A comparative study of two robotic thyroidectomy procedures: transoral vestibular versus bilateral axillary-breast approach.

OBJECTIVE: To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART). METHODS: A total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including age, gender, height, weight, BMI, primary tumor size, number of central lymph node removed, central lymph node metastasis, operating time, total hospital stays, postoperative hospital stays, total postoperative drainage volume, postoperative pain score, cosmetic effect and complications were recorded and analyzed. RESULTS: There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) (P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups (P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case). CONCLUSION: Transoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.

Strengthening mechanism of sub-nano Ni3P and Cu3P phases particles on the Pb-Sn bronze alloy.

The influence of the sub-nano Ni3P and Cu3P phases on the microstructure, mechanical properties, and strengthening mechanism of Cu-20Pb-5Sn-xP (x = 0,0.05,0.1,0.3,0.5) alloy were discussed under the addition of P to obtain a new Pb-Sn bronze alloy applying for bimetallic cylinder block. The results showed that the tensile strength and hardness of the Pb-Sn bronze alloy increase with the P contents, while the elongation increased first and then decreased. The main strengthen mechanism was that sub-nano Ni3P and Cu3P phases dispersed in the matrix, hindering the movement of dislocations during deformation. Additionally, the grain refinement also contributed to the improvement of mechanical properties. The Ni3P phase is easier to form than the Cu3P phase. And it is easier to combine with the matrix and more stable. The Ni3P and Cu3P phases were studied by using different characterization techniques, such as OM, SEM, EDS, XRD, TEM and First-principles, Phase diagram calculation method. When P is added to the alloy, the Ni3P phase first appears in the alloy, and when the P content increases to more than 0.3 wt%, the Cu3P phase begins to appear. This is because the Ni3P phase is easier to form than the Cu3P phase and is more stable. Only after part of P reacts with Ni dissolved in copper to form Ni3P, the remaining P and Cu can form Cu3P.

Nickel carbonate Hydroxide-based Core-Triple-Shelled nanofibers with ultrahigh specific capacity for flexible hybrid supercapacitors.

Designing novel efficient electrode materials with controlled hierarchical structure and composition for advanced supercapacitors remains a great challenge. Herein, a core-triple-shelled hierarchical GCNF/PANI/NCO nanostructure has been designed and fabricated by sequential growth of the conductive polyaniline (PANI) layers and nickel carbonate hydroxide (Ni2(CO3)(OH)2) nanosheets on the graphene-coated electrospun carbon nanofibers (GCNF) via a facile wet-chemical strategy. Taking full advantage of the free-standing architecture of graphene-coated electrospun carbon nanofibers, high conductivity and flexibility of the PANI layers, and abundant active sites of Ni2(CO3)(OH)2 nanosheets, the optimal GCNF/PANI/NCO (2 h) electrode exhibits a high specific capacitance of 1565F g-1 at 1 A/g and enhanced rate capability, which are higher than those of the GCNF, GCNF/PANI, and GCNF/NCO (2 h) electrodes at the same situation, and also exceeds most of the reported nickel carbonate hydroxide-based electrodes in literature. The superior performance should be mainly ascribed to the collaborative contribution of each component. Moreover, a self-assembled GCNF/PANI/NCO//AC hybrid supercapacitor delivers a high energy density of 35.4 Wh kg-1@750 W kg-1 and a long cycle lifespan. This strategy enables the controllable synthesis of core-triple-shelled hierarchical materials applicable to advanced electrochemical applications.

Death associated protein kinase 2 suppresses T-B interactions and GC formation.

Germinal center (GC) formation is a critical step during T-dependent humoral immune responses. We report Death Associated Protein Kinase 2, a serine/threonine kinase, is rapidly induced in T cells following activation and plays an inhibitory role in T cell-mediated help for the GC formation. Specifically, T cells deficient in Dapk2 have an increased ability to physically conjugate with antigen-presenting B cells and to promote GC formation. However, Dapk2 does not regulate T cell receptor signaling strength and does not influence cytokine-driven T-cell subset polarization. Instead, Dapk2 dampens mTORC1 activities by associating with Raptor. Silencing of Raptor rescues defects observed with the Dapk2 insufficiency. Our study thus identifies Dapk2 as a new kinase likely involved in negative regulation of contact-dependent help delivery to B cells and GC formation.

Molecular characterization, pathogenicity, and protection efficacy analysis of 2 wild-type lentogenic class I Newcastle disease viruses from chickens in China.

In this study, 2 wild-type Newcastle disease viruses (NDVs), designated as CK/GX/65/15 and CK/GX/26/15, were isolated from asymptomatic chickens in Guangxi province, China. They were identified as lentogenic NDV with mean death time (MDT) above 90 and intracerebral pathogenicity index (ICPI) below 0.7. The results of complete genome sequence analysis show that the 2 NDV strains are members of class I genotype 3 with the length 15,198 nt, which followed the "rule of six" and the order 3'-NP-P-M-F-HN-L-5'. In addition, 8 amino acid substitutions were identified in the functional domains of fusion protein (F) of CK/GX/65/15 and 9 in CK/GX/26/15, whose amino acid sequences of F protein cleavage site are 112E-R-Q-E-R-L117. The isolates were found to be apathogenic in specific pathogen free (SPF) chickens and ducks without morbidity or mortality. Furthermore, the protection study shows that isolates can provide the same effective protection against a major NDV virulent strain in China (class II genotype VII) as the commercial vaccine LaSota. Moreover, vaccination with isolates reduced number of chickens shedding virus compared to those vaccinated with LaSota. In conclusion, 2 wild-type NDV strains exhibited fine protection efficacy against genotype VII NDV in poultry and can be considered as candidate vaccines against NDV.

HLA-dependent hypersensitivity reaction to nevirapine in Chinese Han HIV-infected patients.

In this study, one hundred and three HIV-positive Chinese Han patients treated with a nevirapine (NVP)-based regimens were investigated for the association between nevirapine hypersensitivity reaction (NVP HSR) and human leukocyte antigen (HLA) allele. HLA-Cw, -DRB1 alleles were determined in 32 NVP HSR cases and 71 NVP-tolerant patients. We found that considerable overlap was observed for the clinical and demographic characteristics of the 32 hypersensitive patients and 71 tolerant patients. Twelve out of 32 NVP HSR cases developed allergic hepatotoxicity. More HLA-Cw*04 alleles were observed in NVP HSR cases than in NVP-tolerant cases (p=0.029). The frequency of HLA-DRB1*15 in NVP-tolerant cases was significant higher than that in NVP HSR cases ( p=0.018). Multivariate logistic regression identified that HLA-Cw*04 presence was a risk factor related to NVP HSR (p=0.030, OR=3.611, 95% CI of OR: 1.135-11.489). To clearly understanding its value in clinical practice, further studies involving larger cohorts of patients from different races with different levels of immune suppression are needed.

End-stage liver disease: prevalence, risk factors and clinical characteristics in a cohort of HIV-HCV coinfected Han Chinese.

INTRODUCTION: Since the advent of combined antiretroviral therapy (cART), liver-related mortality has become the leading cause of non-AIDS-related deaths in human immunodeficiency virus (HIV) infected patients in Western countries. OBJECTIVE: To investigate the incidence, mortality and risk factors of end-stage liver disease (ESLD) in HIV and hepatitis C virus (HCV) coinfected former plasma donors (FPDs) and blood recipients (BRs). METHOD: A retrospective study was conducted. RESULTS: Of 321 HIV-HCV coinfected patients, 42 (13.1%) developed ESLD and 40 (12.5%) died. Factors that were independently associated with ESLD included older age at baseline (Odds ratios [OR]: 2.444, P=0.035), alanine aminotransferase (ALT) greater or equal to 2 (the upper limit of normal [ULN]) at the end of follow-up (OR: 16.460, P=0.000), hepatitis B virus (HBV) (OR: 2.525, P=0.043), CDC stage C (OR: 5.806, P=0.001), duration of cART greater than 5 years (OR: 3.256, P=0.010), and CD4 count greater or equal to 200 cells/mm(3) at the end of follow-up (OR: 0.383, P=0.016). The probability of developing ESLD in HIV-HCV coinfected BRs was significantly higher than in FPDs (P=0.008). Mortality was also significantly higher in HIV-HCV coinfected patients with ESLD than in those without ESLD (P=0.000). CONCLUSION: In the cART era, ESLD was common among HIV-HCV coinfected Han Chinese patients and was responsible for reducing patient survival time.