CT-guided microcoil versus hook-wire localization of pulmonary nodule prior to video-assisted thoracoscopic surgery without fluoroscopic guidance.

BACKGROUND: Both microcoils and hook-wires are commonly utilized for preoperative pulmonary nodule localization due to their convenience, but it remains unclear which one should be prioritized for recommendation. AIMS: To compare the safety and efficacy of microcoils and hook-wires for pulmonary nodule localization. METHODS: From January 2021 to December 2021, 310 consecutive patients (113 males and 197 females) with 341 pulmonary nodules who underwent CT-guided microcoil or hook-wire localization prior to video-assisted thoracoscopic surgery (VATS) at our center were retrospectively included in this study. There were 161 patients in the microcoil group and 149 patients in the hook-wire group. The successful localization rate, complication rate, radiation exposure, and medical costs were compared between the two groups. RESULTS: A total of 341 pulmonary nodules were localized, with a success rate of 99% (180/184) in the microcoil group and 93% (146/157) in the hook-wire group, respectively. All patients successfully underwent VATS. Multivariate analysis revealed that hook-wire localization, shorter needle depth into the lung tissue and the longer waiting time from localization to VATS were the risk factors for the localization failure. The incidences of pneumothorax in the microcoil group and hook-wire group were 34.8% (56/161) and 34.9% (52/149), respectively (P = 0.983). The incidences of pneumorrhagia were 13% (24/184) and 46.5% (73/157), respectively (P = 0.000). Multivariate analysis revealed that hook-wire localization and greater depth of needle penetration into lung tissue were risk factors for pneumorrhagia. CONCLUSION: Microcoil localization of pulmonary nodules is superior to hook-wire localization in terms of efficacy and safety. This finding provides insight into priority and broader promotion of microcoil localization.

Hybrid packed bed bioreactor using combined biodegradation and ozonation to enhance nitrogen and micropollutants removal from landfill leachate.

Landfill leachate contains ammonium and micropollutants. Ammonium can be biologically removed but bio-recalcitrant micropollutants removal requires post-treatment like ozonation. This study developed an expanded clay aggregates packed biofilm column (EBC) and demonstrated its feasibility of coupling biodegradation and ozonation (CBAO) to simultaneously remove nitrogen and bio-recalcitrant micropollutants. The first 60 days only had biodegradation process to start the bioreactor. 51 % nitrogen was biologically removed but the removal of micropollutant carbamazepine (CBZ) was only 30 %. From 61 d to 150 d, both biodegradation and ozonation were performed in the EBC. After 48 h-biodegradation, ozone gas was introduced and bubbling through EBC for 30 min to further remove residual micropollutants. At 0.4 gO3/gCOD, CBZ were completely removed. The average nitrogen removal efficiency (85 %) was increased by 34 % because the increased abundance of nitrifying and denitrifying bacteria in EBC. This study confirmed the promising potential of the CBAO process for treating landfill leachte.

Survival Benefit of Lenvatinib Plus PD-1 Inhibitor with or Without HAIC in Advanced Hepatocellular Carcinoma Beyond Oligometastasis: a Multicenter Cohort Study.

Purpose: The outcome between Lenvatinib plus programmed cell death protein-1 (PD-1) inhibitor and Lenvatinib in HCC beyond oligometastasis was unclear. In this multicenter, we compared the prognosis of Lenvatinib plus PD-1 inhibitor with Lenvatinib in HCC beyond oligometastasis. Patients and Methods: A total of 296 patients from six institutions were included. The patients were divided into two groups: (a) concurrent Lenvatinib plus PD-1 inhibitor treatment (Len+PD-1 group) and (b) Lenvatinib monotherapy (Len group). The primary endpoint was overall survival (OS), the second endpoint was progression-free survival (PFS) and efficacy. Results: The median OS was 20.1 ± 1.2 (17.7-22.5) months and 15.7 ± 1.5 (12.8-18.6) months in the Len+PD-1 and Len groups, respectively. The 12-, 24-, and 36-month OS rates were 79.1%, 39.4%, and 10.7% in the Len+PD-1 group, and 76.3%, 29.7%, and 0% in the Len group, respectively. The OS and PFS rates of the Len+PD-1 group were significantly longer compared with the Len group (hazard ratio [HR], 0.88; 95% confidence index [CI], 0.49-0.94; P = 0.021) and (HR, 0.66; 95% CI, 0.50-0.87; P = 0.003). A subgroup analysis revealed that OS (HR, 0.57; 95% CI, 0.36-0.90; P = 0.016) was improved between the Len+PD-1 and Len groups with hepatic artery infusion chemotherapy (HAIC) treatment, whereas OS (HR, 1.11; 95% CI, 0.68-1.80; P = 0.689) was similar between the Len and Len+PD-1 groups without HAIC. Conclusion: Lenvatinib combined with PD-1 inhibitor significantly improves the survival of HCC beyond oligometastasis. For patients with HAIC, there was obviously significance between Len and Len+PD-1 groups.

Lenvatinib as one of system therapy, is recommended treatment for HCC with multimetastases. The LEAP-002 trial, which evaluated Lenvatinib combined with Pembrolizumab exhibited improved progression-free survival (PFS) and overall survival (OS) compared with Lenvatinib alone. However, the combination efficacy on HCC beyond oligometastasis is unknown. In this multicenter study, we found that Lenvatinib combined with PD-1 inhibitor significantly improved both the OS and PFS and this combination could be recommended for HCC beyond oligometastases. OS and PFS were improved in the Len+PD-1 versus the Len group with hepatic artery infusion chemotherapy (HAIC) treatment, whereas the OS and PFS were similar between the Len and Len+PD-1 groups without HAIC. We provided clinical value that HAIC could be recommended as an effective local therapy to improve the prognosis for advanced HCC.

Degradative solvent-catalyzed extraction of sewage sludge.

It is necessary for the further development of sludge degradative solvent extraction (DSE) to significantly increase the bio-oil yield and adjust its composition. In this study, the effects of MCM-41, HZSM-5, and SSZ-13 on the physical properties, yield, and composition of bio-oil were compared. Results show that all three catalysts effectively promote the conversion of volatiles in the residue to the heavy component (heavy-s). The addition of MCM-41 improved the yieldof both the light component (light-s) and heavy-s. Their yields increased from 8.11% and 20.47% to 14.39% and 29.18%, respectively. Its all-silicon structure and weak acidity have no significant effect on the composition of the bio-oil. HZSM-5 addition increases the light-s yield to 25.58%. Its MFI structure and proper acidity are beneficial to the formation of aromatic hydrocarbons and olefins, while effectively reducing oxygenates. SSZ-13 increases the heavy-s yield to 27.89%, and promoted the formation of nitrogen-containing compounds significantly.

DSC-Recon: Dual-Stage Complementary 4D Organ Reconstruction from X-ray Image Sequence for Intraoperative Fusion.

Accurately reconstructing 4D critical organs contributes to the visual guidance in X-ray image-guided interventional operation. Current methods estimate intraoperative dynamic meshes by refining a static initial organ mesh from the semantic information in the single-frame X-ray images. However, these methods fall short of reconstructing an accurate and smooth organ sequence due to the distinct respiratory patterns between the initial mesh and X-ray image. To overcome this limitation, we propose a novel dual-stage complementary 4D organ reconstruction (DSC-Recon) model for recovering dynamic organ meshes by utilizing the preoperative and intraoperative data with different respiratory patterns. DSC-Recon is structured as a dual-stage framework: 1) The first stage focuses on addressing a flexible interpolation network applicable to multiple respiratory patterns, which could generate dynamic shape sequences between any pair of preoperative 3D meshes segmented from CT scans. 2) In the second stage, we present a deformation network to take the generated dynamic shape sequence as the initial prior and explore the discriminate feature (i.e., target organ areas and meaningful motion information) in the intraoperative X-ray images, predicting the deformed mesh by introducing a designed feature mapping pipeline integrated into the initialized shape refinement process. Experiments on simulated and clinical datasets demonstrate the superiority of our method over state-of-the-art methods in both quantitative and qualitative aspects.

Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma.

BACKGROUND: The efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus programmed cell death protein-1 (PD-1) for unresectable hepatocellular carcinoma (HCC) have rarely been evaluated and it is unknown which factors are related to efficacy. AIM: To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC. METHODS: This study retrospectively enrolled patients with unresectable HCC who received TACE/lenvatinib/PD-1 treatment between March 2019 and April 2022. Overall survival (OS) and progression-free survival (PFS) were determined. The objective response rate (ORR) and disease control rate (DCR) were evaluated in accordance with the modified Response Evaluation Criteria in Solid Tumors. Additionally, the prognostic factors affecting the clinical outcome were assessed. RESULTS: One hundred and two patients were enrolled with a median follow-up duration of 12.63 months. The median OS was 26.43 months (95%CI: 17.00-35.87), and the median PFS was 10.07 months (95%CI: 8.50-11.65). The ORR and DCR were 61.76% and 81.37%, respectively. The patients with Barcelona Clinic Liver Cancer Classification (BCLC) B stage, early neutrophil-to-lymphocyte ratio (NLR) response (decrease), or early alpha-fetoprotein (AFP) response (decrease > 20%) had superior OS and PFS than their counterparts. CONCLUSION: This study showed that TACE/lenvatinib/PD-1 treatment was well tolerated with encouraging efficacy in patients with unresectable HCC. The patients with BCLC B-stage disease with early NLR response (decrease) and early AFP response (decrease > 20%) may achieve better clinical outcomes with this triple therapy.

A CT-based radiomics nomogram for predicting histologic grade and outcome in chondrosarcoma.

OBJECTIVE: The preoperative identification of tumor grade in chondrosarcoma (CS) is crucial for devising effective treatment strategies and predicting outcomes. The study aims to build and validate a CT-based radiomics nomogram (RN) for the preoperative identification of tumor grade in CS, and to evaluate the correlation between the RN-predicted tumor grade and postoperative outcome. METHODS: A total of 196 patients (139 in the training cohort and 57 in the external validation cohort) were derived from three different centers. A clinical model, radiomics signature (RS) and RN (which combines significant clinical factors and RS) were developed and validated to assess their ability to distinguish low-grade from high-grade CS with area under the curve (AUC). Additionally, Kaplan-Meier survival analysis was applied to examine the association between RN-predicted tumor grade and recurrence-free survival (RFS) of CS. The predictive accuracy of the RN was evaluated using Harrell's concordance index (C-index), hazard ratio (HR) and AUC. RESULTS: Size, endosteal scalloping and active periostitis were selected to build the clinical model. Three radiomics features, based on CT images, were selected to construct the RS. Both the RN (AUC, 0.842) and RS (AUC, 0.835) were superior to the clinical model (AUC, 0.776) in the validation set (P = 0.003, 0.040, respectively). A correlation between Nomogram score (Nomo-score, derived from RN) and RFS was observed through Kaplan-Meier survival analysis in the training and test cohorts (log-rank P < 0.050). Patients with high Nomo-score tumors were 2.669 times more likely to suffer recurrence than those with low Nomo-score tumors (HR, 2.669, P < 0.001). CONCLUSIONS: The CT-based RN performed well in predicting both the histologic grade and outcome of CS.

Partial splenic embolization with embosphere microspheres (700-900 µm) for the treatment of hypersplenism: comparison of selective superior splenic artery embolization and inferior splenic artery embolization.

Objective: To compare clinical outcomes of superior versus inferior splenic artery embolization in partial splenic embolization (PSE) and identify predictors of major complications. Material and methods: This retrospective case-control study included 73 patients who underwent PSE between May 2005 and April 2021. They were divided into two groups: the superior and middle splenic artery embolization group (Group A, n = 37) and the inferior and middle splenic artery embolization group (Group B, n = 36). Outcome differences and major complications between the groups were assessed. Logistic regression was used to analyze potential predictors of major complications, and the optimal cutoff value for splenic embolization rates was determined using the Youden index. Results: There were no significant differences in laboratory and radiological outcomes between the two groups. Group A had a significantly lower incidence of major complications than Group B (p = 0.049), a lower Visual Analog Scale (VAS) score for pain (p = 0.036), and a shorter hospital stay (p = 0.022). Independent risk factors for major complications included inferior and middle splenic artery embolization (odds ratio [OR] = 3.672; 95% confidence interval [CI] = 1.028-13.120; p = 0.045) and a higher spleen embolization rate (OR = 1.108; 95% CI = 1.003-1.224; p = 0.044). The optimal cutoff for spleen embolization rate to predict major complications was 59.93% (sensitivity 77.8%, specificity 63.6%). Conclusion: Using 500-700 µm microspheres for PSE, targeting the middle and superior splenic artery yields similar effects to targeting the middle and inferior artery, but results in lower rates of major complications and shorter hospital stays. To effectively minimize the risk of major complications, the embolization rate should be kept below 59.93%, regardless of the target vessel.

An enhanced electrocatalytic oxygen evolution reaction by the photothermal effect and its induced micro-electric field.

Promoting better thermodynamics and kinetics of electrocatalysts is key to achieving an efficient electrocatalytic oxygen evolution reaction (OER). Utilizing the photothermal effect and micro-electric field of electrocatalysts is a promising approach to promote the sluggish OER. Herein, to reveal the relationship of the photothermal effect and its induced micro-electric field with OER performance, NiSx coupled NiFe(OH)y on nickel foam (NiSx@NiFe(OH)y/NF) is synthesized and subjected to the OER under near-infrared (NIR) light. Owing to the photothermal effect and its induced micro-electric field, the OER performance of NiSx@NiFe(OH)y/NF is significantly enhanced. Compared with no NIR light irradiation, the overpotential at 50 mA cm-2 and the Tafel slope of NiSx@NiFe(OH)y/NF under NIR light irradiation were 234.1 mV and 38.0 mV dec-1, which were lower by 12.4 mV and 7.1 mV dec-1, and it exhibited stable operation at 1.6 V vs. RHE for 8 h with 99% activity maintained. This work presents a novel inspiration to understand the photothermal effect-enhanced electrocatalytic OER.

A magnetic multi-layer soft robot for on-demand targeted adhesion.

Magnetic soft robots have shown great potential for biomedical applications due to their high shape reconfigurability, motion agility, and multi-functionality in physiological environments. Magnetic soft robots with multi-layer structures can enhance the loading capacity and function complexity for targeted delivery. However, the interactions between soft entities have yet to be fully investigated, and thus the assembly of magnetic soft robots with on-demand motion modes from multiple film-like layers is still challenging. Herein, we model and tailor the magnetic interaction between soft film-like layers with distinct in-plane structures, and then realize multi-layer soft robots that are capable of performing agile motions and targeted adhesion. Each layer of the robot consists of a soft magnetic substrate and an adhesive film. The mechanical properties and adhesion performance of the adhesive films are systematically characterized. The robot is capable of performing two locomotion modes, i.e., translational motion and tumbling motion, and also the on-demand separation with one side layer adhered to tissues. Simulation results are presented, which have a good qualitative agreement with the experimental results. The feasibility of using the robot to perform multi-target adhesion in a stomach is validated in both ex-vivo and in-vivo experiments.

The Effectiveness of the Educational Model Based on "Moral and Medical Integration" in the Nursing Students' Education in the Operating Theatre.

Objective: As the reform of China's medical and healthcare system progresses and the demand for medical and healthcare services increases, the humanistic quality of medical personnel has received more attention and concern. The humanistic quality of medicine for medical staff is specifically translated into the ethics of nursing for nursing staff. In this study, we explored the effectiveness of the education model based on "moral and medical integration" in the nursing students' education in the operating room. Methods: The "moral and medical integration" education model was implemented in The Affiliated Changzhou No. 2 People's Hospital since September 1, 2021, and 50 nursing students who received the traditional education model before the implementation from May 1, 2021, to August 31, 2021, were selected as the control group. The study group was composed of 50 nursing trainees who received the traditional education model from 1 September 2021 to 30 November 2021 and 50 nursing trainees who received the education model based on the "integration of moral and medical science". The nursing theory and nursing skills scores, professional nursing practice scores, moral courage scores, and satisfaction with teaching were compared between the two groups. Results: The nursing theory scores (t = 14.36, P < .001), nursing skills scores (t = 11.27, P < .001), and teaching satisfaction of the study group (t = 4.76, P < .029) were all higher than those of the control group . After the education, all the professional nursing practice ability scores(t=9.16, P < .001; t = 12.24, P < .001; t = 10.42, P < .001; t = 10.95, P < .001) and moral courage scores(t=7.81, P < .001; t = 11.76, P < 0.001; t = 15.11, P < .001; t = 12.24, P < .001) of the study group were higher than those of the control group (P < .05). Conclusion: The education model based on "moral and medical integration" can help improve the professional nursing level of nursing students in the operating theatre.

Early prediction of dementia using fMRI data with a graph convolutional network approach.

Objective. Alzheimer's disease is a progressive neurodegenerative dementia that poses a significant global health threat. It is imperative and essential to detect patients in the mild cognitive impairment (MCI) stage or even earlier, enabling effective interventions to prevent further deterioration of dementia. This study focuses on the early prediction of dementia utilizing Magnetic Resonance Imaging (MRI) data, using the proposed Graph Convolutional Networks (GCNs).Approach. Specifically, we developed a functional connectivity (FC) based GCN framework for binary classifications using resting-state fMRI data. We explored different types and processing methods of FC and evaluated the performance on the OASIS-3 dataset. We developed the GCN model for two different purposes: (1) MCI diagnosis: classifying MCI from normal controls (NCs); and (2) dementia risk prediction: classifying NCs from subjects who have the potential for developing MCI but have not been clinically diagnosed as MCI.Main results. The results of the experiments revealed several important findings: First, the proposed GCN outperformed both the baseline GCN and Support Vector Machine (SVM). It achieved the best average accuracy of 80.3% (11.7% higher than the baseline GCN and 23.5% higher than SVM) and the highest accuracy of 91.2%. Secondly, the GCN framework with (absolute) individual FC performed slightly better than that with global FC generally. However, GCN using global graphs with appropriate connectivity can achieve equivalent or superior performance to individual graphs in some cases, which highlights the significance of suitable connectivity for achieving performance. Additionally, the results indicate that the self-network connectivity of specific brain network regions (such as default mode network, visual network, ventral attention network and somatomotor network) may play a more significant role in GCN classification.Significance. Overall, this study offers valuable insights into the application of GCNs in brain analysis and early diagnosis of dementia. This contributes significantly to the understanding of MCI and has substantial potential for clinical applications in early diagnosis and intervention for dementia and other neurodegenerative diseases. Our code for GCN implementation is available at:https://github.com/Shuning-Han/FC-based-GCN.

Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and the third leading cause of cancer-related deaths globally. Hepatic arterial infusion chemotherapy (HAIC) treatment is widely accepted as one of the alternative therapeutic modalities for HCC owing to its local control effect and low systemic toxicity. Nevertheless, although accumulating high-quality evidence has displayed the superior survival advantages of HAIC of oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) compared with standard first-line treatment in different scenarios, the lack of standardization for HAIC procedure and remained controversy limited the proper and safe performance of HAIC treatment in HCC. Therefore, an expert consensus conference was held on March 2023 in Guangzhou, China to review current practices regarding HAIC treatment in patients with HCC and develop widely accepted statements and recommendations. In this article, the latest evidence of HAIC was systematically summarized and the final 22 expert recommendations were proposed, which incorporate the assessment of candidates for HAIC treatment, procedural technique details, therapeutic outcomes, the HAIC-related complications and corresponding treatments, and therapeutic scheme management.

Targeted versus Empiric Embolization for Delayed Postpancreatectomy Hemorrhage: A Retrospective Study of 312 Patients.

PURPOSE: To assess the safety and clinical effectiveness of empiric embolization (EE) compared with targeted embolization (TE) in the treatment of delayed postpancreatectomy hemorrhage (PPH). MATERIALS AND METHODS: The data of patients with delayed PPH between January 2012 and August 2022 were analyzed retrospectively. In total, 312 consecutive patients (59.6 years ± 10.8; 239 men) were included. The group was stratified into 3 cohorts according to angiographic results and treatment strategies: TE group, EE group, and no embolization (NE) group. The χ2 or Fisher exact test was implemented for comparing the clinical success and 30-day mortality. The variables related to clinical failure and 30-day mortality were identified by univariable and multivariable analyses. RESULTS: Clinical success of transcatheter arterial embolization was achieved in 70.0% (170/243) of patients who underwent embolization. There was no statistical difference in clinical success and 30-day mortality between the EE and TE groups. Multivariate analyses demonstrated that malignant disease (odds ratio [OR] = 5.76), Grade C pancreatic fistula (OR = 7.59), intra-abdominal infection (OR = 2.54), and concurrent extraluminal and intraluminal hemorrhage (OR = 2.52) were risk factors for clinical failure. Moreover, 33 patients (13.6%) died within 30 days after embolization. Advanced age (OR = 2.59) and intra-abdominal infection (OR = 5.55) were identified as risk factors for 30-day mortality. CONCLUSIONS: EE is safe and as effective as TE in preventing rebleeding and mortality in patients with angiographically negative delayed PPH.

Tuning Blood-Material Interactions to Generate Versatile Hemostatic Powders and Gels.

Polymer-based hemostatic materials/devices have been increasingly exploited for versatile clinical scenarios, while there is an urgent need to reveal the rational design/facile approach for procoagulant surfaces through regulating blood-material interactions. In this work, degradable powders (PLPS) and thermoresponsive gels (F127-PLPS) are readily developed as promising hemostatic materials for versatile clinical applications, through tuning blood-material interactions with optimized grafting of cationic polylysine: the former is facilely prepared by conjugating polylysine onto porous starch particle, while F127-PLPS is prepared by the simple mixture of PLPS and commercial thermosensitive polymer. In vitro and in vivo results demonstrate that PLPS2 with the optimal-/medium content of polylysine grafts achieve the superior hemostatic performance. The underlying procoagulant mechanism of PLPS2 surface is revealed as the selective fibrinogen adsorption among the competitive plasma-protein-adsorption process, which is the foundation of other blood-material interactions. Moreover, in vitro results confirm the achieved procoagulant surface of F127-PLPS through optimal PLPS2 loading. Together with the tunable thermoresponsiveness, F127-PLPS exhibits outstanding hemostatic utilization in both femoral-artery-injury and renal-artery-embolization models. The work thereby pioneers an appealing approach for generating versatile polymer-based hemostatic materials/devices.

Model Simulations and Predictions of Hydroxymethanesulfonate (HMS) in the Beijing-Tianjin-Hebei Region, China: Roles of Aqueous Aerosols and Atmospheric Acidity.

Hydroxymethanesulfonate (HMS) has been found to be an abundant organosulfur aerosol compound in the Beijing-Tianjin-Hebei (BTH) region with a measured maximum daily mean concentration of up to 10 µg per cubic meter in winter. However, the production medium of HMS in aerosols is controversial, and it is unknown whether chemical transport models are able to capture the variations of HMS during individual haze events. In this work, we modify the parametrization of HMS chemistry in the nested-grid GEOS-Chem chemical transport model, whose simulations provide a good account of the field measurements during winter haze episodes. We find the contribution of the aqueous aerosol pathway to total HMS is about 36% in winter in Beijing, due primarily to the enhancement effect of the ionic strength on the rate constants of the reaction between dissolved formaldehyde and sulfite. Our simulations suggest that the HMS-to-inorganic sulfate ratio will increase from the baseline of 7% to 13% in the near future, given the ambitious clean air and climate mitigation policies for the BTH region. The more rapid reductions in emissions of SO2 and NOx compared to NH3 alter the atmospheric acidity, which is a critical factor leading to the rising importance of HMS in particulate sulfur species.

Development and evaluation of polyacrylamide microspheres loaded with phloretin and tantalum for transcatheter arterial embolization.

Transcatheter arterial embolization is an effective treatment for liver cancer. However, the development of novel embolic agents remains a challenge. In this study, we evaluated polyacrylic acid microspheres loaded with phloretin and tantalum as potential embolic agents for liver cancer treatment. Microspheres were synthesised via emulsion polymerisation and characterised in terms of size, shape, and drug-loading efficiency. Nanosized tantalum powder (0 to 15%) was added to the microspheres as an X-ray blocking agent. The maximum drug-loading capacity of the microspheres was approximately 20 mg g-1. The phloretin-loaded microspheres showed a sustained drug release profile in vitro. The microspheres were also evaluated for their in vivo anticancer efficacy in a rabbit VX2 liver tumour model. In conclusion, polyacrylic acid microspheres loaded with phloretin and tantalum have great potential as novel embolic agents for transcatheter arterial embolization for liver cancer treatment.

Dilemma in Differentiation of Spinocerebellar Ataxia Type 17 from Huntington's Disease：Comorbidity or Independent Disease?

Both Huntington's disease (HD) and Spinocerebellar ataxia 17 (SCA17) mutations showed expanded CAG repeats, with overlapping clinical manifestation: motor disorders, psychiatric symptoms and cognitive impairments. Therefore, SCA17 is also called Huntington like disease (HD-like, HDL) type 4. In this paper, we reported that one patient had 47 CAG repeats in HTT gene and 42 CAG repeats in TBP gene. There is a dilemma in differentiation of SCA 17 from HD in one patient, never been reported before. Is the diagnosis comorbidity of HD with SCA17 or HD only?

Effectiveness and safety of non-vitamin K antagonist oral anticoagulant in the treatment of patients with morbid obesity or high body weight with venous thromboembolism: A meta-analysis.

BACKGROUND: Venous thromboembolism (VTE) poses a significant health risk to patients with morbid obesity or high body weight. Non-vitamin K antagonist oral anticoagulants (NOACs) are emerging treatments, but their effectiveness and safety compared with vitamin K antagonists (VKAs) in this population are yet to be thoroughly studied. METHODS: We conducted a systematic review and meta-analysis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four electronic databases were searched for relevant studies comparing the efficacy and safety of NOACs and VKAs in treating patients with VTE with a body mass index > 40 kg/m2 or body weight > 120 kg. Eligible studies were scored for quality using the Newcastle-Ottawa Scale. RESULTS: Thirteen studies were included. The meta-analysis results showed that compared to VKAs, NOACs significantly decreased the risk of VTE occurrence (odds ratio = 0.72, 95% CI: 0.57-0.91, I2 = 0%, P < .001) and were associated with a lower risk of bleeding (odds ratio = 0.74, 95% CI: 0.58-0.95, I2 = 0%, P < .05). Subgroup analysis showed that in the cancer patient subgroup, both risks of VTE occurrence and bleeding were lower in the NOAC group than in the VKA group. In patients without cancer, the risk of VTE was significantly lower in the NOAC group. CONCLUSION: NOACs appear to be more effective and safer than VKAs in patients with morbid obesity or a high body weight with VTE. However, further large-scale randomized controlled trials are required to confirm these findings.