Global burden of acute hepatitis E between 1990 and 2019 and projections until 2030.

BACKGROUND AND AIMS: Acute hepatitis E (AHE) is still a public health issue worldwide. Here, we report the global burden of AHE in 204 countries and territories from 1990 to 2019 by age, sex and socio-demographic index (SDI), and predict the future trends to 2030. METHODS: Data on AHE were collected from the Global Burden of Diseases, Injuries and Risk Factors Study 2019. The average annual percentage change (AAPC) and joinpoint analysis were used to determine the burden trend. RESULTS: In 2019, there were 19.47 million (95% UI, 16.04 to 23.37 million) incident cases of AHE globally, with a 19% increase since 1990. Age-standardized rate (ASR) of disability-adjusted life years (DALYs), prevalent and incident cases declined from 1990 to 2019. In 2019, the ASR of incidence, prevalence and DALYs due to HEV infection were highest in the same regions of South Asia for both sexes. Southern Sub-Saharan Africa presented the highest increases in the ASR for incidence of HEV infection in both males (AAPC = .25) and females (AAPC = .24) from 1990 to 2019. Incident cases are higher in males than females before 55-59 years old. The SDI values were negatively correlated with the age-standardized DALYs. Between 2019 and 2030, the ASR for incidence and prevalence of HEV for both sexes showed an increasing trend. CONCLUSIONS: Although the overall ASR of AHE decreased, the burden of AHE remains an underappreciated problem for society. The findings may provide useful information for policymakers to develop appropriate strategies aimed at reducing the burden of AHE.

Inhibitory effects of phthalate esters (PAEs) and phthalate monoesters towards human carboxylesterases (CESs).

Phthalate esters (PAEs), accompanied by phthalate monoesters as hydrolysis metabolites in humans, have been widely used as plasticizers and exhibited disruptive effects on the endocrine and metabolic systems. The present study aims to investigate the inhibition behavior of PAEs and phthalate monoesters on the activity of the important hydrolytic enzymes, carboxylesterases (CESs), to elucidate the toxicity mechanism from a new perspective. The results showed significant inhibition on CES1 and CES2 by most PAEs, but not by phthalate monoesters, above which the activity of CES1 was strongly inhibited by DCHP, DEHP, DiOP, DiPP, DNP, DPP and BBZP, with inhibition ratios exceeding 80%. Kinetic analyses and in vitro-in vivo extrapolation were conducted, revealing that PAEs have the potential to disrupt the metabolism of endogenous substances catalyzed by CES1 in vivo. Molecular docking results revealed that hydrogen bonds and hydrophobic contacts formed by ester bonds contributed to the interaction of PAEs towards CES1. These findings will be beneficial for understanding the adverse effect of PAEs and phthalate monoesters.

Superconductivity Induced by Lifshitz Transition in Pristine SnS2 under High Pressure.

The importance of electronic structure evolutions and reconstitutions is widely acknowledged for strongly correlated systems. The precise effect of pressurized Fermi surface topology on metallization and superconductivity is a much-debated topic. In this work, an evolution from insulating to metallic behavior, followed by a superconducting transition, is systematically investigated in SnS2 under high pressure. In-situ X-ray diffraction measurements show the stability of the trigonal structure under compression. Interestingly, a Lifshitz transition, which has an important bearing on the metallization and superconductivity, is identified by the first-principles calculations between 35 and 40 GPa. Our findings provide a unique playground for exploring the relationship of electronic structure, metallization, and superconductivity under high pressure without crystal structural collapse.

The value of conventional sonography and ultrasound elastography in decision-making for thyroid nodules in different categories of the Bethesda system for reporting thyroid cytopathology.

PURPOSE: The aim of this study was to evaluate the diagnostic value of conventional sonography and ultrasound elastography for thyroid nodules of each Bethesda category and to analyze their potential role in the corresponding management decision. METHODS: This retrospective study included 557 thyroid nodules diagnosed by conventional ultrasound (US) and real-time ultrasound elastography (RTE) before fine-needle aspiration (FNA) from 458 patients. The US, RTE, and cytological results were collected and analyzed according to different Bethesda categories. Differences in the distribution of sonographic features between groups were evaluated by the Chi-square test or Fisher exact test. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional US and RTE for the diagnosis of malignant nodules in each category were then calculated and analyzed. RESULTS: The diagnostic accuracy of the comprehensive US diagnosis in all categories stayed at a relatively high level from 78.4% to 88.6%, and good specificities ranging from 77.3% to 100% were revealed in all Bethesda categories. As to RTE, the diagnostic accuracies in categories I-IV stayed at a relatively low level ranging from 44.6% to 65.6% except for better performance in categories V and VI (85.2%, 89.1%). Besides, the accuracies of comprehensive US (85.2%, 88.6%) and RTE (85.2%, 89.1%) is relatively low compared to the corresponding cytological diagnoses in categories V and VI. CONCLUSIONS: Conventional US is complementary to FNA for providing additional hints especially in categories I-IV for further clinical managements, while RTE failed to provide useful diagnostic information in general.

Vibration Analysis of Fluid Conveying Carbon Nanotubes Based on Nonlocal Timoshenko Beam Theory by Spectral Element Method.

In this work, we applied the spectral element method (SEM) to analyze the dynamic characteristics of fluid conveying single-walled carbon nanotubes (SWCNTs). First, the dynamic equations for fluid conveying SWCNTs were deduced based on the nonlocal Timoshenko beam theory. Then, the spectral element formulation was established for a free/forced vibration analysis of fluid conveying SWCNTs by introducing discrete Fourier transform. Furthermore, the proposed method was validated using several comparison examples. Finally, the natural frequencies and dynamic responses of a simply-supported fluid conveying SWCNTs were calculated by the SEM, considering different internal fluid velocities and small-scale parameters (SSPs). The effects of fluid velocity and SSPs on the dynamic characteristics of SWCNTs conveying fluid were revealed by the numerical results. Compared with other methods, the SEM shows high accuracy and efficiency.

Preliminary study of confounding factors of elastography and the application of fine-needle aspiration in thyroid nodules with indeterminate elastography.

To investigate confounding factors of real-time ultrasound elastography (RTE) and to evaluate the diagnostic performance of ultrasound (US)-guided FNA for thyroid nodules with indeterminate elastography compared with conventional US. This study included 244 nodules with indeterminate elastography caused by several confounding factors (large or small size, deep location, isthmic or paratracheal location, calcification, thyroiditis, conflicting results between conventional US and RTE), and corresponding prevalences of malignancy were calculated. Additionally, conventional US and US-FNA data were collected and compared. The prevalences of malignancy of confounding factors were 74.1%, 75.0%, 73.3%, 46.2%, 27.3%, and 53.2%, respectively. Sonographic features (border, margin, echogenicity, echohomogeneity, and microcalcification) were significantly different between benign and malignant thyroid nodules (p < 0.05), and most of them exhibited good sensitivity but unsatisfactory specificity and accuracy. While US-FNA exhibited better performance with a sensitivity of 96.9%, a specificity of 99.1% and an accuracy of 98.0% in the diagnosis of malignancy. Given that indeterminate RTE is inevitable with a rather high malignant risk due to several confounding factors, our study revealed that US-FNA was a valuable tool in nodules with indeterminate elastography by increasing the detection rate of thyroid malignancy.

Efficacy of ezetimibe combined with atorvastatin in the treatment of carotid artery plaque in patients with type 2 diabetes mellitus complicated with coronary heart disease.

BACKGROUND: The aim of this study was to evaluate the efficacy of ezetimibe combined with atorvastatin in treatment of carotid artery plaque in patients with type 2 diabetes mellitus complicated with coronary heart disease (CHD). METHODS: A total of 100 patients with carotid atherosclerosis (CAS) confirmed by ultrasound and diagnosed with type 2 diabetes mellitus and CHD were randomly assigned to atorvastatin group (atorvastatin 20 mg/day) or combined treatment group (ezetimibe 10 mg/day and atorvastatin 20 mg/day). All those patients were followed for 12 months. Serum lipid, ALT, AST, and CK were measured before and after treatment. Ultrasonography was used to evaluate the stability of carotid artery plaques. RESULTS: After 12 months of treatment, the level of TC, TG, LDL-C, hs-CRP, FPG and HbA1c decreased in both groups compared with before treatment. TC, TG, LDL-C and hs-CRP in the combined treatment group were much lower than that in the atorvastatin group (P<0.05). The IMT and plaque area in the two groups were lower than that before the treatment (P<0.05). IMT and plaques area in the combined treatment group is much lower than that in the atorvastatin group after treatment. There was no significant difference in two groups on the level of ALT, AST, CK compared with baseline after treatment. CONCLUSIONS: The effect of combined use of atorvastatin and ezetimibe was better than atorvastatin alone, which can effectively reduce the blood lipid levels in diabetic patients with CHD and improve plaque stability. Both treatment regimens were safe and well tolerated.

Correlation between biological characteristics of thrombus and short-term efficiency of thrombolytic therapy by acoustic radiation force impulse imaging technique.

BACKGROUND: The aims of this paper were to evaluate the biological characteristics of lower extremity deep venous thrombosis (DVT) by applying acoustic radiation force impulse imaging technique (ARFI), explore the correlation between the value of shear wave speed (SWV) and short-term efficacy of thrombolytic therapy as well as analyze the application value of shear wave velocity in predicting the short-term efficacy of thrombolytic therapy. METHODS: ARFI for 120 patients with lower extremity DVT was examined and the shear wave velocity values were measured. The thrombus SWV value among the cured group, effective treatment group and ineffective group according to the different effect of thrombolytic therapy and were analyzed and then the cured and effective treatment group were classified into total effective group. The effectiveness and thrombus SWV were compared. The Receiver Operating Characteristic was constructed and the critical effective value of SWV thrombolysis were evaluated. RESULTS: The SWV value has a certain correlation with the effect of thrombolysis. The thrombus in cured group and effective treatment group were significantly less than the ineffective group. There was no significant thrombus hardness difference between cured group and effective group. SWV value can predict the effect of thrombolytic therapy. The critical value was 1.925, which was greater than that of the patients with a poor prognosis, with a sensitivity of 65.59% and a specificity of 88.89%. CONCLUSIONS: The SWV value has a certain correlation with the thrombolysis effect. The biological characteristics of lower extremity DVT can be evaluated by acoustic pulse radiation force imaging technology, which has high value for the clinical treatment plan and the prediction of thrombolysis effect.

Large-area, high-quality monolayer graphene from polystyrene at atmospheric pressure.

Graphene films have been attracting great interest owing to their unique physical properties. In this paper, we develop an efficient method to prepare large-area monolayer graphene (97.5% coverage) by atmospheric pressure chemical vapor deposition on Cu foils using polystyrene in a short time (3 min). Raman spectroscopy, transmission electron microscopy and scanning electron microscopy are employed to confirm the thickness and uniformity of the graphene films. Graphene films on glass substrates show high optical transmittance and electrical conductivity. Magnetic transport studies demonstrate that the as-grown monolayer graphene exhibits a high carrier mobility of 3395 cm2 V-1 s-1 at 25 K. On the basis of the analysis, it is concluded that our method is a simple, safe and versatile approach for the synthesis of monolayer graphene.

Role of real-time elastography in assessing the stage of thrombus.

BACKGROUND: Due to major complication that acute thrombosis can occur, we aim to observe the value of real-time tissue elastography (RTE) in assessing the stage of thrombi. METHODS: We prospectively analyzed 132 patients with deep venous thrombosis confirmed by clinical symptoms and conventional ultrasound examination. RTE imaging of thrombosis were estimated according Itoh's 5-point scale and we also calculated the strain ratio (reference/clot ratio). RESULTS: Differences in thrombus displacement have been presented as different color maps. In the group of acute thrombosis, 70.9% (39/55) showed red color. In the group of subacute thrombosis, 62.8% (27/43) showed green color. In the group of chronic thrombosis, 67.6% (23/34) showed blue color. The strain ratio of the chronic thrombosis group and the subacute thrombosis group were higher than that of the acute thrombosis group (P<0.001, P<0.05). The strain ratio of the chronic thrombosis group was higher than that of the acute and subacute thrombosis group (P<0.05). CONCLUSIONS: RTE has good diagnostic value for assessing the stage of thrombi.

3-Tesla magnetic resonance imaging improves the prostate cancer detection rate in transrectral ultrasound-guided biopsy.

The detection rate of prostate cancer (PCa) using traditional biopsy guided by transrectal ultrasound (TRUS) is not satisfactory. The aim of this study was to determine the utility of 3-Tesla (3-T) magnetic resonance imaging (MRI) prior to TRUS-guided prostate biopsy and to investigate which subgroup of patients had the most evident improvement in PCa detection rate. A total of 420 patients underwent 3-T MRI examination prior to the first prostate biopsy and the positions of suspicious areas were recorded respectively. TRUS-guided biopsy regimes included systematic 12-core biopsy and targeted biopsy identified by MRI. Patients were divided into subgroups according to their serum prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, TRUS findings and digital rectal examination (DRE) findings. The ability of MRI to improve the cancer detection rate was evaluated. The biopsy positive rate of PCa was 41.2% (173/420), and 41 of the 173 (23.7%) patients were detected only by targeted biopsy in the MRI-suspicious area. Compared with the systematic biopsy, the positive rate was significantly improved by the additional targeted biopsy (P=0.0033). The highest improvement of detection rate was observed in patients with a PSA level of 4-10 ng/ml, PSAD of 0.12-0.20 ng/ml2, prostate volume >50 ml, negative TRUS findings and negative DRE findings (P<0.05). Therefore, it is considered that 3-T MRI examination could improve the PCa detection rate on first biopsy, particularly in patients with a PSA level of 4-10 ng/ml, PSAD of 0.12-0.20 ng/ml2, prostate volume of >50 ml, negative TRUS findings and negative DRE findings.

Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients.

AIMS AND OBJECTIVES: To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer. BACKGROUND: With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. DESIGN AND METHODS: Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. RESULTS: A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12.45 ± 6.17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. CONCLUSIONS: Peripherally inserted central venous catheters-related upper extremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. RELEVANCE TO CLINICAL PRACTICE: Risk factors associated with peripherally inserted central venous catheters-related upper extremity venous thrombosis are of critical importance in improving the quality of patients' life. It is very important to grasp the indications to reduce the incidence rate of peripherally inserted central venous catheters-related upper extremity venous thrombosis.

Doppler myocardial performance index in assessment of ventricular function in children with single ventricles.

BACKGROUND: Quantitative assessment of ventricular function in children with single ventricles is both difficult and subjective because of asymmetric ventricular geometry. The Doppler myocardial performance index (MPI) allows the assessment regardless of ventricular shape. This study was designed to evaluate the feasibility of MPI in assessing ventricular function in children with single ventricles before and after total cavopulmonary connection (TCPC). METHODS: Subjects consisted of 161 pediatric patients with single ventricles and 80 normal children without heart disease. The maximum positive rate of ventricular pressure change (Max dp/dt) was obtained in 58 patients by cardiac catheterization. Sixty-eight children with single ventricles received TCPC. MPI was calculated from Doppler tracings of ventricular inflow and outflow, then MPI of single ventricles before and after surgery and normal heart were compared. RESULTS: Normal MPI value was 0.30+/-0.08 in the left ventricle and 0.26+/-0.08 in the right ventricle. Compared to normal children, MPI was significantly higher in 161 children with single ventricles (0.54+/-0.11, P<0.001). MPI correlated inversely with Max (dp/dt) (r=-0.77, P<0.01), and was positively related to age (r=0.54, P<0.01) in patients with single ventricles. MPI did not differ significantly before and after surgery in 68 patients with single ventricles (0.55+/-0.21 vs 0.51+/-0.20, P>0.05). However, MPI in 48 patients of <6 years old decreased significantly (0.55+/-0.21 vs 0.48+/-0.18, P<0.05), suggesting improved ventricular function. CONCLUSIONS: Compared to normal children, ventricular function is impaired in patients with single ventricles and may worsen with age. MPI provides an accurate method for assessing ventricular function in children with single ventricles before and after TCPC.