Ultrasound-Based Deep Learning Radiomics Nomogram for the Assessment of Lymphovascular Invasion in Invasive Breast Cancer: A Multicenter Study.

RATIONALE AND OBJECTIVES: The aim of this study was to develop a deep learning radiomics nomogram (DLRN) based on B-mode ultrasound (BMUS) and color doppler flow imaging (CDFI) images for preoperative assessment of lymphovascular invasion (LVI) status in invasive breast cancer (IBC). MATERIALS AND METHODS: In this multicenter, retrospective study, 832 pathologically confirmed IBC patients were recruited from eight hospitals. The samples were divided into training, internal test, and external test sets. Deep learning and handcrafted radiomics features reflecting tumor phenotypes on BMUS and CDFI images were extracted. The BMUS score and CDFI score were calculated after radiomics feature selection. Subsequently, a DLRN was developed based on the scores and independent clinic-ultrasonic risk variables. The performance of the DLRN was evaluated for calibration, discrimination, and clinical usefulness. RESULTS: The DLRN predicted the LVI with accuracy, achieving an area under the receiver operating characteristic curve of 0.93 (95% CI 0.90-0.95), 0.91 (95% CI 0.87-0.95), and 0.91 (95% CI 0.86-0.94) in the training, internal test, and external test sets, respectively, with good calibration. The DLRN demonstrated superior performance compared to the clinical model and single scores across all three sets (p < 0.05). Decision curve analysis and clinical impact curve confirmed the clinical utility of the model. Furthermore, significant enhancements in net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indicated that the two scores could serve as highly valuable biomarkers for assessing LVI. CONCLUSION: The DLRN exhibited strong predictive value for LVI in IBC, providing valuable information for individualized treatment decisions.

Evaluating the effectiveness and cost-effectiveness of free influenza vaccination policy for older adults in Yinzhou, China: Study protocol of a real-world analyses.

BACKGROUND: Influenza causes excessive morbidity and mortality among older adults. While influenza vaccine provides protection against its infection, the vaccination coverage in China among older adults has been very low. Previous evidence on the cost-effectiveness of government-sponsored free influenza vaccination programs in China was primarily based on literature data, which might not always reflect real-world patient populations. The Yinzhou Health Information System (YHIS) is a regional database that captures electronic health records, insurance claims data, etc. for all residents in Yinzhou district, Zhejiang province, China. We will use YHIS to study the effectiveness, influenza-related direct medical cost and cost-effectiveness analysis (CEA) of the free influenza vaccination program for older adults. In this paper, we describe the study design and innovations in detail. METHODS: We will establish a retrospective cohort of permanent older residents aged 65 and over, using YHIS between 2016 and 2021. We will estimate the vaccine coverage rate, influenza incidence rate and influenza-related direct medical cost from 2016 to 2021. Regression discontinuity will be used to estimate vaccine effectiveness for the 2020/2021 season. We will build a decision tree model to compare the cost-effectiveness of three influenza vaccination options (free trivalent influenza vaccine, free quadrivalent influenza vaccine, and no policy) from both societal and health system perspectives. Parameter inputs will be gathered from both YHIS and published literature. We will calculate the incremental cost-effectiveness ratio with cost and quality-adjusted life years (QALYs) discounted at 5 % annually. DISCUSSION: Our CEA solidifies multiple sources including regional real-world data and literature for a rigorous evaluation of the government-sponsored free influenza vaccination program. The results will provide real-world evidence from real-world data on the cost-effectiveness of a real-world policy. Our findings are expected to support evidence-based policy making and to promote health for older adults.

Assessment of Real-World Patient-Reported Outcomes in Patients Initiating Biologic Agents for the Treatment of Autoimmune Diseases: An Observational Study in Four Patient-Powered Research Networks.

Background: The most reliable and meaningful approach for inclusion of patient-reported outcomes (PROs) in the evaluation of real-world clinical effectiveness of biologics in the treatment of autoimmune diseases is u ncertain. This study aimed to assess and compare the proportions of patients who had abnormalities in PROs measuring important general health domains at the initiation of treatment with biologics, as well as the effects of baseline abnormalities on subsequent improvement. Methods: PROs were collected for patient participants with inflammatory arthritis, inflammatory bowel disease, and vasculitis using Patient-Reported Outcomes Measurement Information System instruments. Scores were reported as T-scores normalized to the general population in the United States. Baseline PROs scores were collected near the time of biologic initiation, and follow-up scores were collected 3 to 8 months later. In addition to summary statistics, the proportion of patients with PROs abnormalities (scores ≥5 units worse than the population norm) was determined. Baseline and follow-up scores were compared, and an improvement of ≥5 units was considered significant. Results: There was wide variation across autoimmune diseases in baseline PROs scores for all domains. For example, the proportion of participants with abnormal baseline pain interference scores ranged from 52% to 93%. When restricted to participants with baseline PROs abnormalities, the proportion of participants experiencing an improvement of ≥5 units was substantially higher. Conclusion: As expected, many patients experienced improvement in PROs following initiation of treatment with biologics for autoimmune diseases. Nevertheless, a substantial proportion of participants did not exhibit abnormalities in all PROs domains at baseline, and these participants appear less likely to experience improvement. For PROs to be reliably and meaningfully included in the evaluation of real-world medication effectiveness, more knowledge and careful consideration are needed to select the most appropriate patient populations and subgroups for inclusion and evaluation in studies measuring change in PROs.

Assessment of the properties of aging biochar used as a substrate in constructed wetlands.

Biochar has gained global recognition as an effective tool for environmental remediation, and is increasingly being used as an alternative substrate in constructed wetlands (CWs). While, most studies have focused on the positive effects of biochar for the pollutant removal in CWs, less is known about aging and longevity of the embedded biochar. This study investigated the aging and stability of biochar embedded in CWs post-treating the effluent of a municipal and an industrial wastewater treatment plant. Litter bags containing biochar were inserted into two aerated horizontal subsurface flow CWs (350 m2 each), and retrieved on several dates (8-775 days after burial) for assessment of weight loss/gain and changes in biochar characteristics. Additionally, a 525-day laboratory incubation test was conducted to analyze biochar mineralization. The results showed that there was no significant biochar weight loss over time, but a slight increase in weight (2.3-3.0%) was observed at the end, likely due to mineral sorption. Biochar pH remained stable except for a sudden drop at the beginning (8.6-8.1), while the electrical conductivity continued to increase (96-256 µS cm-1) throughout the experiment. The sorption capacity of the aged biochar for methylene blue significantly increased (1.0-1.7 mg g-1), and a change in the biochar's elemental composition was also noted, with O-content increasing by 13-61% and C content decreasing by 4-7%. Despite these changes, the biochar remained stable according to the criteria of the European Biochar Foundation and International Biochar Initiative. The incubation test also showed negligible biochar mass loss (<0.02%), further validating the stability of the biochar. This study provides important insights into the evolution of biochar characteristics in CWs.

Deep vein thrombosis and validation of the Caprini risk assessment model in Chinese orthopaedic trauma patients: a multi-center retrospective cohort study enrolling 34,893 patients.

BACKGROUND: The risk of venous thromboembolism among orthopaedic trauma patients is high, but prevalence of deep vein thrombosis (DVT) remains unknown. In addition, the Caprini risk assessment model (RAM) score in orthopaedic trauma patients is undetermined in previous research. This study is aimed to determine the incidence of DVT and then validate the Caprini RAM in orthopaedic trauma patients. METHODS: This is a retrospective cohort study enrolling orthopaedic trauma inpatients from seven tertiary and secondary hospitals during a 3-year period (from April 1, 2018 through April 30, 2021). Caprini RAM scores were assessed by experienced nurses on admission. The patients with suspected DVT were verified through duplex ultrasonography by qualified radiologists, and then prospectively followed once a year after discharge. RESULTS: In total, 34,893 patients were enrolled in our study. The Caprini RAM identified 45.7% of patients at low risk (Caprini score 0-2), 25.9% at medium risk (3-4), and 28.3% at high risk (5-6), highest risk (7-8), and superhigh risk (> 8). Patients with Caprini score > 5 were likely to be older, female, and with longer length of hospital stay. Moreover, 8695 patients had received ultrasonography to detect DVT. The prevalence of DVT was determined to be 19.0% [95% confidence interval (CI) 18.2-19.9%], which significantly increased with Caprini score. The area under curve of the Caprini RAM for DVT was 0.77 (95% CI 0.76-0.78) with a threshold of 4.5. Furthermore, 6108 patients who had received ultrasonography completed the follow-up. DVT patients had a hazard ratio of 1.75 (95% CI 1.11-2.76; P = 0.005) in the mortality, compared to non-DVT ones. Caprini scores were significantly associated with increase in the mortality [odds ratio (OR) 1.14; 95% CI 1.07-1.21; P < 0.001]; DVT remained an independent effect (OR 1.5; 95% CI 1.02-2.26; P = 0.042). CONCLUSIONS: The Caprini RAM may be valid in Chinese orthopaedic trauma patients. Prevalence of DVT and higher Caprini score were significantly associated with increased all-cause mortality among orthopaedic trauma patients after discharge. Further study is warranted to explore the causes of higher mortality in patients with DVT.

Protocol for in vivo and ex vivo assessment of hyperglycemia and islet function in diabetic mice.

Mouse hyperglycemia model and islet function assessment are essential in diabetes research. Here, we provide a protocol to evaluate glucose homeostasis and islet functions in diabetic mice and isolated islets. We describe steps for establishing type 1 and 2 diabetes, glucose tolerance test, insulin tolerance test, glucose stimulated insulin secretion (GSIS) assay, and histological analysis for islet number and insulin expression in vivo. We then detail islet isolation, islet GSIS, ß-cell proliferation, apoptosis, and programming assays ex vivo. For complete details on the use and execution of this protocol, please refer to Zhang et al. (2022).1.

Lighting environmental assessment in enclosed spaces based on emotional model.

Lighting assessment in special operating environments like enclosed spaces is of great research significance and value. In addition to investigating the visual ergonomics of workers, the emotional monitoring and guidance of workers in enclosed spaces is also a research focus. Based on the Circumplex emotion model theory, this paper designs an experiment to assess emotions in an enclosed space with 6 different lighting settings (2 correlated color temperature (CCT) × 3 illuminance levels). From the perspective of subjective assessment, participants used a rapid sensory analysis method (Check-all-that-apply, CATA) and a Subjective Coordinate Scale (SCS) method for rapid ambience perception checking and emotional self-reporting of lighting settings. From the perspective of objective evaluation, the participants' facial expressions were recorded during the experiment using a camera, and then the recorded facial expressions were automatically analyzed and predicted using FaceReader (FRE) software. The CATA and SCS showed similar results, with the 3100 K × 600 lx, 3100 K × 1000 lx and 6500 K × 600 lx lighting settings creating a relaxed, pleasant emotion in participants, the 6500 K × 1000 lx setting creating an excited, tense atmosphere, and the low illumination level settings of 3100 K × 250 lx and 6500 K × 250 lx made participants feel tired and frustrated. The results of the objective emotion analysis indicate that the FRE was able to effectively identify differences in participants' emotions in response to different lighting settings and was consistent with the results of participants' subjective emotion reports. This laboratory study validates that the three methods can effectively assess the enclosed space lighting settings, and provides a reference for further research on the enclosed space lighting settings and emotional monitoring of workers in the future.

Stability Analysis for Delayed Neural Networks via a Generalized Reciprocally Convex Inequality.

This article deals with the stability of neural networks (NNs) with time-varying delay. First, a generalized reciprocally convex inequality (RCI) is presented, providing a tight bound for reciprocally convex combinations. This inequality includes some existing ones as special case. Second, in order to cater for the use of the generalized RCI, a novel Lyapunov-Krasovskii functional (LKF) is constructed, which includes a generalized delay-product term. Third, based on the generalized RCI and the novel LKF, several stability criteria for the delayed NNs under study are put forward. Finally, two numerical examples are given to illustrate the effectiveness and advantages of the proposed stability criteria.

Nucleotide Evolution, Domestication Selection, and Genetic Relationships of Chloroplast Genomes in the Economically Important Crop Genus Gossypium.

Gossypium hirsutum (upland cotton) is one of the most economically important crops worldwide, which has experienced the long terms of evolution and domestication process from wild species to cultivated accessions. However, nucleotide evolution, domestication selection, and the genetic relationship of cotton species remain largely to be studied. In this study, we used chloroplast genome sequences to determine the evolutionary rate, domestication selection, and genetic relationships of 72 cotton genotypes (36 cultivated cotton accessions, seven semi-wild races of G. hirsutum, and 29 wild species). Evolutionary analysis showed that the cultivated tetraploid cotton genotypes clustered into a single clade, which also formed a larger lineage with the semi-wild races. Substitution rate analysis demonstrated that the rates of nucleotide substitution and indel variation were higher for the wild species than the semi-wild and cultivated tetraploid lineages. Selection pressure analysis showed that the wild species might have experienced greater selection pressure, whereas the cultivated cotton genotypes underwent artificial and domestication selection. Population clustering analysis indicated that the cultivated cotton accessions and semi-wild races have existed the obviously genetic differentiation. The nucleotide diversity was higher in the semi-wild races compared with the cultivated genotypes. In addition, genetic introgression and gene flow occurred between the cultivated tetraploid cotton and semi-wild genotypes, but mainly via historical rather than contemporary gene flow. These results provide novel molecular mechanisms insights into the evolution and domestication of economically important crop cotton species.

[Effects of economic fruit forest planting on the stability of red soil aggregates in the subtropical hilly area]. / 亚热带丘岗区经果林种植对红壤团聚体稳定性的影响.

The stability of aggregates is of great significance to evaluate water and soil environment in regions plan-ting economic fruit forest. We explored the effects of economic fruit forest types on the structure and stability of soil aggregates in the 0-50 cm soil layer from 5-year-old Amygdalus persica, Pyrus sorotina, Citrus reticulata, Camellia oleifera and Actinidia chinensis forests in the hilly area in northern Hunan. The content, distribution characteristics and stability indices of soil aggregates from each economic fruit forest were quantitatively analyzed by the Shavinov method. The results showed that most soil aggregates were mechanically stable, with a minimum content of 92.3%. After wet sieving, the size of water-stable aggregates in the soil from Camellia oleifera forest was mainly >2 mm, accounting for 55.9% of the total aggregates. The 0.25-2 mm aggregates were the dominant particles in the A. persica, P. sorotina, C. reticulata and A. chinensis forest soils, with contributions higher than 43.6%. The mean weight diameter (MWD) and the geometric mean diameter (GMD) of soil aggregates for the five economic fruit forest types ranged from 1.10 to 3.19 mm and 0.61 to 2.28 mm, respectively. Furthermore, the percentages of soil aggregate destruction (PAD) and fractal dimension (D) were in the range of 2.9%-37.3% and 2.30-2.68, respectively. With the increases of soil depth, the stability of soil aggregates from A. persica, C. oleifera and A. chinensis forest soils became worse; MWD and GMD decreased by 1.7%-57.7% and 4.5%-65.8%, respectively; PAD and D increased by 0.4%-17.3% and 1.6%-11.1%, respectively. The effects of economic fruit forest types on the stability of soil aggregates decreased with increasing soil depth. Based on the stability indices, aggregate stability from five economic fruit forests followed the order of C. oleifera > A. chinensis > P. sorotina > C. reticulata > A. persica. The type of economic fruit forest improved the stability of soil structure mainly by affecting the content of large-size aggregates. In terms of improving the distribution and stability of soil aggregates, it was suggested that C. oleifera should be given the top priority as the economic fruit forest in the subtropical hilly area, followed by A. chinensis. Whereas A. persica planting might reduce the degree of soil agglomeration, thus, the protective measures of soil loss should be considered during planting. Our results could provide theoretical basis and application guidance for the development, utilization, and ecological management of economic fruit forests in subtropical hilly areas.

Event-Triggered Output Feedback Synchronization of Master-Slave Neural Networks Under Deception Attacks.

The problem of event-triggered synchronization of master-slave neural networks is investigated in this article. It is assumed that both communication channels from the sensor to controller and from controller to actuator are subject to stochastic deception attacks modeled by two independent Markov processes. Two discrete event-triggered mechanisms are introduced for both channels to reduce the number of data transmission through the communication channels. To comply with practical point of view, static output feedback is utilized. By employing the Lyapunov-Krasovskii functional method, some sufficient conditions on the synchronization of master-slave neural networks are derived in terms of linear matrix inequalities, which make it easy to design suitable output feedback controllers. Finally, a numerical example is presented to show the effectiveness of the proposed method.

Patients With Pouchitis Demonstrate a Significant Cost Burden in the First Two Years After Ileal Pouch-Anal Anastomosis.

Pouchitis, the most common long-term complication after colectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), can lead to increased health care costs and diminished quality of life.1 In this study, we aimed to compare the total costs among patients diagnosed with pouchitis in the first 2 years after an IPAA with those among patients who were not diagnosed with pouchitis, using a large administrative claims database. Additionally, we aimed to investigate the specific drivers of cost among patients with an IPAA during the 2-year study period, including inpatient hospitalizations, emergency department visits, and pharmacy-related costs.

Relieving the water-energy nexus pressure through whole supply chain management: Evidence from the provincial-level analysis in China.

Water-energy nexus (WEN) is an international hot-spot issue, while more attentions have been paid to the direct nexus effect resulting from production activities. In this context, this study firstly used the multiregional input-output (MRIO) analysis to offer a full spectrum of water and energy usage throughout the whole supply chain in China, considering production-based perspective and betweenness-based and consumption-based perspectives. And then the principal components analysis (PCA) was applied to further target the critical WEN sectors in Chinese's 30 provinces. The results show that: (1) For most of these provinces, the direct WEN pressure caused by production activities can be found in several traditional resource-intensive sectors, especially in S22 (Production and supply of electric power and steam) and S14 (Smelting and pressing of metals). (2) The most critical transmission sectors with WEN pressure was S12 (Manufacture of chemicals and chemical products), followed by S14 in most of these province. S22 was the key transmission center in several provinces, and S7 (Manufacture of textile) in Fujian and Hubei and S10 (Papermaking and printing) in Zhejiang and Hainan should also be highly-concerned. (3) For all of these provinces, the indirect WEN pressure driven by final consumption appeared in S24 (Construction industry). In addition, S16 (Manufacture of general and special-purpose machinery) and S17 (Manufacture of Transport equipment) were the other two key consumption-based WEN sectors in some provinces. Overall, the WEN pressures in Jiangsu were relatively great in China, and S12 in Hubei was the only sector facing great WEN pressure from all three perspectives. Our results can draw implications for regional sustainable development in China.

Risks of Development of COVID-19 Among Patients With Inflammatory Bowel Disease: A Comparative Assessment of Risk Factors for Incident Infection.

Background: Patients with inflammatory bowel disease (IBD) may be at risk for development of COVID-19 infection due to innate immune dysfunction and/or immunosuppressive medication use. Methods: In a prospective cohort of adult IBD patients, we captured data on clinical risk factors and IBD medication utilization. The outcome of interest was development of patient-reported laboratory confirmed COVID-19. We calculated incidence rate and performed bivariate analyses to describe the effects of risk factors (age, immunosuppression use, obesity, and race) on development of COVID-19. We utilized logistic regression models to determine the independent risks associated with each factor. Results: A total of 3953 patients with IBD were followed for a mean duration of 212 days (SD 157). A total of 103 individuals developed COVID-19 during follow-up (2.6%, rate of 45 per 1000 person-years). Severity of infection was generally mild. Clinical characteristics were similar among those who developed COVID-19 as compared to not. African American race was associated with incident COVID-19 infection (OR 3.37, 95% CI 1.18-9.59). Immunosuppression use was not associated with development of COVID-19 (OR 1.19, 95% CI 0.72-1.75), nor was age (OR 1.00, 95% CI 0.99-1.02), nor obesity (OR 1.01, 95% CI 0.61-1.66). Conclusions: Immunosuppression use did not increase the risk of development of COVID-19. Therapeutic management of IBD should not be altered to prevent a risk of developing COVID-19.

Trajectories of the Transition Readiness Assessment Questionnaire Among Youth With Inflammatory Bowel Disease.

OBJECTIVE: The objective of this study was to describe in detail the trends of the Transition Readiness Assessment Questionnaire (TRAQ-20) with respect to patient age and gender among a cohort of 655 youth with inflammatory bowel disease (IBD) to enhance the tool's utility in clinical and research settings. MATERIALS AND METHODS: All participants in the Crohn's and Colitis Foundation's IBD Partners and IBD Partners Kids and Teens Cohorts ages 12 to 21 who completed the TRAQ-20 at least once were included. We computed centile scores for the TRAQ-20 and applied Kernel regression to generate curves. We computed mean scores for each TRAQ-20 domain by age for the overall cohort and stratified by gender. RESULTS: TRAQ-20 scores generally increase with age. Males have a steeper trajectory from ages 17 to 19 compared with females. By age 21, median overall TRAQ-20 scores for women and men were 4.4 and 4.7, respectively. The "Talking with Providers" domain of the TRAQ-20 had high scores throughout the age range of the cohort, while others had lower scores in younger ages and higher scores in older ages. All TRAQ-20 domains had mean scores of 4 or greater (out of a possible 5) among 21-year-olds. CONCLUSIONS: TRAQ-20 scores increase with age. The rate of increase varies by gender. Rates of increase also differ across domains. The use of transition readiness growth curves can help providers and researchers identify patients who are not achieving expected levels of transition readiness and determine the level of transition readiness that a patient much achieve before transfer to adult care.

Utility of Advanced DWI in the Detection of Spinal Cord Microstructural Alterations and Assessment of Neurologic Function in Cervical Spondylotic Myelopathy Patients.

BACKGROUND: Diffusion-weighted imaging (DWI) can quantify the microstructural changes in the spinal cord. It might be a substitute for T2 increased signal intensity (ISI) for cervical spondylotic myelopathy (CSM) evaluation and prognosis. PURPOSE: The purpose of the study is to investigate the relationship between DWI metrics and neurologic function of patients with CSM. STUDY TYPE: Retrospective. POPULATION: Forty-eight patients with CSM (18.8% females) and 36 healthy controls (HCs, 25.0% females). FIELD STRENGTH/SEQUENCE: 3 T; spin-echo echo-planar imaging-DWI; turbo spin-echo T1/T2; multi-echo gradient echo T2*. ASSESSMENT: For patients, conventional MRI indicators (presence and grades of T2 ISI), DWI indicators (neurite orientation dispersion and density imaging [NODDI]-derived isotropic volume fraction [ISOVF], intracellular volume fraction, and orientation dispersion index [ODI], diffusion tensor imaging [DTI]-derived fractional anisotropy [FA] and mean diffusivity [MD], and diffusion kurtosis imaging [DKI]-derived FA, MD, and mean kurtosis), clinical conditions, and modified Japanese Orthopaedic Association (mJOA) were recorded before the surgery. Neurologic function improvement was measured by the 3-month follow-up recovery rate (RR). For HCs, DWI, and mJOA were measured as baseline comparison. STATISTICAL TESTS: Continuous (categorical) variables were compared between patients and HCs using Student's t-tests or Mann-Whitney U tests (chi-square or Fisher exact tests). The relationships between DWI metrics/conventional MRI findings, and the pre-operative mJOA/RR were assessed using correlation and multivariate analysis. P < 0.05 was considered statistically significant. RESULTS: Among patients, grades of T2 ISI were not correlated with pre-surgical mJOA/RR (P = 0.717  and 0.175, respectively). NODDI ODI correlated with pre-operative mJOA (r = -0.31). DTI FA, DKI FA, and NODDI ISOVF were correlated with the recovery rate (r = 0.31, 0.41, and -0.34, respectively). In multivariate analysis, NODDI ODI (DTI FA, DKI FA, NODDI ISOVF) significantly contributed to the pre-operative mJOA (RR) after adjusting for age. DATA CONCLUSION: DTI FA, DKI FA, and NODDI ISOVF are predictors for prognosis in patients with CSM. NODDI ODI can be used to evaluate CSM severity. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 5.

Assessment of the Ovarian Reserve by Serum Anti-Müllerian Hormone in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The ovarian reserve has been reported to be diminished in patients with rheumatoid arthritis. However, these results are still controversial. Anti-Müllerian hormone (AMH) is considered a reliable biomarker for the ovarian reserve. We thus performed a meta-analysis to evaluate the AMH levels and the effect of DMARDs on the ovarian reserve in rheumatoid arthritis patients. METHODS: PubMed, EMBASE, the Cochrane Library, and 2 Chinese databases (CNKI and Wanfang database), up to September 2021, were searched for relevant studies. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the included studies. Pooled standard mean difference (SMD) with 95% confidence intervals (CIs) were determined with the random-effects model. The heterogeneity was described by I2 statistic and p value from the Cochrane Q test. RESULTS: Eight eligible studies (679 patients and 1,460 controls) were included in the meta-analysis. Compared with healthy control, the AMH levels in RA patients were significantly lower with the pooled SMD of -0.40 (95% CI: -0.66 to -0.14). However, in comparison of AMH with and without DMARD treatment, there was no significant difference with the pooled SMD of -0.1 (95% CI: -0.39 to 0.19). CONCLUSION: The results indicated that there was an increased risk of ovarian failure in RA patients and which is not related to DMARD treatment.

Assessment of anti-PD-(L)1 for patients with coexisting malignant tumor and tuberculosis classified by active, latent, and obsolete stage.

BACKGROUND: It is not a rare clinical scenario to have patients presenting with coexisting malignant tumor and tuberculosis. Whether it is feasible to conduct programmed death-(ligand) 1 [PD-(L)1] inhibitors to these patients, especially those with active tuberculosis treated with concurrent anti-tuberculosis, is still unknown. METHODS: This study enrolled patients with coexisting malignancy and tuberculosis and treated with anti-PD-(L)1 from Jan 2018 to July 2021 in 2 institutions. The progression-free survival (PFS), objective response rate (ORR), and safety of anti-PD-(L)1 therapy, as well as response to anti-tuberculosis treatment, were evaluated. RESULTS: A total of 98 patients were screened from this cohort study, with 45 (45.9%), 21 (21.4%), and 32 (32.7%) patients diagnosed with active, latent, and obsolete tuberculosis, respectively. The overall ORR was 36.0% for anti-PD-(L)1 therapy, with 34.2%, 35.5%, and 41.2% for each subgroup. Median PFS was 8.0 vs 6.0 vs 6.0 months (P=0.685) for each subgroup at the time of this analysis. For patients with active tuberculosis treated with concurrent anti-tuberculosis, median duration of anti-tuberculosis therapy was 10.0 (95% CI, 8.01-11.99) months. There were 83.3% (20/24) and 93.3% (42/45) patients showing sputum conversion and radiographic response, respectively, after anti-tuberculosis therapy, and two patients experienced tuberculosis relapse. Notably, none of the patients in latent and only one patient in obsolete subgroups showed tuberculosis induction or relapse after anti-PD-(L)1 therapy. Treatment-related adverse events (TRAEs) occurred in 33 patients (73.3%) when treated with concurrent anti-PD-(L)1 and anti-tuberculosis. Grade 3 or higher TRAEs were hematotoxicity (n = 5, 11.1%), and one patient suffered grade 3 pneumonitis leading to the discontinuation of immunotherapy. CONCLUSIONS: This study demonstrated that patients with coexisting malignant tumor and tuberculosis benefited equally from anti-PD-(L)1 therapy, and anti-tuberculosis response was unimpaired for those with active tuberculosis. Notably, the combination of anti-PD-(L)1 and anti-tuberculosis therapy was well-tolerated without significant unexpected toxic effects.

Assessment of potential, cost, and environmental benefits of CCS-EWR technology for coal-fired power plants in Yellow River Basin of China.

As an effective emission reduction approach, CO2 capture and storage (CCS) combined with enhanced water recovery (EWR) technology can not only reduce CO2 emissions, but can also recover deep saline water resources to relieve pressure on regional water resources, and can ensure the energy supply and both social and economic development. However, the environmental benefits and application costs of CCS-EWR are uncertain, and are determined by the technology level, geological conditions, and other physical factors. In this study, an optimal source-sink matching model and a techno-economic assessment model were developed to evaluate the contributions of CCS-EWR to carbon emission reduction and the increase of the water supply by considering various uncertain factors, as well as the corresponding costs. In addition, the Yellow River Basin (YRB) in China was selected as the research region because, while there are abundant coal-fired power plants (CFPPs) in the YRB, the water resources are scarce. The results revealed the following. (1) The maximum CO2 capture capacity of the 236 CFPPs in the YRB is about 738.77 Mt/a, and nearly 13.14 Gt of fresh water could be provided until the 236 CFPPs in the YRB retire, which can partially relieve the pressure on the supply of water resources. (2) With the consideration of the CCS-EWR benefits, the average cost of the 236 CFPPs in the YRB in their residual lifetime to reduce their CO2 emissions by 90% will be no more than 180 CNY/t. (3) The incentive effect of the increase of the industrial water price on the profits of CCS-EWR projects is not significant. CCS-EWR technology has better application prospects in China under the dual constraints of carbon-neutral targets and water shortages, and more policy support is required for its deployment.

Redistribution of Intracellular Metabolic Flow in E. coli Improves Carbon Atom Economy for High-Yield 2,5-Dimethylpyrazine Production.

2,5-Dimethylpyrazine (2,5-DMP) is an important pharmaceutical intermediate and an important essence. Conventional chemical synthesis methods are often accompanied by toxic substances as by-products, and the biosynthesis efficiency of 2,5-DMP is insufficient for industrial applications. In this study, the tdh and soaao genes were overexpressed to enhance enzymatic and nonenzymatic reactions in metabolic pathways, and kbl was knocked out to block competitive branching carbon flow metabolic pathways. Finally, a genetically engineered Escherichia coli strain with the highest carbon recovery rate (30.18%) and the highest yield reported to date was successfully constructed, and 9.21 g·L-1 threonine was able to produce 1682 mg·L-1 2,5-DMP after 24 h. At the same time, an expression regulation strategy and whole-cell biocatalysis helped to eliminate the damage to cells caused by 2,5-DMP, aminoacetone, and reactive oxygen species generated by aminoacetone oxidase from S. oligofermentans, and the negative effect of 2-amino-3-ketobutyrate CoA ligase on the yield of 2,5-DMP in E. coli was also demonstrated.