Direct Electron Transfer-Driven Nontoxic Oligomeric Deposition of Sulfonamide Antibiotics onto Carbon Materials for In Situ Water Remediation.

The rising in situ chemical oxidation (ISCO) technologies based on polymerization reactions have advanced the removal of emerging contaminants in the aquatic environment. However, despite their promise, uncertainties persist regarding their effectiveness in eliminating structurally complex contaminants, such as sulfonamide antibiotics (SAs). This study elucidated that oligomerization, rather than mineralization, predominantly governs the removal of SAs in the carbon materials/periodate system. The amine groups in SAs played a crucial role in forming organic radicals and subsequent coupling reactions due to their high f- index and low bond orders. Moreover, the study highlighted the robust adhesion of oligomers to the catalyst surface, facilitated by enhanced van der Waals forces and hydrophobic interactions. Importantly, plant and animal toxicity assessments confirmed the nontoxic nature of oligomers deposited on the carbon material surface, affirming the efficacy of carbon material-based ISCO in treating contaminated surface water and groundwater. Additionally, a novel classification approach, Δlog k, was proposed to differentiate SAs based on their kinetic control steps, providing deeper insights into the quantitative structure-activity relationship (QSAR) and facilitating the selection of optimal descriptors during the oligomerization processes. Overall, these insights significantly enhance our understanding of SAs removal via oligomerization and demonstrate the superiority of C-ISCO based on polymerization in water decontamination.

Predictive modeling of co-infection in lupus nephritis using multiple machine learning algorithms.

This study aimed to analyze peripheral blood lymphocyte subsets in lupus nephritis (LN) patients and use machine learning (ML) methods to establish an effective algorithm for predicting co-infection in LN. This study included 111 non-infected LN patients, 72 infected LN patients, and 206 healthy controls (HCs). Patient information, infection characteristics, medication, and laboratory indexes were recorded. Eight ML methods were compared to establish a model through a training group and verify the results in a test group. We trained the ML models, including Logistic Regression, Decision Tree, K-Nearest Neighbors, Support Vector Machine, Multi-Layer Perceptron, Random Forest, Ada boost, Extreme Gradient Boosting (XGB), and further evaluated potential predictors of infection. Infected LN patients had significantly decreased levels of T, B, helper T, suppressor T, and natural killer cells compared to non-infected LN patients and HCs. The number of regulatory T cells (Tregs) in LN patients was significantly lower than in HCs, with infected patients having the lowest Tregs count. Among the ML algorithms, XGB demonstrated the highest accuracy and precision for predicting LN infections. The innate and adaptive immune systems are disrupted in LN patients, and monitoring lymphocyte subsets can help prevent and treat infections. The XGB algorithm was recommended for predicting co-infection in LN.

Systematic analyses of the factors influencing sperm quality in patients with SARS-CoV-2 infection.

To figure out how does SARS-CoV-2 affect sperm parameters and what influencing factors affect the recovery of sperm quality after infection? We conducted a prospective cohort study and initially included 122 men with SARS-CoV-2 infection. The longest time to track semen quality after infection is 112 days and 58 eligible patients were included in our study eventually. We subsequently exploited a linear mixed-effects model to statistically analyze their semen parameters at different time points before and after SARS-CoV-2 infection. Semen parameters were significantly reduced after SARS-CoV-2 infection, including total sperm count (211 [147; 347] to 167 [65.0; 258], P < 0.001), sperm concentration (69.0 [38.8; 97.0] to 51.0 [25.5; 71.5], P < 0.001), total sperm motility (57.5 [52.3; 65.0] to 51.0 [38.5; 56.8], P < 0.001), progressive motility (50.0 [46.2; 58.0] to 45.0 [31.5; 52.8], P < 0.001). The parameters displayed the greatest diminution within 30 days after SARS-CoV-2 infection, gradually recovered thereafter, and exhibited no significant difference after 90 days compared with prior to COVID-19 infection. In addition, the patients in the group with a low-grade fever showed a declining tendency in semen parameters, but not to a significant degree, whereas those men with a moderate or high fever produced a significant drop in the same parameters. Semen parameters were significantly reduced after SARS-CoV-2 infection, and fever severity during SARS-CoV-2 infection may constitute the main influencing factor in reducing semen parameters in patients after recovery, but the effect is reversible and the semen parameters gradually return to normal with the realization of a new spermatogenic cycle.

Response of Harbin aerosol to latest clean air actions in China.

Cities in Northeast China, e.g., Harbin, were brought to the forefront of air pollution control by a national-level policy promulgated in 2021, i.e., the Circular on Further Promoting the Pollution Prevention and Control Battle (the FP3CB Circular) which aimed at eliminating heavy or severe air pollution events. In this study, we explored the response of Harbin aerosol to the FP3CB Circular, based on observational results from two campaigns conducted during 2020-2021 and 2021-2022. A clear decreasing trend was identified for the impact of domestic biomass burning between the two winters, presumably driven by the clean heating actions. The 2021-2022 winter was also characterized by reduced formation of secondary organic aerosol but enhanced production of nitrate, which could be attributed to the less humid conditions but higher temperatures, respectively, compared to the 2020-2021 winter. The overall effect of these changes was a decrease in the contribution of organic species to wintertime aerosol in Harbin. In addition, the number of heavy or severe pollution days rebounded in the 2021-2022 winter compared to 2020-2021 (5 vs. 3), indicating that the emissions of primary particles and gaseous precursors must be further reduced to achieve the ambitious goals of the FP3CB Circular.

Considerable contribution of secondary aerosol to wintertime haze pollution in new target of the latest clean air actions in China.

Fine particulate matter (PM2.5) in Northeast China was targeted by national-level clean air policy for the first time in 2022, with the release of Action Plan to eliminate heavy air pollution events. In this study, we investigated sources of PM2.5 during three successive winters in Harbin, a megacity in Northeast China, based on observational results from several recent campaigns in 2018-2021. During the 2020-2021 campaign, daytime and nighttime samples were collected in specific months in addition to 24-h integrated measurements, and the two sets of samples were combined in different ways to run a positive matrix factorization model. The source apportionment results suggested that the resolved secondary organic carbon (SOCPMF) had an uncertainty of ∼12%. Secondary aerosols were found to show the following features for the typical winters without agricultural fires. First, SOCPMF could be properly constrained by results from another widely-used approach for SOC estimation, the elemental carbon-tracer method. Second, secondary PM2.5 calculated using SOCPMF and secondary inorganic ions were generally in line with the independent estimations based on air quality data. Third, secondary components accounted for more than 50% of PM2.5 on average and contributed even more significantly during severe haze episodes, which were the focus of the latest Action Plan. This study also found that the wintertime PM2.5 decreased more slowly during 2017-2021 compared to 2013-2017, by ∼1 and 10 µg/m3 per year, respectively, for the metropolitan area where Harbin is located at. Our results highlighted the importance of secondary aerosols for further improving air quality in Northeast China, and for avoiding heavy pollution as required by the latest Action Plan.

Isolation, Purification, and Structural Characterization of Polysaccharides from Codonopsis pilosula and Their Anti-Tumor Bioactivity by Immunomodulation.

The activity of polysaccharides is usually related to molecular weight. The molecular weight of polysaccharides is critical to their immunological effect in cancer therapy. Herein, the Codonopsis polysaccharides of different molecular weights were isolated using ultrafiltration membranes of 60- and 100-wDa molecular weight cut-off to determine the relationship between molecular weight and antitumor activities. First, three water-soluble polysaccharides CPPS-I (<60 wDa), CPPS-II (60-100 wDa), and CPPS-III (>100 wDa) from Codonopsis were isolated and purified using a combination of macroporous adsorption resin chromatography and ultrafiltration. Their structural characteristics were determined through chemical derivatization, GPC, HPLC, FT-IR, and NMR techniques. In vitro experiments indicated that all Codonopsis polysaccharides exhibited significant antitumor activities, with the tumor inhibition rate in the following order: CPPS-II > CPPS-I > CPPS-III. The treatment of CPPS-II exhibited the highest inhibition rate at a high concentration among all groups, which was almost as efficient as that of the DOX·HCL (10 µg/mL) group at 125 µg/mL concentration. Notably, CPPS-II demonstrated the ability to enhance NO secretion and the antitumor ability of macrophages relative to the other two groups of polysaccharides. Finally, in vivo experiments revealed that CPPS-II increased the M1/M2 ratio in immune system regulation and that the tumor inhibition effect of CPPS-II + DOX was superior to that of DOX monotherapy, implying that CPPS-II + DOX played a synergistic role in regulating the immune system function and the direct tumor-killing ability of DOX. Therefore, CPPS-II is expected to be applied as an effective cancer treatment or adjuvant therapy.

Agricultural fire impacts on brown carbon during different seasons in Northeast China.

Brown carbon (BrC) represents not only a major component of haze pollution but also a non-negligible contributor to positive radiative forcing, making it a key species for coordinating air quality and climate policies. In China, field observations on BrC remain limited given the highly variable emission sources and meteorological conditions across different regions. Here we focused on the optical properties of BrC in a distinct but rarely studied megacity in Northeast China, which is within a major agricultural region and experiences extremely cold winter. Agricultural fires were evident in April of 2021 and the fall of 2020, although open burning was strictly prohibited. Such emissions enhanced BrC's mass absorption efficiency at 365 nm (MAE365), more efficiently by the fall fires which were inferred to have relatively high combustion efficiencies (CE). After taking CE into consideration, the relationships between MAE365 and the levoglucosan to organic carbon ratio (a measure of the significance of agricultural fire influence) roughly converged for the fire episodes in different seasons, including those identified in February and March of 2019 by a previous campaign. Agricultural fires also influenced the determination of absorption Ångström exponent (AAE), by resulting in non-linearity for BrC's absorption spectra shown on ln-ln scale. Based on three indicators developed by this study, the non-linearity was inferred to be caused by similar chromophores although the fires were characterized by various CE levels in different seasons. In addition, for the samples without significant influence of open burning, coal combustion emissions were identified as the dominant influencing factor for MAE365, whereas none solid link was found between the solution-based AAE and aerosol source.

[Research Progress on Spatial Differentiation and Influencing Factors of Soil Heavy Metals Based on Geographical Detector].

The geographical detector is a new statistical method to detect spatial stratified heterogeneity and reveal the driving factors behind it. It can not only reveal the influence of a single factor on dependent variables but also evaluate the influence of two-factor interactions and does not need to consider linearity, while also avoiding the influence of multivariate collinearity. Without strong model assumptions, it solves the limitations of traditional methods in analyzing category variables. The research on the spatial differentiation of heavy metals in soil is increasingly widely used. This study collected 40 research reports on the spatial differentiation of soil heavy metals via geographical detector, combed the discrete methods of independent variables, research scale, dependent variables and types of independent variables, factor detection, exchange detection, risk detection, and ecological detection and put forward the problems that need to be clarified in the future application of this research. It is expected to provide support for the deep application of geo-detector in the field of spatial differentiation of soil heavy metals.

Effect of tracheal intubation on postoperative complications in patients with pulmonary hypertension combined with non-cardiothoracic, non-obstetric surgery.

Endotracheal intubation can be associated with certain complications in certain group of patients. However, the relationship between endotracheal intubation and postoperative complications is unclear in patients with pulmonary hypertension (PHTN). This study evaluated the relationship between endotracheal intubation and postoperative complications in non-cardiothoracic and non-obstetric surgery patients with PHTN. A secondhand analysis of non-cardiothoracic, non-obstetric procedures was performed on patients with PHTN between 2007 and 2013 in a hospital at the University of Washington. Multivariable logistic regression analyses were used to calculate the adjusted odds ratios to estimate the association between anesthesia and 30-day postoperative complications. Interaction and stratified analyses were conducted according to the American Society of Anesthesiologists score (ASA), smoking, hypertension, and open surgical approach. A total of 573 patients were included in this study, and the mean age was 60.3; 54% were male. In a multivariate regression model for patients with non-cardiothoracic, non-obstetric surgery combined with PHTN, the risk of 30-day postoperative complications was higher in the tracheal intubation group than in patients with non-intubated anesthesia after adjusting for potential covariates (adjusted odds ratio = 2.47; 95% CI, 1.28-4.78). However, there was no significant difference in postoperative mortality between these groups. Statistical analysis showed no interaction between the variables of tracheal intubation and 30-day postoperative complications. In this study, we found that tracheal intubation anesthesia is associated with increased risk of 30-day postoperative complications in PHTN patients undergoing non-cardiothoracic, non-obstetric surgery. Further studies are needed to confirm our findings.

[Research progress on chemical constituents of Schisandra chinensis and its effect on nonalcoholic fatty liver disease].

Schisandra chinensis, a traditional Chinese medicinal herb, is rich in chemical constituents, including lignans, triterpenes, polysaccharides, and volatile oils. Clinically, it is commonly used to treat cardiovascular, cerebrovascular, liver, gastrointestinal, and respiratory diseases. Modern pharmacological studies have shown that S. chinensis extract and monomers have multiple pharmacological activities in lowering liver fat, alleviating insulin resistance, and resisting oxidative stress, and have good application prospects in alleviating nonalcoholic fatty liver disease(NAFLD). Therefore, this study reviewed the research progress on chemical constituents of S. chinensis and its effect on NAFLD in recent years to provide references for the research on S. chinensis in the treatment of NAFLD.

Mn Pretreatment Improves the Physiological Resistance and Root Exudation of Celosia argentea Linn. to Cadmium Stress.

Phytoextraction using Celosia argentea Linn. by Mn pretreatment can potentially decontaminate Cd-contaminated soils. However, the mechanism that accelerates the Cd bioaccumulation is still unknown. In order to study the effect and mechanism of Mn pretreatment on Cd bioaccumulation in C. argentea, the hydroponic experiments were set to determine the chlorophyll content, antioxidant enzyme activity, malondialdehyde content, and root exudation of C. argentea. The results indicated that after seven days of Mn pretreatment, both the biomass and Cd concentrations in plants increased compared to the control group. One of the mechanisms for this was the improvement in the physiological resistance of C. argentea following pretreatment with Mn. Compared with Cd stress alone, Mn pretreatment increased photosynthesis and reduced membrane lipid peroxidation. Meanwhile, the activities of superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) were significantly reduced in leaves of C. argentea after Mn pretreatment through the reduction in the production of reactive oxygen species. In addition, Mn promoted the exudation of organic acids in the roots of C. argentea. The contents of citric and malic acids increased by 55.3% and 26.4%, respectively, which may be another important reason for Mn pretreatment increasing Cd bioaccumulation in C. argentea. Therefore, the present work shows that the pretreatment of seedlings with Mn can provide a meaningful strategy to improve the remediation efficiency of Cd-contaminated soils by C. argentea.

[Spatial Differentiation and Influencing Factor Analysis of Soil Heavy Metal Content at Town Level Based on Geographic Detector].

Geographic detectors can quickly detect spatial stratified heterogeneity and quantitatively reveal the intensity of driving factors of heavy metal content, which is of great significance for the prevention, control, and remediation of soil heavy metal pollution. In order to reveal the spatial differentiation and influencing factors of soil heavy metal content on the town-scale, 788 topsoil samples were collected from a town in the hinterland of Chengdu Plain. Soil heavy metal (Cd, Hg, As, Cu, Pb, Cr, Zn, and Ni) pollution risk assessments were carried out by using the geo-accumulation index method. Additionally, based on the geographic detector model, 15 factors such as soil properties, topography, soil forming factors, and distance were taken as independent variables, and the contents of each heavy metal element were taken as dependent variables to explore the spatial differentiation and influencing factors of heavy metal content in soils. The results showed that:the average contents of Hg, As, Pb, Cr, Cu, Ni, and Zn in the study area were 1.06-1.93 times the background value of Chengdu, and the content of Cd was lower than the background value; among them, Hg reached the light pollution level, and the other seven heavy metals were at the non-pollution level. The spatial distribution of eight heavy metals was significantly different, the correlation among the elements was significant, and a significant correlation was found between most heavy meals with soil properties; however, the correlation with distance factor and topographic factor was relatively weak. The factor detection showed that TP, TK, pH, TOC, elevation, and distance from the railway had the most significant explanatory power for the heavy metal contents. Interaction detection showed that the interaction between soil properties and other factors was the dominant factor for the spatial variation in heavy metals, and elevation, distance from residential area, distance from railways, and distance from industrial areas were also important factors. Risk detection showed that Hg had the most significant difference in the subregion of elevation and distance from railway, whereas the other seven heavy metals had the most significant difference in the sub-regions of influencing factors of soil properties. The spatial distribution of heavy metals varied significantly in soil at the town-scale, which was closely related to soil properties, topography, and human activities in the study area.

Treatment and surveillance for non-muscle-invasive bladder cancer: a clinical practice guideline (2021 edition).

Non-muscle invasive bladder cancer (NMIBC) is a major type of bladder cancer with a high incidence worldwide, resulting in a great disease burden. Treatment and surveillance are the most important part of NIMBC management. In 2018, we issued "Treatment and surveillance for non-muscle-invasive bladder cancer in China: an evidence-based clinical practice guideline". Since then, various studies on the treatment and surveillance of NMIBC have been published. There is a need to incorporate these materials and also to take into account the relatively limited medical resources in primary medical institutions in China. Developing a version of guideline which takes these two issues into account to promote the management of NMIBC is therefore indicated. We formed a working group of clinical experts and methodologists. Through questionnaire investigation of clinicians including primary medical institutions, 24 clinically concerned issues, involving transurethral resection of bladder tumor (TURBT), intravesical chemotherapy and intravesical immunotherapy of NMIBC, and follow-up and surveillance of the NMIBC patients, were determined for this guideline. Researches and recommendations on the management of NMIBC in databases, guideline development professional societies and monographs were referred to, and the European Association of Urology was used to assess the certainty of generated recommendations. Finally, we issued 29 statements, among which 22 were strong recommendations, and 7 were weak recommendations. These recommendations cover the topics of TURBT, postoperative chemotherapy after TURBT, Bacillus Calmette-Guérin (BCG) immunotherapy after TURBT, combination treatment of BCG and chemotherapy after TURBT, treatment of carcinoma in situ, radical cystectomy, treatment of NMIBC recurrence, and follow-up and surveillance. We hope these recommendations can help promote the treatment and surveillance of NMIBC in China, especially for the primary medical institutions.

Identification, Molecular Cloning, and Functional Characterization of a Coniferyl Alcohol Acyltransferase Involved in the Biosynthesis of Dibenzocyclooctadiene Lignans in Schisandra chinensis.

Schisandra chinensis owes its therapeutic efficacy to the dibenzocyclooctadiene lignans, which are limited to the Schisandraceae family and whose biosynthetic pathway has not been elucidated. Coniferyl alcohol is the synthetic precursor of various types of lignans and can be acetylated to form coniferyl acetate by coniferyl alcohol acyltransferase (CFAT), which belongs to the BAHD acyltransferase family. This catalytic reaction is important because it is the first committed step of the hypothetical biosynthetic pathway in which coniferyl alcohol gives rise to dibenzocyclooctadiene lignans. However, the gene encoding CFAT in S. chinensis has not been identified. In this study, firstly we identified 37 ScBAHD genes from the transcriptome datasets of S. chinensis. According to bioinformatics, phylogenetic, and expression profile analyses, 1 BAHD gene, named ScBAHD1, was cloned from S. chinensis. The heterologous expression in Escherichia coli and in vitro activity assays revealed that the recombinant enzyme of ScBAHD1 exhibits acetyltransferase activity with coniferyl alcohol and some other alcohol substrates by using acetyl-CoA as the acetyl donor, which indicates ScBAHD1 functions as ScCFAT. Subcellular localization analysis showed that ScCFAT is mainly located in the cytoplasm. In addition, we generated a three-dimensional (3D) structure of ScCFAT by homology modeling and explored the conformational interaction between protein and ligands by molecular docking simulations. Overall, this study identified the first enzyme with catalytic activity from the Schisandraceae family and laid foundations for future investigations to complete the biosynthetic pathway of dibenzocyclooctadiene lignans.

[Anti-inflammatory active component in raw materials of Ligustici Rhizoma et Radix based on spectrum-effect relationship].

The present study investigated the correlation of UPLC fingerprints of raw materials of Ligustici Rhizoma et Radix samples with the anti-inflammatory effect and explored the pharmacodynamic material basis for the anti-inflammatory activity. UPLC fingerprints of 18 batches of raw materials of Ligustici Rhizoma et Radix samples were established for the determination of the content of eight components. The toe swelling rate and the content of IL-1ß, IL-6, and PGE2 in rats with toe inflammation induced by carrageenin were measured. Canonical correlation analysis was used to study the spectrum-effect relationship. Cluster analysis indicated that chemical components of Ligusticum sinense and L. jeholense were similar. Methanol extracts of L. sinense, L. jeholense, and Conioselinum vaginatum significantly reduced the toe swelling rate and the content of IL-1ß, IL-6 and PGE2 in swollen tissues. The anti-inflammatory effect of C. vaginatum was weaker than that of L. sinense and L. jeholense. The results of spectrum-effect relationship indicated that there was an obvious correlation between chemical components and pharmacodynamic indexes. In UPLC fingerprints, compounds 1, 3(chlorogenic acid), 4(cryptochlorogenic acid), 5, 6(ferulic acid), 7(isochlorogenic acid B), 9, 11, 13, 15, 16, 17, 18(coniferyl ferulate), 19, 20(N-butylphthalide), 21, 22, and 23 were significantly correlated with anti-inflammation, among which compounds 5, 11, 13, 15, 17, 21, and 23 had negative correlation. This study screened out the effective components with anti-inflammatory activity in raw materials of Ligustici Rhizoma et Radix, which was of great significance to improve the quality evaluation system of raw materials of Ligustici Rhizoma et Radix.

[Research progress in DIR gene of lignan biosynthesis in medicinal plants].

The active components, mainly derived from secondary metabolites of medicinal plants, are the material basis for the efficacy of medicinal plants. Lignans, the secondary metabolites in plants with high bioactivity, are widely distributed in a variety of plant species, and their antiviral, antitumor, antibacterial, and antioxidant activities have been proved in clinical practice. Generally, lignans are diverse in structures with many chiral centers, and most of them are optically active. The biosynthesis of lignans depends on the oxidative coupling reaction through site selection and stereo selection, which impedes synthesized lignans to form racemates, but makes them in a three-dimensional configuration. Dirigent protein(DIR) plays an important role in guiding location selection and stereo selection of lignans in biosynthesis. In vitro studies on lignan biosynthesis have shown that racemic end products are obtained in the absence of DIR proteins, while the products in a three-dimensional configuration can be yielded in the presence of DIR proteins, indicating that DIR proteins play an asymmetric role in the biosynthesis of plant secondary metabolites. The present study reviewed the biolo-gical significance of DIR protein, the cloning of DIR gene, gene structure, catalytic mechanism, and the research progress in Isatis indigotica, Eucommia ulmoides, Forsythia suspensa, Salvia miltiorrhiza, Panax pseudoginseng var. notoginseng, and Schisandra chinensis, which provides a reference for the follow-up research of DIR gene.

Molecular Structure and Phylogenetic Analyses of the Complete Chloroplast Genomes of Three Medicinal Plants Conioselinum vaginatum, Ligusticum sinense, and Ligusticum jeholense.

Most plants of Ligusticum have an important medicinal and economic value with a long history, Ligusticum sinense and L. jeholense ("Gaoben") has long been used in traditional Chinese medicine for the treatment of carminative, dispelling cold, dehumidification, and analgesia. While in the market Conioselinum vaginatum (Xinjiang Gaoben) is substitution for Gaoben, and occupies a higher market share. These three Gaoben-related medicinal materials are similar in morphology, and are difficult to distinguish from each other by the commonly used DNA barcodes. The chloroplast genome has been widely used for molecular markers, evolutionary biology, and barcoding identification. In this study, the complete chloroplast genome sequences of C. vaginatum, L. sinense, and L. jeholense were reported. The results showed that the complete chloroplast genomes of these three species have typical quadripartite structures, which were comprised of 148,664, 148,539, and 148,497 bp. A total of 114 genes were identified, including 81 protein-coding genes (PCGs), 29 tRNA genes, and four rRNA genes. Our study indicated that highly variable region ycf2-trnL and accD-ycf4 that can be used as specific DNA barcodes to distinguish and identify C. vaginatum, L. sinense, and L. jeholense. In addition, phylogenetic study showed that C. vaginatum nested in Ligusticum and as a sister group of L. sinense and L. jeholense, which suggested these two genera are both in need of revision. This study offer valuable information for future research in the identification of Gaoben-related medicinal materials and will benefit for further phylogenetic study of Apiaceae.

CRMP4 CpG Hypermethylation Predicts Upgrading to Gleason Score ≥ 8 in Prostate Cancer.

Background: This study determined the predictive value of CRMP4 promoter methylation in prostate tissues collected by core needle biopsies for a postoperative upgrade of Gleason Score (GS) to ≥8 in patients with low-risk PCa. Method: A retrospective analysis of the clinical data was conducted from 631 patients diagnosed with low-risk PCa by core needle biopsy at multiple centers and then underwent Radical Prostatectomy (RP) from 2014-2019. Specimens were collected by core needle biopsy to detect CRMP4 promoter methylation. The pathologic factors correlated with the postoperative GS upgrade to ≥8 were analyzed by logistic regression. The cut-off value for CRMP4 promoter methylation in the prostate tissues collected by core needle biopsy was estimated from the ROC curve in patients with a postoperative GS upgrade to ≥8. Result: Multivariate logistic regression showed that prostate volume, number of positive cores, and CRMP4 promoter methylation were predictive factors for a GS upgrade to ≥8 (OR: 0.94, 95% CI: 0.91-0.98, P=0.003; OR: 3.16, 95% CI: 1.81-5.53, P<0.001; and OR: 1.43, 95% CI: 1.32-1.55, P<0.001, respectively). The positive predictive rate was 85.2%, the negative predictive rate was 99.3%, and the overall predictive rate was 97.9%. When the CRMP4 promoter methylation rate was >18.00%, the low-risk PCa patients were more likely to escalate to high-risk patients. The predictive sensitivity and specificity were 86.9% and 98.8%, respectively. The area under the ROC curve (AUC) was 0.929 (95% CI: 0.883-0.976; P<0.001). The biochemical recurrence (BCR)-free survival, progression-free survival (PFS), and cancer-specific survival (CSS) were worse in patients with CRMP4 methylation >18.0% and postoperative GS upgrade to ≥8 than in patients without an upgrade (P ≤ 0.002). Conclusion: A CRMP4 promoter methylation rate >18.00% in prostate cancer tissues indicated that patients were more likely to escalate from low-to-high risk after undergoing an RP. We recommend determining CRMP4 promoter methylation before RP for low-risk PCa patients.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition).

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Porous and Ultra-Flexible Crosslinked MXene/Polyimide Composites for Multifunctional Electromagnetic Interference Shielding.

Lightweight, ultra-flexible, and robust crosslinked transition metal carbide (Ti3C2 MXene) coated polyimide (PI) (C-MXene@PI) porous composites are manufactured via a scalable dip-coating followed by chemical crosslinking approach. In addition to the hydrophobicity, anti-oxidation and extreme-temperature stability, efficient utilization of the intrinsic conductivity of MXene, the interfacial polarization between MXene and PI, and the micrometer-sized pores of the composite foams are achieved. Consequently, the composites show a satisfactory X-band electromagnetic interference (EMI) shielding effectiveness of 22.5 to 62.5 dB at a density of 28.7 to 48.7 mg cm-3, leading to an excellent surface-specific SE of 21,317 dB cm2 g-1. Moreover, the composite foams exhibit excellent electrothermal performance as flexible heaters in terms of a prominent, rapid reproducible, and stable electrothermal effect at low voltages and superior heat performance and more uniform heat distribution compared with the commercial heaters composed of alloy plates. Furthermore, the composite foams are well attached on a human body to check their electromechanical sensing performance, demonstrating the sensitive and reliable detection of human motions as wearable sensors. The excellent EMI shielding performance and multifunctionalities, along with the facile and easy-to-scalable manufacturing techniques, imply promising perspectives of the porous C-MXene@PI composites in next-generation flexible electronics, aerospace, and smart devices.