Water-Soluble Luminescent Polymers with Room-Temperature Phosphorescence Based on the α-Amino Acids.

Nonconventional luminophores have received increasing attention, owing to their fundamental importance, advantages in outstanding biocompatibility, easy preparation, environmental friendliness, and potential applications in sensing, imaging, and encryption. Purely organic molecules with outstanding fluorescence and room-temperature phosphorescence (RTP) have emerged as a new library of benign afterglow agents. However, the cost, toxicity, high reactivity, and poor stability of materials also limit their practical applications. Therefore, some natural products, synthetic compounds, and biomolecules have entered horizons of people. The as-designed exhibits sky blue and green fluorescence emission and green RTP emission (a lifetime of 343 ms and phosphorescence quantum of 15.3%) under air condition. This study presents an organic fluorescence for biological imaging and RTP for anti-counterfeiting and encryption based on amino acids, maleic anhydride and 4-vinylbenzenesulfonic acid sodium salt hydrate. This study provides a strategy for nonconventional luminophores in designing and synthesizing pure organic RTP materials.

Mechanisms of Action of Potentilla discolor Bunge in Type 2 Diabetes Mellitus Based on Network Pharmacology and Experimental Verification in Drosophila.

Purpose: Type 2 diabetes mellitus (T2DM) is associated with reduced insulin uptake and glucose metabolic capacity. Potentilla discolor Bunge (PDB) has been used to treat T2DM; however, the fundamental biological mechanisms remain unclear. This study aimed to understand the active ingredients, potential targets, and underlying mechanisms through which PDB treats T2DM. Methods: Components and action targets were predicted using network pharmacology and molecular docking analyses. PDB extracts were prepared and validated through pharmacological intervention in a Cg>InRK1409A diabetes Drosophila model. Network pharmacology and molecular docking analyses were used to identify the key components and core targets of PDB in the treatment of T2DM, which were subsequently verified in animal experiments. Results: Network pharmacology analysis revealed five effective compounds made up of 107 T2DM-related therapeutic targets and seven protein-protein interaction network core molecules. Molecular docking results showed that quercetin has a strong preference for interleukin-1 beta (IL1B), IL6, RAC-alpha serine/threonine-protein kinase 1 (AKT1), and cellular tumor antigen p53; kaempferol exhibited superior binding to tumor necrosis factor and AKT1; ß-sitosterol demonstrated pronounced binding to Caspase-3 (CASP3). High-performance liquid chromatography data quantified quercetin, kaempferol, and ß-sitosterol at proportions of 0.030%, 0.025%, and 0.076%, respectively. The animal experiments revealed that PDB had no effect on the development, viability, or fertility of Drosophila and it ameliorated glycolipid metabolism disorders in the diabetes Cg>InRK1409A fly. Furthermore, PDB improved the body size and weight of Drosophila, suggesting its potential to alleviate insulin resistance. Moreover, PDB improved Akt phosphorylation and suppressed CASP3 activity to improve insulin resistance in Drosophila with T2DM. Conclusion: Our findings suggest that PDB ameliorates diabetes metabolism disorders in the fly model by enhancing Akt activity and suppressing CASP3 expression. This will facilitate the development of key drug targets and a potential therapeutic strategy for the clinical treatment of T2DM and related metabolic diseases.

BINGO: a blind unmixing algorithm for ultra-multiplexing fluorescence images.

MOTIVATION: Spectral imaging is often used to observe different objects with multiple fluorescent labels to reveal the development of the biological event. As the number of observed objects increases, the spectral overlap between fluorophores becomes more serious, and obtaining a "pure" picture of each fluorophore becomes a major challenge. Here, we propose a blind spectral unmixing algorithm called BINGO (Blind unmixing via SVD-based Initialization Nmf with project Gradient descent and spare cOnstrain), which can extract all kinds of fluorophores more accurately from highly overlapping multichannel data, even if the spectra of the fluorophores are extremely similar or their fluorescence intensity varies greatly. RESULTS: BINGO can isolate up to 10 fluorophores from spectral imaging data for a single excitation. nine-color living HeLa cells were visualized distinctly with BINGO. It provides an important algorithmic tool for multiplex imaging studies, especially in intravital imaging. BINGO shows great potential in multicolor imaging for biomedical sciences. AVAILABILITY AND IMPLEMENTATION: The source code used for this paper is available with the test data at https://github.com/Xinyuan555/BINGO_unmixing.

Systematic Review and Meta-Analysis: Impact of Various Hemostasis Methods on Ovarian Reserve Function in Laparoscopic Cystectomy for Ovarian Endometriomas.

Background: Ovarian endometriomas, resulting from the invasion of endometriosis into ovarian tissue, can significantly affect ovarian reserve, potentially leading to infertility. When conservative treatments fail, it may further aggravate ovarian reserve decline by invading the ovarian cortex and, in severe cases, result in premature ovarian failure and infertility. Objective: This study aimed to investigate the impact of various hemostasis methods on ovarian reserve function in cases of laparoscopic cystectomy for ovarian endometriomas. Methods: We conducted a systematic review and meta-analysis to assess the effects of different hemostasis techniques used during laparoscopic cystectomy for ovarian endometriomas. A comprehensive analysis of relevant literature was performed, focusing on the impact of bipolar electrocoagulation, ultrasonic scalpel, and suture hemostasis on ovarian reserve function. The evaluation criteria included Anti-Müllerian hormone levels and antral follicle counts. Results: Our analysis revealed significant variations in the impact of hemostasis methods on ovarian reserve function. While all methods aimed to stop bleeding during surgery, the thermal damage to surrounding tissues differed. Bipolar electrocoagulation, ultrasonic scalpel, and suture hemostasis showed varying effects on ovarian reserve, with implications for post-operative fertility. Conclusions: The choice of the hemostasis method in laparoscopic cystectomy for ovarian endometriomas has a crucial influence on ovarian reserve function. Our findings emphasize the need to consider the potential consequences of thermal damage when selecting a hemostasis technique. Clinicians should weigh the benefits and risks of each method to protect ovarian reserve function effectively. This study offers valuable insights for guiding clinical practice, ensuring optimal outcomes for patients facing endometrioma-related fertility challenges.

Unsaturated Penta-Coordinated Mo5c5+ Sites Enabled Low-Temperature Oxidation of C-H Bonds in Ethers.

Selective oxidation of C-H bonds under mild conditions is one of the most important and challenging issues in utilization of energy-related molecules. Molybdenum oxide nanostructures containing Mo5+ species are effective for these reactions, but the accurate identification of the structure of active Mo5+ species and the catalytic mechanism remain unclear. Herein, unsaturated penta-coordinated Mo5c5+ with a high fraction in MoOx fabricated by the hydrothermal method were identified as the active sites for low-temperature oxidation of dimethyl ether (DME) by the deep correlation of characterizations, density functional theory calculations, and activity results, giving a methyl formate selectivity of 96.3% and DME conversion of 12.5% at unreported 110 °C. Low-temperature electron spin resonance (ESR) and quasi in situ X-ray photoelectron spectra (XPS) with the designed experiments confirm that the Mo5c5+ species can be formed in situ. Molybdenum located at the pentachronic site is preferable to significantly promote the oxidation of the C-H bond in CH3O* at lower temperatures.

Introduction of TiO2 enhancing the catalytic performance of Ti(SO4)2/SiO2 for dimethyl ether oxidation.

The introduction of a small amount of TiO2 changes the surface properties of the SiO2 material, which further significantly affects the dispersion state of Ti(SO4)2. The differences in acidity and redox caused by the distribution of Ti(SO4)2 are closely related to the catalyst performance for dimethyl ether (DME) oxidation. In particular, the calcination temperature could adjust the surface hydroxyl content of TiO2/SiO2, which determines the dispersion of Ti(SO4)2 components, resulting in distinct acid sites and Ti valence. The most number of weak acid sites and the highest proportion of Ti3+/Ti4+ in the Ti(SO4)2/TS-400 °C catalyst remarkably promote the formation of dimethoxymethane (DMM) from 14.4% to 82.6%, compared to the Ti(SO4)2/SiO2 catalyst.

Two-photon fluorescence imaging using a tunable spectral window based on fiber supercontinuum.

Two-photon excitation fluorescence (TPEF) microscopy has evolved into a versatile tool in biological research. However, the multiplexing capability of TPEF microscopy is limited by the narrow spectral bandwidth of the light source. In this study, we apply a photonic crystal fiber in TPEF microscopy to broaden the excitation source bandwidth. We tuned the spectral window using a spatial light modulator as a programmable diffraction grating that was placed behind a prism pair. In addition, we combined a grating pair to compensate for dispersion to improve the two-photon excitation efficiency. The combination of a broad spectrum and a programmable grating enabled fast spectral window tuning rate on a time scale of tens of milliseconds. We demonstrate the performance of our method by imaging live B16 cells labeled with four emission spectrum overlapped fluorescent proteins.

Sanghuang Tongxie Formula Ameliorates Insulin Resistance in Drosophila Through Regulating PI3K/Akt Signaling.

Insulin resistance (IR) is a pivotal pathological characteristic that affects the occurrence and development of type 2 diabetes mellitus (T2DM). Thus, the effective control of IR is of great significance for diabetes prevention and treatment. Traditional Chinese medicine (TCM) represents a valuable tool handed down to the world by the Chinese nation and has a long history of use for diabetes clinical therapy. In this study, we focused on a self-drafted TCM-patented formula, Sanghuang Tongxie Formula (SHTXF), which exhibits clinical efficacy in the treatment of diabetes. To explore the effect and molecular mechanism of SHTXF on IR in vivo, Drosophila melanogaster was used and a (Collagen) Cg > InRK1409A diabetic IR fly model was established. SHTXF water extract was found to contribute toward carbohydrate clearance from the circulating system by converting it into triglycerides (TAG), not glycogen, for nutrient storage. In addition, SHTXF activated phosphatidylinositol-3-kinase (PI3K) activity and improved protein kinase B (PKB, also termed Akt) phosphorylation. Finally, SHTXF promoted Drosophila Forkhead Box O (dFoxO) cytoplasmic localization and inhibited its transcriptional activity. Taken together, these findings not only highlight the positive role of SHTXF in ameliorating IR via the PI3K/Akt pathway but also provide potential drug targets and key insights for use in T2DM clinical treatment strategies.

Selective oxidation conversion of methanol/dimethyl ether.

As important platform compounds, methanol and dimethyl ether (DME) are vital bridges between the coal chemical, petrochemical and fine chemical industries. At present, the synthesis of methanol/DME has been industrialized, and the production capacity is much larger than the market demand. Therefore, the conversion of methanol/DME into more valuable chemicals is an important and significant topic. The synthesis of high value-added oxygenated chemicals and diesel oil additives from methanol/DME by an oxidation method has attracted substantial attention due to it being green and environmentally friendly and having good atom economy. In this feature article, we have summarized the recent advances in the synthesis of formaldehyde, methyl formate, dimethoxymethane, and polyoxymethylene dimethyl ethers, from the selective oxidation of methanol/DME, and further discussed the adsorption and activation of reactant molecules, selective cleavage of C-O, C-H or O-H bonds in methanol/DME molecules and the C-O chain growth in the target products. In the end, major challenges and future prospects are proposed from the viewpoint of catalyst design and application. It is expected that this feature article will provide theoretical guidance for the activation and cleavage of C-O, C-H, or O-H bonds in other small molecules of alcohol/ether as well as low-carbon alkanes, so as to synthesize high value-added chemicals.

The Efficacy and Safety of Ultrasound-Guided, Bi-Level, Erector Spinae Plane Block With Different Doses of Dexmedetomidine for Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial.

Background: The anesthetic characteristics of ultrasound-guided bi-level erector spinae plane block (ESPB) plus dexmedetomidine (Dex) remain unclear. We compared the efficacy and safety of ultrasound-guided bi-level ESPB plus different doses of Dex in patients undergoing video-assisted thoracic surgery (VATS). Methods: One-hundred eight patients undergoing VATS were randomized into three groups: R group (n = 38, 15 ml of 0.375% ropivacaine with 0.1 mg/kg dexamethasone), RD1 group (n = 38, 15 ml of 0.375% ropivacaine plus 0.5 µg/kg DEX with 0.1 mg/kg dexamethasone) and RD2 group (n = 38, 15 ml of 0.375% ropivacaine plus 1.0 µg/kg DEX with 0.1 mg/kg dexamethasone). The primary outcome was the pain 12 h after surgery. Secondary outcomes included the Prince Henry Hospital Pain Score; hemodynamics; consumption of sufentanil; anesthetized dermatomal distribution; recovery time; rescue analgesia; satisfaction scores of patients and surgeon; quick recovery index; adverse effects; the prevalence of chronic pain and quality of recovery. Results: The visual analog scale (VAS) and the Prince Henry pain score were significantly lower in both the RD1 and RD2 groups during the first 24 h after surgery (P < 0.05). Both VAS with coughing and the Prince Henry pain score were significantly lower in the RD2 group than in the RD1 group 8-24 h after surgery (P < 0.05). Both heart rate and mean arterial pressure were significantly different from T2 to T6 in the RD1 and RD2 groups (P < 0.05). The receipt of remifentanil, propofol, Dex, and recovery time was significantly reduced in the RD2 group (P < 0.05). The requirement for sufentanil during the 8-72 h after surgery, less rescue medication, and total press times were significantly lower in the RD2 group (P < 0.05). The time to the first dose of rescue ketorolac was significantly longer in the RD2 group (P < 0.05). Further, anal exhaust, removal of chest tubes, and ambulation were significantly shorter in the RD2 group (P < 0.05). The incidence of tachycardia, post-operative nausea and vomiting, and chronic pain was significantly reduced in the RD2 group, while the QoR-40 score was significantly higher in the RD2 group (P < 0.05). Conclusions: Pre-operative bi-level, single-injection ESPB plus 1 µg/kg DEX provided superior pain relief and long-term post-operative recovery for patients undergoing VATS. Clinical Trial Registration: http://www.chictr.org.cn/searchproj.aspx.

Biomass-Based Carbon-Supported Sulfate Catalyst for Efficient Synthesis of Dimethoxymethane from Direct Oxidation of Dimethyl Ether.

The synthesis of dimethoxymethane (DMM) from direct oxidation of dimethyl ether (DME) is a green and competitive route with good atomic economy and low carbon emission and is also an urgent need. In this work, biomass-based carbon-supported sulfate catalysts were designed and prepared for the efficient synthesis of DMM from DME oxidation. The prepared carbon support from cellulose displayed much larger specific surface area and a developed microporous structure, which effectively benefited a high dispersion of sulfate components, leading to mainly weak acid sites and more oxygen functional groups on the catalyst surface. The Ti(SO4)2/PC-H2SO4 catalyst exhibits excellent performance for DME oxidation with DMM1-2 selectivity up to 96.7%, and DMM selectivity reaches 89.1%, notably higher than that of previously reported results. The distinctive surface structure and chemical properties of the carbon support have important impacts on the dispersion state of sulfate species, affecting the acidic and redox properties of the catalysts.

Oxidative coupling of methane over Mo-Sn catalysts.

A novel Mo-Sn catalyst for the oxidative coupling of methane was designed using a hydrothermal method. At 650 °C, the conversion of methane was 8.6% and the selectivity of the C2 hydrocarbons reached as high as 98.1% over the Mo1Sn3 catalyst, with a CO2 selectivity of only 0.8%. We demonstrated that the deep oxidation of methane to CO2 was further inhibited due to the synergistic effects of moderately strong basic sites and reactive oxygen species on the catalyst surface.

Downregulation of HOXC6 by miR-27a ameliorates gefitinib resistance in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is a major type of lung cancer. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), represented by gefitinib (Gef), are targeted drugs used for the treatment of NSCLC. However, NSCLC patients often develop resistance to tyrosine kinase inhibitors, which limits their efficacy. Homeobox gene HOXC6 is dysregulated in many cancers and contributes to chemoresistance in cancer cells. However, the role and mechanism of HOXC6 in the development of Gef resistance in NSCLC remains unclear. In the present study, we found that HOXC6 was highly expressed in Gef-resistant NSCLC cells. Further experiments showed that silencing of HOXC6 ameliorated Gef resistance in PC9/G cells whereas overexpression of HOXC6 promoted Gef resistance in PC9 cells. HOXC6 influenced Gef sensitivity in NSCLC cells by regulating cell proliferation, colony formation, cell apoptosis, cell cycle, cell mobility and other related signaling molecules or pathways. HOXC6 was also found to be a direct target of miR-27a. As expected, overexpression of miR-27a ameliorated Gef resistance by inhibiting HOXC6 expression in vitro and in vivo. Clinical analysis revealed that high HOXC6 levels and low miR-27a levels were significantly correlated with more malignant clinical features and poorer survival of NSCLC patients. In summary, the present study demonstrates that HOXC6 may be a potential therapeutic target for overcoming Gef resistance in NSCLC patients. A combination of Gef and miR-27a agomirs may be an effective intervention for Gef-resistant NSCLC.

The assessment of the frequency and arrangement of the subsegmental branches of V3 using computed tomography angiography.

BACKGROUND: The frequency and arrangement of the subsegmental branches of the third portion of the vertebral artery (V3) have been assessed in small samples by autopsy, but they have not been assessed by computed tomography angiography (CTA). To determine the frequency and arrangement of subsegmental branches of V3 by CTA and to analyze the interrelationships among frequency, arrangement, sex, and side-to-side. METHODS: First, the radiology records of 668 consecutive patients who underwent cervical or craniocervical CTA scans from October 1, 2017 to October 31, 2019 were retrospectively retrieved. Second, the four demarcation points were ascertained to define the three subsegments by reviewing the resource images, namely, the vertical portion of V3(V3v), horizontal portion of V3(V3h), and extradural portion of V3(V3e). Then, the numerical value and the location of the bifurcating branch in each subsegment of V3 were recorded. Third, the frequency and arrangement of the branches was assessed, and the relationships between sex, laterality and frequency and arrangement were analyzed as well as the interobserver performance. RESULTS: On the left, 25%, 20.21%, and 6.59% were the frequencies of one branch in the V3v, V3h, and V3e, and 1.05%, 0.00%, and 0.45% were the frequencies of two branches, respectively. On the right, 25.04%, 17.07%, and 6.44% were the frequencies of one branch in the V3v, V3h, and V3e, and 1.04%, 0.3%, and 0.15% were the frequencies of two branches, respectively. There were no differences between the side-to-side and numerical values of the branches according to the t-test (P=0.4341, P=0.7968), and there were no differences between the side-to-side variable, sex variable and number of branches according to the t-test (P=0.4474, P=0.3593). There were no differences between the side-to-side and eight arrangements (permutation of 000; 100; 110; 111; 010; 011; 001; 101) by using the two-sample KS test (P=0.942), and there were no differences between sex and the eight arrangements according to the two-sample KS test (P=0.9973, P=0.8519). The interobserver reliability was excellent (Spearman's ranked correlation: 0.9927). CONCLUSIONS: The frequency and arrangement of V3 subsegmental branches could be displayed by source imaging with CTA, and there were no significant differences according to the sex or side of the individual. It was imperative to acquaint the subsegmental branches before the operation involving V3 in the craniocervical junction to determine the surgical approach and reduce bleeding during the surgical procedures.

Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Many patients complain of pain following laparoscopic surgery. Clinicians have used ultrasound-guided posterior transversus abdominis plane block (TAPB) and rectus sheath block (RSB) for multimodal analgesia after surgery. We investigated the analgesic effects of US-guided posterior TAPB with RSB on postoperative pain following laparoscopy-assisted radical resection of early-stage rectal cancer. METHODS: Seventy-eight adults scheduled for laparoscopy-assisted radical resection of rectal cancer were enrolled in this double-blind placebo-controlled trial. Patients were randomized into 3 groups: the TR Group underwent US-guided bilateral posterior TAPB (40 mL 0.33% ropivacaine) with RSB (20 mL 0.33% ropivacaine); the T Group underwent US-guided bilateral posterior TAPB alone; and the Control Group received saline alone. All patients also had access to patient-controlled intravenous analgesia (PCIA) with sufentanil. The primary outcome was postoperative sufentanil consumption at 0-24, 24-48, and 48-72 h. The secondary outcomes were postoperative pain intensity and functional activity score at rest and while coughing for the same three time periods, intraoperative medication dosage, use of rescue analgesia, recovery parameters, and adverse effects. RESULTS: The three groups had no significant differences in baseline demographic and perioperative data, use of intraoperative medications, recovery parameters, and adverse effects. The TR group had significantly lower postoperative use of PCIA and rescue analgesic than in the other two groups (P < 0.05), but the Control Group and T Group had no significant differences in these outcomes. CONCLUSIONS: Postoperative US-guided posterior TAPB with RSB reduced postoperative opioid use in patients following laparoscopy-assisted radical resection of rectal cancer. TRIAL REGISTRATION: The trial was registered with chictr.org (ChiCTR2000029326) on January 25, 2020.

Clinical features and management strategy of symptomatic spontaneous isolated celiac artery dissection.

OBJECTIVES: The aim of this study was to evaluate the clinical features and management strategy for patients with symptomatic spontaneous isolated celiac artery dissection (SICAD). METHODS: In this retrospective study, consecutive patients with symptomatic SICAD from two institutions were included. The demographics, clinical manifestations, comorbidities, imaging findings and treatment strategy selection were obtained from the medical records. The general epidemiological data, treatment regimens and clinical and follow-up outcomes were analysed. RESULTS: Patients were divided into the conservative treatment group (group A, n = 26) and endovascular treatment group (group B, n = 11). Of these 37 patients, extent of dissection in both groups included only celiac trunk (61.54%% vs. 18.18%, p = 0.03), common hepatic artery (CHA) and splenic artery (SA) (3.85%% vs. 54.55%, p = 0.001), CHA (7.69% vs. 18.18%, p = 0.57), SA (23.08% vs. 9.09, p = 0.65) and left gastric artery (LGA) (3.85% vs. 54.55%, p = 0.99). Of note, the extension of the lesion in group A was shorter than that in group B. In addition, there were significantly more type IIb in group A than in group B (42.31% vs. 9.09%, p = 0.06) and the mean length of dissection in group A was 42.3 ± 54.71 mm which was significantly shorter than that in the group B 58.45 ± 3.71 mm (p =0.04). During a median follow-up of 11.5 months, the 1, 3, 6 and 12 month follow-ups were completed in 100% (37/37), 100% (37/37), 94.59% (35/37) and 91.19% (34/37) of patients, respectively. The cumulative rate of persistent disease stability in patients with endovascular treatment group was higher than in that conservative treatment group at the 3, 6, 9 and 12 months (50% vs. 16.67%, p = 0.001; 80% vs. 37.5%, p =0.03; 100% vs. 62.5%, p = 0.012;100% vs. 91.67%, p = 0.02 respectively). CONCLUSION: Most symptomatic SICAD have a tendency to persistent disease stability after conservative treatment. Risk factors for failed conservative treatment were length of dissection and branch involvement. Furthermore, endovascular treatment was associated with a high technical success and persistent disease stability rate, which might be reserved for patients with failed conservative treatment.

Outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection with conservative management.

OBJECTIVES: The aim of this study was to evaluate the computed tomography follow-up outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection (IMAD) after conservative management. METHODS: In this retrospective study, 130 consecutive patients with symptomatic IMAD from three institutions were enrolled from January 2011 to December 2019. The general epidemiological data, clinical manifestations, first-episode symptoms, imaging findings, and treatment strategy selection were analyzed from the medical records. RESULTS: Among 130 patients diagnosed with symptomatic IMAD, positive remodeling of the SMA was achieved in 75.38% (98/130), and negative remodeling of the SMA was achieved in 24.62% (32/130). In the positive remodeling group, complete remodeling was achieved 39.23% (51/130) (type I 6 patients, type IIa 10 patients, type IIb 35 patients), in which type IIb was the most (p = 0.004). Moreover, of the 32 patients in whom negative remodeling of the SMA was achieved, significant differences were observed between the type IIa with respect to dissecting aneurysm formation (p = 0.04).Of the seven factors analyzed with a logistic regression model identified three factors significantly associated with negative remodeling: length of dissection (Waldχ2 13.331; OR 6.945; 95% CI 2.762-10.498; p = 0.014), true lumen residual diameter (TLRD) (Waldχ2 9.626; OR 7.85; 95% CI 1.892-19.063; p = 0.022), and branch involvement (Waldχ2 11.812; OR 7.247; 95% CI 1.245-14.830; p = 0.011). CONCLUSION: The prognosis of most symptomatic IMAD has a tendency to positive remodeling after conservative management, in which the initial type IIb classification is common. In contrast, risk factors for negative remodeling were type IIa, length of dissection, TLRD, and branch involvement. Patients with these morphological characteristics may not benefit from conservative management.

Overwork Death of Chinese Physicians under High-Intensity Pressure, 2007-2018.

BACKGROUND: To summarize the cases of physicians overwork death between Jan 2007 and Dec 2018, the tragedy merits the attention of the authorities and policy-makers to increase their efforts to reduce death among physicians in China. METHODS: Data were extracted from medical databases, local mass media, official documents and medical Bulletin Board System (BBS), in which only included articles, reports and news listed in the retrieval strategy, and unpublished data were excluded. RESULTS: Overall, 110 cases (7 females and 103 males) were enrolled in this study. Most incidents have occurred since 2012, especially in 2017. Of these, 86 (78.18%) physicians worked in public tertiary hospitals, four times more than the number of cases taking place in secondary hospitals. Additionally, overwork death was the most common in surgery-related departments that account for up to 65 (59.1%). Notably, these events, taking place in first-tier cities and the southeastern coastal areas of China, included 27 chief physicians, 31 associate of chief physicians, 21 attending physicians, 10 resident physicians and 4 standardized training physicians. CONCLUSION: Overwork death among Chinese physicians is not only a contemporary health problem but also a critical social issue. The laws and regulations should be perfected to prevent the events. Meanwhile, the public should be aware of the need for more understanding and trust in physicians in China.

Intravascular Leiomyomatosis Extending to Right Atrium: A Rare Caused Syncope.

Intravascular leiomyomatosis (IVL) is a variant of leiomyoma characterized by intravascular proliferation of a histologically benign smooth muscle tumor extending beyond the uterus into distant great vessels or the heart. It is a rare disease and results in death. Here, we reported the case of 48-year-old, otherwise well woman, who presented to the emergency department with syncope. Pulmonary computed tomography (CT) demonstrated a large low-density shadow originating from the inferior vena cava (IVC) extending into the right atrium (RA). Magnetic resonance venography (MRV) showed that a neoplasm was "snakelike," which completely occluded the right internal iliac vein (RIIV), the common iliac vein (CIV), and IVC. A multidisciplinary team of specialists consisting of vascular surgeons, cardiac surgeons, gynecologists, anesthesiologists, and radiologists reviewed the history, clinical examination findings, and diagnostic imaging of the patient. A decision was made to proceed with one-stage surgery (resection of thoracoabdominal tumor extension at one operative setting). After surgery, the patient's vital signs were restored, and her symptoms were disappeared. She was discharged on hospital day 21 without complications. One-stage surgical approach to completely remove an IVL with RA involvement is an optimal choice if the patient's physical condition permits.

Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection.

BACKGROUND: An optimal treatment regimen is sought for symptomatic isolated mesenteric artery dissection (IMAD) on the basis of its clinical staging. METHODS: From January 2011 to December 2018, 120 patients with symptomatic IMAD from two institutions were collected retrospectively. We reviewed the clinical features, risk factors, computed tomography (CT) images, treatment modalities, and follow-up results to propose a new management strategy based on the clinical stages of the disease. RESULTS: A total of 120 patients were collected in this study; 77 patients (69 men, 8 women; median age, 52.53 years; range, 39-73 years) who had undergone successful conservative management with antithrombotic agents were included in group A. The remaining 43 patients (34 men, 9 women; median age, 52.63 years; range, 26-66 years) who underwent invasive therapy were included in group B. Significant differences were observed between the two groups with respect to dissection length (50.72 ± 27.72 mm vs. 62 ± 24.3 mm; P = 0.02), true lumen residual diameter (3.31 ± 1.05 mm vs. 2.83 ± 2.05 mm; P = 0.01), and branch involvement (8 and 19, respectively; P < 0.001). Success was achieved in 76.24% (77/101) of patients treated by conservative management with antithrombotic agents in the acute stage; 43 patients underwent invasive interventional therapy in different stages of symptomatic IMAD. In group A, 6 patients had recurrent abdominal pain, three of whom underwent invasive intervention, and the remaining patients improved after conservative treatment. Positive remodeling was observed in 80.33% (49/61) of patients treated with conservative management alone versus 19.67% (12/61) of patients who experienced negative remodeling. Endovascular intervention in group B, CT angiography, or mesenteric angiography yielded complete remodeling in 23 (76.67%, 23/30) patients and evidence of stent restenosis in 7 (23.33%, 7/30) patients. Among the surgical patients, 7 patients showed improvement in the luminal diameter. However, 3 patients with short bowel syndrome require long-term parenteral nutrition. CONCLUSIONS: Conservative management with antithrombotic agents should be a first-line regimen for symptomatic IMAD in the acute stage. If symptoms persist, endovascular intervention is a safe and feasible treatment in the subacute or chronic stage. When peritonitis is present, surgical treatment should be promptly performed, regardless of the disease stage.