The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data.

BACKGROUND: The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China. METHODS: We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region. RESULTS: During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend. CONCLUSION: This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.

Real-time tracking of electron transfer at catalytically active interfaces in lithium-ion batteries.

Transition metals and related compounds are known to exhibit high catalytic activities in various electrochemical reactions thanks to their intriguing electronic structures. What is lesser known is their unique role in storing and transferring electrons in battery electrodes which undergo additional solid-state conversion reactions and exhibit substantially large extra capacities. Here, a full dynamic picture depicting the generation and evolution of electrochemical interfaces in the presence of metallic nanoparticles is revealed in a model CoCO3/Li battery via an in situ magnetometry technique. Beyond the conventional reduction to a Li2CO3/Co mixture under battery operation, further decomposition of Li2CO3 is realized by releasing interfacially stored electrons from its adjacent Co nanoparticles, whose subtle variation in the electronic structure during this charge transfer process has been monitored in real time. The findings in this work may not only inspire future development of advanced electrode materials for next-generation energy storage devices but also open up opportunities in achieving in situ monitoring of important electrocatalytic processes in many energy conversion and storage systems.

Enhancing organic cathodes of aqueous zinc-ion batteries via utilizing steric hindrance and electron cloud equalization.

Polyaniline (PANI), with merits of high electronic conductivity and capacity, is a promising material for zinc (Zn)-ion batteries. However, its redox window in Zn batteries is often limited, mainly due to the oxidative degradation at high potentials-in which imine groups can be attacked by water molecules. Here, we introduce phytic acid, a kind of supermolecule acid radical ion, as a dopant and electrolyte additive. Various in/ex situ analyses and theoretical calculations prove that the steric hindrance effect can prevent electroactive sites from the attack by water molecules. Meanwhile, the redox reaction can be stabilized by an even distribution of electron cloud due to the conjugated structure of phenazine groups. Accordingly, the assembled Zn-PANI battery can allow stable and long-term charge-discharge reactions to occur at a potential as high as 2.0 V with a discharged plateau of 1.5 V, and it also shows high rate performance and stable long cycle life (75% capacity retention after 1000 cycles at 10 A g-1).

Effectiveness of Huangqi Guizhi Wuwu decoction combined with rehabilitation training for shoulder hand syndrome after stroke: A systematic review and meta-analysis.

BACKGROUND: Shoulder hand syndrome (SHS) is a common complication of stroke. This meta-analysis aimed to evaluate the effectiveness of Huangqi Guizhi Wuwu decoction (HGWD) combined with rehabilitation training in managing it, as its efficacy remains inconclusive. METHODS: Seven databases, including PubMed, EMBASE, Cochrane Library, SinoMed, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP database were searched in this study. The search deadline was April 30, 2023. Randomized controlled trials that included either standalone rehabilitation training or HGWD combined with rehabilitation training were included, and data were independently extracted by 2 reviewers who assessed the risk of bias. RESULTS: Thirteen studies involving 1270 patients were included in this study. Meta-analysis showed that the combined treatment was significantly more effective than standalone rehabilitation therapy (odds ratio = 4.49; 95%CI: 2.98-6.76; Z = 7.17; P < .00001). Compared with the control group, the intervention group had a lower visual analog scale score (mean difference [MD] = -2.80, 95%CI (-3.15, -2.45), Z = 15.84, P < .00001). In addition, the Fugl-Meyer assessment scale score improved (MD = 9.69, 95%CI (7.60, 11.78), Z = 9.08, P < .00001). The SHS score in the intervention group decreased more compared to the control group (standard mean difference = -2.27, 95%CI (-3.19, -1.34), Z = 4.79, P < .00001). Serum biomarkers related to SHS decreased, including serum substance P (MD = -7.52, 95%CI (-8.55, -6.48), Z = 14, P < .00001) and bradykinin (MD = -1.81, 95%CI (-2.68, -0.95), Z = 4.1, P < .00001). Although there was no statistical difference in joint mobility score (MD = -4.19, 95%CI (-8.16, -0.22), Z = 4.79, P = .28), sensitivity analysis after excluding one study still suggested that the joint mobility score of the combined treatment group was higher than that of the standalone rehabilitation treatment group. CONCLUSION: The results of this study indicate that HGWD combined with rehabilitation training may be more effective in treating SHS after stroke compared to standalone rehabilitation therapy.

Electrochemical interfacial catalysis in Co-based battery electrodes involving spin-polarized electron transfer.

Interfacial catalysis occurs ubiquitously in electrochemical systems, such as batteries, fuel cells, and photocatalytic devices. Frequently, in such a system, the electrode material evolves dynamically at different operating voltages, and this electrochemically driven transformation usually dictates the catalytic reactivity of the material and ultimately the electrochemical performance of the device. Despite the importance of the process, comprehension of the underlying structural and compositional evolutions of the electrode material with direct visualization and quantification is still a significant challenge. In this work, we demonstrate a protocol for studying the dynamic evolution of the electrode material under electrochemical processes by integrating microscopic and spectroscopic analyses, operando magnetometry techniques, and density functional theory calculations. The presented methodology provides a real-time picture of the chemical, physical, and electronic structures of the material and its link to the electrochemical performance. Using Co(OH)2 as a prototype battery electrode and by monitoring the Co metal center under different applied voltages, we show that before a well-known catalytic reaction proceeds, an interfacial storage process occurs at the metallic Co nanoparticles/LiOH interface due to injection of spin-polarized electrons. Subsequently, the metallic Co nanoparticles act as catalytic activation centers and promote LiOH decomposition by transferring these interfacially residing electrons. Most intriguingly, at the LiOH decomposition potential, electronic structure of the metallic Co nanoparticles involving spin-polarized electrons transfer has been shown to exhibit a dynamic variation. This work illustrates a viable approach to access key information inside interfacial catalytic processes and provides useful insights in controlling complex interfaces for wide-ranging electrochemical systems.

Generation and characterization of iPS cell line (SYSUSHi002-A) from PBMCs of an AML patient with TP53 mutation.

We have generated an iPSCs line (IPS-AML2-C3, SYSUSHi002-A) from AML cells of a 71-year-old male Acute Myeloid Leukaemia patient with TP53 gene mutation (TP53: c.824G > A, p.Cys275Tyr) using episomal plasmids encoding the factors OCT4, SOX2, KLF4, L-MYC and human miR-302. The IPS-AML2-C3 (SYSUSHi002-A) iPSC line displayed typical embryonic stem cell-like morphology, carried the TP53 gene mutation, expressed several pluripotent stem cell makers, retained normal karyotype (46, XY), and was capable of forming three germ layer cells in vitro.

A Review of Manufacturing Methods for Flexible Devices and Energy Storage Devices.

Given the advancements in modern living standards and technological development, conventional smart devices have proven inadequate in meeting the demands for a high-quality lifestyle. Therefore, a revolution is necessary to overcome this impasse and facilitate the emergence of flexible electronics. Specifically, there is a growing focus on health detection, necessitating advanced flexible preparation technology for biosensor-based smart wearable devices. Nowadays, numerous flexible products are available on the market, such as electronic devices with flexible connections, bendable LED light arrays, and flexible radio frequency electronic tags for storing information. The manufacturing process of these devices is relatively straightforward, and their integration is uncomplicated. However, their functionality remains limited. Further research is necessary for the development of more intricate applications, such as intelligent wearables and energy storage systems. Taking smart wear as an example, it is worth noting that the current mainstream products on the market primarily consist of bracelet-type health testing equipment. They exhibit limited flexibility and can only be worn on the wrist for measurement purposes, which greatly limits their application diversity. Flexible energy storage and flexible display also face the same problem, so there is still a lot of room for development in the field of flexible electronics manufacturing. In this review, we provide a brief overview of the developmental history of flexible devices, systematically summarizing representative preparation methods and typical applications, identifying challenges, proposing solutions, and offering prospects for future development.

Constructing S-deficient nickel sulfide/N-doped carbon interface for improved water splitting activity.

Transition-metal sulfides are an intriguing family of electrocatalysts, yet their water-splitting applications are severely hampered by uncontrollable phase reconstruction and unsatisfactory in-service durability. Herein, we developed an efficient method to construct nickel sulfide (NiS) nanoarrays on foam nickel (NF) while being protected by highly N-doped formamide-derived carbon (termed NiS-NC@NF). The NiS nanocrystals were transformed in situ from highly dispersed Ni-N-C deposited on NF, ensuring a strong coupling effect that tunes the surface properties of NiS nanocrystals via the in situ constructed NiS/N-doped carbon interface. Electrochemical measurements reveal that very low overpotentials of 88.0 and 170.0 mV (vs. RHE) are required to achieve a current density of 10.0 mA cm-2 for hydrogen and oxygen evolution, respectively. The highly N-doped carbon matrix additionally regulates the potential-driven reconstruction of NiS in a controlled extent. Remarkably, the water electrolyzer built with NiS-NC@NF as both anode and cathode delivers an extremely low cell voltage of 1.51 V to initiate water splitting in the alkaline medium.

Role of purinergic signalling in obesity-associated end-organ damage: focus on the effects of natural plant extracts.

Obesity has become one of the major public health problems in both the developing and developed countries. Recent studies have suggested that the purinergic signalling is involved in obesity-associated end-organ damage through purine P1 and P2 receptors. In the search for new components for the treatments of obesity, we and other researchers have found much evidence that natural plant extracts may be promising novel therapeutic approaches by modulating purinergic signalling. In this review, we summarize a critical role of purinergic signalling in modulating obesity-associated end-organ damage, such as overhigh appetite, myocardial ischemia, inflammation, atherosclerosis, non-alcoholic fatty liver disease (NAFLD), hepatic steatosis and renal inflammation. Moreover, we focus on the potential roles of several natural plant extracts, including quercetin, resveratrol/trans-resveratrol, caffeine, evodiamine and puerarin, in alleviating obesity-associated end-organ damage via purinergic signalling. We hope that the current knowledge of the potential roles of natural plant extracts in regulating purinergic signalling would provide new ideas for the treatment of obesity and obesity-associated end-organ damage.

Highly N-Doped Fe/Co Phosphide Superstructures for Efficient Water Splitting.

Developing an inexpensive bifunctional electrocatalyst for overall water splitting is critical for acquiring scalable green hydrogen and thereby realizing carbon neutralization. Herein, an "all-in-one" method is developed for the fabrication of highly N-doped binary FeCo-phosphides (N-FeCoP) with hierarchical superstructure, this delicately designed synthesis route allows the following merits for benefiting water splitting electrocatalysis in alkaline, including high N/defect-doping for mediating the surface property of the as-made N-FeCoP, binary Fe and Co components exhibiting strong coupling interaction, and 3D hierarchical superstructure for shortening diffusion length and thereby improving reaction kinetics. Electrochemical measurements reveal that the N-FeCoP sample exhibits very low overpotentials for initiating the hydrogen and oxygen evolution reactions. Remarkably, overall water splitting can be promoted on N-FeCoP using a commercial primary Zn-MnO2 battery. The developed synthesis strategy may potentially inspire the preparation of other N-doped metal-based nanostructures for broad electrocatalysis.

Genetic polymorphisms of purinergic P2Y2 receptor were associated with the susceptibility to essential hypertension in Chinese postmenopausal women.

Hypertension has become a prominent public health concern. Essential hypertension (EH) is a polygenic disorder caused by multiple susceptibility genes. It has been previously shown that the purinergic P2Y2 receptor (P2Y2R) regulates blood pressure; however, whether P2Y2R genetic polymorphisms correlate with EH has not been investigated in Chinese. Our study included 500 EH cases and 504 controls who are Chinese postmenopausal women. We used allele-specific polymerase chain reaction (ASPCR) to genotype five single-nucleotide polymorphism (SNPs) in the P2Y2R gene, i.e., rs4944831, rs12366239, rs1783596, rs4382936, and rs10898909. We assessed the association of P2Y2R genetic polymorphisms with EH susceptibility. The results demonstrated that P2Y2R rs4382936A was correlated with a high risk of EH; particularly, the participants with the rs4382936A allele and CA/AA/(CA+AA) genotypes were at higher risks to EH compared to the subjects with the rs4382936C allele and CC genotype. Moreover, haplotype CAG combined by rs1783596-rs4382936-rs10898909 was a susceptible haplotype for EH, whereas haplotype CCG was a protective haplotype for EH. These results may provide new evidence for applying P2Y2R genetic polymorphisms as useful markers in clinic screening or monitoring potential EH cases in a population of Chinese postmenopausal women.

The Impact of Racial Disparities on Outcome in Patients With Stage IIIC Endometrial Carcinoma: A Pooled Data Analysis.

OBJECTIVE: To report the impact of race on clinical outcomes in patients with stage IIIC endometrial carcinoma. MATERIALS AND METHODS: A retrospective multi-institutional study included 90 black and 568 non-black patients with stage IIIC endometrial carcinoma who received adjuvant chemotherapy and radiation treatments. Overall survival (OS) and recurrence-free survival (RFS) were calculated by the Kaplan-Meier method. Propensity score matching (PSM) was conducted. Statistical analyses were conducted using SPSS version 27. RESULTS: The Median follow-up was 45.3 months. black patients were significantly older, had more nonendometrioid histology, grade 3 tumors, and were more likely to have >1 positive paraaortic lymph nodes compared with non-black patients (all P <0.0001). The 5-year estimated OS and RFS rates were 45% and 47% compared with 77% and 68% for black patients versus non-black patients, respectively ( P <0.001). After PSM, the 2 groups were well-balanced for all prognostic covariates. The estimated hazard ratios of black versus non-black patients were 1.613 ( P value=0.045) for OS and 1.487 ( P value=0.116) for RFS. After PSM, black patients were more likely to receive the "Sandwich" approach and concurrent chemoradiotherapy compared with non-black ( P =0.013) patients. CONCLUSIONS: Black patients have higher rates of nonendometrioid histology, grade 3 tumors, and number of involved paraaortic lymph nodes, worse OS, and RFS, and were more likely to receive the "Sandwich" approach compared with non-black patients. After PSM, black patients had worse OS with a nonsignificant trend in RFS. Access to care, equitable inclusion on randomized trials, and identification of genomic differences are warranted to help mitigate disparities.

Production and waste treatment of polyesters: application of bioresources and biotechniques.

Chemical resources and techniques have long been used in the history of bulk polyester production and still dominate today's chemical industry. The sustainable development of the polyester industry demands more renewable resources and environmentally benign polyester products. Accordingly, the rapid development of biotechnology has enabled the production of an extensive range of aliphatic and aromatic polyesters from renewable bio-feedstocks. This review addresses the production of representative commercial polyesters (polyhydroxyalkanoates, polylactic acid, poly ε-caprolactone, polybutylene succinate, polyethylene terephthalate, polybutylene terephthalate, polypropylene terephthalate, polyethylene furandicarboxylate, polypropylene furandicarboxylate, and polybutylene furandicarboxylate) or their monomers (lactic acid, succinic acid, 1,4-butanediol, ethylene glycol, terephthalic acid, 1,3-propanediol, and 2,5-furandicarboxylic acid) from renewable bioresources. In addition, this review summarizes advanced biotechniques in the treatment of polyester wastes, representing the near-term trends and future opportunities for waste-to-value recycling and the remediation of polyester wastes under sustainable models. For future prospects, it is essential to further expand: non-food bioresources, optimize bioprocesses and biotechniques in the preparation of bioderived or biodegradable polyesters with promising: material performance, biodegradability, and low production cost.

N4-Vacancy-Functionalized Carbon for High-Rate Li-Ion Storage.

Although heteroatom doping and pore management separately influence the Li+ adsorption and Li+ diffusion properties, respectively, merging their functions into a single unit is intriguing and has not been fully investigated. Herein, we have successfully incorporated both heteroatom doping and pore management within the same functional unit of N4-vacancy motifs, which is realized via acid etching of formamide-derived Zn-N4-functionalized carbon materials (Zn1NC). The N4-vacancy-rich porous carbon (V-NC) renders multiple merits: (1) a high N content of 13.94 atom % for large Li-storage capacity, (2) edged unsaturated N sites favoring highly efficient Li+ adsorption and desolvation, and (3) a shortening of the Li+ diffusion length through N4 vacancy, thereby enhancing the Li-storage kinetics and high-rate performance. This work serves as an inspiration for the creation of heteroatom-edged porous structures with controllable pore sizes for high-rate alkali-ion battery applications.

Study on the Prescription of Acupuncture in the Treatment of Cervical Spondylotic Radiculopathy Based on Computer Vision Image Analysis.

Cervical spondylosis (CS) is a common clinical orthopedic disease. Among cervical spondyloses, cervical spondylotic radiculopathy (CSR) is the most common. Its clinical manifestations are localized neck pain and radial numbness of the shoulder, upper arm, forearm, and even fingers. As far as the status quo is concerned, with the change of lifestyle and working style, the popularity of computer and other entertainment devices, people's neck flexion time has increased significantly compared with the past, the incidence rate of CSR has also increased year by year, and the group of onset has become younger and younger. According to the symptoms, CSR in Chinese medicine belongs to the category of "arthralgia syndrome" and "bone arthralgia." Western medicine has many side effects in the treatment of CSR, while surgical treatment is painful and expensive. Most patients are not willing to accept it. Traditional Chinese medicine acupuncture can relieve the pain, numbness, and other discomforts of CSR, and the acupuncture treatment has less trauma and is a simple operation. At present, there are few acupoint prescriptions for acupuncture in the treatment of CSR. Therefore, the analysis of acupuncture point selection based on computer vision image has important practical significance for the scientific and progressive exploration of CSR acupuncture treatment. In this paper, the etiology, pathology, and clinical manifestations of radical treatment of CS are deeply studied by using literature data and mathematical statistics. The prescription research experiment of acupuncture in the treatment of CSR based on computer was established, and the treatment method was studied by observing VAS, NPQ, and other indexes. The total effective rate was 95.13% in the experimental group and 85.72% in the control group. It is hoped that the research direction of this paper can provide reference for the diversified development of acupuncture and moxibustion and for the treatment ideas and methods of cervical spondylotic radiculopathy.

Metformin suppresses proliferation and differentiation induced by BMP9 via AMPK signaling in human fetal lung fibroblast-1.

Adenosine monophosphosphate-activated protein kinase (AMPK) and its activator metformin were found to be involved in the regulation of fibroblast activation and pulmonary fibrosis. However, the regulatory mechanism has been undetermined. Recently, AMPK has been reported to exert its effect through inhibiting bone morphogenetic protein (BMP) pathway. In this study, human fetal lung fibroblast (HFL-1) cells were treated with metformin or specific AMPKα1 mutants, including constitutively activated mutant (AMPK-CA) and dominant negative mutant (AMPK-DN), combined with BMP9, and then the absorbance of these cells was measured by cell counting kit (CCK)-8 assay. The colony number of HFL-1 cells stimulated by metformin with or without BMP9 was examined by colony formation assay. The protein expressions of differentiated markers (α-smooth muscle actin, collagen I and collagen III) and the key molecules of BMP9 signaling, including activin receptor-like kinase (ALK) one and phosphorylated small mother against decapentaplegic (p-Smad)1/5, were also evaluated by western blot. Data revealed that BMP9 induced the proliferation and differentiation of HFL-1 cells which was suppressed by metformin or AMPK-CA. Meanwhile, the effect of metformin on BMP9-induced activation was counteracted by AMPK-DN. In addition, we found that the expressions of ALK1 and p-Smad1/5 induced by BMP9 were attenuated by metformin and AMPK-CA, whereas the inhibitory responses of metformin to the increased ALK1 and p-Smad1/5 were reduced by AMPK-DN. Accordingly, these results suggested that metformin mitigated BMP9-induced proliferation and differentiation of HFL-1 cells, which was achieved partly through the activation of AMPK and inhibition of ALK1/Smad1/5 signaling.

Comparison of perioperative complications for extended vs standard pelvic lymph node dissection in patients undergoing radical prostatectomy for prostate cancer: a meta-analysis.

INTRODUCTION: Pelvic lymph node dissection (PLND) is widely performed for staging in men undergoing radical prostatectomy (RP) for prostate cancer. Our goal was to synthesize all available evidence and data to evaluate perioperative complications for two templates of PLND, standard (sPLND) vs extended (ePLND), at the time of RP in patients with prostate cancer. METHODS: A meta-analysis was performed on relevant literature about complications during PLND. Pubmed, Scopus, WebofScience, and Cochrane Library were systematically searched through July 2021. Meta-analysis was conducted with both fixed-effects and random-effects models to estimate risk ratios (RRs) between treatments. A subgroup analysis was also conducted based on surgery type - open vs robotic. RESULTS: 13 (1 randomized clinical trial and 12 observational studies) studies published between 1997 and 2019 with a total of 7,036 patients were analyzed. Pooled data showed complications in a random-effects model was lower in the sPLND group than the ePLND group (RR, 0.62; 95% CI 0.40-0.97). In a subgroup analysis, neither the open surgery subgroup nor the robotic surgery subgroup showed significant differences in complication rate between sPLND and ePLND. CONCLUSION: ePLND is associated with a significantly greater risk of perioperative complication compared to sPLND, but not when comparing these templates performed via a robotic approach. Additional studies comparing the complication rates of sPLND and ePLND when utilizing a robotic approach should be conducted.

Research Progresses and Challenges of Flexible Zinc Battery.

Flexible zinc batteries have great potential in wearable electronic devices due to their high safety, low cost, and environmental friendliness. In the past few years, a great deal of work on flexible zinc batteries has been reported, with exciting results. Therefore, many solutions have been proposed in electrode design and electrolyte preparation to ensure the desired flexibility without sacrificing the capacity. This paper reviews the recent progress of flexible zinc batteries. We discuss the differences between various anode materials, cathode materials, and electrolytes, introduce the differences of electrode preparation methods of active materials on flexible substrates and their influence on the performance of the battery. Finally, the challenges and future research trends of flexible zinc batteries in capacity and mechanical properties are pointed out.

Does Prophylactic Paraortic Lymph Node Irradiation Improve Outcomes in Women With Stage IIIC1 Endometrial Carcinoma?

PURPOSE: To evaluate the impact of prophylactic paraortic lymph node (PALN) radiation therapy (RT) on clinical outcomes in patients with International Federation of Obstetrics and Gynecology 2018 stage IIIC1 endometrial cancer (EC). METHODS AND MATERIALS: A multi-institutional retrospective study included patients with International Federation of Obstetrics and Gynecology 2018 stage IIIC1 EC lymph node assessment, status postsurgical staging, followed by adjuvant chemotherapy and RT using various sequencing regimens. Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by the Kaplan-Meier method. Univariable and multivariable analysis were performed by Cox proportional hazard models for RFS/OS. In addition, propensity score matching was used to estimate the effect of the radiation field extent on survival outcomes. RESULTS: A total of 378 patients were included, with a median follow-up of 45.8 months. Pelvic RT was delivered to 286 patients, and 92 patients received pelvic and PALN RT. The estimated OS and RFS rates at 5 years for the entire cohort were 80% and 69%, respectively. There was no difference in the 5-year OS (77% vs 87%, P = .47) and RFS rates (67% vs 70%, P = .78) between patients treated with pelvic RT and those treated with pelvic and prophylactic PALN RT, respectively. After propensity score matching, the estimated hazard ratios (HRs) of prophylactic PALN RT versus pelvic RT were 1.50 (95% confidence interval, 0.71-3.19; P = .28) for OS and 1.24 (95% confidence interval, 0.64-2.42; P = .51) for RFS, suggesting that prophylactic PALN RT does not improve survival outcomes. Distant recurrence was the most common site of first recurrence, and the extent of RT field was not associated with the site of first recurrence (P = .79). CONCLUSIONS: Prophylactic PALN RT was not significantly associated with improved survival outcomes in stage IIIC1 EC. Distant metastasis remains the most common site of failure despite routine use of systemic chemotherapy. New therapeutic approaches are necessary to optimize the outcomes for women with stage IIIC1 EC.

Co-Production of Isoprene and Lactate by Engineered Escherichia coli in Microaerobic Conditions.

Lactate and isoprene are two common monomers for the industrial production of polyesters and synthetic rubbers. The present study tested the co-production of D-lactate and isoprene by engineered Escherichia coli in microaerobic conditions. The deletion of alcohol dehydrogenase (adhE) and acetate kinase (ackA) genes, along with the supplementation with betaine, improved the co-production of lactate and isoprene from the substrates of glucose and mevalonate. In fed-batch studies, microaerobic fermentation significantly improved the isoprene concentration in fermentation outlet gas (average 0.021 g/L), compared with fermentation under aerobic conditions (average 0.0009 g/L). The final production of D-lactate and isoprene can reach 44.0 g/L and 3.2 g/L, respectively, through fed-batch microaerobic fermentation. Our study demonstrated a dual-phase production strategy in the co-production of isoprene (gas phase) and lactate (liquid phase). The increased concentration of gas-phase isoprene could benefit the downstream process and decrease the production cost to collect and purify the bio-isoprene from the fermentation outlet gas. The proposed microaerobic process can potentially be applied in the production of other volatile bioproducts to benefit the downstream purification process.