Tracing Photoinduced Hydrogen Migration in Alcohol Dications from Time-Resolved Molecular-Frame Photoelectron Angular Distributions.

The recent implementation of attosecond and few-femtosecond X-ray pump/X-ray probe schemes in large-scale free-electron laser facilities has opened the way to visualize fast nuclear dynamics in molecules with unprecedented temporal and spatial resolution. Here, we present the results of theoretical calculations showing how polarization-averaged molecular-frame photoelectron angular distributions (PA-MFPADs) can be used to visualize the dynamics of hydrogen migration in methanol, ethanol, propanol, and isopropyl alcohol dications generated by X-ray irradiation of the corresponding neutral species. We show that changes in the PA-MFPADs with the pump-probe delay as a result of intramolecular photoelectron diffraction carry information on the dynamics of hydrogen migration in real space. Although visualization of this dynamics is more straightforward in the smaller systems, methanol and ethanol, one can still recognize the signature of that motion in propanol and isopropyl alcohol and assign a tentative path to it. A possible pathway for a corresponding experiment requires an angularly resolved detection of photoelectrons in coincidence with molecular fragment ions used to define a molecular frame of reference. Such studies have become, in principle, possible since the first XFELs with sufficiently high repetition rates have emerged. To further support our findings, we provide experimental evidence of H migration in ethanol-OD from ion-ion coincidence measurements performed with synchrotron radiation.

Notch signaling regulates Th17 cells differentiation through PI3K/AKT/mTORC1 pathway and involves in the thyroid injury of autoimmune thyroiditis.

PURPOSE: Autoimmune Thyroiditis (AIT) is the most common thyroid disease; however, there were no measures to prevent the progression of the disease. The present study attempts to identify that Notch signaling regulates the differentiation of T helper 17 (Th17) cells by activating downstream Phosphatidylinositol-3 kinase/protein kinase/mechanistic target of rapamycin complex 1 (PI3K/AKT/mTORC1) pathway participating in the thyroid injury of the experimental autoimmune thyroiditis (EAT). METHODS: In vivo experiments, mice were randomly divided into 4 groups: a control group, an EAT group, and two groups with LY294002 treatment (pTg plus 25 mg/kg or 50 mg/kg LY294002, respectively). The degrees of thyroiditis were evaluated, and the percentage of Th17 cells, expression of interleukin-17A (IL-17A), and the main components of the Notch-PI3K signaling pathway were detected in different groups. In vitro experiments, two different dosages of LY294002 (25 and 50 µM) were used to intervene splenic mononuclear cells (SMCs) from EAT mice to further evaluate the regulatory effect of Notch-PI3K pathway on Th17 cells. RESULTS: Our data demonstrate that the infiltration of Th17 cells and the expressions of IL-17A, Notch, hairy and split 1 (Hes1), p­AKT (Ser473), p­AKT (Thr308), p­mTOR (Ser2448), S6K1, and S6K2 increased remarkably in EAT mice. After PI3K pathway was blocked, the degrees of thyroiditis were significantly alleviated, and the proportion of Th17 cells, the expression of IL-17A, and the above Notch-PI3K pathway-related molecules decreased in a dose-dependent manner. Additionally, the proportion of Th17 cells was positively correlated with the concentration of serum thyroglobulin antibody (TgAb), IL-17A, and Notch-PI3K pathway-related molecules mRNA levels. CONCLUSIONS: Notch signal promotes the secretion of IL-17A from Th17 cells by regulating the downstream PI3K/AKT/mTORC1 pathway through Hes-Phosphatase and tensin homolog (PTEN) and participates in thyroid autoimmune damage, and the PI3K pathway inhibitor may play important effects on AIT by affecting Th17 cells differentiation.

[Reconsideration of the indications for unicompartmental knee arthroplasty].

Unicompartmental knee arthroplasty (UKA), a procedure that has gradually emerged in recent years, is considered an effective treatment for resolving knee pain and restoring good function due to its significant clinical advantages. In the 1980s, Kozinn and Scott proposed the classic indications as selection criteria to identify ideal candidates for UKA. However, as treatment concepts, surgical instruments, surgical techniques, and prosthesis designs for this disease have improved, these indications proposed more than 30 years ago appear too limited, leading to some limitations in the widespread use of UKA. Specifically, surgeons have offered new perspectives on issues related to obesity, age, patellofemoral arthritis, severe varus deformity of the knee, anterior cruciate ligament deficiency, flexion contracture, failed high tibial osteotomy and post-traumatic arthritis. For this reason, this article will briefly discuss modern perspectives involving the indications for UKA based on current evidence with the aim of providing a reference for the reader.

Value of deep-learning image reconstruction at submillisievert CT for evaluation of the female pelvis.

AIM: To assess the value of deep-learning reconstruction (DLR) at submillisievert computed tomography (CT) for the evaluation of the female pelvis, with standard dose (SD) hybrid iterative reconstruction (IR) images as reference. MATERIALS AND METHODS: The present study enrolled 50 female patients consecutively who underwent contrast-enhanced abdominopelvic CT for clinically indicated reasons. Submillisievert pelvic images were acquired using a noise index of 15 for low-dose (LD) scans, which were reconstructed with DLR (body and body sharp), hybrid-IR, and model-based IR (MBIR). Additionally, SD scans were reconstructed with a noise index of 7.5 using hybrid-IR. Radiation dose, quantitative image quality, overall image quality, image appearance using a five-point Likert scale (1-5: worst to best), and lesion evaluation in both SD and LD images were analysed and compared. RESULTS: The submillisievert pelvic CT examinations showed a 61.09 ± 4.13% reduction in the CT dose index volume compared to SD examinations. Among the LD images, DLR (body sharp) had the highest quantitative quality, followed by DLR (body), MBIR, and hybrid-IR. LD DLR (body) had overall image quality comparable to the reference (p=0.084) and favourable image appearance (p=0.209). In total, 40 pelvic lesions were detected in both SD and LD images. LD DLR (body and body sharp) exhibited similar diagnostic confidence (p=0.317 and 0.096) compared with SD hybrid-IR. CONCLUSION: DLR algorithms, providing comparable image quality and diagnostic confidence, are feasible in submillisievert abdominopelvic CT. The DLR (body) algorithm with favourable image appearance is recommended in clinical settings.

[Pathological features and immune microenvironment in HER-2 intratumoral heterogeneous breast cancers].

Objective: To observe the clinical pathology features, and immune microenvironment of HER-2 intratumoral heterogeneity breast cancer. Methods: Thirty cases of HER-2 intratumoral heterogeneous breast cancer were retrospectively analyzed in Tianjin Medical University Cancer Institute and Hospital from November 2017 to June 2020. HER-2 expression was detected by immunohistochemistry and verified by dual color silver-enhanced in-situ hybridization (D-SISH). HER-2 intratumoral positive and negative regions were divided. The pathological characteristics, subtype, and the level of tumor infiltrating lymphocytes (TILs) and the expression of programmed cell death-ligand 1 (PD-L1) were evaluated respectively. Results: The proportion of HER-2 positive cells of the breast cancer ranged from 10% to 90%. The pathological type was mainly invasive non-special typecarcinoma. Six cases presented different pathological types between HER-2 positive and negative regions. The HER-2-positive areas included 2 cases of carcinoma with apocrine differentiation, and the negative areas included 2 cases of invasive micropapillary carcinoma, 1 case of invasive papillary carcinoma, and 1 case of carcinoma with apocrine differentiation. In HER-2 positive regions, 17 cases were Luminal B and 13 cases were HER-2 overexpressed types. There were 22 cases of Luminal B and 8 cases of triple negative tumors in the HER-2 negative areas. The levels of TILs in HER-2 positive and negative areas accounted for 53.3% (16/30) and 26.7% (8/30), respectively, with a statistically significant difference (P=0.035). The positive expression of PD-L1 in HER-2 positive area and HER-2 negative area were 6 cases and 9 cases, respectively. Among 8 cases with HER-2 negative regions containing triple negative components, 4 cases were positive for PD-L1 expression. Conclusions: In the case of HER-2 intratumoral heterogeneity, it is necessary to pay attention to both HER-2 positive and negative regions, and evaluate subtype separately as far as possible. For HER-2 intratumoral heterogeneous breast cancer containing triple negative components, the treatment mode can be optimized by refining the intratumoral expression of PD-L1.

[Comparison of clinical effects of endoscopic thyroidectomy using the modified gasless transsubclavian approach and traditional open surgery for cN0 unilateral papillary thyroid carcinoma].

Objective: To compare the clinical effects of endoscopic thyroidectomy using a modified gasless transsubclavian approach and the traditional neck approach for unilateral papillary thyroid carcinoma (cN0). Methods: The clinical data of 135 patients with cN0 papillary thyroid carcinoma who underwent unilateral thyroidectomy in the Department of Thyroid Surgery, the First Hospital of Jilin University from October 2020 to November 2022 were retrospectively analyzed. There were 37 males and 98 females, aging (43.2±8.8) years (range: 21 to 59 years). There were 51 cases using the modified gasless transsubclavian approach (TS group) and 84 cases using the traditional neck approach (TN group). Comparative analyses were performed between the operative results of the 2 groups by t-test, Wilcoxon rank sum test, and χ2 test. Results: All endoscopic operations were successfully completed without conversion to the traditional neck approach. Compared to the TN group, the TS group had a longer operation time (M(IQR)) (73.5 (22.5) minutes vs. 90.0 (30.0) minutes, Z=-5.831, P<0.01), more postoperative drainage (60 (25) ml vs. 95 (45) ml, Z=-6.275, P<0.01), higher hospitalization costs (22 687 (3 488) yuan vs. 26 652 (2 431) yuan, Z=-6.944, P<0.01), and a higher rate of parathyroid autotransplantation (15.5% (13/84) vs. 60.8% (31/51), χ2=29.651, P<0.01). There was no significant difference in the total exposure rate of the central compartment, postoperative hospitalization time, the number of dissected lymph nodes, the number of metastatic lymph nodes, C-reactive protein ratio before and after operation, and preoperative and postoperative parathyroid hormone (all P>0.05). Conclusion: Endoscopic thyroidectomy using the modified gasless transsubclavian approach is safe for cN0 papillary thyroid carcinoma, with longer operating time, more postoperative drainage, higher hospitalization costs, and more difficulty in preserving the inferior parathyroid gland in situ compared to traditional open surgery.

Glucosylglycerol Extends Chronological Lifespan of the Budding Yeast via an Increased Osmolarity Response.

Glucosylglycerol (GG) is an osmolyte that protects cells from extreme conditions. It is produced by sucrose phosphorylase, an enzyme that uses sucrose and glycerol as substrate. GG protects tissue integrity in desert plants during harsh conditions and guards cyanobacteria against high salinity (halotolerant). However, no extensive research has been conducted on the lifespan application of this compound on the yeast Saccharomyces cerevisiae. We designed this study to (1) characterize GG's effect on yeast chronological lifespan (CLS) and (2) to determine the mechanisms underlying its lifespan promotion on strain DBY746. The results obtained in our study confirm that GG causes increased longevity when administered at moderate doses (48 mM and 120 mM). In addition, we discovered that GG promotes yeast cell longevity by increasing the osmolarity of the culture medium. The maximum lifespan increased by approximately 15.38% and 34.6%, (i.e., 115.38 and 134.61) respectively, upon administration of GG at 48 mM and 120 mM concentrations. Elucidation of the mechanisms underlying this positive response suggests that GG promotes CLS by activities that modulate reactive oxygen species (ROS) generation, as evident in its increased ROS generation (mitohormesis). An increase in medium osmolarity caused by GG supplementation triggers ROS production and promotes longevity in the yeast (S. cerevisiae). An in-depth study on the potential application of this molecule in aging research is crucial; this will aid in expounding the mechanisms of this geroprotector and its longevity supportive tendencies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01055-y.

[Effect of tourniquet on morphology and stiffness of quadriceps in patients receiving total knee arthroplasty: a randomized controlled trial].

Objective: To evaluate tourniquet effect on the morphology and stiffness of quadriceps in patients receiving total knee arthroplasty (TKA). Methods: Total of 80 patients with primary knee osteoarthritis receiving unilateral primary TKA from August 2020 to June 2021 in Peking University Third Hospital were enrolled in this randomized controlled trial. The patients were randomly divided into tourniquet group and non-tourniquet group (40 cases in each group). The study measured and compared postoperative thickness and stiffness of quadriceps, as well as circumference of the affected thigh in two groups. Results: There were 11 males and 29 females in tourniquet group, 9 males and 31 females in non-tourniquet group, with mean age of (69.1±5.1) years and (67.4±5.3) years, respectively. There was no significant difference in demographic information such as gender, age and BMI (all P<0.05). Postoperative thickness of quadriceps, stiffness of quadriceps and circumferenceï¼»x¯±s or M （Q1，Q3）］of the affected thigh in all patients were (2.76±0.69) cm, 25.20 (17.83, 32.90) m/s, 54.00 (51.13, 56.00) cm. These outcomes in tourniquet and non-tourniquet groupï¼»x¯±s or M （Q1，Q3）］were (2.78±0.76) cm and (2.73±0.61) cm, 24.00 (17.15, 33.13) m/s and 25.20 (18.68, 32.85) m/s, 54.00 (49.75, 55.00) cm and 54.50 (52.13, 57.53) cm, respectively; no significant deference was found in these indexes between the two groups (all P>0.05). Conclusion: Tourniquet has no significant effect on morphology and stiffness of quadriceps in patients undergoing TKA.

[Effects of reduced portosystemic flow on hepatic myelopathy in patients with cirrhosis after TIPS].

Objective: To investigate the impact of a reduced portacaval shunt on hepatic myelopathy (HM) in patients with cirrhosis after a transjugular intrahepatic portosystemic shunt (TIPS). Methods: Patients who developed HM after receiving TIPS at the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to June 2018 were retrospectively analyzed. HM severity was quantified by clinical spasticity index (CSI) and Fugl-Meyer Assessment (FMA) of the lower extremity. Clinical manifestations were combined with grades Ⅰ-Ⅳ. HM patients were divided into drug treatment (group A) and flow restriction group (group B) according to different treatment methods. The changes in CSI and FMA of the lower extremity after treatment were statistically analyzed in the two groups. P<0.05 was considered a statistically significant difference. Results: A total of 421 cases of cirrhosis who underwent TIPS were enrolled. Among them, 30 developed HM, with 22 in group A and 8 in group B. The incidence of HM after TIPS surgery was about 7.13%. After treatment, CSI was gradually increased and FMA of lower extremity was gradually decreased in group A, while vice-versa in group B. CSI in the two groups were differed significantly at 6, 12, 18, and 24 months after treatment (P<0.05), while the difference in FMA of the lower extremity was statistically significant at 12, 18, and 24 months after treatment (P<0.05). CSI was decreased and FMA of lower extremity was increased after treatment in patients with group A HM grade I. CSI, and FMA of lower extremity changes were statistically significant (P<0.05) when compared with patients with HM grades Ⅱ-Ⅳ. The incidence of hepatic encephalopathy was significantly lower in group B than that in group A (P=0.034), but there was no statistically significant difference between the two groups in the incidence of gastrointestinal bleeding, ascites, infection, MELD score and mortality. Conclusion: A reduced portacaval shunt can improve HM in patients with liver cirrhosis after TIPS, and drug therapy alone is effective for patients with early HM grade I.

[Status of HVPG clinical application in China in 2021].

Objective: The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China. Methods: This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems. Results: According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%). Conclusion: Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

[The influence of subjective comfort of working environment on occupational stress of railway station workers].

Objective: To explore the influential factors of job stress suffered by workers in railway stations, the level of job stress of were measured and subjective comfort of employees targeting to working environment were reported. Methods: In March 2019, a cluster sampling study was designed to collect the personal characteristics, job characteristics and subjective comfort degree of working environment of 432 employees in Chongqing railway stations. Meanwhile, job stress was assessed using the effort-reward imbalance scale. Chi-square test was used to compare the difference of occupational stress detection rate among different stratified factors such as occupational characteristics. Logistic regression was applied to analyze the influential factors of occupational stress. Results: The detection rate of job stress of workers in the railway stations was 31.02% (134/432) . The detection rate of job stress was higher among the divorced workers in railway stations, those earning less than 5, 000 yuan per month, those with 10-20 years' length of service, those who worked as a conductor and other workers including baggageman, station master on duty and assistant engineer (χ(2)=9.61, 14.76, 23.28, 11.06, P=0.008, 0.002, 0.000, 0.011) . The detection rate of job stress was higher among those whose working environment subjective feelings were uncomfortable, the differences were statistically significant (P<0.001) . The results showed that the occupational stress of the staff in the railway stations was influenced by their subjective feeling of air quality, noise and Space Layout (P<0.05) . The risk factors of occupational stress were air quality, noise and uncomfortable space layout (OR=0.571, 0.068, 0.441, P=0.051, 0.054, 0.007) . Conductor, other (Bellboy, Duty Station Master, assistant engineer) were the risk factors of occupational stress (OR=1.884, 2.703, P=0.065, 0.019) . The employees of station A and station B were the risk factors of occupational stress (OR=4.681, 1.811, P=0.002, 0.067) . Conclusion: The higher detection rate of job stress of workers in the railway stations is correlated with the subjective comfort degree of the working environment of the workers.

M-BLUE protocol for coronavirus disease-19 (COVID-19) patients: interobserver variability and correlation with disease severity.

AIM: To retrospectively evaluate the interobserver variability of intensive care unit (ICU) practitioners and radiologists who used the M-BLUE (modified bedside lung ultrasound in emergency) protocol to assess coronavirus disease-19 (COVID-19) patients, and to determine the correlation between total M-BLUE protocol score and three different scoring systems reflecting disease severity. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consent was not required. Ninety-six lung ultrasonography (LUS) examinations were performed using the M-BLUE protocol in 79 consecutive COVID-19 patients. Two ICU practitioners and three radiologists reviewed video clips of the LUS of eight different regions in each lung retrospectively. Each observer, who was blind to the patient information, described each clip with M-BLUE terminology and assigned a corresponding score. Interobserver variability was assessed using intraclass correlation coefficient. Spearman's correlation coefficient analysis (R-value) was used to assess the correlation between the total score of the eight video clips and disease severity. RESULTS: For different LUS signs, fair to good agreement was obtained (ICC = 0.601, 0.339, 0.334, and 0.557 for 0-3 points respectively). The overall interobserver variability was good for both the five different readers and consensus opinions (ICC = 0.618 and 0.607, respectively). There were good correlations between total LUS score and scores from three systems reflecting disease severity (R=0.394-0.660, p<0.01). CONCLUSION: In conclusion, interobserver agreement for different signs and total scores in LUS is good and justifies its use in patients with COVID-19. The total scores of LUS are useful to indicate disease severity.

Simultaneous multi-slice accelerated diffusion-weighted imaging with higher spatial resolution for patients with liver metastases from neuroendocrine tumours.

AIM: To evaluate the imaging characteristics of simultaneous multi-slice (SMS) accelerated diffusion-weighted imaging (DWI) with decreased section thickness, with and without motion correction, in comparison to conventional DWI (cDWI) for the detection of lesions in patients with neuroendocrine tumour (NET) liver metastases. MATERIALS AND METHODS: Fifteen patients with NET liver metastases underwent cDWI (section thickness [SL]=4 mm) and SMS-DWI (SL=2 mm). Non-linear motion-corrected (Moco)-SMS-DWI was generated in addition to the original series. Qualitative imaging characteristics (five-point Likert scale), the number of high signal lesions, and the detectability and delineation of lesions were evaluated and compared using the Friedman and the Dunn-Bonferroni tests. The test-retest variability (TRV) of the cDWI and SMS-DWI techniques was investigated among 11 healthy volunteers who underwent cDWI (SL=4 mm) and SMS-DWI (SL=4 mm) twice. The Friedman and the Dunn-Bonferroni post-hoc tests were used to compare the mean apparent diffusion coefficient (ADC) and the TRV in different liver regions between the three series. RESULTS: Moco-SMS-DWI demonstrated significantly superior overall image quality (p<0.001) with significantly fewer artefacts (p=0.003) than cDWI. The number of lesions detected by cDWI, SMS-DWI, and Moco-SMS-DWI were 348, 504, and 523, respectively. The detectability and delineation of the lesions and the ADC values were significantly higher on the SMS-DWI and Moco-SMS-DWI images than on the cDWI images (all p<0.001). Moco-SMS-DWI showed significantly higher TRV than cDWI in regions near the liver edge (p=0.018). CONCLUSIONS: SMS-DWI achieves higher spatial resolution than cDWI within the same acquisition time, detects more lesions, and provides better lesion delineation. By applying motion correction, the TRV of DWI could be enhanced in regions near the liver edge.

[Analysis of pancreatic segmentation algorithm based on deep learning to improve pancreatic critical region segmentation ability on dual-phase CT].

Objective: To investigate the segmentation effects of the deep learning method on CT in the arterial phase and venous phase respectively by using subjective and objective evaluation system, and to investigate the factors that affect the difference between arterial phase and venous phase pancreas segmentation and the related factors affecting the venous pancreas segmentation. Method: A total of 218 cases of pancreatic CT scan data in the Department of Radiology of Peking Union Medical College Hospital from January to November 2019 were retrospectively collected. Each case contained images of arterial and venous phases, and the data were randomly divided into training set (139 cases), validation set (20 cases) and test set (59 cases) according to the ratio of the training and verification set to the test set of 7∶3. The two-stage global local progressive fusion network was trained on the training set, the model parameters of the optimal segmentation effect were found on the validation set, and the test set was predicted and the results were evaluated subjectively and objectively. The Likert 5-point scale was used for subjective evaluation based on the critical regions between pancreas and peripheral organs, while the Dice similarity coefficient (DSC) was used for objective evaluation. The paired t test or Wilcoxon paired rank test was used to compare the differences of subjective and objective scores of the arterial phase and venous phase. Results: For the critical regions of the pancreas at the duodenum, duodenal jejunal flexure, left adrenal gland, portal vein, superior mesenteric vein, splenic artery and splenic vein, the median number of subjective scores in arterial phase were 4(4, 5), 5(4, 5), 5(4, 5), 4(4, 5), 5(4, 5), 5(5, 5) and 4(3, 5)points respectively, the median number(first quartile, third quartile) of subjective scores in venous phase were 4(4, 4), 5(4, 5), 5(4, 5), 5(4, 5), 5(5, 5), 4(3, 4) and 5(5, 5) points respectively,there were statistically significant differences of the median number(first quartile, third quartile) of the subjective scores between the arterial and venous phase for the critical regions of the pancreas at the organs described above (all P<0.05). DSC in the venous phase was slightly higher than that in the arterial phase and the difference was not statistically significant (DSC: 0.932 vs 0.921, P=0.952). Subjective scores in venous phase of the pancreas and duodenal jejunum, stomach, and left adrenal gland with fat gaps were 4.64,4.68 and 4.63 points respectively, and those of the group without fat gaps were 4.56,4.62 and 4.56 points respectively, there were statistically significant differences of the subjective scores in venous phase of the groups with fat gaps or not between the pancreas and the organs described above (t=2.147, 2.112, 2.277, all P<0.05). Except the spleen, the density differences between the critical regions of the pancreas and other surrounding organs were statistically significant in arterial phase and venous phase segmentation (all P<0.05). Conclusion: Dual-phase CT was used to construct a deep learning automatic pancreas segmentation model, and the segmentation effect was evaluated subjectively and objectively. Subjective evaluation was helpful to improve the ability to segment the critical regions of the pancreas in the future.

[The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)].

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

[Effect of occupational stress on depression in gas field workers].

Objective: To explore the occurrence level of depressive symptoms and it's influencing factors among gas field workers. Methods: In October 2018, a cross-sectional study was conducted in 1726 gas field workers from a gas field by using cluster sampling method. Questionaire was used to evaluate the individual factors, depressive symptoms, occupational stress factors and stress regulatory factors. The correlation between depressive symptoms and occupational stress was analyzed. Multivariate logistic regression was used to analyze the influencing factors of depressive symptoms. Results: The depressive symptoms score of gas field workers was 12.00 (7.00, 19.00) point. Correlation analysis revealed that depressive symptoms score was positively related to sleep disorders (r=0.598) , effort (r=0.186) , daily tension (r=0.478) , negative affectivity (r=0.565) , social support (r=0.446) and monotony of work (r=0.484) (P<0.01) . And it was negatively related to reward (r=-0.386) , work stability (r=-0.294) , promotion opportunities (r=-0.258) , positive affectivity (r= -0.310) , self-efficacy (r=-0.312) , contral strategy (r=-0.268) , support strategy (r=-0.209) and job satisfaction (r=-0.398) (P<0.01) . Multivariate logistic regression analysis revealed that sleep disorder, high negative affectivity, low support from colleagues, low support from family, high monotony of work and high daily tension were the risk factors for depressive symptoms of gas field worker (OR=3.423, 95%CI: 2.644-4.397; OR=2.847, 95%CI: 2.200-3.683; OR=1.646, 95%CI: 1.215-2.116; OR=1.496, 95%CI: 1.164-1.923; OR=1.578, 95%CI: 1.227-2.303; OR=1.903, 95%CI: 1.480-2.440; P<0.01) . High work stability, high self-efficacy and high job satisfaction were protective factors for depressive symptoms of gas field workers (OR=0.752, 95%CI: 0.591-0.958; OR=0.590, 95%CI: 0.465-0.749; OR=0.718, 95%CI: 0.516-0.999; P<0.05) . Conclusion: Occupational stress factors have a great influence on the depressive symptoms of gas field workers. Increased work stability, self-efficacy and job satisfaction could reduce the risk of depressive symptoms.

Antifungal activity of cinnamaldehyde against Fusarium sambucinum involves inhibition of ergosterol biosynthesis.

AIMS: In this study, the antifungal effect of cinnamaldehyde against Fusarium sambucinum and its underlying mechanisms were determined. METHODS AND RESULTS: Minimum inhibitory concentration and minimal fungicidal concentration of cinnamaldehyde were 3 and 4 mmol l-1 on spore germination and colony development assays in vitro, respectively. Furthermore, the lesion diameter of potato tubers and tuber slices inoculated with F. sambucinum was reduced by 76·9 and 69% after treatment with 4 mmol l-1 cinnamaldehyde. Cytometric analyses revelled that cinnamaldehyde significantly affected the integrity of cell membrane firstly, then decreased mitochondrial membrane potential and induced the accumulation of intracellular reactive oxygen species. Meanwhile, high-performance liquid chromatography results indicated that 3 mmol l-1 cinnamaldehyde could reduce the ergosterol content by 67·94%. This effect was accompanied by a down-regulation of ERG11, ERG6 and ERG4 which were involved in ergosterol biosynthesis. CONCLUSION: Theses results suggest that cinnamaldehyde exerts strong antifungal activity against F. sambucinum, probably by affecting the ergosterol biosynthetic processes what leads to the disruption of cell membrane integrity. SIGNIFICANCE AND IMPACT OF THE STUDY: Cinnamaldehyde is a predominant constituent and key flavour compound of cinnamon essential oil. It has been used as a food additive and flavorant. It is expected to be a novel and safe fungicide for controlling dry rot in potato tubes.

In vitro gas production and rumen fermentation profile of fresh and ensiled genetically modified high-metabolizable energy ryegrass.

We previously generated a high-metabolizable energy (HME) perennial ryegrass (Lolium perenne) by genetically modifying the plant to increase the leaf lipid content. Although substantial progress has been made toward characterizing physiological changes of HME ryegrass, very limited information exists for feeding value and its suitability for adoption into the pastoral system. In this study, independent HME ryegrass lines with a range of elevated leaf lipid concentrations were analyzed for changes in fatty acids and possible associated changes in the broader nutritional profile, including the gross energy, which was found to increase by 6.8%. Because ryegrass is often ensiled and fermentation in the rumen leads to biohydrogenation of fatty acids as well as enteric methane production, we sought to investigate these effects on HME ryegrass. This was achieved by performing mini-scale silos and using an automated gas measurement system to incubate the material in rumen fluid in vitro for 24 h. Our study included treatments comprising 3 independent HME ryegrass genotypes and wild-type control materials prepared fresh and as silage, employing in total 5 incubation studies, using rumen fluids collected from 4 nonlactating Jersey × Holstein cows. At intervals during the incubation, the production of gases, volatile fatty acids, and the degree of biohydrogenation were measured. Statistical data analysis indicated that differences in the nutritional compositions of the ensiled materials largely reflected those of their fresh counterparts. Incubation of both fresh and ensiled HME ryegrass in rumen fluid resulted in: (1) a greater percentage of valuable unsaturated fatty acids compared with the control; (2) a significant reduction of butyrate; and (3) a 10 to 15% decrease in the methane proportion of the total gas production. We conclude that ensiling could be a convenient option for preserving HME as a locally produced high-value supplementary feed; however, large-scale application needs to be investigated. In this paper we discuss the potential use of HME ryegrass to enhancing forage feeding value and the potential environmental benefits to the pastoral agriculture industry.

Road network intersection density and childhood obesity risk in the US: a national longitudinal study.

OBJECTIVES: Road intersection density is an important indicator of walkability. The objectives of this study were to examine the trends in intersection density in the US from 2007 to 2011 and assess the associations between intersection density and childhood obesity risk at the state level. STUDY DESIGN: Longitudinal analyses were conducted to assess the spatial-temporal changes of population-weighted intersection density in relation to the risk of childhood obesity in the US. METHODS: Road network data from the Topologically Integrated Geographic Encoding and Referencing (TIGER) (2007-2011), the prevalence of overweight and obesity data from the National Survey of Children's Health (NSCH) (2007-2011), and the American Community Survey (ACS) (2011) were used. Geographic information system (GIS) visualization and spatial and regression analyses were conducted. Mixed-effect models were fit to assess the longitudinal relationship between intersection density and childhood obesity. RESULTS: Between 2007 and 2011, population-weighted intersection density remained relatively stable in most states. Low-intersection-density states were clustered in the Southeastern region in both 2007 and 2011. The high-intersection-density states were clustered in the Middle Atlantic Division. California and Nevada also were identified as high-intersection-density clusters in 2011. States with lower road intersection density corresponded with states with higher childhood obesity prevalence. Our mixed-effect model estimates suggested that increased intersection density was associated with decreased obesity prevalence. CONCLUSIONS: This study provided empirical evidence for longitudinal associations between neighborhood intersection density and childhood obesity prevalence based on national data and offered a new perspective of the role that road network plays in childhood obesity prevention.

Communication skills of providers at primary healthcare facilities in rural China.

INTRODUCTION: Effective provider-patient communication has been confirmed to improve diagnosis, treatment planning, health outcomes, patient satisfaction, and treatment compliance. Few studies have measured the effectiveness of communication between patients and rural providers in China. To fill this gap in the literature, the present study describes the communication skills of providers at primary healthcare facilities in rural China and investigates the provider- and facility-level factors underlying these communication skills. METHODS: The standardised patients successfully completed 504 interactions across two tiers of China's rural health system and engaged with providers at village clinics and township health centres. We assessed providers' communication skills based on recorded interactions between the providers and the standardised patients using the SEGUE Framework, which contains the following five dimensions: 'Set the stage', 'Elicit information', 'Give information', 'Understand the patient's perspective', and 'End the encounter'. RESULTS: The providers' overall average score was 50.6% on the SEGUE communication tasks. They did well in 'Set the stage' (54.4%) and 'Elicit information' (56.2%) but performed poorly in 'End the encounter' (24.5%) and 'Understand the patient's perspective' (44.0%). Female and younger providers scored 0.75 (P<0.05) and 0.04 (P<0.01) points higher than their male and older counterparts on total SEGUE score, respectively. CONCLUSION: Providers in rural China had relatively poor communication skills overall, especially in terms of their demonstration of care for patients and inviting them to participate in the interaction. Gender and age were significantly associated with providers' level of communication skills in rural China.