Concentrations and influencing factors of 17 elements in placenta, cord blood, and maternal blood of women from an e-waste recycling area.

BACKGROUND: The effects of prenatal element exposure on mothers and fetuses have generated concern. Profiles of trace and toxic elements in biological material are urgently desired, especially for women who reside near e-waste recycling facilities. The aim of this study was to investigate elements concentrations in placenta, cord blood, and maternal blood of women and to evaluate the influencing factors. METHODS: A group of 48 women from an e-waste recycling site and a group of 31 women from a non-e-waste recycling site were recruited. Basic characteristics were collected by questionnaire and the concentrations of 17 elements in placenta, cord blood, and maternal blood samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Finally, the generalized linear model regression analysis (GLM) was used to test the association between element concentrations and possible factors. RESULTS: Compared to the control group, the exposed group had significantly elevated cadmium (Cd), zinc (Zn), nickel (Ni), and antimony (Sb) in placenta, and higher lead (Pb) in maternal blood and cord blood (P<0.05). Sb concentration in maternal blood was significantly lower than in the control group (P<0.05). GLM analysis showed that element concentrations were mainly associated with maternal age [chromium (Cr), iron (Fe), selenium (Se), cobalt (Co), mercury (Hg) in placenta, copper (Cu) in maternal blood], education (Se, Sb in placenta), family income (Cu in maternal blood and Ni in placenta), passive smoking [Cu and Zn in placenta, Pb in maternal blood], and e-waste contact history (Hg in cord blood, Cu, Zn, and Cd in maternal blood). CONCLUSIONS: Women in the e-waste recycling area had higher toxic element levels in the placenta and blood samples. More preventive measures were needed to reduce the risk of element exposure for mothers and fetuses in these areas.

Increased adipose tissue is associated with improved overall survival, independent of skeletal muscle mass in non-small cell lung cancer.

BACKGROUND: The prognostic significance of non-cancer-related prognostic factors, such as body composition, has gained extensive attention in oncological research. Compared with sarcopenia, the prognostic significance of adipose tissue for overall survival in non-small cell lung cancer remains unclear. We investigated the prognostic value of skeletal muscle and adipose tissue in patients with non-small cell lung cancer. METHODS: This retrospective study included 4434 patients diagnosed with non-small cell lung cancer between January 2014 and December 2016. Cross-sectional areas of skeletal muscle and subcutaneous fat were measured, and the pericardial fat volume was automatically calculated. The skeletal muscle index and subcutaneous fat index were calculated as skeletal muscle area and subcutaneous fat area divided by height squared, respectively, and the pericardial fat index was calculated as pericardial fat volume divided by body surface area. The association between body composition and outcomes was evaluated using Cox proportional hazards model. RESULTS: A total of 750 patients (501 males [66.8%] and 249 females [33.2%]; mean age, 60.9 ± 9.8 years) were included. Sarcopenia (60.8% vs. 52.7%; P < 0.001), decreased subcutaneous fat index (51.4% vs. 25.2%; P < 0.001) and decreased pericardial fat index (55.4% vs. 16.5%; P < 0.001) were more commonly found in the deceased group than survived group. In multivariable Cox regression analysis, after adjusting for clinical variables, increased subcutaneous fat index (hazard ratio [HR] = 0.56, 95% confidence interval [CI]: 0.47-0.66, P < 0.001) and increased pericardial fat index (HR = 0.47, 95% CI: 0.40-0.56, P < 0.001) were associated with longer overall survival. For stage I-III patients, increased subcutaneous fat index (HR = 0.62, 95% CI: 0.48-0.76, P < 0.001) and increased pericardial fat index (HR = 0.43, 95% CI: 0.34-0.54, P < 0.001) were associated with better 5-year overall survival rate. Similar results were recorded in stage IV patients. For patients with surgery, the prognostic value of increased subcutaneous fat index (HR = 0.60, 95% CI: 0.44-0.80, P = 0.001) and increased pericardial fat index (HR = 0.51, 95% CI: 0.38-0.68, P < 0.001) remained and predicted favourable overall survival. Non-surgical patients showed similar results as surgical patients. No association was noted between sarcopenia and overall survival (P > 0.05). CONCLUSIONS: Increased subcutaneous fat index and pericardial fat index were associated with a higher 5-year overall survival rate, independent of sarcopenia, in non-small cell lung cancer and may indicate a reduced risk of non-cancer-related death.

Clinical safety and possible efficacy of tirofiban in combination with intravenous thrombolysis by recombinant tissue plasminogen activator for early treatment of capsular warning syndrome (CWS).

The purpose of this study was to assess the efficacy and safety of the combination of tirofiban with intravenous thrombolysis (IVT) in treating patients with capsular warning syndrome (CWS) who failed to respond to the treatment of intravenous thrombolysis alone. Tirofiban was approved for the treatment of CWS patients with fluctuating symptoms or no substantial improvement after intravenous thrombolysis within 24 h in our hospital from October 2019 to June 2021. Patients were evaluated with the National Institutes of Health Stroke Scale (NIHSS) at admission, at 72 h post-thrombolysis, at 1-week, and at 3-months with the modified Rankin Scales (MRS) score. A total of 12 patients received tirofiban and eight patients received control treatment with a history of CWS in our cohort. Among the patients, 13 patients smoked more than one pack of cigarettes a day, 17 had hypertension, 17 had hypercholesterolemia, 7 had diabetes, 1 had the history of cerebral infarction, 2 had atrial fibrillation, 7 had mild big vascular stenosis, 13 had lesions of the perforating branch by imaging, and 19 had acute capsular infarction. In both the tirofiban and control groups, NIHSS scores were significantly reduced after intravenous thrombolysis or 1-week after onset compared with before intravenous thrombolysis (P < 0.001). Before and after intravenous thrombolysis, there were no differences between the tirofiban group and control group (P = 0.970, P = 0.384, respectively). The tirofiban group, however, showed remarkably lower scores in both 1-week NIHSS and 3-month MRS than the control (P = 0.012, P = 0.003, respectively). Our study revealed that tirofiban did not increase the risk of hemorrhage and had favorable clinical efficacy as a remedial treatment for CWS patients with poor prognosis for intravenous thrombolysis, therefore indicating great potential for broader use.

Clinical Characteristics of 254 COVID-19 Inpatients in Yichang, Hubei, China, and Efficacy of Integrated Chinese and Western Medicine Treatment.

Introduction: There is no effective treatment plan for coronavirus disease 2019 (COVID-19). We employed a combination of Chinese and Western medicine treatment for some COVID-19 inpatients. Methods: This study was a prospective cohort study that observed non-critical COVID-19 inpatients. The differences will be observed in the time from admission to two consecutive 2019-nCoV nucleic acid test negatives and the Visual Analog Scale (VAS) score between the two groups. Results: A total of 254 confirmed COVID-19 patients were included in this study. The median time from the admission to two consecutive negative nucleic acid tests was 14 days for the integrated Chinese and Western Medicine (ICWM) group, while the Western Medicine (WM) group was 16 days. Besides, the median VAS score of the ICWM group was 0, which was an average decrease of 2 points compared to the time of admission. Conclusion: For non-critical COVID-19 patients, it was safe and have more benefits to add traditional Chinese medicine decoction based on WM treatment.

Five-Year Outcomes After Endovascular Treatment for Large Vessel Occlusion Stroke.

Background: The long-term outcomes of acute large vessel occlusion (LVO) in anterior circulation treated by endovascular treatment (EVT) remains to be determined. The aim of this study was to assess the 5-year outcomes of patients with LVO who underwent EVT. Methods: This study was an observational, nationwide registry of consecutive patients with acute LVO who received EVT in 28 comprehensive stroke centers in China. The primary outcome was the proportion of favorable outcome [modified Rankin Scale score (mRS) 0-2] at 5 years. Secondary outcomes included proportions of patients with excellent outcome (mRS 0-1), all-cause mortality and risk of stroke recurrence at 5 years. Results: A total of 807 patients were included into the study and had 90-day follow-up data, 657 patients had 5-year follow-up data. At 90 days, 218 patients (27.0%) had an excellent outcome, 349 patients (43.2%) had a favorable functional outcome. 199 patients (24.7%) died. At 5 years, 190 patients (28.9%) had an excellent outcome, 261 patients (39.7%) had a favorable functional outcome, 317 patients (48.2%) died and 129 (28.2%) had stroke recurrence. Because of missing 5-year follow-up data, among available 269 patients who achieved functional independence at 90 days, 208 (77.3%) maintained favorable outcome, 19 (7.1%) had disability (mRS 3-5) and 42 (15.6%) died at 5 years. Furthermore, among available 189 patients with mRS 3-5 at 90 days, 53 (28.0%) patients achieved favorable functional outcome, 60 (31.7%) patients maintained unfavorable functional outcome and 76 (40.2%) patients died within 5 years. Multivariate analyses identified that younger age [odds ratio (OR): 0.96; 95% CI, 0.93-0.99; P = 0.009], lower mRS at 90 days (OR: 0.15; 95% CI, 0.10-0.23; P < 0.001) and absence of stroke recurrence (OR: 0.001; 95% CI, 0.000-0.006; P < 0.001) were significantly associated with favorable outcome at 5 years. Advanced age (OR: 1.06, 95% CI, 1.04-1.08; P < 0.001), higher mRS at 90 days (OR: 0.84; 95% CI, 0.73-0.98; P = 0.021) and atrial fibrillation (OR: 1.63; 95% CI, 1.02-2.60; P = 0.04) were independent factors for stroke recurrence. Conclusion: Our results indicated that the beneficial effect of EVT in patients with acute LVO can be sustained during the course of at least 5 years. Reducing the risk of stroke recurrence by anticoagulation for atrial fibrillation may be a crucial strategy to improve long-term outcome.

3D convolutional neural network model from contrast-enhanced CT to predict spread through air spaces in non-small cell lung cancer.

PURPOSE: The purpose of this study was to compare the efficacy of five non-invasive models, including three-dimensional (3D) convolutional neural network (CNN) model, to predict the spread through air spaces (STAS) status of non-small cell lung cancer (NSCLC), and to obtain the best prediction model to provide a basis for clinical surgery planning. MATERIALS AND METHODS: A total of 203 patients (112 men, 91 women; mean age, 60 years; age range 22-80 years) with NSCLC were retrospectively included. Of these, 153 were used for training cohort and 50 for validation cohort. According to the image biomarker standardization initiative reference manual, the image processing and feature extraction were standardized using PyRadiomics. The logistic regression classifier was used to build the model. Five models (clinicopathological/CT model, conventional radiomics model, computer vision (CV) model, 3D CNN model and combined model) were constructed to predict STAS by NSCLC. Area under the receiver operating characteristic curves (AUC) were used to validate the capability of the five models to predict STAS. RESULTS: For predicting STAS, the 3D CNN model was superior to the clinicopathological/CT model, conventional radiomics model, CV model and combined model and achieved satisfactory discrimination performance, with an AUC of 0.93 (95% CI: 0.70-0.82) in the training cohort and 0.80 (95% CI: 0.65-0.86) in the validation cohort. Decision curve analysis indicated that, when the probability of the threshold was over 10%, the 3D CNN model was beneficial for predicting STAS status compared to either treating all or treating none of the patients within certain ranges of risk threshold CONCLUSION: The 3D CNN model can be used for the preoperative prediction of STAS in patients with NSCLC, and was superior to the other four models in predicting patients' risk of developing STAS.

Development and Validation of a CT-Based Signature for the Prediction of Distant Metastasis Before Treatment of Non-Small Cell Lung Cancer.

RATIONALE AND OBJECTIVES: To develop and validate a radiomics model, a clinical-semantic model and a combined model by using standard methods for the pretreatment prediction of distant metastasis (DM) in patients with non-small-cell lung cancer (NSCLC) and to explore whether the combined model provides added value compared to the individual models. MATERIALS AND METHODS: This retrospective study involved 356 patients with NSCLC. According to the image biomarker standardization initiative reference manual, we standardized the image processing and feature extraction using in-house software. Finally, 6692 radiomics features were extracted from each lesion based on contrast-enhanced chest CT images. The least absolute shrinkage selection operator and the recursive feature elimination algorithm were used to select features. The logistic regression classifier was used to build the model. Three models (radiomics model, clinical-semantic model and combined model) were constructed to predict DM in NSCLC. Area under the receiver operating characteristic curves were used to validate the ability of the three models to predict DM. A visual nomogram based on the combined model was developed for DM risk assessment in each patient. RESULTS: The receiver operating characteristic curve showed predictive performance for DM of the radiomics model (area under the curve [AUC] values for training and validation were 0.76 [95% CI, 0.704 - 0.820] and 0.76 [95% CI, 0.653 - 0.858], respectively). The combined model had AUCs of 0.78 (95% CI, 0.723 - 0.835) and 0.77 (95% CI, 0.673 - 0.870) in the training and validation cohorts, respectively. Both the radiomics model and combined model performed better than the clinical-semantic model (0.70 [95% CI, 0.634 - 0.760] and 0.67 [95% CI, 0.554 - 0.787] in the training and validation cohorts, respectively). CONCLUSION: The radiomics model and combined model may be useful for the prediction of DM in patients with NSCLC.

Feasibility of MRI-based radiomics features for predicting lymph node metastases and VEGF expression in cervical cancer.

PURPOSE: To investigate the predictive value of MRI-based radiomics features for lymph node metastasis (LNM) and vascular endothelial growth factor (VEGF) expression in patients with cervical cancer. METHOD: A total of 163 patients with cervical cancer were enrolled in this study. A total of 134 patients were included for LNM differentiation, and 118 were included for VEGF expression discrimination. The patients were randomly assigned to the training group or test group at a ratio of 2:1. Radiomics features were extracted from T1WI enhanced and T2WI MRI scans of each patient, and tumor stage was also documented according to the International Federation of Gynecology and Obstetrics (FIGO) guidelines. The least absolute shrinkage and selection operator algorithm was used for feature selection. The results of 5-fold cross validation were applied to select the best classification models. The performances of the constructed models were further evaluated with the test group. RESULTS: Sixteen radiomics features and the FIGO stage were selected to construct the LNM discrimination model. The LNM prediction model achieved the best diagnostic performance, with areas under the receiver operating curve (AUCs) of 0.95 and 0.88 in the training group and test group, respectively. Nine radiomics characteristics were screened to build the VEGF prediction model, with AUCs of 0.82 and 0.70 in the training group and test group, respectively. Decision curve analysis confirmed their clinical usefulness. CONCLUSIONS: The presented radiomics prediction models demonstrated potential to noninvasively differentiate LNM and VEGF expression in cervical cancer.

Application and mechanism of manganese-coated caramelization nanospheres for active targeting in hepatobiliary tumors.

Aim: To elucidate the MRI mechanisms of manganese oxide-coated carbohydration nanosphere (Mn@CNS) for active targeting in hepatobiliary tumors. Materials & methods: The cytotoxicity, internalization pathway, metabolism and excretion pathway of Mn@CNS were assessed by several cell types. The MRI of Mn@CNS was verified via rat models bearing hepatobiliary tumors. Results: Mn@CNS showed no obvious cytotoxicity. Mice macrophage and hepatocellular Mn content significantly differed between pre- and post-uptake levels (p < 0.01). The animal experiment revealed fine T1 imaging of hepatobiliary tumors with peak enhancement at 3 h. Mn@CNS was metabolized within the cells and excreted mainly via feces. Conclusion: Mn@CNS is safe, biodegradable, and may serve as a new strategy for active target imaging and treatment applications.

Structural and functional characterization of peptide YY on feeding in Schizothorax davidi.

Several studies have demonstrated that the neuropeptide peptide YY (PYY) plays an important role in feeding in mammals and fish. However, thus far, the feeding regulation function of PYY in Schizothorax davidi has not been well understood. Here, we identified the full-length cDNA sequence of PYY in S. davidi for the first time. S. davidi PYY contains 803 bp nucleotides including a 328 bp 3' untranslated region (UTR), a 181 bp 5' UTR, and a 294 bp open reading frame encoding a peptide of 97 amino acids. S. davidi PYY expression was observed in almost all tissues, with the highest expression detected in the hypothalamus. PYY mRNA expression in the hypothalamus was significantly elevated after a meal (P < 0.01), and significantly decreased after fasting (P < 0.01). PYY expression levels were increased sharply following refeeding after 9 days (P < 0.01), suggesting that it might function as a satiety factor in S. davidi.

Specific imaging characteristic of solitary necrotic nodule of the liver: Marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI.

OBJECTIVES: To obtain specific imaging findings of solitary necrotic nodule of the liver (SNNL) using longer delayed contrast-enhanced MRI and compare them with those of three mimic hepatic diseases. METHODS: Sixteen patients with SNNL underwent plain and contrast-enhanced triphasic CT and multiphasic MRI with delayed time prolonged to 2 h after contrast bolus injection. Twenty-three patients with mimic lesions including seven with eight HCCs, five with five iCCs and 11 with metastatic lesions served as the control group. Those patients also received plain and multiphasic contrast-enhanced MRI. Imaging features of lesions such as peripheral wash-out time were evaluated. RESULTS: Among the 16 SNNLs, with a prolonged delayed MRI time, the enhancement degree of tumour periphery increased gradually. When it was up to 1 h, all lesions represented moderate/marked peripheral enhancement with internal hypointensity. However, the peripheral wash-out in seven HCCs (87.5%) and all metastatic lesions except three appeared at 10 or 15 min, one iCC (20%) at 30 min and the other lesions at 1 h. CONCLUSIONS: Longer MRI with a delayed time of 1-2 h may be useful in diagnosis SNNL, revealing the specific imaging characteristic of SNNL as pronounced peripheral enhancement with internal hypointensity. KEY POINTS: • Longer delayed MRI plays an important role in the diagnosis of SNNL. • Characteristic imaging feature of SNNL is pronounced peripheral enhancement with internal hypointensity. • Periphery wash-out time can differentiate SNNL from mimic diseases. • Imaging findings of SNNL on routine CT and MRI are unspecific.

Angioplasty and stenting for patients with symptomatic intracranial atherosclerosis: study protocol of a randomised controlled trial.

INTRODUCTION: Whether adding percutaneous transluminal angioplasty and stenting (PTAS) to background medical treatment is effective for decreasing the incidence of stroke or death in patients with symptomatic intracranial atherosclerosis (ICAS) is still controversial. We perform a randomised controlled trial to examine the effectiveness and safety of an improved PTAS procedure for patients with ICAS. METHODS AND ANALYSIS: A randomised controlled trial will be conducted in three hospitals in China. Eligible patients with ICAS will be randomly assigned to receive medication treatment (MT) plus PTAS or MT alone. The MT will be initiated immediately after randomisation, while the PTAS will be performed when patients report relief of alarm symptoms defined as sudden weakness or numbness. All patients will be followed up at 30 days, 3 and 12 months after randomisation. The primary end point will be the incidence of stroke or death at 30 days after randomisation. Secondary outcomes will be the incidence of ischaemic stroke in the territory of stenosis arteries, the incidence of in-stent restenosis, the Chinese version of the modified Rankin Scale and the Chinese version of the Stroke-Specific Quality of Life (CSQoL). ETHICS AND DISSEMINATION: The study protocol is approved by institutional review boards in participating hospitals (reference number FZ20160003, 180PLA20160101 and 476PLA2016007). The results of this study will be disseminated to patients, physicians and policymakers through publication in a peer-reviewed journal or presentations in conferences. It is anticipated that the results of this study will improve the quality of the current PTAS procedure and guide clinical decision-making for patients with ICAS. TRIAL REGISTRATION NUMBER: NCT02689037.