Chronic venous disease of lower limbs in young men at high-altitude: A cross-sectional survey.

OBJECTIVES: The aim of this study was to understand the prevalence of chronic venous disease (CVD) of lower limbs in young men at high-altitude in Xizang, and to provide prevention measures. METHODS: The convenient sampling method was used to conduct a questionnaire survey among males aged 18 to 40 above an altitude of 3000 meters in Xizang in April 2023. The contents of the questionnaire included basic information, symptoms of CVD of lower limbs, protection status and training needs. Multivariate logistic regression model was calculated to evaluate the risk factors for CVD. RESULTS: A total of 350 survey questionnaires were received, and 326 valid samples were collected. The prevalence of CVD of lower limbs (C1-C6) was 37.42% (95%CI: 32.17%-42.68%), the ratio of C0 to C5 were 62.58%, 27.30%, 3.07%, 4.60%, 2.15% and 0.31%, respectively, no one reached C6. The top three symptoms of CVD were lower limb fatigue (18.10%), heaviness (15.34%) and pain (13.19%). 46.01% of respondents were unaware of CVD, and 12.88% of respondents did not have any protective measures of CVD. Multivariate logistic regression showed that age (OR = 1.076, 95%CI: 1.018-1.137, p = .009), preference for spicy food (OR = 1.747, 95%CI: 1.083-2.818, p = .022), unbalanced diet (OR = 1.877, 95%CI: 1.049-3.358, p = .034) and physical exercise (OR 0.610, 95%CI: 0.377-0.986, p = .044) were the independent risk factors for CVD. CONCLUSIONS: This study provided data on the prevalence of CVD in young men at high-altitude and the risk factors for CVD. The findings of this study may facilitate the development of individualized clinical assessments and targeted prevention programs.

Calcium Doped NASICON Electrolyte with Graphite Coating for Stable All-solid-state Sodium Metal Batteries.

All-solid-state sodium metal batteries face the challenges of low ionic conductivity of solid electrolytes and poor wettability towards metallic Na anode. Herein, Na3Zr2Si2PO12 solid electrolyte is doped with Ca2+, obtaining a high ionic conductivity of 2.09×10-3 S cm-1 with low electronic conductivity of 1.43×10-8 S cm-1 at room temperature, which could accelerate Na+ transportation and suppress sodium dendrite growth. Meanwhile, a graphite-based interface layer is coated on Na3.4Zr1.8Ca0.2Si2PO12 (Na3.4Zr1.8Ca0.2Si2PO12-G) in order to improve the solid-solid contact between solid electrolyte and Na anode, realizing a uniform current distribution and smooth Na metal plating/stripping, and thus achieving a triple higher critical current density of 3.5 mA cm-2 compared with that of Na3.4Zr1.8Ca0.2Si2PO12. In addition, the assembled Na3V2(PO4)3/Na3.4Zr1.8Ca0.2Si2PO12-G/Na all-solid-state battery exhibits excellent electrochemical performances with a reversible capacity of 81.47 mAh g-1 at 1 C and capacity retention of 97.75 % after 500 cycles.

Epidemiological Survey of Congenital Heart Disease Among Children Aged from 2 to 18 in Suo County, Nagqu, Tibet.

Lin, Tian, Huaping Jia, Yunming Li, Yongxing Xu, Bei Zhao, Dong Zheng, Hongfeng Yan, Meihui Zhao, Yanlei Li, Liping Xia, Fengxia Zhou, Cuiping Liu, Ke Ma, Ma Mi, and Jianwen Gu. Epidemiological survey of congenital heart disease among children aged from 2 to 18 in Suo County, Nagqu, Tibet. High Alt Med Biol. 00:000-000, 2024. Background: Studies have reported the prevalence of congenital heart disease (CHD) in parts of Tibet, but relative epidemiological surveys are rare. We aimed to explore the prevalence of CHD in children and its relationship with family history in Suo County, Nagqu, Tibet, an altitude of 3,980 meters. Methods: We recruited 4,002 children aged 2-18 years. Subjects underwent a family history investigation, cardiac auscultation, and clinical manifestation examination and then received echocardiographic screening. Results: The prevalence of CHD among children in Suo County was 0.97% (39 cases), much higher than the prevalence at sea level. The most common subtype was atrial septal defect, accounting for 53.9% of CHD, followed by patent ductus arteriosus (33.3%) and ventricular septal defect (12.8%). We also found that children whose mothers had previously borne children with CHD had a higher risk of CHD than those without (p = 0.002); other factors related to CHD during pregnancy, such as smoking, drinking, drug use, and viral infection, showed no statistical differences between children with and without CHD. Conclusions: The prevalence of CHD in children in Suo County is much higher than at low altitude, consisting mostly of simple forms with left-to-right shunt, with rare complex CHD. These results support implementing diagnostic and treatment plans to prevent CHD in Suo County.

Tungsten and Boron Codoping toward High Ionic Conductivity and Stable Sodium Solid Electrolyte for All-Solid-State Sodium Batteries.

Sodium solid electrolytes with high ionic conductivity and good interfacial stability with sodium metal are crucial to realize high-performance all-solid-state sodium batteries. In this work, W and B-codoped Na3Sb1-xWxS4-xBx solid electrolytes are prepared by melt-quenching with further annealing. The synthesized Na3Sb0.95W0.05S3.95B0.05 solid electrolyte possesses a high ionic conductivity of 11.06 mS cm-1 under 25 °C and shows significantly improved interface compatibility with metal sodium. Specifically, Na/Na3Sb0.95W0.05S3.95B0.05/Na symmetric cell can stable cycle for 500 h under a current density of 0.05 mA cm-2. In addition, the resultant TiS2/Na3Sb0.95W0.05S3.95B0.05/Na battery exhibits an initial charge capacity of 164.1 mAh g-1 at 0.1 C with a capacity retention of 76.4% after 100 cycles. This work provides a new strategy to realize the high ionic conductivity of sodium solid electrolytes with improved interfacial stability with sodium anode.

Global trends and partial forecast of adverse effects of medical treatment from 1990 to 2019: an epidemiological analysis based on the global burden of disease study 2019.

BACKGROUND: The possibility of adverse effects of medical treatment (AEMT) is increasing worldwide, but little is known about AEMT in China. This study analyzed the health burden of AEMT in China in recent years through the Global Burden of Disease Study (GBD) 2019 and compared it with the worldwide average level and those in different sociodemographic index (SDI) regions. METHODS: We calculated the age-standardized rate (ASR) of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), incidence and prevalence attributed to AEMT in China, worldwide and countries with different sociodemographic indices during 1990-2019 using the latest data and methods from the GBD 2019. RESULTS: From 1990 to 2019, the global age-standardized death rate (ASDR), DALYs, and YLLs for AEMT showed a significant downward trend and were negatively associated with the SDI. By 2040, the ASDR is expected to reach approximately 1.58 (95% UI: 1.33-1.80). From 1990 to 2019, there was no significant change in the global incidence of AEMT. The occurrence of AEMT was related to sex, and the incidence of AEMT was greater among females. In addition, the incidence of AEMT-related injuries and burdens, such as ASR of DALYs, ASR of YLLs and ASR of YLDs, was greater among women than among men. Very old and very young people were more likely to be exposed to AEMT. CONCLUSIONS: From 1990 to 2019, progress was made worldwide in reducing the harm caused by AEMT. However, the incidence and prevalence of AEMT did not change significantly overall during this period. Therefore, the health sector should pay more attention to AEMT and take effective measures to reduce AEMT.

Resilient and Tough Conductive Polymer Hydrogel for a Low-Hysteresis Strain Sensor.

Conductive polymer hydrogels are vital in strain sensors, yet achieving high resilience and toughness is a challenge. This study employs a prestretch method to engineer a tough conductive polymer hydrogel with sufficient resilience. Initially, a blend film of polyvinylalcohol (PVA) and ethylene-vinyl alcohol copolymer (EVOH) is prepared through solution casting, followed by a swelling process to form a PVA-EVOH hydrogel. This hydrogel, with PVA crystallites as crosslinking points, exhibits high toughness. The hydrogel is then immersed in pyrrole and ferric chloride solutions for in-situ polymerization of polypyrrole (PPy), creating a conductive PPy/PVA-EVOH hydrogel. Finally, a 200% prestretch is applied, breaking short chains within the network, eliminating energy dissipation at low strains. This results in a hydrogel with a 100% elastic deformation range, while maintaining high fracture toughness (1700 J m-2 ). The prestretched PPy/PVA-EVOH hydrogel functions as a strain sensor with low hysteresis, providing consistent strain measurements during loading and unloading. This outperforms the non-prestretched sample, which shows inconsistent responses between stretching and releasing.

Influencing factors of hospitalization in maintenance haemodialysis outpatients after a diagnosis of COVID-19.

BACKGROUND: The clinical manifestations of maintenance haemodialysis (MHD) outpatients diagnosed with coronavirus disease 2019 (COVID-19) are highly heterogeneous. They are prone to progress to severe conditions, and they often require hospitalization. To better guide the management of MHD outpatients, this retrospective observational study assessed risk factors for hospitalization of MHD patients after a diagnosis of COVID-19. METHODS: The demographic data, comorbidities, laboratory indicators and imaging data of 128 MHD outpatients at our haemodialysis centre with confirmed COVID-19 infection from December 2022 to January 2023 were collected. The relationships between these factors and hospitalization of patients were analyzed. RESULTS: Among the 128 patients, 25 (19.53%) were hospitalized. One of the 25 inpatients was mechanically ventilated, and two of them died. Multivariate logistic regression analysis showed that the hospitalization rate was correlated with age, comorbid diabetes and peripheral blood lymphocyte count. CONCLUSION: Older age, comorbid diabetes and lower lymphocyte count are important risk factors for hospitalization of MHD outpatients after a diagnosis of COVID-19. Focusing on these factors may help in early identification of patients who may need to be admitted due to potential disease progression.

Chamber Attention Network (CAN): Towards interpretable diagnosis of pulmonary artery hypertension using echocardiography.

INTRODUCTION: Accurate identification of pulmonary arterial hypertension (PAH) in primary care and rural areas can be a challenging task. However, recent advancements in computer vision offer the potential for automated systems to detect PAH from echocardiography. OBJECTIVES: Our aim was to develop a precise and efficient diagnostic model for PAH tailored to the unique requirements of intelligent diagnosis, especially in challenging locales like high-altitude regions. METHODS: We proposed the Chamber Attention Network (CAN) for PAH identification from echocardiographic images, trained on a dataset comprising 13,912 individual subjects. A convolutional neural network (CNN) for view classification was used to select the clinically relevant apical four chamber (A4C) and parasternal long axis (PLAX) views for PAH diagnosis. To assess the importance of different heart chambers in PAH diagnosis, we developed a novel Chamber Attention Module. RESULTS: The experimental results demonstrated that: 1) The substantial correspondence between our obtained chamber attention vector and clinical expertise suggested that our model was highly interpretable, potentially uncovering diagnostic insights overlooked by the clinical community. 2) The proposed CAN model exhibited superior image-level accuracy and faster convergence on the internal validation dataset compared to the other four models. Furthermore, our CAN model outperformed the others on the external test dataset, with image-level accuracies of 82.53% and 83.32% for A4C and PLAX, respectively. 3) Implementation of the voting strategy notably enhanced the positive predictive value (PPV) and negative predictive value (NPV) of individual-level classification results, enhancing the reliability of our classification outcomes. CONCLUSIONS: These findings indicate that CAN is a feasible technique for AI-assisted PAH diagnosis, providing new insights into cardiac structural changes observed in echocardiography.

Efficacy and safety of compound glycyrrhizin in combination with conventional therapy in treatment of vitiligo: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Vitiligo is an acquired chronic depigmentary disorder affecting approximately 0.5% to 1% of individuals worldwide. The compound glycyrrhizin (CG), a complementary medicine, has been reported for treatment of vitiligo, but the evidence has not been systematically evaluated. We systematically assessed the efficacy and safety of CG in combination with conventional therapy for the treatment of vitiligo. METHODS: We searched Embase, Web of Science, PubMed, The Cochrane Library, Chinese BioMedical Literature Database (CBM), Wanfang Data, China National Knowledge Infrastructure (CNKI), and VIP information from inception to July 2022. Randomized controlled trials comparing CG combined with conventional therapy with conventional therapy alone for vitiligo were included in our analysis. The primary outcome was treatment response, which defined as >50% repigmentation rate of vitiligo after treatment. The secondary outcome was incidence of adverse events. Meta-analysis was performed using the Review Manager 5.4 software. Statistical heterogeneity was evaluated with chi-square and I2 statistics, dichotomous data were expressed as risk ratios (RR) with 95% confidence intervals using the Mantel-Haenszal method. RESULTS: Thirty-nine studies enrolling with 3994 participants were subjected to this review. The results of our meta-analysis indicated that addition of CG had superior effectiveness on repigmentation rate than phototherapy (RR = 1.28; P < .001), immunosuppressant (RR = 1.76; P < .001), traditional Chinese medicine (RR = 1.38; P < .001), combination of phototherapy and immunosuppressant (RR = 1.42; P < .001), and combination of phototherapy and traditional Chinese medicine (RR = 1.37; P < .001). In addition, CG did not increase the incidence of adverse events for vitiligo (RR = 0.79; P = .05). CONCLUSIONS: CG as a complementary medicine has a potential benefit in treatment of vitiligo. However, since the methodological flaws in the studies we included, more high-quality randomized controlled trials are warranted.

NaF-Rich Multifunctional Layers toward Stable All-Solid-State Sodium Batteries.

NASICON oxide solid electrolytes are considered promising candidates for all-solid-state sodium batteries due to their extremely high ionic conductivity and favorable electrochemical stability. However, the practical application of NASICON electrolytes is greatly impeded by poor electrolyte-electrode interfacial contact and continuous sodium dendrite propagation. Herein, a NaF-rich multifunctional interface layer on the surface of a Na anode (Na@NaF-rich), containing NaF, amorphous carbon, and an unreacted C-F bond species, is developed in situ by the reaction between Na and commercial poly(tetrafluoroethylene). This NaF-rich interface layer is proven to reduce the diffusion barriers at the Na/NASICON electrolyte interface and homogenize Na deposition as well as suppress Na dendrite growth, thus achieving a high critical current density of 4 mA cm-2. The resultant Na3V2(PO4)3@C/Na@NaF-rich all-solid-state cell showed a high initial specific capacity of 117.6 mAh g-1 at 0.1 C with a Coulombic efficiency of 94.8%. Even at 0.5 and 1 C, it still exhibited high capacity retentions of 83.3% and 80.4%, respectively, after 750 cycles.

Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS.

Background: With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models. Results: After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese. Conclusion: The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Comparative Efficacy and Acceptability of 12 Phosphorus-Lowering Drugs in Adults with Hyperphosphatemia and Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Hyperphosphatemia is associated with cardiovascular morbidity and mortality in adults with chronic kidney disease (CKD). Drug therapy has an irreplaceable role in the management of hyperphosphatemia. OBJECTIVES: We aimed to compare and rank phosphorus-lowering drugs, including phosphate binder and nonphosphate binder, in hyperphosphatemia adults with CKD. METHODS: We did a systematic review and frequentist random-effect network meta-analysis. We searched in PubMed, Cochrane Library, Web of Science, and Embase from inception to February 1, 2023, for randomized controlled trials of 12 phosphorus-lowering drugs in adults with hyperphosphatemia and CKD. Primary outcomes were efficacy (changes in serum phosphorus) and acceptability (treatment withdrawals due to any cause). We ranked each drug according to the value of surface under the cumulative ranking curve. We applied the Confidence in Network Meta-Analysis frameworks to rate the certainty of evidence. This study was registered with PROSPERO, number CRD42022322270. RESULTS: We identified 2,174 citations, and of these, we included 94 trials comprising 14,459 participants and comparing 13 drugs or placebo. In terms of efficacy, except for niacinamide, all drugs lowered the level of serum phosphorus compared with placebo, with mean difference ranging between -1.61 (95% credible interval [CrI], -2.60 to -0.62) mg/dL for magnesium carbonate and -0.85 (-1.66 to -0.05) mg/dL for bixalomer. Only ferric citrate with odds ratios 0.56 (95% CrI: 0.36-0.89) was significantly associated with fewer dropouts for acceptability. Of the 94 trials, 43 (46%), 7 (7%), and 44 (47%) trials were rated as high, moderate, and low risk of bias, respectively, the certainty of the evidence was moderate to very low. CONCLUSIONS: Magnesium carbonate has the best phosphorus-lowering effect in hyperphosphatemia adults with CKD; considering efficacy and acceptability, ferric citrate shows evidence to be the most appropriate drug with or without dialysis.

Enhanced electrically and thermally conductive free-standing graphene films with two-dimensional copper sheets as the catalyst and bridge.

Two-dimensional copper sheets were introduced as the catalyst and bridge to enhance the electrical and thermal conductivity of graphene films prepared from graphene oxide nanosheets via a thermal reduction method. The effects of adding different amounts of copper sheets in the composite films were investigated, and the results show that the electrical and thermal conductivity of the graphene films could be increased by 3 times and 64.9%, respectively. The two-dimensional copper sheets not only play an important role as a catalyst toward improving the graphitization degree of reduced graphene oxide, but also act as a bridge and promote the interconnection of the electrical and thermal conduction paths in the composite films due to the good electrical and thermal conductivity of copper. Moreover, the heat dissipation experiment shows that this enhanced graphene composite film has potential applications in the heat management of electronics.

The Relationship Between Pain Intensity and Pain-Related Activity Patterns in Older Adults with Chronic Musculoskeletal Pain: Mediating Roles of Pain Resilience and Pain Catastrophizing.

Purpose: To explore the relationship between pain intensity, pain resilience, pain catastrophizing, and pain-related activity patterns in older adults with chronic musculoskeletal pain (CMP). Patients and Methods: A total of 220 elderly Chinese with chronic musculoskeletal pain were recruited from a tertiary general hospital. Participants completed several measures including a demographic questionnaire, Brief Pain Inventory (BPI), Pain Resilience Scale (PRS), Pain Catastrophizing Scale (PCS), and Patterns of Activity Measure-Pain (POAM-P). Moreover, Process version 3.5 plug-in SPSS26 was used to test the mediation effect between variables. Results: The scores of POAM-P in older adults with CMP from high to low were: avoidance (27.39 ± 8.10), pacing (24.25 ± 9.48), and overdoing (16.65 ± 10.95). Mediation analysis revealed that pain resilience and pain catastrophizing mediated the relationship between pain intensity and pain-related activity patterns (avoidance and pacing) in older adults with CMP. Conclusion: These results provide evidence for the role of pain resilience and pain catastrophizing in the relationship between pain intensity and pain-related activity patterns. Interventions targeting these factors should be included in activity management programs for elderly CMP patients. It may be possible to reduce the negative impact of pain intensity on activity patterns by improving pain resilience and reducing pain catastrophizing.

Application of aptamer-drug delivery system in the therapy of breast cancer.

Despite significant treatment advances, breast cancer remains the leading cause of cancer death in women. From the current treatment situation, in addition to developing chemoresistant tumours, distant organ metastasis, and recurrences, patients with breast cancer often have a poor prognosis. Aptamers as "chemical antibodies" may be a way to resolve this dilemma. Aptamers are single-stranded, non-coding oligonucleotides (DNA or RNA), resulting their many advantages, including stability for long-term storage, simplicity of synthesis and function, and low immunogenicity, a high degree of specificity and antidote. Aptamers have gained popularity as a method for diagnosing and treating specific tumors in recent years. This article introduces the application of ten different aptamer delivery systems in the treatment and diagnosis of breast cancer, and systematically reviews their latest research progress in breast cancer treatment and diagnosis. It provides a new direction for the clinical treatment of breast cancer.

Rapid Evaporation of a Metal Electrode for a High-Efficiency Perovskite Solar Cell.

Organic-inorganic hybrid perovskite solar cells (PSCs) have attracted considerable attention due to the excellent optoelectronic properties of perovskite materials. The energy consumption and high cost issues of metal electrode evaporation should be addressed before large-scale manufacturing and application. We developed an effective metal electrode evaporation procedure for the fabrication of high-efficiency planar heterojunction (PHJ) PSCs, with an inverted device structure of glass/indium tin oxide (ITO)/poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine] (PTAA)/perovskite/[6,6]-phenyl-C61-butyric acid methyl ester (PCBM)/(E)-ß-caryophyllene (BCP)/Ag. The effect of the evaporation rate for an evaporator with a small-volume metal cavity on the performance of PHJ-PSC devices was investigated systematically. Through controlling the processes of Ag electrode evaporation, the charge dynamics of the devices were studied by analyzing their charge recombination resistance and lifetime, as well as their defect state density. Our findings reveal that the evaporation rate of an evaporator with a small cavity is favorable for the performance of PHJ-PSCs. As a result, PHJ-PSCs fabricated using a very thin, non-doped PTAA film exhibit photoelectric conversion efficiency (PCE) of 19.21%, with an open-circuit voltage (Voc) of 1.132 V. This work showcases the great potential of rapidly evaporating metal electrodes to reduce fabrication costs, which can help to improve the competitiveness in the process of industrialization.

A processable Prussian blue analogue-mediated route to promote alkaline electrocatalytic water splitting over bifunctional copper phosphide.

Prussian blue analogues (PBAs) as a class of metal-organic frameworks demonstrate a promising platform to develop cost-effective high-performance electrocatalysts. However, the construction of delicate micro/nanostructures and controllable doping are still a challenging task for the fabrication of highly efficient copper-based electrocatalysts. Herein, we report a facile synthesis of copper foam supported Cu3P@Co-Cu3P (CH@PBA-P/CF) sub-microwire arrays as an active electrocatalyst for alkaline water splitting. The Co-Cu3P shell derived from the Cu3[Co(CN)6]2 PBA serves as the source of active sites. Co doping and construction of core-shell structures endow the CH@PBA-P/CF electrocatalyst with abundant catalytic sites, enhanced intrinsic activity, and low charge transport resistance. The catalytic electrode integrated with 3D copper foam and 1D sub-microwire arrays is highly conductive and stable, which promotes the charge transport and improves the structural stability. As a consequence, CH@PBA-P/CF shows impressive catalytic performances toward the HER and OER in terms of low overpotentials of 231 and 312 mV at a current density of 50 mA cm-2 in 1 M KOH, respectively. Notably, the water electrolyzer using the CH@PBA-P/CF electrode exhibits better water splitting performance than the one using noble metal-based couples.

Clinical utility of tumour mutational burden on efficacy of immune checkpoint inhibitors in malignant solid tumours: protocol for a systematic review and meta-analysis.

INTRODUCTION: A major development in solid malignancy treatment is the application of immune checkpoint inhibitors (ICIs), which have produced durable responses and increased survival rates. However, the therapeutic effect of ICIs has great heterogeneity in patients with cancer. We propose a systematic review to evaluate the predictive value of tumour mutation burden (TMB) on efficacy of ICIs. METHODS AND ANALYSIS: A systematic literature search will be conducted in the PubMed, OVID, Web of Science, Embase and Cochrane Central Register of Controlled Trials Library databases up to 31 May 2022. We will compare the efficacy of ICIs between TMB high group and TMB low group in terms of the HRs of overall survival (OS) and progression-free survival (PFS), and the OR of the objective response rate/overall response rate (ORR). The HRs of PFS and OS, and the OR of ORR, will be measured by an inverse variance weighted fixed effects model (I2≤50%) or a DerSimonian-Laird random effects model (I2>50%). In addition, subgroup analysis, sensitivity analysis, heterogeneity analysis and publication bias will be conducted. We plan to conduct a subgroup analysis on age, sex, area, number of patients (high/low TMB), cancer type, tumour size, stage, line of therapy, TMB sequencing method, type of immunotherapy and follow-up period. ETHICS AND DISSEMINATION: Ethical approval and informed consent are not needed, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care. This systematic review is anticipated to be finished in December 2023, and the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021262480.

Hand-assisted laparoscopic versus laparoscopic-assisted radical gastrectomy in the treatment of advanced distal gastric cancer: final results of a single-center randomized study.

OBJECTIVE: To compare the results and 5- and 8-year overall survival (OS) and disease-free survival (DFS) of hand-assisted laparoscopic surgery (HALS) and laparoscopic-assisted surgery (LAS) in radical gastrectomy for advanced distal gastric cancer. METHODS: A total of 124 patients admitted to our institution from May 2009 to April 2013 were randomly divided into a HALS group (n = 62) and a LAS group (n = 62). Postoperatively, 110 patients were followed for 5 and 8 years, and 14 patients were lost to follow-up. The 5- and 8-year OS and DFS rates of the groups were compared and analyzed. RESULTS: The 5- and 8-year OS rates, respectively, were 38.8% and 19.4% in the HALS group and 38.3% and 15.3% in the LAS group (log-rank test, χ2 = 0.250). The 5- and 8-year DFS rates, respectively, were 23.1% and 10.6% in the HALS group and 19.3% and 11.6% in the LAS group (log-rank test, χ2 = 0.109). No significant differences were found. CONCLUSION: Compared with LAS, HALS radical gastrectomy for advanced distal gastric cancer had a lower conversion rate to open surgery, shorter surgical duration, and more thorough dissection of lymph nodes; 5- and 8-year OS and DFS rates were similar to those with LAS.

Association of bone-related biomarkers with femoral neck bone strength.

BACKGROUND: Femoral neck fractures are the worst consequence of osteoporosis (OP), and its early prevention and treatment have become a public health problem. This study aims to investigate the relationship of bone-related biomarkers, femoral neck bone mineral density (BMD) and maximum load (Lmax), selecting the indicator which can reflect femoral neck bone loss and reduced bone strength. METHODS: A total of 108 patients were recruited from January 2017 to December 2019. Venous blood samples were collected from patients before total hip replacement, and femoral neck samples were collected during the surgery. Femoral neck BMD, femoral neck Lmax, bone-related markers (serum levels of bone turnover markers, protein expression of type I collagen (COL-I) and osteopontin (OPN) in femoral neck) were all measured and analyzed. RESULTS: The expression of COL-I in femoral neck were significantly decreased, whereas other markers were all significantly increased with the decreasing of femoral neck BMD and Lmax (P < 0.05). Among them, serum C-terminal telopeptide of type I collagen (CTX) levels and OPN expression of femoral neck were increased in osteopenia. In multiple linear regression analysis, CTX and OPN were both negatively correlated with femoral neck BMD and Lmax, and they were independent factors of femoral neck BMD and Lmax, whereas COL-I was independent factor affecting Lmax (P < 0.05). Besides, CTX was negatively correlated with COL-I (ß = -0.275, P = 0.012) and positively correlated with OPN (ß = 0.295, P = 0.003). CONCLUSIONS: Compared with other indicators, serum CTX was more sensitive to differences in bone mass and bone strength of femoral neck, and could be considered as surrogate marker for OPN and COL-I.Early measurement of CTX could facilitate the diagnosis of osteopenia and provide a theoretical basis for delaying the occurrence of femoral neck OP and fragility fractures.