Observation of the scaling dimension of fractional quantum Hall anyons.

Unconventional quasiparticles emerging in the fractional quantum Hall regime1,2 present the challenge of observing their exotic properties unambiguously. Although the fractional charge of quasiparticles has been demonstrated for nearly three decades3-5, the first convincing evidence of their anyonic quantum statistics has only recently been obtained6,7 and, so far, the so-called scaling dimension that determines the propagation dynamics of the quasiparticles remains elusive. In particular, although the nonlinearity of the tunnelling quasiparticle current should reveal their scaling dimension, the measurements fail to match theory, arguably because this observable is not robust to non-universal complications8-12. Here we expose the scaling dimension from the thermal noise to shot noise crossover and observe an agreement with expectations. Measurements are fitted to the predicted finite-temperature expression involving both the scaling dimension of the quasiparticles and their charge12,13, in contrast to previous charge investigations focusing on the high-bias shot-noise regime14. A systematic analysis, repeated on several constrictions and experimental conditions, consistently matches the theoretical scaling dimensions for the fractional quasiparticles emerging at filling factors ν = 1/3, 2/5 and 2/3. This establishes a central property of fractional quantum Hall anyons and demonstrates a powerful and complementary window into exotic quasiparticles.

Fine mapping of stem rust resistance derived from soft red winter wheat cultivar AGS2000 to an NLR gene cluster on chromosome 6D.

The Puccinia graminis f. sp. tritici (Pgt) Ug99-emerging virulent races present a major challenge to global wheat production. To meet present and future needs, new sources of resistance must be found. Identification of markers that allow tracking of resistance genes is needed for deployment strategies to combat highly virulent pathogen races. Field evaluation of a DH population located a QTL for stem rust (Sr) resistance, QSr.nc-6D from the breeding line MD01W28-08-11 to the distal region of chromosome arm 6DS where Sr resistance genes Sr42, SrCad, and SrTmp have been identified. A locus for seedling resistance to Pgt race TTKSK was identified in a DH population and an RIL population derived from the cross AGS2000 × LA95135. The resistant cultivar AGS2000 is in the pedigree of MD01W28-08-11 and our results suggest that it is the source of Sr resistance in this breeding line. We exploited published markers and exome capture data to enrich marker density in a 10 Mb region flanking QSr.nc-6D. Our fine mapping in heterozygous inbred families identified three markers co-segregating with resistance and delimited QSr.nc-6D to a 1.3 Mb region. We further exploited information from other genome assemblies and identified collinear regions of 6DS harboring clusters of NLR genes. Evaluation of KASP assays corresponding to our co-segregating SNP suggests that they can be used to track this Sr resistance in breeding programs. However, our results also underscore the challenges posed in identifying genes underlying resistance in such complex regions in the absence of genome sequence from the resistant genotypes.

Evaluation of urinary limonene metabolites as biomarkers of exposure to greenness.

Exposure to plants is known to improve physical and mental health and living in areas of high vegetation is associated with better health. The addition of quantitative measures of greenness exposure at individual-level to other objective and subjective study measures will help establish cause-and-effect relationships between greenspaces and human health. Because limonene is one of the most abundant biogenic volatile organic compounds emitted by plants, we hypothesized that urinary metabolites of inhaled limonene can serve as biomarkers of exposure to greenness. To test our hypothesis, we analyzed urine samples collected from eight human volunteers after limonene inhalation or after greenness exposure using liquid chromatography-high resolution mass spectrometry-based profiling. Eighteen isomers of nine metabolites were detected in urine after limonene inhalation, and their kinetic parameters were estimated using nonlinear mixed effect models. Urinary levels of most abundant limonene metabolites were elevated after brief exposure to a forested area, and the ratio of urinary limonene metabolites provided evidence of recent exposure. The identities and structures of these metabolites were validated using stable isotope tracing and tandem mass spectral comparison. Together, these data suggest that urinary metabolites of limonene, especially uroterpenol glucuronide and dihydroperillic acid glucuronide, could be used as individualized biomarkers of greenness exposure.

[18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography and conventional imaging modalities in the diagnosis of diabetic foot osteomyelitis: a meta-analysis.

AIM: This meta-analysis aimed to evaluate the comparative diagnostic efficacy of [18F]Fluorodeoxyglucose positron emission tomography ([18F]FDG PET) and conventional imaging, MRI, and white blood cell (WBC) scintigraphy in detecting foot osteomyelitis among diabetic patients. MATERIALS AND METHODS: An exhaustive search was conducted within the PubMed and Embase databases to identify publications available up until February 2024. Studies were included if they evaluated the diagnostic efficacy of [18F]FDG PET or the comparative diagnostic performance between PET and (MRI or WBC scintigraphy). Two researchers independently assessed the quality of the included studies, utilizing the Quality Assessment of Diagnostic Performance Studies (QUADAS-2) tool. RESULTS: Nine retrospective or prospective studies involving 605 patients were included in the meta-analysis. For [18F]FDG PET, the overall sensitivity was 0.83(95% CI: 0.69-0.94), while the overall specificity was 0.92(95% CI: 0.86-0.97). In the head-to-head comparison, no significant difference of sensitivity was found between [18F]FDG PET and MRI (0.72 vs. 0.68, P=0.81), as well as between [18F]FDG PET and WBC scintigraphy (0.57 vs. 0.66, P=0.64). In addition, specificity was also found to be no significant difference between [18F]FDG PET and MRI (0.90 vs. 0.82, P=0.27), as well as [18F]FDG PET and WBC scintigraphy (0.81 vs. 0.93, P=0.09). CONCLUSION: [18F]FDG PET demonstrates similar sensitivity and specificity to MRI and WBC scintigraphy in detecting foot osteomyelitis among diabetic patients. MRI, often cited as a primary choice in guidelines, might be preferred due to its lower cost and lower dose. Further larger sample prospective studies are needed to confirm these findings.

Global trends in deaths and disability-adjusted life years of diabetes attributable to second-hand smoke and the association with smoke-free policies.

OBJECTIVES: The diabetic burden attributable to second-hand smoke (SHS) is a global public health challenge. We sought to explore the diabetic burden attributable to SHS by age, sex, and socioeconomic status during 1990-2019 and to evaluate the health benefit of smoke-free policies on this burden. STUDY DESIGN: Cross-sectional study. METHODS: The diabetic burden attributable to SHS was extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 dataset. Country-level smoke-free policies were obtained from the World Health Organization Global Health Observatory. The deaths or disability-adjusted life years (DALYs) were quantified, and the average annual percentage changes were calculated. Hierarchical linear mixed models were applied to evaluate the health effects. RESULTS: From 1990 to 2019, the absolute number of global deaths and DALYs of diabetes attributable to SHS has doubled, and the age-standardised rate has significantly increased. The disease burden was higher in females than in males and increased with increasing age. The SHS-related diabetic burden varied across regions and countries. Age-standardised death or DALY rates first increased and then decreased with increased Socio-demographic Index (SDI), peaking in the 0.60-0.70 range. In low to low-middle, and middle to high-middle SDI countries, SHS-related diabetic deaths and DALYs were significantly lower in countries with more than 3 smoke-free public places than in countries with 0-2 smoke-free public places. CONCLUSIONS: More attention should be paid to females and the elderly, who bear a heavy SHS-related diabetic burden. Banning smoking in public places was associated with reduced burden of SHS-attributable diabetes, especially in low to middle social development countries.

Computed tomography scan accuracy for the prediction of lobe and division of liver tumors by four board-certified radiologists.

OBJECTIVE: (1) Evaluate the accuracy of computed tomography (CT) scans for localization of liver masses. (2) Assess the agreement between radiologists on localization. (3) Determine if location influences the accuracy of localization and histopathologic diagnosis. (4) Determine what lobar vasculature radiologists found most useful for localization. STUDY DESIGN: Retrospective. ANIMALS: A total of 67 client-owned dogs with a total of 75 hepatic masses. METHODS: Records were reviewed for relevant data. Localization for each hepatic mass was performed by four radiologists (JH, EH, ML, JF) independently. RESULTS: Overall accuracy of mass localization was 217/292 (74.3%) by lobe and 264/300 (88%) by division. Accuracy for the quadrate lobe (11/27, 40.7%) was lower (p < .05) than for the caudate process of the caudate lobe (19/24, 79.2%), left medial lobe (47/64, 73.4%) and left lateral lobe (95/101, 89.6%). Accuracy for the right lateral lobe (17/35, 48.6%) was lower (p < .05) lower than for the left lateral lobe (95/101, 89.6%). Accuracy of localization was 173/192 (90.1%) for masses located in the left division, 37/48 (77.1%) in the central division, and 53/60 (88.3%) for the right division. The agreement (kappa) between radiologists was good (0.61-0.8) to excellent (0.81-1) for division and moderate (0.41-0.6) to good for lobe localization. CONCLUSION: CT localization was more accurate for division than lobe localization of canine hepatic masses. Similarly, radiologists had a better agreement for division than lobe localization. CLINICAL SIGNIFICANCE: This study supports CT as a useful modality for liver mass localization based on division. CT localization to specific lobes should be interpreted with some caution.

[Multi-omics prediction of lymph node metastasis status in breast cancer].

Lymph node metastasis status stands as a pivotal prognostic indicator in forecasting the outlook for breast cancer patients. Consequently, precise evaluation of this status holds paramount importance in the staging, treatment, and prognosis of breast cancer. The utilization of radiomics, genomics, proteomics, transcriptomics, and histopathology methodologies has notably enhanced the precision of lymph node metastasis status prediction in breast cancer. This review provides an overview of recent advancements in omics-based lymph node metastasis prediction for breast cancer, elucidating the significance of various omics prediction models and integrated multi-omics models in this predictive endeavor. The overarching goal is to augment the accuracy of preoperative lymph node metastasis status prediction in breast cancer, thereby aiding clinicians in the selection of efficacious personalized treatment strategies, while concurrently averting undertreatment of patients with a heightened risk of metastasis.

China's prevention and control experience of echinococcosis: A 19-year retrospective.

Echinococcosis poses a significant threat to public health. The Chinese government has implemented prevention and control measures to mitigate the impact of the disease. By analyzing data from the Chinese Center for Disease Control and Prevention and the State Council of the People's Republic of China, we found that implementation of these measures has reduced the infection rate by nearly 50% between 2004 to 2022 (from 0.3975 to 0.1944 per 100,000 person-years). Nonetheless, some regions still bear a significant disease burden, and lack of detailed information limites further evaluation of the effects on both alveolar and cystic echinococcosis. Our analysis supports the continuing implementation of these measures and suggests that enhanced wildlife management, case-based strategies, and surveillance systems will facilitate disease control.

[Opportunities and challenges in accurate early diagnosis and treatment of lung cancer/pulmonary nodules].

Lung cancer remains the most prevalent and lethal malignancy in our country. Early diagnosis and treatment are crucial for improving patient prognosis in lung cancer/pulmonary nodules. Recent advancements in non-invasive/minimally invasive liquid biopsy, multi-omics, and artificial intelligence technologies have significantly enhanced the accuracy of early lung cancer/pulmonary nodule diagnosis. However, an early diagnostic method with both high sensitivity and specificity is yet to be established. Furthermore, addressing the methods and extent of early precision surgery, local precision therapy, perioperative combined treatment, and postoperative recurrence and metastasis monitoring are urgent challenges in the early management of lung cancer/pulmonary nodules. Integrating the advantages of various treatment strategies and formulating personalized and precise treatment plans is key to further improving patient survival. In the future, while exploring new therapeutic strategies, it is necessary to continuously search for biomarkers to identify the population that will benefit from the treatment effectively. Additionally, large-sample randomized controlled clinical studies should be conducted to investigate the benefits of long-term patient survival under a diverse range of treatment strategies.

[The therapeutic effect and prognostic value of oligoclonal bands after autologous stem cell transplant in patients with multiple myeloma].

Objective: To investigate the therapeutic effect and prognostic value of oligoclonal bands (OB) in multiple myeloma (MM) patients after autologous stem cell transplant (ASCT). Methods: The data of 156 patients with MM who underwent ASCT after inductive treatment in the Department of Hematology, Jiangsu Provincial People's Hospital from December 2013 to February 2022 were retrospectively analyzed, including 91 males and 65 females. The median age was 56 (26, 71) years. Patients were divided into two groups according to OB formation after ASCT treatment, including OB group (n=60) and non-OB group (n=96). The last follow-up date was August 31, 2023, and the follow-up period was 42 (18, 117) months. The clinical baseline characteristics and efficacy of the two groups were compared. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups by Kaplan-Meier method. Cox risk regression modal was used to analyze the risk factors associated with prognosis. Results: There were no significant differences in age, type, stage, risk stratification, extramedullary disease (EMD), proportion of circulating plasma cells and induction therapy regimen between OB and non-OB groups (all P>0.05). The proportion of patients in OB group who achieved complete response (CR) or above after ASCT treatment was 93.3% (56/60), which was higher than that in non-OB group (80.2%, 77/96) (P=0.024). The negative rate of minimal residual disease (MRD) in OB group was 66.7% (40/60), which was higher than that in non-OB group (34.4%, 33/96) (P=0.001). The median PFS and OS in the OB group were not reached, and the median PFS and OS in the non-OB group were 28 (2, 80) months and 86 (2, 100) months, respectively. The PFS (P<0.001) and OS (P=0.017) of patients with OB were considerably longer. In the Cox multivariate analysis, OB was an independent prognostic factor for PFS in MM patients (HR=0.314, 95%CI: 0.153-0.644, P=0.002). Subgroup analysis showed that among high-risk patients with mSMART, the OS of patients in OB group was not reached, which was significantly better than that of non-OB group [71 (2, 90) months, P=0.046]. However, no significant difference was observed in the OS of patients with OB and those with non-OB in standard risk group (not reached vs not reached, P=0.103). In those with EMD at diagnosis, patients with OB had significantly better OS than those with non-OB [not reached vs 47 (6, 74) months, P=0.037]. However, no significant difference was observed in the OS of patients with OB and those with non-OB in those without EMD at diagnosis [not reached vs 86 (2, 100) months, P=0.130]. Conclusions: OB formation after ASCT treatment in MM patients is related to the efficacy and prognosis. OB formation can increase the negative MRD rate, prolong the OS and improve the prognosis, especially for newly diagnosed patients with extramedullary disease or patients with high-risk genetic characteristics.

[The characteristics and impact on prognosis of cytopenia after anti-BCMA-CAR-T therapy in patients with relapsed and refractory multiple myeloma].

Objective: To investigate the characteristics of cytopenia and its impact on prognosis in patients with relapsed and refractory multiple myeloma (RRMM) after B-cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) immunotherapy therapy. Methods: Clinical data of 36 RRMM patients received BCMA CAR-T therapy at the First Affiliated Hospital of Nanjing Medical University from April 2017 to March 2023 were retrospectively collected. Among them, there were 17 males and 19 females, with an age [M (Q1, Q3)] of 62 (53, 67) years. The follow-up deadline was August 31, 2023, and the follow-up time [M (Q1, Q3)] was 33 (10, 30) months. The characteristics of cytopenia at different time points before lymphodepleting chemotherapy and after CAR-T cell infusion in all patients were analyzed. Kaplan-Meier method was used to compare the differences in progression-free survival (PFS) and overall survival (OS) in patients with different clinical characteristics. Single-cell sequencing analysis was used to analyze the changes in hematopoietic stem cells in three patients after CAR-T cell therapy. Results: The incidence of cytopenia after BCMA CAR-T cell therapy in 36 RRMM patients reached 100%. The incidence of neutropenia peaked on the 7th and 28th day after cell infusion with a biphasic pattern of change.Patients with all grade neutropenia reached 61.1% (22/36) and grade 3 or higher reached 33.3% (12/36) on the 7th day, while patients with all grade neutropenia reached 67.9% (19/28) and grade 3 or higher reached 28.6% (8/28) on the 28th day (P<0.001),respectively. The occurrence rate of lymphopenia reached a peak on the day of CAR-T cell infusion [97.2% (35/36) patients showed lymphopenia, while 80.6% (29/36) patients showed grade 3 or higher lymphopenia] (P<0.001).The incidence of all grade of thrombocytopenia and severe thrombocytopenia (grade 3 or higher) peaked on the 14th day after cell infusion, with the rates of 69.4% (25/36) and 30.6% (11/36) respectively, which had a prolonged duration(P<0.001). Even after 12 months, 40% (8/20) of patients still experienced thrombocytopenia.The incidence of anemia peaked on the 7th and 14th day after cell infusion, with a rate of 100% (36/36) (P<0.001). 50% (10/20) of patients still had anemia even 12 months after cell infusion. Kaplan-Meier survival analysis showed that patients with thrombocytopenia < grade 3 had undefined OS, while patients with thrombocytopenia ≥grade 3 had shorter OS [17 (95%CI: 2-32) months, χ2=4.154, P=0.042], indicating a poorer prognosis. However, there was no statistically significant difference in the relationship between other cytopenia and survival (all P>0.05). Single-cell sequencing analysis of bone marrow cells revealed decreased proliferation, increased apoptosis, and cell cycle arrest of hematopoietic stem cells after CAR-T cell infusion. Conclusions: All patients experienced varying degrees of cytopenia after receiving BCMA CAR-T cell infusion, and patients with thrombocytopenia ≥grade 3 had shorter OS and poorer prognosis.

[The prognosis and related factors impacting renal response in newly diagnosed multiple myeloma patients with renal impairment].

Objective: To investigate the prognosis and related factors impacting renal response in newly diagnosed multiple myeloma (NDMM) patients with renal impairment. Methods: A total of 375 NDMM patients diagnosed at the Department of Hematology, the First Affiliated Hospital of Nanjing Medical University from August 2012 to April 2022 were retrospectively recruited. Patients were categorized into non-renal impairment group(n=273) and renal impairment group (n=102) according to renal function at initial diagnosis. All patients received≥2 cycles of bortezomib-based induction chemotherapy after admission. The hematological response included stringent complete response (sCR), complete response (CR), very good partial response (VGPR), partial response (PR) and stable disease (SD). The renal responses were defined as CR, PR, minor response (MR) and non-response (NR). General clinical data of the patients were collected, and patients were followed up by telephone. The follow-up deadline was December 3, 2022, and the median follow-up time [M (Q1, Q3)] was 42 (22, 61) months. Kaplan-Meier analysis was used to plot the survival curve. The log-rank test was utilized for inter-group comparisons. Multivariate logistic regression modeling facilitated the exploration of associated factors impacting renal response. Results: In the renal impairment group, there were 68 males and 34 females with a median age [M (Q1, Q3)] of 64 (58, 69) years. In the non-renal impairment group, there were 149 males and 124 females with a median age of 62 (54, 68) years. Compared with the renal impairment group, the age, lactate dehydrogenase and 24-hour urinary protein quantity were increased, the proportion of patients with light chain M protein and the proportion of patients at the DS-Ⅲ stage, ISS-Ⅲ stage and R-ISS-Ⅲ stage were higher, the hemoglobin level and the proportion of patients receiving autologous hematopoietic stem cell transplantation were lower in the renal impairment group (all P<0.05). In 102 patients with renal impairment, renal responses of CR, PR, MR and NR were obtained in 53 (52.0%), 8 (7.9%), 18 (17.6%), 23 (22.5%) patients, respectively, and the overall response rate was 77.5% (79/102). Kaplan-Meier survival curve revealed that the median progression-free survival (PFS) was 24.0 (95%CI: 18.3-29.7) months in the renal impairment group, which was shorter than 31.0 (95%CI: 24.7-37.3) months in the non-renal impairment group (P=0.003). The median overall survival (OS) was 46.0 (95%CI: 36.5-55.5) months in the renal impairment group, which was shorter than 79.0 (95%CI: 59.9-98.1) months in the non-renal impairment group (P=0.002). Among the renal impairment group, patients with renal response of less than PR exhibited a median PFS of 19.0 (95%CI: 9.7-28.3) months, which was shorter than 28.0 (95%CI: 21.4-34.5) months for those achieving PR or better (P=0.048). The median OS was 31.0 (95%CI: 23.5-38.5) months in renal response with less than PR group, which was also worse than 57.0 (95%CI: 42.8-71.2) months for those who achieved PR or better (P=0.003). The results of multivariate logistic regression showed that hematological response achieving VGPR or better was a factor associated with renal response achieving PR (OR=4.20, 95%CI: 1.20-14.68, P=0.025). Conclusions: The prognosis of NDMM patients with renal impairment is poor. The hematological response with VGPR or better is related to the renal response achieving PR.

[Prognostic value of skeletal muscle measured by CT at the T4 level in advanced EGFR-positive non-small cell lung cancer patients treated with ecotinib].

Objective: To investigate the prognostic value of skeletal muscle measured by CT at the level of the fourth thoracic vertebra (T4) in advanced epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC) patients treated with ecotinib. Methods: The study retrospectively reviewed clinical and pathological characteristics of 176 patients with advanced EGFR-positive NSCLC who received ecotinib and underwent chest CT scans at Wuhan Union Hospital between January 2017 and October 2020. Among them, 70 were male and 106 were female, with ages ranging from 27 to 80 (58.6±10.6) years. As of August 21, 2021, the median follow-up duration was 19.2 months (95%CI: 15.3 to 23.7 months). The optimal cut-off value of skeletal muscle density (T4-SMD) on CT images at the T4 level were determined using X-tile software. Kaplan-Meier analysis and log-rank test were used to plot progression-free survival curves. Cox proportional hazards regression models were employed to analyze factors influencing 1-year progression-free survival (PFS), and a nomogram prognostic model was constructed accordingly. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were utilized to evaluate the predictive value of the nomogram. Results: The T4-SMD [M (Q1,Q3)] of 176 patients was 42.56 (37.05, 45.93) HU. Patients were divided into low T4-SMD group (n=122) and high T4-SMD group (n=54) based on the cut-off value (The values for males and females were 49.44 and 41.41 HU, respectively) of T4-SMD. The median PFS time and 1-year PFS rate in the low T4-SMD group were significantly lower than those in the high T4-SMD group [10.4 (95%CI: 9.3-11.8) vs 13.7 (95%CI: 11.1-18.5) months, 36.1% vs 59.3%, respectively, P=0.034]. Eastern Cooperative Oncology Group performance status (HR=3.308, 95%CI: 1.183-9.247, P=0.023), lactate dehydrogenase level (HR=1.852, 95%CI: 1.037-3.307, P=0.037), systemic immune-inflammation index (HR=1.772, 95%CI: 1.019-3.080, P=0.043), and T4-SMD (HR=0.563, 95%CI: 0.325-0.974, P=0.040) were prognostic factors for 1-year PFS in advanced EGFR-positive NSCLC patients treated with ecotinib. A nomogram for predicting 1-year PFS of advanced EGFR-positive NSCLC patients treated with ecotinib was constructed based on the four indicators selected by multivariate Cox regression analysis. The area under the ROC curve of the nomogram was 0.775 (95%CI: 0.676-0.874). The calibration curve showed good consistency between the predicted and actual 1-year PFS. DCA demonstrated good clinical prediction effectiveness of the nomogram. Conclusion: Low T4-SMD is a prognostic risk factor for patients with advanced EGFR-positive NSCLC receiving icotinib therapy.

[Value of surgery combined chemotherapy and radiation therapy in locally advanced neuroendocrine carcinoma of the cervix: a single-center retrospective cohort study].

Objective: To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) . Methods: This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24); χ2=1.296, P=0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24); χ2=0.001, P=0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24); χ2=0.113, P=0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference (χ2=0.080, P=0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences (P=0.287, P=0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9%; P=0.138) and 5-year OS rate (36.1% vs 38.8%; P=0.217). Conclusions: Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.

Trans-arterial embolization versus chemoembolization for neuroendocrine liver metastases: a propensity matched analysis.

INTRODUCTION: Locoregional therapies are a mainstay of treatment for patients with neuroendocrine liver metastases (NELM), yet the optimal transarterial approach remains undefined and recent studies have raised concern over the safety of transarterial chemoembolization (TACE). METHODS: Patients with NELM who underwent TACE or transarterial embolization (TAE) at a single institution between 2000-2022 were retrospectively reviewed. Propensity score matching (PSM) controlling for age, sex, bilateral disease, tumor size, lobar embolization, grade, and extrahepatic disease was utilized to compare short- and long-term outcomes. RESULTS: Among 412 patients with NELM, 329 underwent TACE and 83 TAE. Mean age was 60.7 ± 11.1 years. Patients primarily presented with synchronous (69.2%), bilateral (84.2%), and G1 disease (48.8%) and underwent staged procedures (55.8%). Following PSM, TACE was associated with slightly worse post-procedure laboratory values, but no difference in complications compared to TAE (23.3%vs29.3%, p = 0.247). TACE was associated with improved mean PFS (21.8vs10.7 months, p = 0.002), but no difference in radiographic size, chromogranin level, or median overall survival (50.0 months vs not met, p = 0.833). CONCLUSION: Among patients with NELM, TACE was associated with similar short-term outcomes and improved PFS, but no difference in OS compared to TAE. These findings highlight the need for additional research on the optimal locoregional therapy for NELM.

[Bronchoscopic intervention therapy for pulmonary mucormycosis with main bronchial occlusion: a case report].

Pulmonary mucormycosis is one of the most common types of mucormycosis. Tracheobronchial pulmonary mucormycosis primarily affects the tracheobronchial tree, causing lesions that can invade the airway mucosa and muscular layer, damaging the cartilage. It is characterised by acute onset, rapid progression, and high mortality rate, making clinical treatment challenging. This article reports the diagnosis and treatment of a patient with pulmonary mucormycosis complicated by left main bronchus occlusion. In addition to systemic treatment, which consisted mainly of an intravenous injection of amphotericin B combined with an oral suspension of posaconazole, the patient underwent multiple bronchoscopic interventions, including local infusion of amphotericin B under endoscopy, balloon dilation and silicone stent placement. After four months of comprehensive treatment, the therapeutic effect was satisfactory. This report demonstrates that bronchoscopic intervention therapy plays an important role in the comprehensive treatment of pulmonary mucormycosis, especially in preventing death from the progression to obstructive pneumonia.

[UGT1A1 gene mutation spectrum with indirect hyperbilirubinemia in children].

Objective: To explore the relevancy between the uridine diphosphate-glucuronylgly-cosyltransferase 1A1 (UGT1A1) gene mutation and the phenotype of indirect hyperbilirubinemia in children. Methods: Sixteen cases with indirect hyperbilirubinemia who visited the Department of Gastroenterology, Children's Hospital of Nanjing Medical University from July 2013 to November 2019 were retrospectively analyzed and were divided into Gilbert syndrome (GS), Crigler-Najjar syndrome type II (CNS-II), and indirect hyperbilirubinemia groups unexplained by UGT1A1 gene mutations. The differences in gene mutation site information and general clinical data were compared. The association between gene mutation spectrum and bilirubin level was explored by t-test analysis. Results: Ten of the sixteen cases with indirect hyperbilirubinemia had GS, three had CNS-II, and three had indirect hyperbilirubinemia unexplained by UGT1A1 gene mutations. A total of six mutation types were detected, of which c.211G > A accounted for 37.5% (6/16), c.1456T > G accounted for 62.5% (10/16), and TATA accounted for 37.5% (6/16), respectively. Compared with the GS group, the CNS group had early disease onset incidence, high serum total bilirubin (t = 5.539, P < 0.05), and indirect bilirubin (t = 5.312, P < 0.05). However, there was no significant difference in direct bilirubin levels (t = 1.223, P > 0.05) and age of onset (t = 0.3611, P > 0.05) between the two groups. There was no significant correlation between the number of UGT1A1 gene mutations and serum bilirubin levels. Children with c.1456T > G homozygous mutations had the highest serum bilirubin levels. Conclusion: The common pathogenic variants of the UGT1A1 gene sequence are c.1456T > G, c.211G > A, and TATA, indicating that these site mutations are related to the occurrence of indirect hyperbilirubinemia and have important guiding significance for the etiological analysis of indirect hyperbilirubinemia in children.

[Innovation and development of surgical techniques for pancreatic tumors].

In recent years, great progress has been made in the diagnosis and treatment of pancreatic tumors. In terms of diagnosis, three-dimensional CT reconstruction, PET-CT scan, endoscopic ultrasound with needle biopsy are used to evaluate the benign or malignant stage and biological characteristics of the tumor, to make treatment decisions more scientific and reasonable. In terms of treatment, new technologies, such as arterial priority arterial sheath dissection and radical resection of the retroperitoneal lipo-lymphatic layer, have continuously emerged to improve radical curability of tumors. For benign or low-grade malignant pancreatic tumors, function-preserving surgery is adopted to avoid long-term complications. Minimally invasive pancreatic surgery has advanced in leaps and bounds. Both standard radical surgery and function-preserve surgery can be performed under a laparoscope or robot. Non-surgical treatment has developed quickly with each passing day; for locally advanced or metastatic pancreatic cancer, neoadjuvant therapy is expected to be down-staged or transformed into surgery. These advances in diagnosis and treatment technology have led to multidisciplinary teamwork. Based on accurate assessment, giving full play to the advantages of laparoscopic and robotic systems in diagnosis and treatment, attaching importance to comprehensive nonsurgical treatment and doctor-patient communication with care throughout the process, these are keys to improve the clinical efficacy of pancreatic tumors in the era of minimally invasive surgery.

[Explore the safety and efficiency of mild myopia retention in patients with myopia and presbyopia].

Objective: To explore the corrective effects of a personalized corneal refractive surgery design that retains mild myopia in patients over 40 years old with refractive errors and presbyopia. Methods: A retrospective case series study was conducted, including 60 patients (120 eyes) over 40 years old who underwent corneal refractive surgery at Peking Union Medical College Hospital l from January 2023 to December 2023. The patients were divided into two groups based on their preference: Group A (retained mild myopia) and Group B (fully corrected), with 30 patients (60 eyes) in each group. Preoperative and postoperative visual acuity, subjective refraction, slit-lamp examination, corneal topography, and intraocular pressure were assessed at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. The effectiveness and safety indices were calculated based on visual acuity before and after surgery. The National Eye Institute Refractive Quality of Life questionnaire was used to evaluate patient satisfaction and postoperative visual symptoms. Results: There were no significant differences in preoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), corneal thickness, and intraocular pressure between the two groups (all P>0.05). At the final follow-up, the proportions of eyes with UDVA≥0.8 and≥1.0 were 93.3% (56/60) and 60.0% (36/60) in Group A, and 100% (60/60) and 83.3% (50/60) in Group B, respectively. The SE was significantly different between Group A [(-0.35±0.52) D] and Group B [(-0.07±0.55) D] (P<0.05). Near visual acuity was better in Group A than in Group B (P<0.05). The effectiveness indices were 0.96±0.23 and 0.99±0.12, and the safety indices were 1.02±0.11 and 1.02±0.07 for Groups A and B, respectively. Both groups had high overall satisfaction, but Group A had higher scores for near vision, reading, and computer screen viewing. Conclusion: The personalized corneal refractive surgery design that retains mild myopia provides good corrective effects for patients over 40 years old with refractive errors, improving patient satisfaction and quality of life.

Aluminum Alkyl Induced Isomerization of Group†IV meso Metallocene Complexes.

The synthesis of group IV metallocene precatalysts for the polymerization of propylene generally yields two different isomers: The racemic isomer that produces isotactic polypropylene (iPP) and the meso isomer that produces atactic polypropylene (aPP). Due to its poor physical properties, aPP has very limited applications. To avoid obtaining blends of both polymers and thus diminish the mechanical and thermal properties of iPP, the meso metallocene complexes need to be separated from the racemic ones tediously-rendering the metallocene-based polymerization of propylene industrially far less attractive than the Ziegler/Natta process. To overcome this issue, we established an isomerization protocol to convert meso metallocene complexes into their racemic counterparts. This protocol increased the yield of iPP by 400 % while maintaining the polymer's excellent physical properties and was applicable to both hafnocene and zirconocene complexes, as well as different precatalyst activation methods. Through targeted variation of the ligand frameworks, methoxy groups at the indenyl moieties were found to be the structural motifs responsible for an isomerization to take place-this experimental evidence was confirmed by density functional theory calculations. Liquid injection field desorption ionization mass spectrometry, as well as 1H and 29Si nuclear magnetic resonance studies, allowed the proposal of an isomerization mechanism.