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Background: Observational research suggests that hypotension is a potential hazard factor of delirium. Nevertheless, previous observational articles are limited in their ability to establish causality between hypotension and delirium. The present study was sought to explore the genetic causal relationship between these two conditions using two-sample Mendelian randomization (MR). Methods: Genome-wide association study (GWAS) summarized data for hypotension and delirium were obtained from the FinnGen Consortium. The researchers utilized several statistical methods, such as inverse-variance weighted (IVW), weighted median, MR Egger, weighted mode, and simple mode in conducting the MR statistical analysis. In order to identify heterogeneity among the MR outcomes, we employed the Cochrane's Q test. Furthermore, we used the MR-Egger intercept test and MR pleiotropy residual sum and outliers (MR-PRESSO) test to examine horizontal pleiotropy. Results: The findings revealed that hypotension was identified as an independent hazard variable for delirium (p = 0.010, odds ratio [OR] [95% confidence interval (CI)] = 1.302 [1.066-1.592]) using the IVW method. The presence of horizontal pleiotropy was found to have minimal impact on establishing causal relationship (p = 0.999), and there was no evidence to suggest heterogeneity between genetic variations (p = 0.379). Additionally, the leave-one-out method demonstrated the stability and robustness of this association. Conclusion: We performed two-sample MR analyses and found evidence of a genetic causal relationship between hypotension and delirium. Our findings suggest that individuals with a genetic predisposition for hypotension may have a higher risk of developing delirium. This suggests that interventions aimed at improving perioperative hypotension could aid in limiting the incidence of delirium.
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Background: Opioids are irreplaceable analgesics owing to the lack of alternative analgesics that offer opioid-like pain relief. However, opioids have many undesirable central side effects. Restricting opioids to peripheral opioid receptors could reduce those effects while maintaining analgesia. Methods: To achieve this goal, we developed Tet1-LNP (morphine), a neural-targeting lipid nanoparticle encapsulating morphine that could specifically activate the peripheral opioid receptor in the dorsal root ganglion (DRG) and significantly reduce the side effects caused by the activation of opioid receptors in the brain. Tet1-LNP (morphine) were successfully prepared using the thin-film hydration method. In vitro, Tet1-LNP (morphine) uptake was assessed in differentiated neuron-like PC-12 cells and dorsal root ganglion (DRG) primary cells. The uptake of Tet1-LNP (morphine) in the DRGs and the brain was assessed in vivo. Von Frey filament and Hargreaves tests were used to assess the antinociception of Tet1-LNP (morphine) in the chronic constriction injury (CCI) neuropathic pain model. Morphine concentration in blood and brain were evaluated using ELISA. Results: Tet1-LNP (morphine) had an average size of 131 nm. Tet1-LNP (morphine) showed high cellular uptake and targeted DRG in vitro. CCI mice treated with Tet1-LNP (morphine) experienced prolonged analgesia for nearly 32 h compared with 3 h with free morphine (p < 0.0001). Notably, the brain morphine concentration in the Tet1-LNP (morphine) group was eight-fold lower than that in the morphine group (p < 0.0001). Conclusion: Our study presents a targeted lipid nanoparticle system for peripheral neural delivery of morphine. We anticipate Tet1-LNP (morphine) will offer a safe formulation for chronic neuropathic pain treatment, and promise further development for clinical applications.
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Analgésicos Opioides , Ganglios Espinales , Morfina , Nanopartículas , Animales , Morfina/administración & dosificación , Morfina/farmacocinética , Morfina/química , Morfina/farmacología , Ganglios Espinales/efectos de los fármacos , Ganglios Espinales/metabolismo , Nanopartículas/química , Ratas , Células PC12 , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/farmacocinética , Analgésicos Opioides/química , Analgésicos Opioides/farmacología , Masculino , Neuralgia/tratamiento farmacológico , Ratones , Lípidos/química , Proteínas Proto-Oncogénicas/metabolismo , Nervios Periféricos/efectos de los fármacos , Oxigenasas de Función Mixta/metabolismo , Proteínas de Unión al ADN , LiposomasRESUMEN
Background: The aim of the present study was to build and internally validate a nomogram model for predicting prolonged length of stay (PLOS) among patients receiving free vascularized flap reconstruction of head and neck cancer (HNC). Methods: A retrospective clinical study was performed at a single center, examining patients receiving free vascularized flap reconstruction of HNC from January 2011 to January 2019. The variables were obtained from the electronic information system. The primary outcome measure was PLOS. Univariate and multivariate analyses were used to find risk factors for predicting PLOS. A model was then built according to multivariate results. Internal validation was implemented via 1000 bootstrap samples. Results: The study included 1047 patients, and the median length of stay (LOS) was 13.00 (11.00, 16.00) days. Multivariate analysis showed that flap types ((radial forearm free flap (odds ratio [OR] = 2.238; 95% CI, 1.403-3.569; P = 0.001), free fibula flap (OR = 3.319; 95% CI, 2.019-4.882; P < 0.001)), duration of surgery (OR = 1.002; 95% CI, 1.001-1.003; P = 0.004), postoperative complications (OR = 0.205; 95% CI, 0.129-0.325; P = P < 0.001) and unplanned reoperation (OR = 0.303; 95% CI, 0.140-0.653; P = 0.002) were associated with PLOS. In addition to these variables, blood transfusion was comprised in the model. The AUC of the model was 0.78 (95% CI, 0.711-0.849) and 0.725 (95% CI, 0.605-0.845) in the primary and internal validation cohorts, respectively. The DCA revealed the clinical utility of the current model when making intervention decisions within the PLOS possibility threshold range of 0.2-0.8. Conclusions: Our study developed a nomogram that exhibits a commendable level of accuracy, thereby aiding clinicians in assessing the risk of PLOS among patients receiving free vascularized flap reconstruction for HNC.
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Shape morphing of biopolymer materials, such as chitosan (CS) films, has great potential for applications in many fields. Traditionally, their responsive behavior has been induced by the differential water swelling through the preparation of multicomponent composites or cross-linking as deformation is not controllable in the absence of these processes. Here, we report an interfacial dehydration strategy to trigger the shape morphing of the monocomponent CS film without cross-linking. The release of water molecules is achieved by spraying the surface with a NaOH solution or organic solvents, which results in the interfacial shrinkage and deformation of the entire film. On the basis of this strategy, a range of CS actuators were developed, such as soft grippers, joint actuators, and a light switch. Combined with the geometry effect, edited deformation was also achieved from the planar CS film. This shape-morphing strategy is expected to enable the application of more biopolymers in a wide range of fields.
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In order to enhance the performance of a continuous-wave photocathode electron gun at Peking University, and to achieve electron beams with higher current and brightness, a multifunctional drive laser system named PULSE (Peking University drive Laser System for high-brightness Electron source) has been developed. This innovative system is capable of delivering an average output power of 120 W infrared laser pulse at 81.25â MHz, as well as approximately 13.8 W of green power with reliable stability. The utilization of two stages of photonic crystal fibers plays a crucial role in achieving this output. Additionally, the incorporation of two acousto-optic modulators enables the selection of macro-pulses with varying repetition frequencies and duty cycles, which is essential for effective electron beam diagnosis. Furthermore, the system employs a series of birefringent crystals for temporal pulse shaping, allowing for stacking Gaussian pulses into multiple types of distribution. Overall, the optical schematic and operating performance of PULSE are detailed in this paper.
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A universal characteristic of eukaryotic transcription is that the promoter recruits RNA polymerase II (RNAPII) to produce both precursor mRNAs (pre-mRNAs) and short unstable promoter upstream transcripts (PROMPTs) toward the opposite direction. However, how the transcription machinery selects the correct direction to produce pre-mRNAs is largely unknown. Here, through multiple acute auxin-inducible degradation systems, we show that rapid depletion of an RNAPII-binding protein complex, Integrator, results in robust PROMPT accumulation throughout the genome. Interestingly, the accumulation of PROMPTs is compensated by the reduction of pre-mRNA transcripts in actively transcribed genes. Consistently, Integrator depletion alters the distribution of polymerase between the sense and antisense directions, which is marked by increased RNAPII-carboxy-terminal domain Tyr1 phosphorylation at PROMPT regions and a reduced Ser2 phosphorylation level at transcription start sites. Mechanistically, the endonuclease activity of Integrator is critical to suppress PROMPT production. Furthermore, our data indicate that the presence of U1 binding sites on nascent transcripts could counteract the cleavage activity of Integrator. In this process, the absence of robust U1 signal at most PROMPTs allows Integrator to suppress the antisense transcription and shift the transcriptional balance in favor of the sense direction.
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Regiones Promotoras Genéticas , ARN Polimerasa II , Transcripción Genética , ARN Polimerasa II/metabolismo , Humanos , Regiones Promotoras Genéticas/genética , Fosforilación , Precursores del ARN/metabolismo , Precursores del ARN/genética , Células HeLa , Sitio de Iniciación de la TranscripciónRESUMEN
The surface morphologies of polymer films have been used to improve the performance or enable new applications of films, such as controllable adhesion, shape morphing and light management. However, complicated and destructive methods were applied to produce surface morphologies on chitosan (CS) film. To overcome this challenge, we report an evaporation-induced self-assembly to form the tunable morphologies on the surface of short-chain chitosan film by varying the evaporation rates that influence the aggregation behavior of polymer chains between order and disorder. It enables the simple, tunable and scalable fabrication of surface morphologies on CS film (CS solution concentration: 2 wt%, drying from room temperature (RT) to 80 °C) that provides controllable haze (3-74 %) and high transmittance (>85 %) for the production of hazy and transparent window coatings. This simple approach to producing tunable surface morphologies could inspire the synthesis of multifunctional polymer films with different surface structures, whose applications can be extended to cell culture interfaces, flexible bioelectronic and optoelectronic devices.
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Quitosano , Quitosano/química , Polímeros , Fenómenos FísicosRESUMEN
In order to evaluate the feasibility of using Burkholderia sp. Y4 as a cadmium ï¼Cdï¼-reducing bacterial agent in contaminated wheat fieldsï¼ the changes in the rhizosphere soil microbial community and Cd available stateï¼ as well as the content and transport characteristics of Cd in the wheat rootï¼ basal nodeï¼ internodeï¼ and grain under the treatment of strain Y4 were tested using microbial high-throughput sequencingï¼ step-by-step extractionï¼ subcellular distributionï¼ and occurrence analyses. The results showed that root application of strain Y4 significantly reduced the root and grain Cd content of wheat by 7.7% and 30.3%ï¼ respectivelyï¼ compared with that in the control treatment. The Cd content and Cd transfer factor results in wheat vegetative organs showed that strain Y4 reduced the Cd transfer factor from basal node to internode by 79.3%ï¼ and Cd content in the wheat internode stem also decreased by 50.9%. The study of Cd occurrence morphology showed that strain Y4 treatment increased the proportion of residual Cd in roots and basal gangliaï¼ decreased the contents of inorganic and water-soluble Cd in rootsï¼ and increased the content of residual Cd in basal ganglia. Further examination of the subcellular distribution of Cd showed that the Cd content in root cell walls and basal ganglia cell fluid increased by 21.3% and 98.2%ï¼ respectivelyï¼ indicating that the Cd fixation ability of root cell walls and basal ganglia cell fluid was improved by the strain Y4 treatment. In the rhizosphere soilï¼ it was found that the microbial community structure was changed by strain Y4 application. Under the Y4 treatmentï¼ the relative abundance of Burkholderia increased from 9.6% to 11.5%ï¼ whereas that of Acidobacteriota decreased. Additionallyï¼ the relative abundance of Gemmatimonadalesï¼ Pseudomonadalesï¼ and Chitinophagales were also increased by strain Y4 treatment. At the same timeï¼ the application of strain Y4 increased the pH value of rhizosphere soil by 8.3%. The contents of exchangeable Cdï¼ carbonate-bound Cdï¼ and iron-manganese oxide-bound Cd in the soil decreased by 44.4%ï¼ 21.7%ï¼ and 15.9%ï¼ respectivelyï¼ whereas the proportion of residual Cd reached 53.6%. Root application of strain Y4 increased the contents of nitrate nitrogen and ammonium nitrogen in the soil by 22.0% and 21.4%ï¼ respectivelyï¼ and the contents of alkaline nitrogen also increased to a certain extent. In conclusionï¼ the root application of strain Y4 not only improved soil nitrogen availability but also inhibited Cd transport and accumulation from contaminated soil to wheat grains in a "two-stage" manner by reducing Cd availability in rhizosphere soil and improving Cd interception and fixation capacity of wheat roots and basal nodes. Thereforeï¼ Burkholderia Y4 has application potential as a Cd-reducing and growth-promoting agent in wheat.
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Burkholderia , Compuestos Férricos , Contaminantes del Suelo , Cadmio/análisis , Triticum , Burkholderia/fisiología , Factor de Transferencia , Suelo/química , Nitrógeno/análisis , Contaminantes del Suelo/análisisRESUMEN
Microorganisms play an important role in heavy metal bioremediation and soil fertility. The effects of soil inoculation with Pseudomonas sp. W112 on Cd accumulation in wheat were investigated by analyzing the transport, subcellular distribution and speciation of Cd in the soil and plants. Pseudomonas sp. W112 application significantly decreased Cd content in the roots, internode and grains by 10.2%, 29.5% and 33.0%, respectively, and decreased Cd transfer from the basal nodes to internodes by 63.5%. Treatment with strain W112 decreased the inorganic and water-soluble Cd content in the roots and increased the proportion of residual Cd in both the roots and basal nodes. At the subcellular level, the Cd content in the root cell wall and basal node cytosol increased by 19.6% and 61.8%, respectively, indicating that strain W112 improved the ability of the root cell wall and basal node cytosol to fix Cd. In the rhizosphere soil, strain W112 effectively colonized and significantly decreased the exchangeable Cd, carbonate-bound Cd and iron-manganese oxide-bound Cd content by 43.5%, 27.3% and 17.6%, respectively, while it increased the proportion of residual Cd by up to 65.2%. Moreover, a 3.1% and 23.5% increase in the pH and inorganic nitrogen content in the rhizosphere soil, respectively, was recorded. Similarly, soil bacterial community sequencing revealed that inoculating with strain W112 increased the abundance of Pseudomonas, Thauera and Azoarcus, which are associated with inorganic nitrogen metabolism, and decreased that of Acidobacteria, which is indicative of soil alkalinization. Hence, root application of Pseudomonas sp. W112 improved soil nitrogen availability and inhibited Cd accumulation in the wheat grains in a two-stage process: by reducing the Cd availability in the rhizosphere soil and by improving Cd interception and fixation in the wheat roots and basal nodes. Pseudomonas sp. W112 may be a suitable bioremediation agent for restoring Cd-contaminated wheat fields.
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Cadmio , Contaminantes del Suelo , Cadmio/análisis , Triticum/metabolismo , Suelo/química , Disponibilidad Biológica , Pseudomonas/metabolismo , Contaminantes del Suelo/análisis , Raíces de Plantas/metabolismo , Nitrógeno/análisisRESUMEN
Crop straws provide enormous biomass residues applicable for biofuel production and trace metal phytoremediation. However, as lignocellulose recalcitrance determines a costly process with potential secondary waste liberation, genetic modification of plant cell walls is deemed as a promising solution. Although pectin methylation plays an important role for plant cell wall construction and integrity, little is known about its regulation roles on lignocellulose hydrolysis and trace metal elimination. In this study, we initially performed a typical CRISPR/Cas9 gene-editing for site mutations of OsPME31, OsPME34 and OsPME79 in rice, and then determined significantly upgraded pectin methylation degrees in the young seedlings of three distinct site-mutants compared to their wild type. We then examined distinctively improved lignocellulose recalcitrance in three mutants including reduced cellulose levels, crystallinity and polymerization or raised hemicellulose deposition and cellulose accessibility, which led to specifically enlarged biomass porosity either for consistently enhanced biomass enzymatic saccharification under mild alkali pretreatments or for cadmium (Cd) accumulation up to 2.4-fold. Therefore, this study proposed a novel model to elucidate how pectin methylation could play a unique enhancement role for both lignocellulose enzymatic hydrolysis and Cd phytoremediation, providing insights into precise pectin modification for effective biomass utilization and efficient trace metal exclusion.
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Oryza , Oryza/metabolismo , Pectinas/metabolismo , Cadmio/metabolismo , Biomasa , Biodegradación Ambiental , Lignina/metabolismo , Celulosa/metabolismo , MetilaciónRESUMEN
Malic acid (MA) plays an important role in plant tolerance to toxic metals, but its effect in restricting the transport of harmful metals remains unclear. In this study, japonica rice NPB and its fragile-culm mutant fc8 with low cellulose and thin cell wall were used to investigate the influence of MA on the accumulation of 4 toxic elements (Cd, Pb, Ni, and Cr) and 8 essential elements (K, Mg, Ca, Fe, Mn, Zn, Cu and Mo) in rice. The results showed that fc8 accumulated less toxic elements but more Ca and glutamate in grains and vegetative organs than NPB. After foliar application with MA at rice anthesis stage, the content of Cd, Pb, Ni significantly decreased by 27.9-41.0%, while those of Ca and glutamate significantly increased in both NPB and fc8. Therefore, the ratios between Cd and Ca in grains of NPB (3.4) and fc8 (1.5) were greatly higher than that in grains of NPB + MA (1.1) and fc8+MA (0.8) treatments. Meanwhile, the expression of OsCEAS4,7,8,9 for the cellulose synthesis in secondary cell walls were down-regulated and cellulose content in vegetative organs of NPB and fc8 decreased by 16.7-21.1%. However, MA application significantly up-regulated the expression of GLR genes (OsGLR3.1-3.5) and raised the activity of glutamic-oxalacetic transaminease for glutamate synthesis in NPB and fc8. These results indicate that hazard risks of toxic elements in foods can be efficiently reduced through regulating cellulose biosynthesis and GLR channels in plant by combining genetic modification in vivo and malic acid application in vitro.
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Metales Pesados , Oryza , Contaminantes del Suelo , Cadmio/análisis , Cromo/metabolismo , Níquel/toxicidad , Níquel/metabolismo , Oryza/genética , Oryza/metabolismo , Regulación hacia Arriba , Regulación hacia Abajo , Plomo/metabolismo , Glutamatos/genética , Glutamatos/metabolismo , Celulosa/metabolismo , Contaminantes del Suelo/análisis , Suelo , Metales Pesados/análisisRESUMEN
The distributions of heavy metals in paddy fields and rice along river valleys were studied to explore the key factors affecting the accumulation of heavy metals in the upstream terraces and downstream plains. Results from 975 sampling sites showed that elevation, growing season and soil organic matter (OM) had significant effects on the content of Cd and Pb in topsoil and rice. The content of Cd (0.47-0.66 mg kg-1) and Pb (49.9-68.6 mg kg-1) in paddy fields with low elevation (30-60 m) in the downstream plains was significantly higher than the content of Cd (0.29-0.38 mg kg-1) and Pb (43.9-56.3 mg kg-1) in the upstream terraces with high altitude (60-90 m). In the double-rice production area, late rice generally produced grains with higher Cd and Pb content than early rice. Soil Cd was positively increased with the content of OM, especially in the downstream plains. When elevation was used for principal component analysis, plains with low elevation were grouped together with high content of total and soluble Cd, OM and Pb in soil, as well as high content of Cd and Pb in late rice. Altitude is one of the key factors affecting Cd content in rice. Although content of Cr (93.7-138.0 mg kg-1) was significantly higher than that of Cd and Pb in soil, content of Cr was lower than that of Cd in rice. These results indicate that paddy fields with elevation of 30-60 m in the downstream plains had high risk to produce late rice with Cd and Pb content exceeding the food safety standard 0.2 mg kg-1, which may be resulted from the driving force of runoff on soil soluble Cd and Pb from terraces to alluvial plains in river valleys.
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Aiming at purification of NOx from hydrogen internal combustion engines (HICEs), the hydrogen selective catalytic reduction (H2-SCR) reaction was investigated over a series of Pt/KFI zeolite catalysts. H2 can readily reduce NOx to N2 and N2O while O2 inhibited the deNOx efficiency by consuming the reductant H2. The Pt/KFI zeolite catalysts with Pt loading below 0.1 wt.% are optimized H2-SCR catalysts due to its suitable operation temperature window since high Pt loading favors the H2-O2 reaction which lead to the insufficient of reactants. Compared to metal Pt0 species, Ptδ+ species showed lower activation energy of H2-SCR reaction and thought to be as reasonable active sites. Further, Eley-Rideal (E-R) reaction mechanism was proposed as evidenced by the reaction orders in kinetic studies. Last, the optimized reactor was designed with hybrid Pt/KFI catalysts with various Pt loading which achieve a high NOx conversion in a wide temperature range.
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Hidrógeno , Zeolitas , Hidrógeno/química , Oxidación-Reducción , Cinética , Amoníaco/química , CatálisisRESUMEN
The present study aimed to investigate the association between intraoperative body temperature and prolonged length of stay (PLOS) after free flap reconstruction. A total of 753 patients who underwent head and neck surgery with free flap reconstruction were collected and randomly assigned into primary and validation cohorts. In the primary cohort, univariable and multivariable analyses were conducted to evaluate associations between intraoperative time-weighted (TW) temperature (TW average [TWA] temperature, TW hypothermia and TW hyperthermia) and PLOS. Nomograms were developed with and without intraoperative TW temperature, and validated in the validation cohort. Severe intraoperative TW hypothermia (OR = 1.004; 95% CI: 1.000, 1.007; p = 0.032) was identified as an independent risk factor for PLOS. Intraoperative TWA temperature and TW hypothermia showed linear related predictive effect for PLOS. The nomogram incorporating intraoperative TW temperature showed higher C-index (0.652, 95% CI: 0.591, 0.713) and improved net reclassification improvement for non-event (0.277, 95% CI: 0.118, 0.435; p < 0.001). Lower TWA temperature with mild TW hypothermia had a preventive effect on PLOS with a linear association, which may provide a modified range for intraoperative temperature management. The proposed nomogram incorporating intraoperative TW temperature could be used to develop personalized preventive strategies for PLOS after free flap reconstruction. IRB NUMBER: SYSEC-KY-KS-2022-037. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable.
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Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Hipotermia , Humanos , Hipotermia/complicaciones , Temperatura , Tiempo de Internación , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/complicaciones , Estudios Retrospectivos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiologíaRESUMEN
Phase-amplitude coupling (PAC) across frequency might be associated with the long-range synchronization of brain networks, facilitating the spatiotemporal integration of multiple cell assemblies for information transmission during inhibitory control. However, sleep problems may affect these cortical information transmissions based on cross-frequency PAC, especially when humans work in environments of social isolation. This study aimed to evaluate changes in the theta-beta/gamma PAC of task-related electroencephalography (EEG) for humans with insufficient sleep. Here, we monitored the EEG signals of 60 healthy volunteers and 18 soldiers in the normal environment, performing a Go/Nogo task. Soldiers also participated in the same test in isolated cabins. These measures demonstrated theta-beta PACs between the frontal and central-parietal, and robust theta-gamma PACs between the frontal and occipital cortex. Unfortunately, these PACs significantly decreased when humans experienced insufficient sleep, which was positively correlated with the behavioral performance of inhibitory control. The evaluation of theta-beta/gamma PAC of Go/Nogo task-related EEG is necessary to help understand the different influences of sleep problems in humans.
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Encéfalo , Privación de Sueño , Humanos , Encéfalo/fisiología , ElectroencefalografíaRESUMEN
In the present work, we report on two passive NOx adsorber (PNA) material candidates: the novel support CeSnOx with and without Pd loading. The NOx adsorption and storage capacities of fresh and hydrothermally aged CeSnOx and Pd/CeSnOx were investigated. The results show that CeSnOx exhibits a rather large NOx uptake and storage capacity (28.9 µmol/g), while the loading of Pd on CeSnOx can further increase the storage capacity to 37.6 µmol/g and affect the desorption temperature of NOx. It was found that the NOx desorption temperature of Pd/CeSnOx was compatible with the efficient operating window of selective catalytic reduction (SCR) catalysts. After a hydrothermal aging treatment at 800 °C for 12 h, the NOx adsorption and storage capacities of CeSnOx and Pd/CeSnOx increased, indicating excellent hydrothermal stability. The interaction of Pd with CeSnOx, the state of Pd species, and the structure of CeSnOx and Pd/CeSnOx are studied by combination of the characterization results.
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This study aimed to evaluate the association between preoperative flurbiprofen, a non-selective COX inhibitor, and reoperation for flap crisis after free flap reconstruction. In this retrospective study, patients who underwent head and neck surgery with free flap reconstructions were collected. To identify risk factors for reoperation from demographic features and perioperative variables, univariate and multivariate logistic analyses were conducted. After propensity score matching (PSM), univariate and adjusted multivariate analyses were employed to explore the impact of preoperative flurbiprofen on reoperation after free flap reconstruction. This study comprised 437 patients, 33 of whom underwent reoperations for flap crisis. After multivariate analysis, radiotherapy history (P = 0.005; odds ratio [OR] = 0.225; 95% CI, 0.080-0.636) and preoperative flurbiprofen (P = 0.038; OR = 5.059; 95% CI, 1.094-23.386) were identified as independent factors for reoperation. PSM was achieved, and preoperative flurbiprofen was found to diminish the reoperation rate (P = 0.046; OR = 4.765; 95% CI, 1.029-22.202) without increasing bleeding complications. Within the limitations of the study, flurbiprofen should be administered preoperatively to reduce the rate of reoperations for flap crisis whenever appropriate.
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Purpose: The objectives were to investigate the safety and efficacy of thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma patients with clinically significant portal hypertension (CSPH). Materials and Methods: From July 2016 to September 2019, hepatocellular carcinoma patients with CSPH treated by liver transplantation (N=37) or thermal ablation (N=114) were enrolled. Cumulative intrahepatic recurrence, overall survival and major complications were compared by propensity score matching. Results: In the two matched groups, the 1-, 2-, and 3-year intrahepatic recurrence rates for the ablation group (22.3%, 50.0%, and 50.0%, respectively) were significantly higher than those for the transplantation group (4.5%, 4.5%, and 4.5%, respectively) (P=0.016). The 1-, 2-, and 3-year overall survival rates were comparable between the two groups [96.1%, 88.7%, and 88.7%, respectively (ablation group) vs. 84.6%, 76.2%, and 76.2%, respectively (transplantation group)] (P=0.07). The major complication rate for the ablation group [4.8% (3/62)] was significantly lower than that for the transplantation group [36.0% (9/25)] (P<0.001). Conclusions: Thermal ablation is a safe and effective alternative for hepatocellular carcinoma patients with CSPH.
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Background: Inflammation has been recognized to be a factor that substantially influences tumorigenesis and tumor prognosis. Hence, this study was aimed to investigate an inflammatory marker with the most potent prognostic ability and to evaluate the survival estimation capability of dynamic change in this marker for patients suffered from oral squamous cell carcinoma (OSCC). Methods: 469 patients' inflammatory indicators including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammatory response index (SIRI), were calculated. Their predictive abilities for overall survival (OS) were evaluated by Kaplan-Meier curves to screen for the one with the most potent prognostic value. The predictive ability of dynamic changes in this marker was verified and a predictive nomogram incorporating inflammatory indicators was developed. Results: A high LMR was identified to be an indicator of a satisfactory survival rate. Compared with that of other inflammatory markers, area under the receiver operating characteristics (ROC) curve (AUC) of LMR for 1-year and 3-year OS was significantly larger (P<0.001). Dynamic LMR change remained an significant parameter for predicting OS (OR: 2.492, 95% CI: 1.246-4.981, p = 0.010). The nomogram incorporating LMR exhibited a superior prognostic significance than the TNM system, as suggested by the C-index (0.776 vs 0.651 in primary cohort; 0.800 vs 0.707 in validation cohort, P<0.001) and AUC. Conclusions: LMR was demonstrated to possess a more potent survival estimation capability than the other three inflammatory parameters. Dynamic changes in LMR serves as a significant parameter for overall survival estimation of primary OSCC patients. The established nomogram incorporating inflammatory markers showed more accuracy and sensitivity for survival estimation of primary OSCC patients.