Molecular Insights into Macromolecules Structure, Function, and Regulation.

Macromolecules exhibit ordered structures and complex functions in an aqueous environment with strong thermodynamic fluctuations [...].

Nomogram to predict ventilator-associated pneumonia in large vessel occlusion stroke after endovascular treatment: a retrospective study.

Background: Ventilator-Associated Pneumonia (VAP) severely impacts stroke patients' prognosis after endovascular treatment. Hence, this study created a nomogram to predict the occurrence of VAP after endovascular treatment. Methods: The individuals with acute ischemic stroke and large vessel occlusion (AIS-LVO) who received mechanical ventilation and endovascular therapy between July 2020 and August 2023 were included in this retrospective study. The predictive model and nomogram were generated by performing feature selection optimization using the LASSO regression model and multifactor logistic regression analysis and assessed the evaluation, verification and clinical application. Results: A total of 184 individuals (average age 61.85 ± 13.25 years, 73.37% male) were enrolled, and the rate of VAP occurrence was found to be 57.07%. Factors such as the Glasgow Coma Scale (GCS) score, duration of stay in the Intensive Care Unit (ICU), dysphagia, Fazekas scale 2 and admission diastolic blood pressure were found to be associated with the occurrence of VAP in the nomogram that demonstrating a strong discriminatory power with AUC of 0.862 (95% CI, 0.810-0.914), and a favorable clinical net benefit. Conclusion: This nomogram, comprising GCS score, ICU duration, dysphagia, Fazekas scale 2 and admission diastolic blood pressure, can aid clinicians in predicting the identification of high-risk patients for VAP following endovascular treatment in large vessel occlusion stroke.

Navigate biopsy with ultrasound under augmented reality device: Towards higher system performance.

PURPOSE: Biopsies play a crucial role in determining the classification and staging of tumors. Ultrasound is frequently used in this procedure to provide real-time anatomical information. Using augmented reality (AR), surgeons can visualize ultrasound data and spatial navigation information seamlessly integrated with real tissues. This innovation facilitates faster and more precise biopsy operations. METHODS: We have developed an augmented reality biopsy navigation system characterized by low display latency and high accuracy. Ultrasound data is initially read by an image capture card and streamed to Unity via net communication. In Unity, navigation information is rendered and transmitted to the HoloLens 2 device using holographic remoting. Concurrently, a retro-reflective tool tracking method is implemented on the HoloLens 2, enabling the simultaneous tracking of the ultrasound probe and biopsy needle. Distinct navigation information is provided during in-plane and out-of-plane punctuation. To evaluate the effectiveness of our system, we conducted a study involving ten participants, assessing puncture accuracy and biopsy time in comparison to traditional methods. RESULTS: Ultrasound image was streamed from the ultrasound device to augmented reality headset with 122.49±11.61ms latency, while only 16.22±11.25ms was taken after data acquisition from image capture card. Navigation accuracy reached 1.23±0.68mm in the image plane and 0.95±0.70mm outside the image plane, within a depth range of 200 millimeters. Remarkably, the utilization of our system led to 98% and 95% success rate in out-of-plane and in-plane biopsy, among ten participants with little ultrasound experience. CONCLUSION: To sum up, this paper introduces an AR-based ultrasound biopsy navigation system characterized by high navigation accuracy and minimal latency. The system provides distinct visualization contents during in-plane and out-of-plane operations according to their different characteristics. Use case study in this paper proved that our system can help young surgeons perform biopsy faster and more accurately.

Dual-Region Computed Tomography Radiomics-Based Machine Learning Predicts Subcarinal Lymph Node Metastasis in Patients with Non-small Cell Lung Cancer.

BACKGROUND: Noninvasively and accurately predicting subcarinal lymph node metastasis (SLNM) for patients with non-small cell lung cancer (NSCLC) remains challenging. This study was designed to develop and validate a tumor and subcarinal lymph nodes (tumor-SLNs) dual-region computed tomography (CT) radiomics model for predicting SLNM in NSCLC. METHODS: This retrospective study included NSCLC patients who underwent lung resection and SLNs dissection between January 2017 and December 2020. The radiomic features of the tumor and SLNs were extracted from preoperative CT, respectively. Ninety machine learning (ML) models were developed based on tumor region, SLNs region, and tumor-SLNs dual-region. The model performance was assessed by the area under the curve (AUC) and validated internally by fivefold cross-validation. RESULTS: In total, 202 patients were included in this study. ML models based on dual-region radiomics showed good performance for SLNM prediction, with a median AUC of 0.794 (range, 0.686-0.880), which was superior to those of models based on tumor region (median AUC, 0.746; range, 0.630-0.811) and SLNs region (median AUC, 0.700; range, 0.610-0.842). The ML model, which is developed by using the naive Bayes algorithm and dual-region features, had the highest AUC of 0.880 (range of cross-validation, 0.825-0.937) among all ML models. The optimal logistic regression model was inferior to the optimal ML model for predicting SLNM, with an AUC of 0.727. CONCLUSIONS: The CT radiomics showed the potential for accurately predicting SLNM in NSCLC patients. The ML model with dual-region radiomic features has better performance than the logistic regression or single-region models.

Continuous real-time monitoring of carbon dioxide emitted from human skin by quartz-enhanced photoacoustic spectroscopy.

In this study, a skin gas detection system based on quartz enhanced photoacoustic spectroscopy (QEPAS) with a constant temperature collection chamber and an automatic frequency adjustment function was used to collect and monitor carbon dioxide (CO2) emissions from human skin. The detection element of the system is an on-beam structure assembled by a 30.72 kHz quartz tuning fork (QTF). A laser with a wavelength of 4991.26 cm-1 is emitted (with a wavelength adjustment range of 10 cm-1) to excite the QTF. When the integration time is 365 s, the system can achieve a minimum detection limit (MDL) of 2.6 ppmv. The sensitivity of the system is 636.9 ppmv/V. The gas detection system is used to monitor the concentration of CO2 emissions from different parts of the skin and the same part covered by different cosmetics. The CO2 emission rate is defined as the ratio of the skin gas monitoring time of 25 min to the CO2 concentration variable in the gas chamber (volume of 8 mL). The results were collected from three healthy volunteers. Among the six different parts, the cheeks emitted the fastest rate (the average rate was 365.5 ppmv/min) of CO2, and the thighs emitted the slowest rate (the average rate was 56.4 ppmv/min) of CO2. Comparing the experimental results of the six sites at different times, the order of the CO2 emission rate is identical for all six sites. In the experiments with the three cosmetic products (experimental site: forearm), comparing the CO2 emission rate from clean skin with the CO2 emission rate from cosmetic-covered skin shows that sunscreen is the most breathable, followed by barrier cream, and foundation is the least breathable.

Monolithic 6 × 6 transmitter-router with simultaneous sub-nanosecond port and wavelength switching.

A monolithic 6 × 6 transmitter-router with both port and wavelength switching at sub-nanosecond speed is proposed and experimentally demonstrated. Based on an intra-cavity cyclic echelle diffraction grating router (EDGR) and semiconductor optical amplifier (SOA) arrays, each selectable output port can realize a selected multi-wavelength laser (MWL) output. The measurement results show that all 36 input-output combinations have a single-mode emission spectrum with a sidemode suppression ratio (SMSR) over 30 dB. Simultaneous switching of six laser wavelengths is achieved together with the switching of the output port by a single electrode selection. The switching time is less than 1 ns. It can offer a cost-effective solution to multi-wavelength multi-port optical transmitter-routers for fast distributed optical switching in datacenters and high-performance computers (HPCs).

Triptolide decreases tumor-associated macrophages infiltration and M2 polarization to remodel colon cancer immune microenvironment via inhibiting tumor-derived CXCL12.

Colon cancer is a common and deadly human digestive tract malignant tumor with poor prognosis. Immunotherapy has elicited tremendous success as a treatment modality for multiple solid tumors. Triptolide is extracted from the traditional Chinese medicine Tripterygium wilfordii Hook. F which shows various pharmacological actions including antitumor, anti-inflammatory, antimicrobial, antifibrosis, and antirheumatic. However, the influence of triptolide treatment on remodeling tumor immune microenvironment is still unknown in colon cancer. This study was aimed to investigate the therapeutic effect of triptolide treatment on colon cancer and the impact on tumor immune microenvironment and its underlying mechanism. We used CT26 subcutaneous tumors to conduct in vivo experiments and HT29, CT16, and Raw264.7 cells to perform in vitro assays. Triptolide had a therapeutic effect against colon cancer in vivo. Triptolide treatment distinctly inhibited the proliferation of colon cancer cells and induced apoptosis in vitro. In colon cancer immune microenvironment, triptolide treatment decreased the infiltration of tumor-associated macrophages through downregulating tumor-derived CXCL12 expression via nuclear factor kappa B and extracellular signal-regulated protein kinases 1 and 2 axis to remodel the immune microenvironment. Triptolide-educated colon cancers retarded the macrophages polarize to anti-inflammatory M2 status by decreasing the expression of Arg-1, CD206, and interleukin-10. Moreover, triptolide inhibited the migration of colon cancer cells via decreasing vascular endothelial growth factor expression. Our results identified the role of triptolide treatment in remodeling colon cancer immune microenvironment along with the distinct cytotoxicity function against colon cancer cells, which may provide the evidence for triptolide treatment in clinical.

Arterial Stiffness Response to Regular Aerobic Training in Hypercholesterolemia Patients.

Physical exercise increase is confirmed as a fundamental treatment for hypercholesterolemia patients, but the effect on the arterial stiffness and oxidative stress is still unclear. 74 hypercholesterolemia patients were divided into 2 groups. The exercise group received dietary recommendations and a 3-month exercise program, prescribed according to their first cardiopulmonary exercise tests(CPET), while the control group only received dietary recommendations. All patients underwent blood tests, CPET and brachial-ankle pulse wave velocity (baPWV) studies at enrollment and at 3 months' follow-up. At the end of 3 months, there was no change in total cholesterol (TC) level in either group. However, in the exercise group, we found maximal exercise parameters increased and baPWV values declined. Meanwhile, there were significant changes in the level of malondialdehyde, 8-isoprostane-F2α and superoxide dismutase. Moreover, the change of baPWV was positively correlated with the change of 8-isoprostane-F2α (r=0.36, P<0.01). In the control group, no change in baPWV or oxidative biomarker was observed. Our findings suggested that regular aerobic exercise could lessen arterial stiffness in hypercholesterolemia patients, even in the context of no obvious TC decrease. During this process, favorable adjustment in oxidative stress might be an important pathway, which remains to be further explored.

Comparison of oxidative stress biomarkers in hypertensive patients with or without hyperhomocysteinemia.

Hyperhomocysteinemia is an independent risk factor for cardiovascular impairment in hypertension. Oxidative stress is important in the molecular mechanisms associated with hypertension, but there are few studies focusing on the comparison of oxidative stress biomarkers in hypertensive patients with or without hyperhomocysteinemia. The study included 50 newly diagnosed hypertensive patients with hyperhomocysteinemia, 50 newly diagnosed hypertensive patients without hyperhomocysteinemia, and 50 age-matched healthy controls. Serum levels of malondialdehyde, nitric oxide, 8-isoprostane-F2ɑ, superoxide dismutase, catalase, and glutathione peroxides were compared. Levels of malondialdehyde and 8-isoprostane-F2ɑ were higher in both hypertensive groups than in the control group (8.3 ± 1.8 µmol/L vs. 6.5 ± 1.3 µmol/L vs. 4.3 ± 1.2 µmol/L, P < 0.05; 23.5 ± 12.1 pg/mL vs. 17.4 ± 10.3 pg/mL vs. 13.9 ± 7.5 pg/mL, P < 0.05), while levels of superoxide dismutase and catalase were lower in both hypertensive groups than in the control group (120.5 ± 13.7 U/mL vs. 131.3 ± 18.2 U/mL vs. 149.1 ± 14.6 U/mL, P < 0.05; 23.8 ± 7.4 U/mL vs. 24.6 ± 9.2 U/mL vs. 33.5 ± 8.2 U/mL, P < 0.05). In hypertensive subgroups, serum malondialdehyde levels were higher in the hyperhomocysteinemia group than the other group (8.3 ± 1.8 µmol/L vs. 6.5 ± 1.3 µmol/L; P < 0.05), and superoxide dismutase activities were lower in the hyperhomocysteinemia group than the other group (120.5 ± 13.7 U/mL vs. 131.3 ± 18.2 U/mL; P < 0.05). Moreover, in hypertensive patients, homocysteine levels were significantly correlated with malondialdehyde (r = 0.39, P < 0.01), 8-isoprostane-F2ɑ (r = 0.47, P < 0.05), superoxide dismutase (r = -0.51, P < 0.01), and catalase (r = -0.51, P < 0.05), respectively. Our findings demonstrated oxidative stress was more severe in hypertensive patients with hyperhomocysteinemia than those hypertensive patients without it. Besides, there were strong relationships between homocysteine activities and oxidative/antioxidative parameters, which indicated that homocysteine might aggravate the oxidative stress in hypertension to produce contributory effects on cardiovascular impairment.

ECG data compression using a neural network model based on multi-objective optimization.

Electrocardiogram (ECG) data analysis is of great significance to the diagnosis of cardiovascular disease. ECG compression should be processed in real time, and the data should be based on lossless compression and have high predictability. In terms of the real time aspect, short-time Fourier transformation is applied to the processing of signal wave for reducing computational time. For the lossless compression requirement, wavelet-transformation that is a coding algorithm can be used to avoid loss of data. In practice, compression is required to avoid storing redundant recording data that are not useful in the diagnosis platform. The obtained data can be preprocessed to remove noise by using wavelet transform, and then a multi-objective optimize neural network model is used to extract feature information. Compared with the existing traditional methods such as direct data processing method and transform method, our proposed compression model has self-learning ability to achieve high data compression ratio at 1:19 without losing important ECG information and compromising quality. Upon testing, we demonstrated that the proposed ECG data compression method based on multi-objective optimization neural network is effective and efficient in clinical practice.

Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China.

OBJECTIVES: It is estimated that there are more than 16 million adults with drug-resistant hypertension in China. Nevertheless, the prevalence of and risk factors for primary aldosteronism, a highly curable condition among adults with drug-resistant hypertension, has not been fully investigated. METHODS: Between January 2010 and October 2011, a multicenter epidemiologic study was conducted among 1656 patients with resistant hypertension in 11 provinces of China. Serum aldosterone and plasma renin activity were measured in every participant and aldosterone-to-renin ratio (ARR) was calculated. Patients with ARR more than 20 underwent an intravenous (i.v.) sodium infusion test, and diagnosis of primary aldosteronism was established by the presence of unsuppressed postinfusion aldosterone (>8 ng/dl). Patients with biochemically proved primary aldosteronism then underwent adrenal computed tomography (CT) scanning and adrenal vein sampling (AVS) for subtype classification. RESULTS: Among the 1656 patients, 494 (29.8%) had ARR greater than 20 and underwent i.v. sodium infusion. Of these 494, 118 were diagnosed as primary aldosteronism, yielding a prevalence of 7.1% (95% confidential interval 5.9-8.3%). Seventy of the 118 patients were categorized into unilateral (39) and bilateral (31) by AVS. Generalized additive regression analysis revealed that among all the factors investigated (age of hypertension onset, BMI, family history of hypertension, cigarette smoking, alcohol consumption, diabetes, serum potassium, hyperlipidemia, and creatinine), only age of hypertension onset and serum potassium were independently associated with the presence of primary aldosteronism. CONCLUSION: The prevalence of primary aldosteronism among Chinese patients with resistant hypertension is relatively lower than that reported previously for other ethnic populations. The screening for primary aldosteronism should be focused on those with early onset hypertension and/or hypokalemia.

[Value of adrenal venous sampling in the subtype diagnosis of primary aldosteronism].

OBJECTIVE: To assess the diagnostic value of adrenal venous sampling (AVS) in the subtype diagnosis of primary aldosteronism (PA). METHODS: The diagnosis of PA was made in 36 patients based on an elevated ratio of plasma aldosterone (ALD) to plasma rennin activity (PRA) (ARR) and confirmed tests (saline infusion or captopril challenge) in recent 3 years. All PA patients underwent adrenal computed tomographic scan (CT) and AVS. The diagnostic accuracy of CT and AVS in the subtype differentiation of PA were evaluated by comparing the differences of CT findings, AVS results and clinical outcomes. RESULTS: Fifteen of 36 patients (42%) had a final diagnosis of aldosterone-producing adenoma (APA) and another 21 patients (58%) with bilateral adrenal hyperplasia (BAH). The level of ALD was significantly higher in APA group than that in BAH group (298.9 ± 91.0 vs 226.3 ± 59 ng/L, P < 0.05). PRA (ng×ml(-1)×h(-1)) in APA patients were markedly lower than that in BAH counterparts (0.18 ± 0.14 vs 0.28 ± 0.29 ng×ml(-1)×h(-1), P < 0.01). Consequently, ARR in APA group was evidently higher than that in BAH group (2444.7 ± 1405.2 vs 1550.0 ± 1059.8, P < 0.05). Plasma potassium in APA patients was lower than that in those with BAH (2.71 ± 0.57 vs 3.17 ± 0.40 mmol/L). But there was no statistic significance (P > 0.05). The CT findings were discordant with the AVS results in 27.8% of patients (10/36). The accuracy of adrenal CT scan was only 72.2% in the subtype diagnosis of PA, provided AVS was the gold standard for distinguishing between APA and BAH. Reliance on CT findings could lead to inappropriate management in 25% of PA patients. Conversely, the AVS results were concordant with the clinical outcomes in 94.4% of all patients. CONCLUSION: CT scan is not a reliable method of differentiating primary aldosteronism. Compared with CT, AVS is more accurate in establishing a correct diagnosis of primary aldosteronism. AVS should be performed routinely before operation in PA patients opting for adrenalectomy.

Pioglitazone ameliorates nonalcoholic steatohepatitis by down-regulating hepatic nuclear factor-kappa B and cyclooxygenases-2 expression in rats.

BACKGROUND: Pioglitazone is effective in nonalcoholic steatohepatitis (NASH), but the mechanisms of action are not completely understood. This study was designed to investigate the effects of pioglitazone on hepatic nuclear factor-kappa B (NF-κB) and cyclooxygenases-2 (COX-2) expression in NASH rats. METHODS: Thirty Sprague-Dawley male rats were randomly assigned to a control group (n = 10), NASH group (n = 10), and pioglitazone treatment group (n = 10). Liver tissues were processed for histology by hematoxylin & eosin and Masson stained. Serum alanine aminotransferase (ALT), cholesterol, triglyceride, fasting blood glucose (FBG), fasting insulin (FINS) levels and biochemical parameters of antioxidant enzyme activities, tumor necrosis factor alpha (TNF-α), prostaglandin E(2) (PGE(2)) levels in serum and liver were measured. The mRNA and protein expression of peroxisome proliferator-activated receptor gamma (PPARγ), NF-κB and COX-2 were determined by real-time polymerase chain reaction, Western blotting and immunohistochemistry. One-way analysis of variance (ANOVA) and Wilcoxon's signed-rank test was used for the statistical analysis. RESULTS: There were severe steatosis, moderate inflammatory cellular infiltration and fibrosis in NASH rats. After pioglitazone treatment, steatosis, inflammation and fibrosis were significantly improved compared with the NASH group (χ(2) = 20.40, P < 0.001; χ(2) = 20.17, P < 0.001; χ(2) = 13.98, P = 0.002). Serum ALT, cholesterol, triglyceride, FBG, FINS levels were significantly elevated in the NASH group (P < 0.05). In the NASH group, total anti-oxidation competence (T-AOC), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX) and malondialdehyde (MDA) levels in serum and liver were conspicuous disordered than those parameters in the control group. Meanwhile, TNF-α and PGE(2) levels in serum and liver were significantly increased compared with the control group. Immunohistochemistry showed NF-κB and COX-2 expression in liver was significantly elevated. However, PPAR? level was decreased in the NASH group. Real-time PCR and Western blotting revealed mRNA and protein expression of COX-2 were increased in the NASH group compared with the control group (0.57 ± 0.08 vs. 2.83 ± 0.24; 0.38 ± 0.03 vs. 1.00 ± 0.03, P < 0.001 and P = 0.004, respectively). After pioglitazone intervention, all of those parameters markedly improved (P < 0.05 or P < 0.01). CONCLUSION: Down-regulating hepatic NF-κB and COX-2 expression, at least in part, is one of the possible therapeutic mechanisms of pioglitazone in NASH rats.