Varied immune responses of HBV-specific B cells in patients undergoing pegylated interferon-alpha treatment for chronic hepatitis B.

BACKGROUND & AIMS: The changes of HBV-specific B-cells in chronic hepatitis B (CHB) patients underwent pegylated interferon-alfa (PEG-IFNα) treatment and achieved functional cure remain unclear. We aimed to evaluate the alterations in HBV-specific B-cells during treatment and therefore explored the mechanism of functional recovery of HBsAg-specific B-cells. METHODS: We included 39 nucleos(t)ide analogues-treated CHB patients who received sequential combination therapy with PEG-IFNα and 8 treatment-naive CHB patients. HBV-specific B-cells were characterized ex vivo using fluorescent labeled HBsAg and HBcAg. The frequency, phenotype, and subsets of HBV-specific B-cells and follicular helper T cells (Tfh-cells) were detected using flow cytometry. The functionality of HBV-specific B-cells was quantified through ELISpot assays. RESULTS: During treatment, the fraction of activated memory B-cells (MBCs) among HBsAg-specific B-cells and the expression of IgG, CXCR3, and CD38 increased. Antibody-secretion capacity of HBsAg-specific B-cell was restored after treatment only in patients with a functional cure and it showed a positive correlation with serum hepatitis B surface antibody levels. The phenotype and function of HBsAg-specific B-cells differed between patients with and without functional cure. Patients with functional cure exhibited IgG+ classical MBCs and plasmablasts in HBsAg-specific B-cells. HBcAg-specific B-cells displayed both attenuated antibody secretion with reduced IgG expression and an IgM+ atypical type of MBCs after treatment, irrespective of with and without functional cure. The number of CD40L+ Tfh-cells increased after PEG-IFNα treatment and positively correlated with HBsAg-specific B-cell activation. CONCLUSIONS: After PEG-IFNα treatment, HBsAg- and HBcAg-specific B-cells exhibit various changes in antibody secretion. Their functional differences are reflected in the alterations in phenotypes and subtypes. The presence of CD40L+ Tfh-cells is associated with the active recovery of HBsAg-specific B-cells. IMPACT AND IMPLICATIONS: HBV-related complications and hepatocellular carcinoma remain the leading causes of mortality from chronic liver disease worldwide, and a cure is rarely achieved with antiviral therapies. Elucidating the immunological mechanisms underlying the functional cure of CHB patients offers a promising therapeutic strategy for viral clearance, such as therapeutic vaccine. We analyzed the alterations in HBV-specific B-cells in patients treated with PEG-IFNα and identified novel pathways for immunotherapeutic boosting of B cell immunity.

Self-Assembled Tetranuclear Square Complex of Chromium(III) Bridged by Radical Pyrazine: A Molecular Model for Metal-Organic Magnets.

The attractive electronic properties of metal-pyrazine materials─electrical conductivity, magnetic order, and strong magnetic coupling─can be tuned in a wide range depending on the metal employed, as well as its ligand-imposed redox environment. Using solvent-directed synthesis to control the dimensionality of such systems, a discrete tetranuclear chromium(III) complex, exhibiting a rare example of bridging radical pyrazine, has been prepared from chromium(II) triflate and neutral pyrazine. The strong antiferromagnetic interaction between CrIII (S = 3/2) and radical pyrazine (S = 1/2) spins, theoretically estimated at about -932 K, leads to a thermally isolated ST = 4 ground state, which remains the only populated state observable even at room temperature.

Comparison of indocyanine green and blue-stained glue for preoperative localization for pulmonary nodules.

Background: In patients with pulmonary nodules undergoing computed tomography (CT)-guided localization procedures, a range of liquid-based materials have been employed to date in an effort to guide video-assisted thoracoscopic surgery (VATS) procedures to resect target nodules. However, the relative performance of these different liquid-based localization strategies has yet to be systematically evaluated. Accordingly, this study was developed with the aim of examining the relative safety and efficacy of CT-guided indocyanine green (IG) and blue-stained glue (BSG) PN localization. Methods: Consecutive patients with PNs undergoing CT-guided localization prior to VATS from November 2021 - April 2022 were enrolled in this study. Safety and efficacy outcomes were compared between patients in which different localization materials were used. Results: In total, localization procedures were performed with IG for 121 patients (140 PNs), while BSG was used for localization procedures for 113 patients (153 PNs). Both of these materials achieved 100% technical success rates for localization, with no significant differences between groups with respect to the duration of localization (P = 0.074) or visual analog scale scores (P = 0.787). Pneumothorax affected 8 (6.6%) and 8 (7.1%) patients in the respective IG and BSG groups (P = 0.887), while 12 (9.9%) and 10 (8.8%) patients of these patients experienced pulmonary hemorrhage. IG was less expensive than BSG ($17.2 vs. $165). VATS sublobar resection procedure technical success rates were also 100% in both groups, with no instances of conversion to thoracotomy. Conclusions: IG and BSG both offer similarly high levels of clinical safety and efficacy when applied for preoperative CT-guided PN localization, with IG being less expensive than BSG.

FL% is associated with the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk and total arch replacement.

Objectives: The diameter, area, and volume of the true lumen and false lumen (FL) have been measured in previous studies to evaluate the extent of DeBakey type I aortic dissection. However, these indicators have limitations because of the irregular shapes of the true and false lumens and the constant oscillation of intimal flap during systole and diastole. The ratio of arch lengths seems to be a more reliable indicator. FL% was defined as the ratio of the arch length of FL to the circumference of the aorta at the different levels of the aorta. The purpose of this article was to investigate whether FL% is a predictor of the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk (FET) and total arch replacement. Methods: In this retrospective observational study, we analyzed a total of 344 patients with acute DeBakey type I aortic dissection that underwent FET and total arch replacement at our center from October 2015 to October 2019. The patients were divided into two groups by cluster analysis according to the perioperative course. Binary logistic regression analyses were performed to determine whether FL% could predict the severity of acute DeBakey type I aortic dissection. The area under the receiver operating characteristic curve (AUROC) was used to assess the power of the multivariate logistic regression model for the severity of acute DeBakey type I aortic dissection. Results: The patients in the ultra-high-risk group (109 patients) had significantly more severe clinical comorbidities and complications than the patients in the high-risk group (235 patients). The ascending aortic FL% [odds ratio (OR), 11.929 (95% CI: 1.421-100.11); P = 0.022], location of initial tear [OR, 0.68 (95% CI: 0.47-0.98); P = 0.041], the degree of left iliac artery involvement [OR, 1.95 (95% CI: 1.15-3.30); P = 0.013], and the degree of right coronary artery involvement [OR, 1.46 (95% CI: 1.01-2.12); P = 0.045] on preoperative computed tomography angiography were associated with the severity of acute DeBakey type I aortic dissection. The AUROC value of this multivariate logistic regression analysis was 0.940 (95% CI: 0.914-0.967; P < 0.001). The AUROC value of ascending aortic FL% was 0.841 (95% CI: 0.798-0.884; P < 0.001) for the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Conclusions: Ascending aortic FL% was validated as an essential radiologic index for assessing the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Higher values of ascending aortic FL% were more severe.

Presurgical computed tomography-guided localization of lung ground glass nodules: comparing hook-wire and indocyanine green.

BACKGROUND: Presurgical computed tomography (CT)-guided localization is frequently employed to reduce the thoracotomy conversion rate, while increasing the rate of successful sublobar resection of ground glass nodules (GGNs) via video-assisted thoracoscopic surgery (VATS). In this study, we compared the clinical efficacies of presurgical CT-guided hook-wire and indocyanine green (IG)-based localization of GGNs. METHODS: Between January 2018 and December 2021, we recruited 86 patients who underwent CT-guided hook-wire or IG-based GGN localization before VATS resection in our hospital, and compared the clinical efficiency and safety of both techniques. RESULTS: A total of 38 patients with 39 GGNs were included in the hook-wire group, whereas 48 patients with 50 GGNs were included in the IG group. There were no significant disparities in the baseline data between the two groups of patients. According to our investigation, the technical success rates of CT-based hook-wire- and IG-based localization procedures were 97.4% and 100%, respectively (P = 1.000). Moreover, the significantly longer localization duration (15.3 ± 6.3 min vs. 11.2 ± 5.3 min, P = 0.002) and higher visual analog scale (4.5 ± 0.6 vs. 3.0 ± 0.5, P = 0.001) were observed in the hook-wire patients, than in the IG patients. Occurrence of pneumothorax was significantly higher in hook-wire patients (27.3% vs. 6.3%, P = 0.048). Lung hemorrhage seemed higher in hook-wire patients (28.9% vs. 12.5%, P = 0.057) but did not reach statistical significance. Lastly, the technical success rates of VATS sublobar resection were 97.4% and 100% in hook-wire and IG patients, respectively (P = 1.000). CONCLUSIONS: Both hook-wire- and IG-based localization methods can effectively identified GGNs before VATS resection. Furthermore, IG-based localization resulted in fewer complications, lower pain scores, and a shorter duration of localization.

Computed tomography-guided indocyanine green localization of multiple ipsilateral lung nodules.

Introduction: Approximately 20% of lung nodule (LN) patients have more than one moderate-to-high malignant risk LNs. When performing one-stage video-assisted thoracoscopic surgery (VATS) in patients with multiple LNs, the ability to simultaneously localize all of these nodules is critical to operative success. Aim: To explore the efficacy and safety of computed tomography (CT)-guided indocyanine green (IG) localization for multiple ipsilateral LNs. Material and methods: This was a retrospective study of 278 LN patients who underwent CT-guided IG localization prior to VATS resection. Of these patients, 68 underwent localization of multiple ipsilateral LNs, whereas 210 underwent localization of a single LN. Results: In total, 160 LNs were localized in 68 patients in the multiple localization group, while one LN was localized for each of the 210 patients in the single localization group. A 100% technical success rate was achieved in both of these groups, and the mean respective localization durations in the multiple and single LN groups were 11.3 ±4.7 min and 6.3 ±2.7 min (p = 0.001). Of the patients in the multiple and single LN groups, 22 and 15, respectively, experienced pneumothorax (p = 0.001), while 14 and 20 experienced lung hemorrhage (p = 0.016). Wedge/segmental LN technical success rates in both of these groups were 100%. Conclusions: The CT-guided IG-mediated localization of multiple ipsilateral LNs is a safe and effective strategy, although it requires a longer operative duration and is associated with higher rates of adverse events as compared to single nodule localization.

Urgent-start peritoneal dialysis in the hemophilia a patient with chronic kidney disease: A case report.

Key Clinical Message: This case illustrates that under comprehensive management of individual and clinical needs, urgent-start peritoneal dialysis can be performed safely without bleeding complications in patients with hemophilia A who developed end-stage renal disease. Patients in these cases can benefit from synthetic strategy. Abstract: Hemophilia A is a serious inherited bleeding disorder resulting from a deficiency of coagulation factor VIII (FVIII). Chronic kidney disease (CKD) involvement in hemophilia is relatively rare, but there has been an upward trend in the survival time of patients with prolonged hemophilia. Although peritoneal dialysis (PD) is often used as the first treatment modality for renal replacement treatment, limited data are available on comprehensive management in the hemophilia A population, especially for urgent-start PD. A 56-year-old man who had hemophilia A, was diagnosed with CKD 3 years ago and developed end-stage renal disease was admitted to our hospital after contracting pneumonia and undergoing subsequent Type I respiratory failure. Urgent-start PD improved his condition and health outcomes, and protected his residual renal function. This case is the first study of a Chinese male patient with hemophilia A who developed end-stage renal disease. We summarize the clinical treatment and nursing care strategies of urgent-start PD in a hemophilia A patient with end-stage renal disease. This case illustrates that under comprehensive management of individual and clinical needs, urgent-start PD can be performed safely without bleeding complications in patients with hemophilia A.

Preoperative lung nodule localization: comparison of hook-wire and indocyanine green.

Introduction: Computed tomography (CT)-guided localization approaches are commonly used to guide video-assisted thoracoscopic surgery (VATS)-based lung nodule (LN) resection. Aim: To compare the relative safety and efficacy of CT-guided hook-wire (HW) and indocyanine green (IG) approaches to preoperative LN localization. Material and methods: In total, this study analyzed data from 41 patients who underwent CT-guided HW localization prior to VATS-based LN resection between December 2017 and December 2020, as well as 53 patients who underwent CT-guided IG localization prior to VATS-based LN resection between January 2021 and September 2021. Both clinical efficacy and complication rates were compared in these two groups. Results: Overall, 41 patients underwent HW localization for 42 LNs, while 53 patients underwent IG localization for 55 LNs in the respective groups. The respective rates of successful localization in the HW and IG groups were 97.6% and 100% (p = 1.000). The average duration of CT-guided localization was significantly shorter for patients in the IG group relative to the HW group (p = 0.003). The total complication rate was significantly higher in the HW group than that in the IG group (p = 0.004). Prolonged localization duration was an independent risk factor of pneumothorax (p = 0.004). Rates of technical success for the wedge resection procedure (p = 1.000), VATS duration (p = 0.623), and blood loss (p = 0.800) were comparable in both patient groups. Conclusions: HW and IG localization procedures achieved similar efficacy outcomes when used to preoperatively localize LNs. However, IG localization may exhibit better safety than HW localization.

Advances in the prevention and treatment of postoperative delirium by acupuncture: A review.

Postoperative delirium is a common postoperative complication of neurocognitive dysfunction, especially in elderly surgical patients. Postoperative delirium not only damages patients' recovery but also increases social costs. Therefore, its prevention and treatment has essential clinical and social significance. However, due to its intricate pathogenesis and limited pharmacological interventions, the effective prevention and treatment of postoperative delirium remains a thorny problem. As traditional acupuncture therapy has been shown to be an effective treatment in many neurological disorders, and in recent years, it has begun to be clinically used as an intervention for postoperative delirium. Although most clinical and animal studies confirm that multiple types of acupuncture interventions can alleviate or prevent postoperative delirium by relieving acute postoperative pain, reducing the consumption of anesthetics and analgesics, attenuating neuroinflammation and neuronal lesions, while more evidence-based medical evidence and clinical validation are needed for these encouraging effects.

Oncogenic FLT3 internal tandem duplication activates E2F1 to regulate purine metabolism in acute myeloid leukaemia.

Oncogene FLT3 internal tandem duplication (FLT3-ITD) mutation accounts for 30 % of acute myeloid leukaemia (AML) cases and induces transformation. Previously, we found that E2F transcription factor 1 (E2F1) was involved in AML cell differentiation. Here, we reported that E2F1 expression was aberrantly upregulated in AML patients, especially in AML patients carrying FLT3-ITD. E2F1 knockdown inhibited cell proliferation and increased cell sensitivity to chemotherapy in cultured FLT3-ITD-positive AML cells. E2F1-depleted FLT3-ITD+ AML cells lost their malignancy as shown by the reduced leukaemia burden and prolonged survival in NOD-PrkdcscidIl2rgem1/Smoc mice receiving xenografts. Additionally, FLT3-ITD-driven transformation of human CD34+ hematopoietic stem and progenitor cells was counteracted by E2F1 knockdown. Mechanistically, FLT3-ITD enhanced the expression and nuclear accumulation of E2F1 in AML cells. Further study using chromatin immunoprecipitation-sequencing and metabolomics analyses revealed that ectopic FLT3-ITD promoted the recruitment of E2F1 on genes encoding key enzymatic regulators of purine metabolism and thus supported AML cell proliferation. Together, this study demonstrates that E2F1-activated purine metabolism is a critical downstream process of FLT3-ITD in AML and a potential target for FLT3-ITD+ AML patients.

Anatomical type analysis of right interlobar artery based on chest thin-slice CT scan and three-dimensional reconstruction.

PURPOSE: To analyse and summarize branching pattern types of the interlobar portion of right pulmonary arteries (RPA) through chest thin-slice CT scans and three-dimensional reconstruction. METHODS: A total of 179 patients (58 males and 121 females, with an average age of 53.9 years) at the Thoracic Surgery Department of Ningbo First Hospital were retrospectively included from December 2020 to December 2021. All patients completed preoperative thin-slice CT scans and three-dimensional reconstructions of the chest. The clinical data and branching patterns were collected. Data were analysed using SPSS 21.0. RESULTS: The branching pattern types of the interlobar portion of RPA were divided into 4 types according to the order and number of branches: Type I (145/179, 81.0%), Asc. A2, MA, A6; Type II (28/179, 15.6%), Asc. A2 deletion, MA, A6; Type III (5/179, 2.8%), Asc. A2, A6, MA; and Type IV (1/179, 0.6%), MA, Asc. A2, A6. Type I was the most common pattern. Furthermore, according to the number of branches of MA and A6, this pattern can be subdivided into 15 subcategories. CONCLUSION: Chest thin-slice CT scans and 3D reconstructions can provide surgeons with accurate lung anatomy, which helps surgeons perform preoperative planning and complete surgery successfully.

Redox-Programmable Spin-Crossover Behaviors in a Cationic Framework.

Metal-organic frameworks (MOFs) provide versatile platforms to construct multi-responsive materials. Herein, by introducing the neutral tetradentate ligand and the linear dicyanoaurate(I) anion, we reported a rare cationic MOF [FeII(TPB){AuI(CN)2}]I·4H2O·4DMF (TPB = 1,2,4,5-tetra(pyridin-4-yl)benzene) with hysteretic spin-crossover (SCO) behavior near room temperature. This hybrid framework with an open metal site (AuI) exhibits redox-programmable capability toward dihalogen molecules. By means of post-synthetic modification, all the linear [AuI(CN)2]- linkers can be oxidized to square planar [AuIII(CN)2X2]- units, which results in the hysteretic SCO behaviors switching from one-step to two-step for Br2 and three-step for I2. More importantly, the stepwise SCO behaviors can go back to one-step via the reduction by l-ascorbic acid (AA). Periodic DFT calculations using various SCAN-type exchange-correlation functionals have been employed to rationalize the experimental data. Hence, these results demonstrate for the first time that switchable one-/two-/three-stepped SCO dynamics can be manipulated by chemical redox reactions, which opens a new perspective for multi-responsive molecular switches.

The role of E2A in ATPR-induced cell differentiation and cycle arrest in acute myeloid leukaemia cells.

Acute myeloid leukaemia (AML) is a biologically heterogeneous disease with an overall poor prognosis; thus, novel therapeutic approaches are needed. Our previous studies showed that 4-amino-2-trifluoromethyl-phenyl retinate (ATPR), a new derivative of all-trans retinoic acid (ATRA), could induce AML cell differentiation and cycle arrest. The current study aimed to determine the potential pharmacological mechanisms of ATPR therapies against AML. Our findings showed that E2A was overexpressed in AML specimens and cell lines, and mediate AML development by inactivating the P53 pathway. The findings indicated that E2A expression and activity decreased with ATPR treatment. Furthermore, we determined that E2A inhibition could enhance the effect of ATPR-induced AML cell differentiation and cycle arrest, whereas E2A overexpression could reverse this effect, suggesting that the E2A gene plays a crucial role in AML. We identified P53 and c-Myc were downstream pathways and targets for silencing E2A cells using RNA sequencing, which are involved in the progression of AML. Taken together, these results confirmed that ATPR inhibited the expression of E2A/c-Myc, which led to the activation of the P53 pathway, and induced cell differentiation and cycle arrest in AML.

Unraveling the mechanism of efficient adsorption of riboflavin onto activated biochar derived from algal blooms.

Riboflavin is commercially produced primarily by bio-fermentation. Nonetheless, purification and separation are particularly complex and costly. Adsorption from the fermentation liquor is an alternative riboflavin separation technology during which a cost-efficient adsorbent is highly desired. In this study, a low-cost activated algal biomass-derived biochar (AABB) was applied as an adsorbent to efficiently adsorb riboflavin from an aqueous solution. The adsorption capacity of riboflavin on AABB increased with the increase in pyrolysis temperature and initial riboflavin concentration. The adsorption isotherms were well described by the Freundlich and Langmuir models. The AABB displayed excellent adsorption performance and its maximum adsorption capacity was 476.9 mg/g, which was 6.8, 6.8, and 5.2 times higher than that of laboratory-prepared activated rape straw biochar, activated broadbean shell biochar and commercial activated carbon, respectively, which was mainly ascribed to its larger specific surface area and abundant functional groups. The mass transfer model results showed that mass transfer resistance was dependent on both the film mass transfer and porous diffusion. Raman and Fourier transform-infrared spectra confirmed the presence of π-π interactions and hydrogen bonding between riboflavin and the AABB. The adsorption of riboflavin onto AABB was a spontaneous process, which was dominated by van der Waals forces. These results will be beneficial for developing effective riboflavin recovery technologies and simultaneously utilizing waste algal blooms.

Modification of regenerated cellulose ultrafiltration membranes with multi-walled carbon nanotubes for enhanced antifouling ability: Field test and mechanism study.

Although ultrafiltration (UF) has been extensively employed for drinking water purification, it is crucial to further develop novel membrane materials to improve the antifouling capacity and satisfy the practical usage. Multi-walled carbon nanotubes (MWCNTs) have characteristics that could potentially improve the membrane antifouling performance. Therefore, in this study, modified cellulose UF membranes were prepared using MWCNTs of various outer diameters ranging from 10 to 20 nm to 40-60 nm. The antifouling properties of the modified membrane and natural organic matter (NOM) removal mechanism were investigated while treating water from a local drinking water source river. Overall, the antifouling ability increased by more than one-fold when the nascent cellulose membrane was coated with MWCNTs (outer diameter of 40-60 nm) at a loading of 17.4 g/m2. The molecular weight distribution profiles of the NOM in the raw water and permeates suggest the superior performance of the modified membranes in removing two major NOM fractions with molecular weights ranging from approximately 5 k-30 k and 500 k-1000 k. Based on its hydrophobicity, the NOM of the raw water was fractionated into the strong hydrophobic (SHPO), the weak hydrophobic, the strong hydrophilic and the moderately hydrophilic (MHPI) fractions. The WHPO fraction caused the highest fouling compared with the other fractions under consistent experimental conditions. Meanwhile, the modified membranes showed a preference for removing the MHPI and SHPO fractions. These results imply that MWCNTs can be employed to improve the antifouling property of cellulose UF membranes and have the potential to selectively remove moderately hydrophilic contaminants from water.

Three Silver(I) Coordination Polymers Based on Pyridyl Ligands and Auxiliary Carboxylic Ligands: Luminescence and Efficient Sensing Properties.

Easily producible sensors for harmful industrial waste compounds are of significant interest for both human health and the environment. Three novel coordination polymers, [Ag(µ-aca)(µ4-bztpy)1/2] (1), [Ag(µ-bza)(µ-bpa)] (2), and [Ag2(µ-aca)2(µ-bpa)2]·EtOH·2H2O (3), were assembled in this study by reactions using Ag+ as a node with the pyridyl ligand 1,2,4,5-tetrakis(4-pyridyl)benzene (bztpy) or 9,10-bis(4-pyridyl)anthracene (bpa) and an auxiliary chelating carboxylic ligand. Single-crystal X-ray structural analyses revealed that compound 1 has a 3D framework consisting of 1D [Ag(aca)]∞ chains and bztpy linkers, while 2 and 3 have 2D layered structures consisting of binuclear Ag-carboxylate units and bpa linkers, respectively. Topological studies revealed that 1 has a bbf topology, while 2 and 3 are 2D [4,4] rhombic grids. The compounds were further characterized by powder X-ray diffraction, IR, elemental analysis, thermogravimetric analysis, and a luminescence study. The solids of 1-3 exhibited intense photoluminescent emission with λemmax at ca. 493, 472, and 500 nm, respectively. Remarkably, due to their excellent framework stability, 1 and 2 can act as multiresponsive luminescent sensors for nitrobenzene, Fe3+, and Cr2O72- with a high selectivity and sensitivity ascribed to their quenching effect.

A spin-crossover phenomenon in a 2D heterometallic coordination polymer with [Pd(SCN)4]2- building blocks.

Two new two-dimensional (2D) coordination polymers, [FeII(L)2{PdII(SCN)4}] (L1 = 3-(9-anthracenyl)-pyridine (1) and L2 = 4-(9-anthracenyl)-pyridine (2)), were constructed by employing square-planar [Pd(SCN)4]2- building blocks. Compound 1 exhibits a complete spin-crossover (SCO) behaviour under normal atmospheric pressure, and represents the first SCO example in a 2D system containing [Pd(SCN)4]2- units. In contrast, compound 2 only shows paramagnetic behaviour at measured temperatures. It is clear that the fine-tuning of the monodentate ligand can modulate the ligand field and packing fashions, which sheds light on developing new SCO materials.

Mild hypothermic circulatory arrest with selective cerebral perfusion in open arch surgery.

BACKGROUND: This study aimed to evaluate whether the use of mild hypothermic circulatory arrest (HCA) with selective cerebral perfusion (SCP) in open arch procedure provides comparable perioperative results to moderate HCA for patients with dissected or degenerative arch pathologies. METHODS: Between January 2017 and September 2020, a total of 88 consecutive patients (mean age 47±11 years, 71 males) underwent open arch repair under a single surgeon at our institution with mild or moderate systemic hypothermia assisted by unilateral or bilateral SCP. Patients were divided into groups according to the nasopharyngeal temperature at the beginning of HCA: a moderate HCA group (n=47, 53.4%) and a mild HCA group (n=41, 46.6%). The postoperative mortality, morbidity, and visceral organ functions between these groups were analyzed retrospectively. RESULTS: Compared to the moderate HCA group, the mild HCA group had a significantly higher core temperature (nasopharynx: 24.4±0.8 vs. 28.5±2, P<0.001; bladder 25.9±0.9 vs. 30±1.2, P<0.001), and the incidence of major adverse events (MAE) in this group was markedly lower (21.3% vs. 4.9%, P=0.031). No differences were identified between the two groups refer to in-hospital mortality, permanent neurological deficit (PND), temporary neurological deficit (TND), and paraplegia (8.5% vs. 2.4%, P=0.366; 8.5% vs. 0, P=0.120; 6.4% vs. 7.3%, P=1.0; 4.3% vs. 2.4%, P=1.0, respectively). In the moderate HCA group, 6 patients (12.8%) developed acute renal failure needing replacement therapy, which did not occur in the mild HCA group (P=0.028). The duration of ventilator support and intensive care unit stay was shorter in the mild HCA group, as well as a decreased volume of drainage during the first 24 h and reduced platelet transfusion. CONCLUSIONS: The preliminary results of the mild HCA group with SCP applied in open arch repair, mainly in total arch replacement (TAR) and stented elephant trunk (SET) implantation for aortic dissection, were satisfactory. Furthermore, comparable inferior outcomes were obtained with mild HCA compared with that of the conventional moderate HCA strategy. These encouraging surgical and postoperative results favor this more aggressive hypothermia strategy in open arch repair.

[Occurrence of Antibiotics and Antibiotic Resistance Genes in Representative Drinking Water Resources in Jiangsu Province].

Emerging contaminants including antibiotics and antibiotic resistance genes (ARGs) have been frequently detected in drinking water resources. In this study, the occurrence of antibiotics and ARGs in various environmental matrices in representative drinking water sources in Jiangsu Province and their influencing factors were explored. Five representative drinking water sources in northern, central, and southern Jiangsu were selected. Water, surface sediment, and epilithic biofilm samples were harvested near the water intakes of each water resource in December 2018 and June 2019. The concentrations and abundances of ten antibiotics, one integrase gene intl1, and seven common ARGs were measured. The results suggest that the concentrations of the target antibiotics and ARGs are relatively low compared to previously reported data in China and elsewhere in the world. The target antibiotics were detected in all of the water sources. The concentrations of sulfonamides in the water, surface sediment, and epilithic biofilm ranged from not found (NF) to 37.4 ng·L-1, NF to 47.3 ng·g-1, and NF to 3759.1 ng·g-1, respectively; the concentrations of quinolones in three matrices were NF-5.3 ng·L-1, 0.4-32.5 ng·g-1, and NF-4220.9 ng·g-1, respectively. The detection rates of the ARGs including sul 1, sul2, tetW, and tetQ were 100%, among which the sulfonamides sul1 and sul2 showed the highest abundance. The absolute abundances of sul1 in the three matrices were 2.48×106 copies·L-1, 3.54×107 copies·g-1, and 1.44×109 copies·g-1, respectively. The abundances of ARGs in the sediments and epilithic biofilms were comparable, and were much higher than in the water body. The phyla Bacteroidetes, Proteobacteris, Firmicutes, Verrucobacteria, and Actinomycetes have proven potential hosts for ARGs and might play an important role in the transmission and diffusion of resistance genes. This study offers baseline information on the presence of antibiotics and ARGs in the drinking water sources of Jiangsu Province, providing a significant theoretical basis for ARGs pollution control and safety guidelines for drinking water resources.

Association between uveitis and psoriatic disease: a systematic review and Meta-analysis based on the evidence from cohort studies.

AIM: To conduct a systematic review and Meta-analysis to examine the association between uveitis and psoriatic disease, and to evaluate whether one condition predisposes individuals to the other. METHODS: We performed a comprehensive search of PubMed and EMBASE to identify cohort studies examining the association between uveitis and psoriatic disease [psoriasis and/or psoriatic arthritis (PsA)]. We used a random-effects model to calculate the pooled relative risks (RRs) adjusted for confounders, along with the 95% confidence intervals (CIs). RESULTS: This Meta-analysis included a total of 6 studies and a maximum of 80 178 648 participants. Compared with non-psoriatic controls, uveitis risk was significantly elevated in patients with psoriasis (RR=1.49; 95%CI: 1.08-2.07), and PsA (RR=3.16; 95%CI: 2.16-4.63). Furthermore, pre-existing uveitis was associated with a significantly increased risk of psoriasis (RR=1.62; 95%CI: 1.44-1.83), and PsA (RR=4.44; 95%CI: 3.52-5.60). CONCLUSION: The results of this systematic review and Meta-analysis suggest an overall positive bidirectional association between uveitis and psoriatic disease (psoriasis and PsA), warranting increased awareness among clinicians involved in the management of these two conditions. Therefore, there remains a need for more detailed studies of the possible common pathogenesis of psoriatic disease and uveitis.