Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature.

BACKGROUND: Perihilar cholangiocarcinoma (pCCA) is a highly malignant tumor arising from the biliary tree. Radical surgery is the only treatment offering a chance of long-term survival. However, limited by the tumor's anatomic location and peri-vascular invasion, most patients lose the chance for curative treatment. Therefore, more methods to increase the resectability of tumors as well as to improve outcomes are needed. CASE SUMMARY: A 68-year-old female patient had a hepatic hilar mass without obvious symptoms. Laboratory results showed hepatitis B positivity. Magnetic resonance imaging indicated that the mass (maximum diameter: 41 mm) invaded the left and right branches of the main portal vein, as well as the middle, left and right hepatic veins; enlarged lymph nodes were also detected in the hilum. The patient was diagnosed with pCCA, and the clinical stage was determined to be T4N1M0 (stage IIIC). Considering the tumor's anatomic location and vascular invasion, systematic conversion therapy followed by ex vivo liver resection and autotransplantation (ELRA) was determined as personalized treatment for this patient. Our original systemic sequential therapeutic strategy (lenvatinib and tislelizumab in combination with gemcitabine and cisplatin) was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment, without severe toxicity. ELRA, anastomotic reconstruction of the middle hepatic vein, right hepatic vein, root of portal vein, inferior vena cava and right hepatic artery, and lymph node dissection were performed at one month after systemic therapy. Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis. Although the middle hepatic vein was partially obstructed four months later, hepatic vein stent implantation successfully addressed this problem. The patient has survived for 22 mo after the diagnosis, with no evidence of recurrence or metastasis. CONCLUSION: An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.

A novel circRNA, circRACGAP1, hampers the progression of systemic lupus erythematosus via miR-22-3p-mediated AKT signalling.

BACKGROUND: Systemic lupus erythematosus (SLE) is defined as a multisystem autoimmune disease involving various organs, of which exact molecular mechanisms remain elusive. Here, we aimed to investigate a novel circular RNA (circRNA), circRACGAP1, abnormally expressed in SLE and explored its underlying regulatory network. METHODS: The expression patterns of circRACGAP1 were determined in patients diagnosed with SLE by using a qRT-PCR assay. Spearman correlation analysis was employed to evaluate the correlation between circRACGAP1 and clinicopathological variables in patients with SLE. Flow cytometry and TUNEL assays were subjected to assess the cell apoptosis. Nuclear-cytoplasmic fractionation and luciferase reporter assay was used to verify the circRACGAP1/miR-22-3p/PTEN axis. Western blot analysis was performed to measure the PTEN/AKT signalling-related proteins and apoptotic-related biomarkers. RESULTS: Down-regulated circRACGAP1 was observed and correlated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, anti-double-stranded (ds) DNA, and complement C3 level in patients with SLE. Overexpression of circRACGAP1 significantly alleviated cell apoptosis in Jurkat cells within UVB exposure. Mechanistic investigation revealed that circRACGAP1 could serve as a sponge of miR-22-3p to regulate PTEN/AKT signalling. CONCLUSIONS: Collectively, circRACGAP1 regulated the AKT signalling pathway via binding to miR-22-3p in the progression of SLE, suggesting therapeutic targets for SLE treatment.

Pathological Change of Chronic Hepatitis B Patients with Different Tongue Coatings by Circular Multi-Omics Integrated Analysis.

OBJECTIVE: To compare the circular pathological changes of chronic hepatitis B (CHB) patients according to the tongue diagnosis. METHODS: Totally 41 CHB patients with typical white tongue coating (WTC) or yellow tongue coating (YTC) were enrolled and 14 healthy volunteers with normal tongue manifestation served as controls. The mRNA expression of peripheral leukocytes was detected by GeneChips, and 9 genes were randomly selected for expression validation. Circular metabolites were detected by gas chromatographymass spectrometry. Biological information was analyzed based on ingenuity pathways analysis or metabolomics database and the integrated networks were constructed by ClueGO. RESULTS: A total of 945 and 716 differentially expressed genes were found in patients with WTC and YTC relative to healthy volunteers respectively. The biological information analysis indicated that CHB patients had obviously increased functions in cell death, apoptosis and necrosis (Z-score ⩾2, P<0.05) and decreased activation in T lymphocytes (Z-score ⩽-2, P<0.05), regardless of the tongue manifestation. Compared to patients with WTC, the YTC patients were predicted to be more active in functions related to virus replication (Z-score ⩾2, P<0.05), and the content of circular fatty acids, such as oleic acid (P=0.098) and lauric acid (P=0.035), and citric acid cycle-related metabolites were higher in the YTC patients (P<0.1). The integrated analysis based on differential genes and metabolites indicated that the most difference in the biological function network between the WTC and YTC patients was tumor necrosis factor receptor associated factor 6 mediated-nuclear factor kappa-B activation process. CONCLUSIONS: CHB patients with YTC had more severe inflammation and fatty acids metabolism aberrant than patients with WTC. The results facilitate the modern pathological annotation of Chinese medicine tongue diagnosis theory and provide a reference for the interpretation of pharmacological mechanisms of Chinese medicine treatment.

Novelelectronic health records applied for prediction of pre-eclampsia: Machine-learning algorithms.

OBJECTIVE: To predict risk of pre-eclampsia (PE) in women using machine learning (ML) algorithms, based on electronic health records (EHR) collected at the early second trimester. STUDY DESIGN: A total of 3759 cases of pregnancy who received antenatal care at Xinhua hospital Chongming branch Affiliated to Shanghai Jiaotong University were included in this retrospective EHR-based study. Thirty-eight candidate clinical parameters routinely available at the first visit in antenatal care were collected by manual chart review. Logistic regression (LR), random forest (RF), support vector machine (SVM) and extreme gradient boosting (XGBoost) were used to construct the prediction model. Features that contributed to the model predictions were identified using XGBoost. OUTCOME MEASURES: The performance of ML models to predict women at risk of PE was quantified in terms of accuracy, precision, recall, false negative score, f1_score, brier score and the area under the receiver operating curve (auROC). RESULTS: The XGboost model had the best prediction performance (accuracy = 0.920, precision = 0.447, recall = 0.789, f1_score = 0.571, auROC = 0.955). The most predictive feature of PE development was fasting plasma glucose, followed by mean blood pressure and body mass index. An easy-to-use model that a patient could answer independently still enabled accurate prediction, with auROC of 0.83. CONCLUSION: risk of PE development can be predicted with excellent discriminative ability using ML algorithms based on EHR collected at the early second trimester. Future studies are needed to assess the real-world clinical utility of the model.

catena-poly[[[(2,2'-bipyridine-2κN,N')-µ-cyanido-1:2κN:C-cyanido-2κC-tris-(methanol-1κO)(nitrato-1κO,O')iron(II)yttrium(III)]-di-µ-cyanido-1:2'κN:C;2:1'κC:N] methanol solvate hemihydrate].

The title complex, {[Fe(II)Y(III)(CN)(4)(NO(3))(C(10)H(8)N(2))(CH(3)OH)(3)]·CH(3)OH·0.5H(2)O}(n), is built up of ladder-like chains oriented along the c axis. Each ladder consists of two strands based on alternating Fe(II) and Y(III) ions connected by cyanide bridges. Two such parallel chains are connected by additional cyanide anions (the 'rungs' of the ladder), which likewise connect Fe(II) and Y(III) ions, such that each [Fe(bipy)(CN)(4)](2-) (bipy is 2,2'-bipyridine) unit coordinates with three Y(III) ions and each Y(III) ion connects with three different [Fe(bipy)(CN)(4)](2-) units. The Fe(II) atom is six-coordinated in a distorted octa-hedral geometry and the Y(III) atom cation is eight-coordinated in a distorted dodeca-hedral environment. The uncoordinated methanol solvent mol-ecules are involved in hydrogen-bonding inter-actions with the one terminal cyanide group and a coordinated methanol mol-ecule from another [Y(III)(NO(3))(CH(3)OH)(3)](2+) unit. Adjacent ladder-like chains are also held together by hydrogen bonds between the terminal cyanide ligands of the [Fe(CN)(4)(bipy)](2-) units in one chain and the OH donors of CH(3)OH ligands from [Y(III)(NO(3))(CH(3)OH)(3)] units in neighboring chains. The water molecule exhibits half-occupation.

µ-Oxido-bis-({2,2'-[o-phenylenebis(nitrilo-methylidyne)]diphenolato}iron(III)) methanol monosolvate dihydrate.

The title complex, [Fe(2)(C(20)H(14)N(2)O(2))(2)O]·CH(4)O·2H(2)O, is composed of µ-oxido-bridged ferric 2,2'-[o-phenylene-bis(nitrilo-methylidyne)]diphenolate (salphen) dimers, one methanol mol-ecule and two H(2)O mol-ecules. Each iron(III) ion, surrounded by two coordinating N and O atoms from the salphen ligand and one bridging O atom, shows a five-coordinate square-pyramidal geometry. One of the two solvent water mol-ecules is disordered over three positions with occupancies of 0.44 (1), 0.37 (1) and 0.19 (1).

Comparative Analysis of Clinical and Medication Information between Chronic Hepatitis B Patients with Damp Heat Syndrome and Spleen Deficiency Syndrome.

Traditional Chinese medicine (TCM) has a long history in the treatment of chronic hepatitis B (CHB) based on the syndrome identification. Previous studies reported CHB patients with damp-heat (DH) syndrome accompanied with a severe liver function damage, but lacked the medication analysis. In this study, we analyzed 999 CHB patients with unidentified individual-level data from database to explore clinical features of two common syndromes of CHB patients based on the real world. Compared with the spleen deficiency (SD) syndrome, the CHB patients with DH syndrome had a significantly higher level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P < 0.05) but took more immunomodulators and hepatoprotective drugs (P < 0.1). Similarly, in the follow-up of 207 patients after 3 months, the improvement trend of ALT and AST of patients with sustained SD syndrome was significantly better than those whose TCM syndrome changed from SD to DH (P < 0.05). The logistic model indicated DH syndrome was a significant negative factor for reducing ALT level in CHB patients (OR = 4.854, P=0.032). This study suggests that CHB patients with DH syndrome have potentially more serious and sustained liver damage than the SD syndrome, which provides a reference for the personalized management of CHB patients from the perspective of TCM syndromes.

A cyanide-bridged Fe(II)-Nd(III) bimetallic assembly with a one-dimensional ladder-like chain structure.

The title complex, catena-poly[[[(2,2'-bipyridine-1kappa(2)N,N')tris(methanol-2kappaO)(nitrato-2kappa(2)O,O')-mu-cyanido-1:2C:N-cyanido-1kappaC-iron(II)neodymium(III)]-di-mu-cyanido-1:2'C:N;2:1'N:C] methanol solvate], {[Fe(II)Nd(III)(CN)(4)(NO(3))(C(10)H(8)N(2))(CH(3)OH)(3)].CH(3)OH}(n), is made up of ladder-like one-dimensional chains oriented along the c axis. Each ladder consists of two strands based on alternating Fe(II) and Nd(III) centers connected by cyanide bridges. Furthermore, two such parallel chains are connected by additional cyanide cross-pieces (the ;rungs' of the ladder), which likewise connect Fe(II) and Nd(III) centers, such that each [Fe(CN)(4)(bipy)](2-) unit (bipy is 2,2'-bipyridine) coordinates with three Nd(III) centers and each Nd(III) center connects with three different [Fe(CN)(4)(bipy)](2-) units. In the complex, the iron(II) cation is six-coordinated with a distorted octahedral geometry and the neodymium(III) cation is eight-coordinated with a distorted dodecahedral environment.

Diaqua-(5,5,7,12,12,14-hexa-methyl-1,4,8,11-tetra-azacyclo-tetra-deca-ne)nickel(II) tetra-cyanidonickelate(II).

In the title complex, [Ni(C(16)H(36)N(4))(H(2)O)(2)][Ni(CN)(4)], the [Ni(teta)(H(2)O)(2)](2+) cations (teta = 5,5,7,12,12,14-hexa-methyl-1,4,8,11-tetra-azacyclo-tetra-deca-ne) and [Ni(CN)(4)](2-) anions are arranged in an alternating fashion through electrostatic and N-H⋯N and O-H⋯N hydrogen-bonding inter-actions, forming a two-dimensional layered structure. Adjacent layers are linked through weak van der Waals inter-actions, resulting in a three-dimensional supra-molecular network.

Fabrication, characterization and field emission properties of large-scale uniform ZnO nanotube arrays.

Large-scale well-aligned ZnO nanotubes with outer diameters of 100-300 nm and lengths of tens of micrometres have been prepared by a template-based chemical vapour deposition method. The photoluminescence spectrum of the ZnO nanotube arrays consists of a strong violet band at 414 nm, a blue band at 462 nm and a weak shoulder peak at around 480 nm. The field emission of the ZnO nanotube arrays shows a turn-on field of about 7.3 V microm(-1) at a current density of 0.1 microA cm(-2) and emission current density up to 1.3 mA cm(-2) at a bias field of 11.8 V microm(-1).