check time, and adverse effects between magnetically controlled capsule gastroscopy (MCCG) and conventional gastroscopy in patients with gastric disorders. MATERIAL AND METHODS: PubMed, Embase, Cochrane, CKNI and Wanfang Data were searched for studies dated prior to 30 January 2020. We used the QUADAS criteria for quality evaluation. We extracted the diagnostic rate, check time, and adverse events from the studies, then used STATA15.0 to calculate variables (sensitivity, specificity, positive likelihood ratio [LR+], negative likelihood ratio [LR-] and diagnostic odds ratio), draw forest plots and SROC curves, and completed sensitivity analysis. RESULTS: A total of 278 titles were identified after an initial search and nine studies with 1,146 individuals were included in the analysis. The pooled sensitivity, specificity, LR+ and LR- of MCCG in detecting gastric disorders were 90%, 92%, 10.6, and 0.11, respectively. A ROC curve was drawn with Q = 0.9060 and AUG = 0.96. The diagnostic odds ratio was 93. CONCLUSIONS: No significant difference in diagnosis accuracy was demonstrated between MCCG and conventional gastroscopy. The MCCG had a longer check time than conventional gastroscopy and the adverse events occurrence rate was lower. MCCG is a convenient and reliable examination method for gastric diseases.

Needle-based confocal laser endomicroscopy for diagnosis of pancreatic cystic lesions: a meta-analysis.

BACKGROUND AND AIM: The role of needle-based confocal laser endomicroscopy (nCLE) in the diagnosis of pancreatic cystic lesions (PCLs) remains controversial. This study aimed to systematically evaluate the diagnostic accuracy and adverse effects of nCLE in the detection of pathological subtypes in patients with PCLs. MATERIAL AND METHODS: We conducted a comprehensive literature search using MEDLINE, EMBASE, and Cochrane for identifying studies that reported the use of nCLE for PCLs diagnosis (dated prior to 10 October 2020). Studies with a sample size >10 were included. We used the QUADAS-2 criteria for quality evaluation. We first extracted the diagnostic rates and the information on adverse events (AEs) from the studies; then used STATA15.0 to calculate the variables, draw forest plots and summary receiver operating characteristic (SROC) curves; and finally, we completed subgroup analyses to explore the heterogeneity. RESULTS: Overall, 299 article titles were identified after an initial search, and ten studies with 547 individuals with PCLs were included in the analysis. The pooled sensitivity, specificity, positive likelihood ratio, and pooled negative likelihood ratio of nCLE in detecting gastric disorders were 90%, 96%, 20.4, and 0.11, respectively. The pooled sensitivity and specificity showed a substantial heterogeneity. An ROC curve was constructed with an area under the curve (AUC) of 0.94. The overall AEs rate of pancreatitis was 2.7%. CONCLUSIONS: We showed that nCLE had a relatively high sensitivity and specificity for diagnosing PCLs with a relatively low rate of AEs occurring. We suggest that nCLE has good diagnostic accuracy for PCLs.

GAT-LI: a graph attention network based learning and interpreting method for functional brain network classification.

BACKGROUND: Autism spectrum disorders (ASD) imply a spectrum of symptoms rather than a single phenotype. ASD could affect brain connectivity at different degree based on the severity of the symptom. Given their excellent learning capability, graph neural networks (GNN) methods have recently been used to uncover functional connectivity patterns and biological mechanisms in neuropsychiatric disorders, such as ASD. However, there remain challenges to develop an accurate GNN learning model and understand how specific decisions of these graph models are made in brain network analysis. RESULTS: In this paper, we propose a graph attention network based learning and interpreting method, namely GAT-LI, which learns to classify functional brain networks of ASD individuals versus healthy controls (HC), and interprets the learned graph model with feature importance. Specifically, GAT-LI includes a graph learning stage and an interpreting stage. First, in the graph learning stage, a new graph attention network model, namely GAT2, uses graph attention layers to learn the node representation, and a novel attention pooling layer to obtain the graph representation for functional brain network classification. We experimentally compared GAT2 model's performance on the ABIDE I database from 1035 subjects against the classification performances of other well-known models, and the results showed that the GAT2 model achieved the best classification performance. We experimentally compared the influence of different construction methods of brain networks in GAT2 model. We also used a larger synthetic graph dataset with 4000 samples to validate the utility and power of GAT2 model. Second, in the interpreting stage, we used GNNExplainer to interpret learned GAT2 model with feature importance. We experimentally compared GNNExplainer with two well-known interpretation methods including Saliency Map and DeepLIFT to interpret the learned model, and the results showed GNNExplainer achieved the best interpretation performance. We further used the interpretation method to identify the features that contributed most in classifying ASD versus HC. CONCLUSION: We propose a two-stage learning and interpreting method GAT-LI to classify functional brain networks and interpret the feature importance in the graph model. The method should also be useful in the classification and interpretation tasks for graph data from other biomedical scenarios.

Identifying Parkinson's disease with mild cognitive impairment by using combined MR imaging and electroencephalogram.

OBJECTIVES: To analyse the changes of quantitative electroencephalogram (qEEG) and cortex structural magnetic resonance (MR) imaging in Parkinson's disease with mild cognitive impairment (PD-MCI) and to explore the "composite marker"-based machine learning model in identifying PD-MCI. METHODS: Retrospective analysis of patients with PD identified 36 PD-MCI and 35 PD with normal cognition (PD-NC). QEEG features of power spectrum and structural MR features of cortex based on surface-based morphometry (SBM) were extracted. Support vector machine (SVM) was established using combined features of structural MR and qEEG to identify PD-MCI. Feature importance evaluation algorithm of mean impact value (MIV) was established to sort the vital characteristics of qEEG and structural MR. RESULTS: Compared with PD-NC, PD-MCI showed a statistically significant difference in 5 leads and waves of qEEG and 7 cortical region features of structural MR. The SVM model based on these qEEG and structural MR features yielded an accuracy of 0.80 in the training set and had a high prediction accuracy of 0.80 in the test set (sensitivity was 0.78, specificity was 0.83, area under the receiver operating characteristic curve was 0.77), which was higher than the model built by the feature separately. QEEG features of theta wave in C3 had a marked impact on the model for classification according to the MIV algorithm. CONCLUSIONS: PD-MCI is characterized by widespread structural and EEG abnormality. "Composite markers" could be valuable for the individualized diagnosis of PD-MCI by machine learning. KEY POINTS: • Explore the brain abnormalities in Parkinson's disease with mild cognitive impairment by using the quantitative electroencephalogram and cortex structural MR simultaneously. • Multimodal features based support vector machine for identifying Parkinson's disease with mild cognitive impairment has an acceptable performance. • Theta wave in C3 is the most influential feature of qEEG and cortex structure MR imaging in identifying Parkinson's disease with mild cognitive impairment using support vector machine.

Retracted: Evodiamine Induces Apoptosis, G2/M Cell Cycle Arrest, and Inhibition of Cell Migration and Invasion in Human Osteosarcoma Cells via Raf/MEK/ERK Signalling Pathway.

An editorial decision has been made to retract this manuscript due to breach of publishing guidelines, following the identification of non-original and manipulated figures. Reference: Yuelai Zhou, Jinlong Hu: Evodiamine Induces Apoptosis, G2/M Cell Cycle Arrest, and Inhibition of Cell Migration and Invasion in Human Osteosarcoma Cells via Raf/MEK/ERK Signalling Pathway.  Med Sci Monit 2018; 24: 5874-5880. 10.12659/MSM.909682.

Comparison of Suture-Button Versus Syndesmotic Screw in the Treatment of Distal Tibiofibular Syndesmosis Injury: A Meta-analysis.

Traditionally screw fixation is an effective surgical procedure for the treatment of unstable syndesmosis injuries. However, it is still a controversy whether suture-button (SB) device can achieve better clinical outcomes and decrease the risk of complications compared with syndesmotic screw (SS). The present meta-analysis was conducted to figure out whether SB fixation was superior to traditionally screw fixation. Twelve clinical studies were identified, involving 320 patients in the SB group and 334 patients in the SS group. Among patients treated with SB, the American Orthopaedic Foot & Ankle Society (AOFAS) score was significantly higher at 3-month follow-up (p = .01) and 2-year follow-up (p = .02), and the Olerud-Molander Ankle (OMA) score at 1-year follow-up (p = .002). In addition, the SB group had significantly better results in the malreduction (p = .0008), implant failure (p < .01), implant removal (p < .01), and local irritation (p = .004). No statistical differences were found in the AOFAS at 6 months follow-up (p = .33) and 1-year follow-up (p = .33), OMA at 3 months follow-up (p = .09), 6 months follow-up (p = .14) and 2 years follow-up (p = .36), the Foot and Ankle Disability Index (p = .73), Euro Qol 5-dimension questionnaire (p = .33), dorsiflexion (DF; p = .91), plantarflexion (p = .23), medial clear space (p = .42), tibiofibular clear space (p = .60), tibiofibular overlap (p = .84), and other complications (p = .95). Based on this meta-analysis, there was no significant difference in postoperative radiological measurements, and no sufficient evidence was found to support the improved clinical outcomes compared with SS fixation group. However, SB technique could improve functional outcomes, reduce the rate of implant removal, implant failure, local irritation, and malreduction without increasing risk of other complications. Therefore, the SB technique should be recommended in the treatment of syndesmosis injuries.

Promoting Reversible Redox Kinetics by Separator Architectures Based on CoS2 /HPGC Interlayer as Efficient Polysulfide-Trapping Shield for Li-S Batteries.

Main obstacles from the shuttle effect and slow conversion rate of soluble polysulfide compromise the sulfur utilization and cycling life for lithium sulfur (Li-S) batteries. In pursuit of a practically viable high performance Li-S battery, a separator configuration (CoS2 /HPGC/interlayer) as efficient polysulfide trapping barrier is reported. This configuration endows great advantages, particularly enhanced conductivity, promoted polysulfide trapping capability, accelerated sulfur electrochemistry, when using the functional interlayer for Li-S cells. Attributed to the above merits, such cell shows excellent cyclability, with a capacity of 846 mAh g-1 after 250 cycles corresponding to a high capacity retention of 80.2% at 0.2 C, and 519 mAh g-1 after 500 cycles at 1C (1C = 1675 mA g-1 ). In addition, the optimized separator exhibits a high initial areal capacity of 4.293 mAh cm-2 at 0.1C. Moreover, with CoS2 /HPGC/interlayer, the sulfur cell enables a low self-discharge rate with a very high capacity retention of 97.1%. This work presents a structural engineering of the separator toward suppressing the dissolution of soluble Li2 Sn moieties and simultaneously promoting the sulfur conversion kinetics, thus achieving durable and high capacity Li-S batteries.

Endoscopic diagnosis of gastrointestinal melanoma.

Background: Gastrointestinal (GI) melanoma can be diagnosed by endoscopy combined with biopsy and subsequent pathological examination. However, the disease may be misdiagnosed due to the limited awareness of GI melanoma.Objective: We aimed to describe characteristics of GI melanoma that can be detected by endoscopy and endoscopic ultrasound (EUS).Methods: We retrospectively analyzed patients with GI melanoma diagnosed by endoscopic biopsy or postoperative pathology between August 2008 and January 2017. Images of endoscopic examinations, including endoscopy and EUS, were reviewed to characterize GI melanomas.Results: A total of 21 patients (9 males, 12 females) with GI melanoma were enrolled in this study. Several types of melanoma were identified: anorectal melanoma (n = 15), esophageal melanoma (n = 3), gastric melanoma (n = 2), and melanoma of the small intestine (n = 1). EUS was performed for one case of esophageal melanoma, one case of gastric melanoma, and seven cases of anorectal melanoma.Conclusions: GI melanoma is a rare disease. Most GI melanomas showed typical endoscopic manifestations, including black plaques. EUS is a reliable tool for evaluating the depth of infiltration of GI melanoma.