Progress of Exsolved Metal Nanoparticles on Oxides as High Performance (Electro)Catalysts for the Conversion of Small Molecules.

Utilizing electricity and heat from renewable energy to convert small molecules into value-added chemicals through electro/thermal catalytic processes has enormous socioeconomic and environmental benefits. However, the lack of catalysts with high activity, good long-term stability, and low cost strongly inhibits the practical implementation of these processes. Oxides with exsolved metal nanoparticles have recently been emerging as promising catalysts with outstanding activity and stability for the conversion of small molecules, which provides new possibilities for application of the processes. In this review, it starts with an introduction on the mechanism of exsolution, discussing representative exsolution materials, the impacts of intrinsic material properties and external environmental conditions on the exsolution behavior, and the driving forces for exsolution. The performances of exsolution materials in various reactions, such as alkane reforming reaction, carbon monoxide oxidation, carbon dioxide utilization, high temperature steam electrolysis, and low temperature electrocatalysis, are then summarized. Finally, the challenges and future perspectives for the development of exsolution materials as high-performance catalysts are discussed.

Enhancing the Intrinsic Activity and Stability of Perovskite Cobaltite at Elevated Temperature Through Surface Stress.

Perovskite-based oxides attract great attention as catalysts for energy and environmental devices. Nanostructure engineering is demonstrated as an effective approach for improving the catalytic activity of the materials. The mechanism for the enhancement, nevertheless, is still not fully understood. In this study, it is demonstrated that compressive strain can be introduced into freestanding perovskite cobaltite La0.8 Sr0.2 CoO3- δ (LSC) nanofibers with sufficient small size. Crystal structure analysis suggests that the LSC fiber is characterized by compressive strain along the ab plane and less distorted CoO6 octahedron compared to the bulk powder sample. Accompanied by such structural changes, the nanofiber shows significantly higher oxygen reduction reaction (ORR) activity and better stability at elevated temperature, which is attributed to the higher oxygen vacancy concentration and suppressed Sr segregation in the LSC nanofibers. First-principle calculations further suggest that the compressive strain in LSC nanofibers effectively shortens the distance between the Co 3d and O 2p band center and lowers the oxygen vacancy formation energy. The results clarify the critical role of surface stress in determining the intrinsic activity of perovskite oxide nanomaterials. The results of this work can help guide the design of highly active and durable perovskite catalysts via nanostructure engineering.

Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.

BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical course and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. METHODS: Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan and Xishui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic, and clinical data were collected. The clinical course of survivors and non-survivors were compared. Risk factors for death were analyzed. RESULTS: A total of 107 discharged patients with COVID-19 were enrolled. The clinical course of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia, and radiological multi-lobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury, and adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough, and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia, and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome, refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia, and death. Older age and male sex were independent risk factors for poor outcome of the illness. CONCLUSIONS: A period of 7-13 days after illness onset is the critical stage in the COVID-19 course. Age and male gender were independent risk factors for death of COVID-19.

Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study.

BACKGROUND: Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. METHODS: 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables. RESULTS: Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17-17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94-7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16-4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use ≤ 3 days initiation vs no corticosteroids use) using MSM were performed. CONCLUSIONS: Early initiation of corticosteroid use (≤ 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19.

The 798 Art District: Multi-scalar drivers of land use succession and industrial restructuring in Beijing.

Since the post-1980 economic reforms, Chinese cities, in particular large cites, have experienced far reaching industrial restructuring and spatial transformation. A decentralization of manufacturing industries from urban centres was accompanied by the rise of service and creative industry districts on previous industrial sites. This article explores the interconnections of global forces, state-market relationships, land use policies, art markets, the Chinese system of governance, and other trans-local factors in transforming Beijing from an industrial city to a service and creative industries-oriented global metropolis, by examining the rise and transformation of Beijing 798 Art District. The case study finds that decommissioned industrial sites had characteristics that made them attractive when central and local governments started to promote creative industries, but, with development of urban art districts, the impact of avant-garde artists on the direction of development was reduced, and developers, high profile galleries and multinational corporations had an increasing influence. The results of our study indicate that the literature on intra-metropolitan location and change, and the evolution of industrial districts should pay more attention to the reuse of the decommissioned industrial land and sites for industrial restructuring, and particularly to the role of multi-scalar factors in reshaping the geography of cities.

Internal and external carotid artery embolism following facial injection of autologous fat.

Autologous fat injection is a common aesthetic procedure for soft-tissue augmentation of the face. Although this procedure is generally regarded as safe, several patients have experienced acute visual loss or cerebral infarction after these injections. We describe a case of internal and external carotid artery fat embolism that occurred following injection of autologous fat into the face. It appeared that the injected fat entered a branch of the left external carotid artery and that the embolus likely migrated into the left internal carotid artery and distally into the left ophthalmic artery, left anterior artery, and middle cerebral artery. LEVEL OF EVIDENCE 5:

Thermo-responsive imprinted hydrogel with switchable sialic acid recognition for selective cancer cell isolation from blood.

In this work, a sialic acid (SA)-imprinted thermo-responsive hydrogel layer was prepared for selective capture and release of cancer cells. The SA-imprinting process was performed at 37 °C using thermo-responsive functional monomer, thus generating switchable SA-recognition sites with potent SA binding at 37 °C and weak binding at a lower temperature (e.g., 25 °C). Since SA is often overexpressed at the glycan terminals of cell membrane proteins or lipids, the SA-imprinted hydrogel layer could be used for selective cancer cell recognition. Our results confirmed that the hydrogel layer could efficiently capture cancer cells from not only the culture medium but also the real blood samples. In addition, the captured cells could be non-invasively released by lowing the temperature. Considering the non-invasive processing mode, considerable capture efficiency, good cell selectivity, as well as the more stable and durable SA-imprinted sites compared to natural antibodies or receptors, this thermo-responsive hydrogel layer could be used as a promising and general platform for cell-based cancer diagnosis.

Stimulation of α7 nicotinic acetylcholine receptor by nicotine increases suppressive capacity of naturally occurring CD4+CD25+ regulatory T cells in mice in vitro.

α7 Nicotinic acetylcholine receptor (α7 nAChR) has been found in several non-neuronal cells and is described as an important regulator of cellular function. Naturally occurring CD4(+)CD25(+) regulatory T cells (Tregs) are essential for the active suppression of autoimmunity. The present study investigated whether naturally occurring Tregs expressed α7 nAChR and investigated the functionary role of this receptor in controlling suppressive activity of these cells. We found that CD4(+)CD25(+) Tregs from naive C57BL/6J mice positively expressed α7 nAChR, and its activation by nicotine enhanced the suppressive capacity of Tregs. Nicotine stimulation up-regulated the expression of cytotoxic T-lymphocyte-associated antigen (CTLA)-4 and forkhead/winged helix transcription factor p3 (Foxp3) on Tregs but had no effect on the production of interleukin (IL)-10 and transforming growth factor-ß1 by Tregs. In the supernatants of CD4(+)CD25(+) Tregs/CD4(+)CD25(-) T-cell cocultures, we observed a decrease in the concentration of IL-2 in nicotine-stimulated groups, but nicotine stimulation had no effect on the ratio of IL-4/interferon (IFN)-γ, which partially represented T-cell polarization. The above-mentioned effects of nicotine were reversed by a selective α7 nAChR antagonist, α-bungarotoxin. In addition, the ratio of IL-4/IFN-γ was increased by treatment with α-bungarotoxin. We conclude that nicotine might increase Treg-mediated immune suppression of lymphocytes via α7 nAChR. The effect is related to the up-regulation of CTLA-4 as well as Foxp3 expression and decreased IL-2 secretion in CD4(+)CD25(+) Tregs/CD4(+)CD25(-) T-cell coculture supernatants. α7 nAChR seems to be a critical regulator for immunosuppressive function of CD4(+)CD25(+) Tregs.

Construction of Multifunctional Nanoarchitectures in One Step on a Composite Fuel Catalyst through In Situ Exsolution of La0.5Sr0.5Fe0.8Ni0.1Nb0.1O3-δ.

Multifunctional nanoarchitecture (MNA) on catalysts has attracted great attention because of its capability to improve the performance, durability, and resistance to unwanted side reactions. Such structures, however, are conventionally prepared by deposition methods, which inherently suffer from costly and time-consuming drawbacks. Here, we report a simple one-step process to successfully construct a novel MNA with core-shell nanoparticles anchored at the heterointerface of dual-phase oxide substrates through a phase transition and in situ exsolution of perovskite La0.5Sr0.5Fe0.8Ni0.1Nb0.1O3-δ (LSFNNb0.1) in wet H2 (3% H2O) at 800 °C. The core-shell nanoparticles are composed of a Ni-Fe alloy core and a SrLaFeO4-type layered perovskite oxide shell (RP-Ruddlesden-Popper-layered perovskites), which synergistically improves the electrochemical activity and effectively suppresses aggregation and coarsening of the metallic core. The RP phase also covers the surface of perovskite bulk (SP-single perovskite), forming the heterointerface and preventing further decomposition of the SP phase. The RP/SP heterointerface may improve the kinetics of surface exchange of oxygen species, resulting in the enhancement of performance and durability of the reduced LSFNNb0.1 as an anode for solid oxide fuel cells (SOFCs). A doped zirconia electrolyte-supported single cell with the anode achieves the maximum power density (MPD) of 0.83 W cm-2 at 800 °C in wet H2, and the corresponding polarization resistance is as low as 0.15 Ω cm2. This work reveals the formation mechanism of the MNA by investigating the evolution of the crystal structure, composition and morphology of LSFNNb0.1, when changing reducing temperature and time in wet H2 and 5% H2-Ar. The oxygen vacancies and phase transitions are found to play important roles in the formation of the MNA. The construction of MNAs in one step opens a new opportunity to design and prepare high-performance and stable catalysts for applications in energy conversion and storage.

Poly(vinylene carbonate)-Based Composite Polymer Electrolyte with Enhanced Interfacial Stability To Realize High-Performance Room-Temperature Solid-State Sodium Batteries.

Solid-state rechargeable batteries using polymer electrolytes have been considered, which can avoid safety issues and enhance energy density. However, commercial application of the polymer electrolyte solid-state battery is still significantly limited by the low room-temperature ionic conductivity, poor mechanical properties, and weak interfacial compatibility between the electrolyte and electrode, especially for the room-temperature solid-state rechargeable battery. In this work, a poly(vinylene carbonate)-based composite polymer electrolyte (PVC-CPE) is reported for the first time to realize room-temperature solid-state sodium batteries with high performances. This in situ solidified PVC-CPE possesses superior ionic conductivity (0.12 mS cm-1 at 25 °C), high Na+ transference number (tNa+ = 0.60), as well as enhanced electrode/electrolyte interfacial stability. Notably, the composite cathode NaNi1/3Fe1/3Mn1/3O2 (c-NFM) is designed through the in situ growth of the polymer electrolyte inside the electrode to decrease interfacial resistance and facilitate effective ion transport in electrode/electrolyte interfaces. It is demonstrated that the solid-state c-NFM/PVC-CPE/Na battery assembled by a one-step in situ solidification method exhibits remarkably enhanced cell performances at room temperature compared with a reference NFM/PVC-CPE/Na assembled through a conventional ex situ method. The battery presents a high initial specific capacity of 104.2 mA h g-1 at 0.2 C with a capacity retention of 86.8% over 250 cycles and ∼80.2 mA h g-1 at 1 C. This study suggests that PVC-CPE is a very promising electrolyte for solid-state sodium batteries. This study also suggests a new method to design high-performance polymer electrolytes for other solid-state rechargeable batteries to realize high safety and considerable electrochemical performance at room temperature.

A self-assembled dual-phase composite as a precursor of high-performance anodes for intermediate temperature solid oxide fuel cells.

A durable high-performance anode with a unique microstructure of a hetero-structured surface layer and exsolved Fe-Cu bimetal nano-fibers is fabricated from a self-assembled dual-phase precursor consisting of a single perovskite (SP) and a Ruddlesden-Popper (RP) layered perovskite component. This work opens up new opportunities to fabricate high-performance anodes for IT-SOFCs.

Lithium sulfonate-grafted poly(vinylidenefluoride-hexafluoro propylene) ionomer as binder for lithium-ion batteries.

Lithium sulfonate-grafted poly(vinylidenefluoride-hexafluoro propylene) P(VDF-HFP) ionomers are synthesized through covalent attachment of taurine and used as binder for the LiFePO4 cathode of lithium-ion batteries(LIBs). The incorporation of the ionomer binders will add ionic conducting channels inside the electrodes, and prevent electrolyte depletion during rapid charge-discharge processes. It leads to an improved performance of LIBs using the ionomer binders including cycling stability and rate capability compared to that of LIBs using non-ionic binders (PVDF and PVDF-HFP). Therefore, the lithium sulfonate-grafted P(VDF-HFP) ionomers offer a new route to develop high-power LIBs.

Voltammetric characterization on the hydrophobic interaction in polysaccharide hydrogels.

Cyclic voltammetric (CV) investigations on the properties of microdomains in polysaccharide hydrogels, methyl cellulose (MC) and kappa-carrageenan (CAR), coated on glassy carbon electrodes were reported in which methylene blue (MB), tris(1,10-phenanthroline)cobalt(III) (Co(phen)3(3+/2+)) cations, and ferricyanide/ferrocyanide (Fe(CN)6(3-/4-)) anions were used as electroactive probes. Information on the patterns and strength of intermolecular interactions in these polysaccharide hydrogels can be inferred from the net shift of normal potentials (E degrees'), the change of peak currents (ip), the ratio of binding constants (K(red)/K(ox)) for reduced and oxidized forms of bound species, and the apparent diffusion coefficients (D(app)) of probe in hydrogels. The transition of hydrophobic interaction in MC hydrogel with temperature was manifested by the CV method, which is in agreement with the evolution of the storage modulus (G') during gelation. It was also found that, in addition to inducing the change of E degrees' and ip of these probes used, the hydrophobic-hydrophilic nature of the microenvironment in hydrogels coated on the substrate electrodes greatly influenced the peak-peak separation (DeltaEp) of MB and the redox reversibility of Fe(CN)6(3-/4-) via modulation of both the heterogeneous electron-transfer process at the gel-substrate interface and the charge-transfer process in hydrogels. The results imply that the CV method is of significant benefit to the understanding of the gelation driving forces in the polysaccharide hydrogels at a molecular level.

Comparison of curdlan and its carboxymethylated derivative by means of Rheology, DSC, and AFM.

Curdlan was carboxymethylated in an aqueous alkaline medium using monochloroacetic acid as the etherifying agent. The structure of carboxymethylated curdlan (CMc) was analyzed by FT-IR and NMR spectroscopy, which revealed that the carboxymethyl group was introduced mainly at the C-6 position as well as at the C-2 and C-4 positions. Furthermore, CMc was compared with the native curdlan by using rheology and DSC methods. It was found that in water, both polysaccharides behaved as pseudoplastic fluids and fit the power law and Herschel-Bulkley rheological models well. Both the storage shear modulus G' and the loss shear modulus G'' of CMc aqueous solutions decreased and became more frequency dependent with decreasing concentration in comparison with the curdlan aqueous suspensions. The modulus-temperature curve also suggested that the gel characteristic of curdlan has been lost after chemical modification, which is consistent with the DSC results. AFM images revealed differences in the conformation of native and carboxymethylated curdlan, which changed from the aggregation of macromolecules to triple helices. All the experimental results suggest that the hydrogen bonds that bind curdlan with interstitial water to form the micelles have been destroyed completely and that the hydrophobic interactions related to the methylene groups at C-6 formed above 55 degrees C disappeared due to the introduction of the hydrophilic carboxymethyl group.

Vagal Modulation of the Inflammatory Response in Sepsis.

The vagus nerve can sense peripheral inflammation and transmit action potentials from the periphery to the brainstem. Vagal afferent signaling is integrated in the brainstem, and efferent vagus nerves carry outbound signals that terminate in spleen and other organs. Stimulation of efferent vagus nerve leads to the release of acetylcholine in these organs. In turn, acetylcholine interacts with members of the nicotinic acetylcholine receptor (nAChR) family, particularly with the alpha7 nicotinic acetylcholine receptor (α7nAChR), which is expressed by macrophages and other cytokine-producing cells. Ultimately, the production of proinflammatory cytokines is markedly inhibited. This neuroimmune communication is termed "the inflammatory reflex". The uncontrolled inflammation as a result from sepsis can lead to multiple organ failure, and even death. Experimental data show that regulation of the inflammatory reflex appears to be a useful interventional strategy for septic response. Herein, we review recent advances in the understanding of the inflammatory reflex and discuss potential therapeutics that vagal modulation of the immune system for the treatment of severe sepsis and septic shock.

Novel Nano-composites SDC-LiNaSO4 as Functional Layer for ITSOFC.

As an ionic conductive functional layer of intermediate temperature solid oxide fuel cells (ITSOFC), samarium-doped ceria (SDC)-LiNaSO4 nano-composites were synthesized by a sol-gel method and their properties were investigated. It was found that the content of LiNaSO4 strongly affected the crystal phase, defect concentration, and conductivity of the composites. When the content of LiNaSO4 was 20 wt%, the highest conductivity of the composite was found to be, respectively, 0.22, 0.26, and 0.35 S cm-1 at temperatures of 550, 600, and 700 °C, which are much higher than those of SDC. The peak power density of the single cell using this composite as an interlayer was improved to, respectively, 0.23, 0.39, and 0.88 W cm-2 at 500, 600, and 700 °C comparing with that of the SDC-based cell. Further, the SDC-LiNaSO4(20 wt%)-based cell also displayed better thermal stability according to the performance measurements at 560 °C for 50 h. These results reveal that SDC-LiNaSO4 composite may be a potential good candidate as interlayer for ITSOFC due to its high ionic conductivity and thermal stability.

Advances in sepsis-associated liver dysfunction.

Recent studies have revealed liver dysfunction as an early event in sepsis. Sepsis-associated liver dysfunction is mainly resulted from systemic or microcirculatory disturbances, spillovers of bacteria and endotoxin (lipopolysaccharide, LPS), and subsequent activation of inflammatory cytokines as well as mediators. Three main cell types of the liver which contribute to the hepatic response in sepsis are Kupffer cells (KCs), hepatocytes and liver sinusoidal endothelial cells (LSECs). In addition, activated neutrophils, which are also recruited to the liver and produce potentially destructive enzymes and oxygen-free radicals, may further enhance acute liver injury. The clinical manifestations of sepsis-associated liver dysfunction can roughly be divided into two categories: Hypoxic hepatitis and jaundice. The latter is much more frequent in the context of sepsis. Hepatic failure is traditionally considered as a late manifestation of sepsis-induced multiple organ dysfunction syndrome. To date, no specific therapeutics for sepsis-associated liver dysfunction are available. Treatment measure is mainly focused on eradication of the underlying infection and management for severe sepsis. A better understanding of the pathophysiology of liver response in sepsis may lead to further increase in survival rates.

Advances in the management of acute liver failure.

Acute liver failure (ALF) is an uncommon but dramatic clinical syndrome characterized by hepatic encephalopathy and a bleeding tendency due to abrupt loss of liver function caused by massive or submassive liver necrosis in a patient with a previously healthy liver. The causes of ALF encompass a wide variety of toxic, viral, metabolic, vascular and autoimmune insults to the liver, and identifying the correct cause can be difficult or even impossible. Many patients with ALF develop a cascade of serious complications involving almost every organ system, and death is mostly due to multi-organ failure, hemorrhage, infection, and intracranial hypertension. Fortunately, the outcome of ALF has been improved in the last 3 decades through the specific treatment for the disease of certain etiology, and the advanced intensive care management. For most severely affected patients who fail to recover after treatment, rapid evaluation for transfer to a transplantation center and consideration for liver transplantation is mandatory so that transplantation can be applied before contraindications develop. This review focuses on the recent advances in the understanding of various contributing etiologies, the administration of etiology-specific treatment to alleviate the liver injury, and the management of complications (e.g., encephalopathy, coagulopathy, cardiovascular instability, respiratory failure, renal failure, sepsis and metabolic disturbance) in patients with ALF. Assessment of the need for liver transplantation is also presented.

An anti-transferrin receptor antibody enhanced the growth inhibitory effects of chemotherapeutic drugs on human glioma cells.

Transferrin receptor (TfR) has been used as a target for antibody-based therapy of cancer. Anti-TfR antibody together with chemotherapeutic drugs has potential for cancer therapy. In this study, we investigated the in vitro anti-tumor effects of the anti-TfR monoclonal antibody (mAb), 7579, alone or in combination with Nimustine, a chemotherapeutic drug, on the gliomas cell lines U251 and U87MG. Our results indicated that 7579 alone dramatically down-regulated surface expression of TfR on tumor cells and induced S phase accumulation and apoptosis of tumor cells. Compared with 7579 or Nimustine used alone, the combination of 7579 with Nimustine demonstrated enhanced growth inhibitory effect on tumor cells. PI (Propidium iodide)/Annexin V staining analyzed by FCM (flow cytometry) demonstrated that 7579 enhanced the cytotoxic effects of chemotherapeutic drug on tumor cells, indicating the therapeutic effect of 7579 was mediated mainly by promoting tumor cell necrosis. Using the median-effect/combination-index isobologram method, we further evaluated the nature of 7579/chemotherapeutic drug interactions. Synergistic interaction was observed for combination of 7579 with Nimustine. Our study provides additional evidence to develop combination therapies of anti-TfR mAbs-plus chemoimmunotherapy for gliomas.

Predicting lymph node status in patients with early gastric carcinoma using double contrast-enhanced ultrasonography.

INTRODUCTION: Double contrast-enhanced ultrasonography (DCUS) is a new method we used in predicting lymph node metastasis (LNM) in patients with early gastric cancer. MATERIAL AND METHODS: Seventy-six patients with early gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined using DCUS preoperatively. Group N1 included 15 patients with LNM and group N0 61 patients without LNM. RESULTS: In group N1, 13 patients (87%) had marked hyperenhancement during early arterial phase using DCUS, and 2 patients (13%) were unmarked as hyperenhancement. In group N0, 24 patients (39%) had marked hyperenhancement during early arterial phase using DCUS, and 37 patients (61%) had unmarked hyperenhancement. The sensitivity and specificity of marked hyperenhancement in predicting LNM in patients with early gastric cancer was 86.7% and 60.7% respectively, and the Youden's index was 0.474. The κ value of this method was 0.89. CONCLUSIONS: Double contrast-enhanced ultrasonography is a new valuable method to evaluate LNM at an early stage of gastric cancer and prognosis of early gastric cancer preoperatively.