Real-world effectiveness of a new powered stapling system with gripping surface technology on the intraoperative clinical and economic outcomes of gastrectomy for gastric cancer.

BACKGROUND: Surgical staplers have been widely used to facilitate surgeries, and this study aimed to examine the real-world effectiveness of a new powered stapling system with Gripping Surface Technology (GST) on intraoperative outcomes of gastrectomy for gastric cancer. METHOD: The data were extracted from the Fourth Hospital of Hebei Medical University's (FHHMU) medical records system. Participants (N = 121 patients) were classified into the GST (n = 59) or non-GST group (n = 62), based on the use of the GST system. The intraoperative outcomes such as bleeding were assessed by reviewing video records. T-tests, Chi-square tests, and Mann-Whitney-U tests were used to compare the baseline characteristics between groups. Multivariate logistic regression was conducted for adjusting outcomes to study the effect of variables. RESULTS: Compared with the non-GST group, the GST group had significantly lower risks for intraoperative bleeding, intraoperative anastomosis intervention rate, intraoperative suture, and intraoperative pression (aORs: 0.0853 (p < 0.0001), 0.076 (p = 0.0003), 0.167 (p = 0.0012), and 0.221 (p = 0.0107), respectively). The GST group also consumed one fewer cartridge than the non-GST group (GST:5 vs non-GST: 6, p = 0.0241). CONCLUSION: The use of the GST system was associated with better intraoperative outcomes and lower cartridge consumption in Chinese real-world settings.

Novel multileaf collimator designs with tongues and grooves in leaf end and Monte Carlo simulations.

In this study, we proposed 2 new multileaf collimator leaf designs to eliminate leaf gaps for closed leaf pairs so that radiation leakage can be avoided. In the new designs, multi tongues and grooves were added to the conventional multileaf collimators leaf ends. Thus, when a pair of leaves closed, tongues of a leaf can enter grooves of its opposing leaf. Consequently, there would be no radiation leakage through closed leaves. One design was named finger-shaped MLC, and another design with doubled leaf end thickness was named hand-shaped MLC. Monte Carlo simulations were performed to simulate dosimetric characteristics of the new MLC designs and comparison to conventional MLCs was performed. The simulations show that for the closed field, the new designs reduce leakage dramatically. And for the open field, the finger-shaped MLC has a larger penumbra width than conventional MLC, while the penumbra for the hand-shaped MLC is comparable to that of conventional MLC. With the application of new MLC designs, it is expected to eliminate leaf gaps for MLC usage and protect normal tissues better.

Automating General Movements Assessment with quantitative deep learning to facilitate early screening of cerebral palsy.

The Prechtl General Movements Assessment (GMA) is increasingly recognized for its role in evaluating the integrity of the developing nervous system and predicting motor dysfunctions, particularly in conditions such as cerebral palsy (CP). However, the necessity for highly trained professionals has hindered the adoption of GMA as an early screening tool in some countries. In this study, we propose a deep learning-based motor assessment model (MAM) that combines infant videos and basic characteristics, with the aim of automating GMA at the fidgety movements (FMs) stage. MAM demonstrates strong performance, achieving an Area Under the Curve (AUC) of 0.967 during external validation. Importantly, it adheres closely to the principles of GMA and exhibits robust interpretability, as it can accurately identify FMs within videos, showing substantial agreement with expert assessments. Leveraging the predicted FMs frequency, a quantitative GMA method is introduced, which achieves an AUC of 0.956 and enhances the diagnostic accuracy of GMA beginners by 11.0%. The development of MAM holds the potential to significantly streamline early CP screening and revolutionize the field of video-based quantitative medical diagnostics.

Toxicological Assessment of Higher Olefins in OECD TG 422 Repeated Dose and Reproductive /Developmental Toxicity Screening Tests in Han Wistar Rats.

Higher olefins (HO) are used primarily as intermediates in the production of other chemicals, such as polymers, fatty acids, plasticizer alcohols, surfactants, lubricants, amine oxides, and detergent alcohols. The potential toxicity of five HO (i.e., 1-Octene, Nonene, Decene, Hexadecene, and 1-Octadecene) with carbon ranging from C8 to C18 was examined in a combined repeated dose and reproduction/developmental toxicity screening study (OECD TG 422). These five HO were administered to Han Wistar rats by gavage at 0 (controls), 100, 300, and 1000 mg/kg bw/day. As a group of substances, adaptive changes in the liver (liver weight increase without pathological evidence), as well as increased kidney weight in male rats, were observed in HO with carbon numbers from C8 to C10. The overall systemic no observed adverse effect level (NOAEL) for all HO was determined at 1000 mg/kg bw/day. In the reproductive/developmental toxicity assessment, offspring viability, size, and weights were reduced in litters from females treated with Nonene at 1000 mg/kg bw/day. The overall no observed effects level (NOEL) for reproductive toxicity was considered to be 300 mg/kg bw/day for Nonene and 1000 mg/kg bw/day for the other four HO, respectively. These data significantly enrich the database on the toxicity of linear and branched HO, allowing comparison with similar data published on a range of linear and branched HO. Comparisons between structural class and study outcome provide further supportive data in order to validate the read-across hypothesis as part of an overall holistic testing strategy.

Risk assessment for postoperative venous thromboembolism using the modified Caprini risk assessment model in lung cancer.

Background: Postoperative venous thromboembolism (VTE) is a well-documented cause of morbidity and mortality in lung cancer patients. However, risk identification remains limited. In this study, we sought to analyze the risk factors for VTE and verify the predictive value of the modified Caprini risk assessment model (RAM). Methods: This prospective single-center study included patients with resectable lung cancer who underwent resection between October 2019 and March 2021. The incidence of VTE was estimated. Logistic regression was used to analyze the risk factors for VTE. Receiver operating characteristic (ROC) curve analysis was performed to test the ability of the modified Caprini RAM to predict VTE. Results: The VTE incidence was 10.5%. Several variables, including age, D-dimer, hemoglobin (Hb), bleeding, and patient confinement to bed were significantly associated with VTE after surgery. The difference between the VTE and non-VTE groups in the high-risk levels was statistically significant (P<0.001), while the low and moderate risk levels showed no significant difference. The combined use of the modified Caprini score and the Hb and D-dimer levels showed an area under the curve (AUC) was 0.822 [95% confidence interval (CI): 0.760-0.855. P<0.001]. Conclusions: The risk-stratification approach of the modified Caprini RAM is not particularly valid after lung resection in our population. The use of the modified Caprini RAM combined with Hb and D-dimer levels shows a good diagnostic performance for VTE prediction in patients with lung cancer undergoing resection.

Dietary sources apportionment and health risk assessment for trace elements among residents of the Tethys-Himalayan tectonic domain in Tibet, China.

Dietary intake of toxic elements (TEs) and essential trace elements (ETEs) can significantly impact human health. This study collected 302 samples, including 78 food, 104 drinking water, 73 cultivated topsoil, and 47 sedimentary rock from a typical area of Tethys-Himalaya tectonic domain. These samples were used to calculate the average daily dose of oral intake (ADDoral) and assess the health risks of five TEs and five ETEs. The results indicate that grain and meat are the primary dietary sources of TEs and ETEs for local residents. The intake of manganese (Mn) and copper (Cu) is mainly from local highland barley (66.90% and 60.32%, respectively), iron (Fe) is primarily from local grains (75.51%), and zinc (Zn) is mainly from local yak meat (60.03%). The ADDoral of arsenic (As), Mn, Fe and Zn were found to be higher than the maximum oral reference dose in all townships of study area, indicating non-carcinogenic health risks for local residents. Additionally, lead (Pb) and nickel (Ni) in 36.36% townships, and Cu in 81.82% townships were above the maximum oral reference dose, while As posed a carcinogenic risk throughout the study area. The concentrations of As, mercury (Hg), Pb, Mn, Cu Fe and selenium (Se) in grains were significantly correlated with those in soils. Moreover, the average concentrations of As in Proterozoic, Triassic, Jurassic and Cretaceous was 43.09, 12.41, 15.86 and 6.22 times higher than those in the South Tibet shell, respectively. The high concentrations of TEs and ETEs in the stratum can lead to their enrichment in soils, which, in turn, can result in excessive intake by local residents through the food chain and biogeochemical cycles . To avoid the occurrence of some diseases caused by dietary intake, it is necessary to consume a variety of exotic foods, such as high-selenium foods, foreign rice and flour in order to improve the dietary structure.

The non-invasive echocardiographic assessment of right ventricular myocardial work in a healthy population.

BACKGROUND: Non-invasive right ventricular (RV) myocardial work (RVMW) is the latest indicator used to assess RV function. Nevertheless, the physiological determinants of RVMW have not been studied, and reference ranges for normal RVMW indices have yet to be established. METHODS: A total of 263 healthy volunteers (median age: 34 years, males: 38%) were prospectively enrolled. RVMW indices were analysed by an RV pressure-strain loop (RVPSL) in specific software. RESULTS: The lowest values of the RVMW indices in males and females were 133 mmHg% and 206 mmHg% for RV global work index (RVGWI), 165 mmHg% and 241 mmHg% for RV global constructive work (RVGCW) and 78% and 83% for RV global work efficiency (RVGWE), respectively. The highest values for RV global wasted work (RVGWW) in males and females were 67 mmHg% and 69 mmHg%, respectively. RVGWI and RVGCW were significantly lower in males than those in females. RVGWW significantly increased with age in males and females. RVGWE significantly decreased with age in females. Multivariable analysis revealed that RVGWI, RVGCW and RVGWE increased as pulmonary artery systolic pressure (PASP) increased. CONCLUSIONS: Normal reference values of non-invasive RVMW were obtained by echocardiography. Quantitative data on RVMW could be essential in clinical work and clinical experiments.

Assessment of delivered dose in prostate cancer patients treated with ultra-hypofractionated radiotherapy on 1.5-Tesla MR-Linac.

Objective: To quantitatively characterize the dosimetric effects of long on-couch time in prostate cancer patients treated with adaptive ultra-hypofractionated radiotherapy (UHF-RT) on 1.5-Tesla magnetic resonance (MR)-linac. Materials and methods: Seventeen patients consecutively treated with UHF-RT on a 1.5-T MR-linac were recruited. A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate. We collected data for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan. Results: Overall, 290 MR scans were collected (85 pre-MR, 85 PV-MR, 49 Bn-MR and 71 post-MR scans). With a median on-couch time of 49 minutes, the mean planning target volume (PTV)-V95% of all scans was 97.83 ± 0.13%. The corresponding mean clinical target volume (CTV)-V100% was 99.93 ± 0.30%, 99.32 ± 1.20%, 98.59 ± 1.84%, and 98.69 ± 1.85%. With excellent prostate-V100% dose coverage, the main reason for lower CTV-V100% was slight underdosing of seminal vesicles (SVs). The median V29 Gy change in the rectal wall was -1% (-20%-17%). The V29 Gy of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow. Conclusions: This 3D-MR-based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period with adaptive ATS workflow on 1.5-T MR-linac, albeit with a relatively long on-couch time. The 3-mm CTV-PTV margin was adequate for prostate irradiation but occasionally insufficient for SVs. More attention should be paid to restricting high-dose RT to the rectal wall when optimizing the ATS plan.

Dynamic assessment of the tricuspid annulus in a healthy Asian population: A four-dimensional echocardiography study.

BACKGROUND: Tricuspid annulus (TA) geometry and function reference values are limited, especially for Asian populations. We aimed to explore TA using four-dimensional echocardiography (4DE) in a healthy Asian population. METHODS: A total of 355 healthy Asian volunteers (median age 34 years; 52% males) were prospectively enrolled. TA geometry and function were analyzed using 4DE throughout the cardiac cycle. RESULTS: The TA area, perimeter, and dimensions were smallest at end systole (ES) and largest at late diastole (LD). Normal TA parameters at end diastole (ED) in different sex and age groups were obtained. TA areas, perimeters, and dimensions in males were significantly larger than those in females at ED; BSA-indexed perimeters and BSA-indexed dimensions in males were significantly smaller than those in females at ED. TA parameters correlated well with tricuspid valve (TV) tenting, right ventricle (RV), and right atrium (RA) parameters. CONCLUSIONS: Reference values of TA parameters were obtained by 4DE in an Asian population. Quantitative data on TA geometry and function are essential for TA pathology and therapeutics.

Acceptable risk assessment and management of environmental pollution emergency events base on distance model.

Existing environmental management regulations and assessment methods can help understand and relieve pollution problems greatly affecting the natural world. However, what is lacking is awareness and targeted recommendations for environmental pollution emergency events (EPEEs). Here we analyzed a total of 2164 EPEEs in China from 2000 to 2021 in terms of annual variations, spatial distributions, phases of regional development, and pollution sources. The findings showed that regional economies can have significant impacts on the occurrence of EPEEs. Regarding the four causes of pollution, the contribution from industrial sources was above 80 %, especially water pollution events, for which it accounted for 84 %. The probability of pollution events specifically relates to regional GDP and it was highest in those provinces with the highest GDP rankings, albeit there were marked differences in the industrial structure. In order to better manage EPEEs, an Environment-Emergency Distance Model (EEDM) is proposed. This model uses the Multidimensional psychological distance to quantitatively evaluate the acceptable public risk level after the occurrence of EPEEs. This method provides a basis for pollution prevention and remediation by visualizing the risk acceptable for the public and provides guidance for sustainable environmental development.

Community public health safety emergency management and nursing insurance service optimization for digital healthy urban environment construction.

The purpose of this paper is to promote the construction of digital healthy cities and improve the living standards of urban residents. Based on this, this paper analyzes the development of healthy cities, and studies community public health safety emergency management and nursing insurance service optimization methods for healthy urban environment construction. First, the concept of digital healthy urban environment construction is discussed. Then, the role of environmental health is discussed. Finally, two methods are designed to study the emergency management of public health safety and nursing insurance services in urban communities under the condition of environmental health. The results show that in the environmental health score of the city, the scores of X1 (the urban air quality excellent rate) and X6 (citizens' satisfaction with the environmental quality) were relatively low between 2016 and 2018, below 0.5 points. The scores for the remaining 3 years were relatively high, above 0.5. The scores of X2 (green coverage rate of built-up area), X3 (average grade sound effect of environmental noise in urban area), X4 (harmless treatment rate of domestic waste) and X5 (centralized treatment rate of domestic sewage) were relatively high from 2016 to 2018, above 0.5 points, and relatively low in the remaining 3 years, below 0.5 points. Meanwhile, residents are very satisfied with information collection and information management in public health and safety emergency management, and the number of very satisfied people is basically more than 40%. Satisfaction with resource allocation and privacy management is high, and the number of very satisfied people is basically above 30%. However, the satisfaction with risk perception and management measures is very low, and the number of very satisfied people is basically below 20%. It shows that the current construction of the community's public health and safety emergency management system is relatively poor in terms of X2-X5, while the development of X1 and X6 is relatively mature. The research not only provides a reference for the construction and improvement of a digital healthy city, but also contributes to the improvement of the healthy life of urban residents.

The Relationship Between Enterprise Financial Risk and R&D Investment Under the Influence of the COVID-19.

The COVID-19 pandemic has dealt a considerable blow to the development of Chinese enterprises. Therefore, exploring how to reduce the enterprise financial risk under the impact of the COVID-19 has become a current research hotspot. We select the data of 3,098 A-share companies in the quarters of 2019 and 2020, use the Z-score model to reasonably evaluate enterprise financial risk, and analyze the impact of Research and Development (R&D) investment on enterprise financial risk under the COVID-19.The results show that: ① The COVID-19 pandemic has increased the number of high-risk enterprises. ② R&D investment can effectively reduce the enterprise financial risk, and enterprises that attach importance to scientific research are relatively less affected by the COVID-19. ③ Compared with non-state-owned enterprises, R&D investment under state-owned enterprises can better help enterprises reduce financial risk. ④ When the enterprise financial risk is lower, the role of R&D investment in reducing financial risk is more significant. With the increase of financial risk, the effect of R&D investment on it is weakened. The research results are beneficial to help enterprises to correctly assess their financial risks during the COVID-19, so that enterprises can reasonably invest in research and development, and ultimately ensure the sustainable development of enterprises under the COVID-19.

Assessment of the Intestinal Absorption of Higher Olefins by the Everted Gut Sac Model in Combination with In Silico New Approach Methodologies.

To reduce the number of animals and studies needed to fulfill the information requirements as required by Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) (EC no. 1907/2006), a read-across approach was used to support approximately 30 higher olefins. This study aimed to assess the absorption potential of higher olefins through the gut wall as the experimentally determined bioavailability which would strengthen the read-across hypothesis and justification, reducing the need for toxicity studies on all of the higher olefins. The absorption potential of a series of higher olefins (carbon range from 6 to 28, with five configurations of the double bond) was determined in the in vitro everted rat small intestinal sac model and subsequently ranked. In addition, in silico approaches were applied to predict the reactivity, lipophilicity, and permeability of higher olefins. In the in vitro model, everted sacs were incubated in "fed-state simulated small intestinal fluid" saturated with individual higher olefins. The sac contents were then collected, extracted, and analyzed for olefin content using gas chromatography with a flame ionization detector. The C6 to C10 molecules were readily absorbed into the intestinal sacs. Marked inter-compound differences were observed, with the amount of absorption generally decreasing with the increase in carbon number. Higher olefins with ≥C14 carbons were either not absorbed or very poorly absorbed. In the reactivity simulation study, the reactivity is well described by the position of the double bond rather than the number of carbon atoms. In the lipophilicity and permeability analysis, both parameter descriptors depend mainly on the number of carbon atoms and less on the position of the double bond. In conclusion, these new approach methodologies provide supporting information on any trends or breakpoints in intestinal uptake and a hazard matrix based on carbon number and position of the double bond. This matrix will further assist in the selection of substances for inclusion in the mammalian toxicity testing programme.

Quantitative assessment of retinal vessel density and thickness changes in internal carotid artery stenosis patients using optical coherence tomography angiography.

OBJECTIVE: To quantitatively assess the retinal features of patients with different degrees of internal carotid artery stenosis (ICAS), particularly mild ICAS patients, utilizing optical coherence tomography angiography (OCTA). METHODS: Thirty-two mild ICAS patients (mild ICAS group), 34 moderate to severe ICAS patients (nonmild ICAS group), and 40 controls were enrolled in this study. Retinal vessel density was quantitatively measured by OCTA, including radial peripapillary capillary vessel density (RPC-VD), superficial and deep capillary plexus vessel density (SCP/DCP-VD). Structural parameters were collected from optical coherence tomography (OCT), including retinal thickness and subfoveal choroidal thickness (SFCT). Furthermore, LASSO-penalized logistic regression was used to construct the diagnostic model based on retinal parameters. ROC curves and nomogram plots were used to assess the diagnostic ability of this model for ICAS. RESULTS: The macular SCP-VD of mild ICAS patients was significantly lower than that of controls and lower than that of nonmild ICAS patients (all p < 0.05). However, there was no difference among the three groups in terms of DCP-VD (p > 0.05). RPC-VD could effectively discriminate between the mild ICAS group and the nonmild ICAS group (p = 0.005). For structural OCT, only the SFCT decreased as the ICAS degree increased (p < 0.05). Diagnostic scores based on retinal parameters showed a strong diagnostic capability for mild ICAS (AUC = 0.8656). CONCLUSION: Mild ICAS patients exhibited distinct retinal features compared to nonmild ICAS patients and control subjects. OCTA potentially represents a promising method for the early detection of ICAS patients and the noninvasive surveillance of haemodynamic changes in those patients.

The Impact of Digital Economy on the Economic Growth and the Development Strategies in the post-COVID-19 Era: Evidence From Countries Along the "Belt and Road".

The digital economy is considered as an effective measure to mitigate the negative economic impact of the Corona Virus Disease 2019 (COVID-19) epidemic. However, few studies evaluated the role of digital economy on the economic growth of countries along the "Belt and Road" and the impact of COVID-19 on their digital industries. This study constructed a comprehensive evaluation index system and applied a panel data regression model to empirically analyze the impact of digital economy on the economic growth of countries along the "Belt and Road" before COVID-19. Then, a Global Trade Analysis Project (GTAP) model was used to examine the impact of COVID-19 on their digital industries and trade pattern. Our results show that although there is an obvious regional imbalance in the digital economy development in countries along the "Belt and Road", the digital economy has a significantly positive effect on their economic growth. The main impact mechanism is through promoting industrial structure upgrading, the total employment and restructuring of employment. Furthermore, COVID-19 has generally boosted the demand for the digital industries, and the impact from the demand side is much larger than that from the supply side. Specifically, the digital industries in Armenia, Israel, Latvia and Estonia have shown great growth potential during the epidemic. On the contrast, COVID-19 has brought adverse impacts to the digital industries in Ukraine, Egypt, Turkey, and the Philippines. The development strategies are proposed to bridge the "digital divide" of countries along the "Belt and Road," and to strengthen the driving effect of the digital economy on industrial upgrading, employment and trade in the post-COVID-19 era.

The Effect of Big Data-Based Digital Payments on Household Healthcare Expenditure.

Whether families using big data-based digital payments will increase household healthcare expenditure is a subject that needs to be investigated in the era of big data. Based on the data from China Family Panel Studies (CFPS), 24,126 samples from 2014 to 2018 are used to examine the impact and mechanism of big data-based digital payments on household healthcare expenditure. The empirical results of this paper show that the use of digital payments by households can significantly increase household healthcare expenditure with the empowerment of big data. This research employs the instrumental variable method to verify and produce consistent estimation results in order to address potential endogeneity issues such as measurement error and missing variables. We learn via mechanism analysis that household adoption of big data-driven digital payments can remove credit limitations and build social capital, resulting in higher household health-care spending. We also perform a heterogeneity analysis. The findings reveal that when a family's traditional financial accessibility is high, the head of the household is young or middle-aged, and the head of the household has a higher level of education, digital payment will play a larger role in encouraging household healthcare expenditure. The conclusions of this paper are still solid after changing the indicators of household healthcare expenditure substituting the indicators of digital payment, and adjusting the variables. As a result, this article provides micro-evidence for the usage of digital payments by households to enhance healthcare spending. JEL Classification: D12 G21 O30 O53 I12.

Impact of financial inclusion and globalization on environmental quality: evidence from G20 economies.

Sustainable development and addressing climate change are among the most pressing issues faced by countries around the world. This research investigates the dynamic associations between financial inclusion, globalization and CO2 emissions of G20 nations from 2005 to 2018, considering the effects of industrial structure, corruption, green energy utilization and economic growth as control variables. In this study, both financial inclusion and globalization index were measured using principal component analysis (PCA). This study examines long-term associations using cross-sectional augmented autoregressive distributed lag (CS-ARDL) technique that offers more accurate outcomes. In addition, the VECM Granger causality method was applied to find causal relationships between study variables. Findings show that in financial inclusion, globalization has positive significant effect on carbon emissions. Moreover, corruption and economic have positive impact on carbon emissions, and renewable energy shows negative impact on environmental quality. The findings of this research are critical for achieving sustainable development and pollution control goals. Governments need to work to bring into line the financial inclusion goals with renewable energy consumption habits and environmental strategies.

Assessment of Carbon Nanoparticle Suspension Lymphography-Guided Distal Gastrectomy for Gastric Cancer.

Importance: Carbon nanoparticle suspension injection (CNSI) can be used to visualize lymph node (LN) drainage in gastric cancer. The tracing and diagnostic value of carbon nanoparticle suspension lymphography-guided distal gastrectomy for gastric cancer has not been thoroughly reported. Objective: To compare the number of lymph nodes identified in patients with gastric cancer receiving a CNSI vs no injection. Design, Setting, and Participants: This is a retrospective cohort study including patients with clinical T1 to T4 disease who underwent laparoscopic or robotic distal gastrectomy. Data from a cohort of 1225 patients at the Fourth Hospital of Hebei Medical University (Shijiazhuang, China) from November 2019 to February 2021 were analyzed. Patients were divided into the CNSI group and conventional group after 1:1 propensity matching analysis. The mean number of LNs detected was compared between groups, and the diagnostic role of CNSI was analyzed in the CNSI group. Statistical analysis was performed from May to July 2021. Exposure: CNSI was peritumorally injected under an endoscope 1 day before surgery in the CNSI group, and the conventional group did not receive any treatment before surgery. Main Outcomes and Measures: The main outcome was the number of LNs detected. Gastrectomy with systematic D1+ (ie, stations 1, 3, 4sb, 4d, 5, 6, and 7) or D2 (ie, all D1 stations, plus 8a, 9, 11p, and 12a) lymphadenectomy was performed. Black-stained LNs and nonblack-stained LNs were examined separately in the CNSI group. Results: A total of 312 consecutive patients (mean [SD] age, 56.7 [10.4] years; 216 [69.2%] men) who underwent distal gastrectomy were enrolled, including 78 patients in the CNSI group, and another 78 patients determined from 1:1 propensity score matching, making an overall cohort size of 156 patients. The mean (SD) number of LNs detected in the CNSI group was 59.6 (21.4), which was significantly higher than that in the conventional group (30.0 [11.3] LNs; P < .001). In the CNSI group, the mean (SD) number of LNs detected at black-stained LN stations was significantly higher than that at nonstained LN stations (9.2 [6.1] LNs per station vs 3.5 [3.2] LNs per station; P < .001). For black-stained LN stations, the sensitivity was 97.8% (95% CI, 91.6%-99.6%), specificity was 38.1% (95% CI, 34.2%-42.3%), positive predictive value was 20.1% (95% CI, 16.6%-24.2%), and negative predictive value was 99.1% (95% CI, 96.4%-99.8%); for the black-stained LNs, sensitivity was 97.6% (95% CI, 95.3%-98.8%), specificity was 35.4% (95% CI, 33.9%-36.8%), positive predictive value was 11.6% (95% CI, 10.5%-12.8%), and negative predictive value was 99.4% (95% CI, 98.8%-99.7%). Conclusions and Relevance: These findings suggest that CNSI was associated with facilitating the dissection of all positive LNs, which could improve surgical quality. Carbon nanoparticle suspension-guided lymphography may be an alternative to conventional systematic lymphadenectomy for distal gastrectomy.

Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta.

BACKGROUND: Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic balloon occlusion of the internal iliac artery (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta. METHODS: A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n = 248) and the control group in which patients did not have PBOIIA (n = 172). Meanwhile, we performed a subgroup analysis in whether taking parallel transverse uterine incision (PTUI) surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected. RESULTS: Median estimated blood loss (mEBL) was 2200 mL in the balloon group and 2150 mL in the control group respectively, there was no significant difference between two-groups comparison (P > 0.05), and the rate of patients with hysterectomy was also has no difference between the two groups (36.3% verus 35.5%, P > 0.05), while there is a significant difference between two groups in the amount of PRBCs transfused [3 (0-31.5) verus 3 (0-39), P <0.05], moreover, the proportion of PRBCS> 8 units in the balloon group is significantly lower than that in control group (11.29% verus 23.26%, P <0.05).. However, the total hospitalization costs (45,624.4 ± 11,061.9 verus 37,523.1 ± 14,662.2, CYN) and surgery costs (19,910.6 ± 2622.6 verus 11,850.5 ± 3146.1, CYN) in balloon group were significantly higher than those in control group (P < 0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL (P >0.05), but it could significantly decrease hysterectomy rates (P <0.05). CONCLUSIONS: PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta. and although it could reduce the intraoperative PRBCs in patients with massive hemorrhage, it significantly increases the financial cost for patients. Therefore, PBOIIA should not be routinely recommended to patients with placenta previa and accreta.

Assessment of the Clinical Trials Safety Profile of PD-1/PD-L1 Inhibitors Among Patients With Cancer: An Updated Systematic Review and Meta-Analysis.

BACKGROUND: Understanding the safety and adverse event profiles of PD-1/PD-L1 inhibitors is important in guiding cancer immunotherapy. Consequently, we designed this meta-analysis to evaluate the safety of PD-1/PD-L1 inhibitors in clinical trials involving cancer patients. METHODS: Four safety indicators comprising treatment-related adverse events, death, discontinuation of therapy and grades 3-5 adverse events were evaluated using the random effect model. The quality of enrolled trials was assessed using the Newcastle Ottawa Scale (NOS). RESULTS: Forty-four clinical trials were included in the final meta-analysis. Compared with chemotherapy, the risk of death due to the use of PD-1/PD-L1 inhibitors was much lower than that experienced in the control group (OR = 0.65, 95%CI: [0.47, 0.91], I2 = 0%, Z = 2.52 (P = 0.01)). Similar observations were apparent regarding the other three indicators of safety and also when the use of PD-1/PD-L1 inhibitors alone is compared with the combined use of PD-1/PD-L1 and CTLA-4. When used together with chemotherapy, PD-1/PD-L1 inhibitors increased the incidence of the adverse events as compared to the use of chemotherapy alone. Increased risks for adverse events were also noticed with the use of PD-1/PD-L1 inhibitors over the use of a placebo. CONCLUSION: The use of PD-1/PD-L1 inhibitors alone is associated with a better safety profile compared to either the use of chemotherapy or the use of PD-1/PD-L1 inhibitors with other anticancer regimens.