Screening parameters for diagnosing primary aldosteronism in patients with moderate to severe obstructive sleep apnea hypopnea syndrome and resistant hypertension.

Background: Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) combined with resistant hypertension (RH) have a high risk of developing primary aldosteronism (PA). This study investigated the aldosterone-renin ratio (ARR), plasma aldosterone concentration (PAC), and plasma renin activity (PRA) to determine the optimal cutoff values for PA diagnosis in patients with OSAHS combined with RH. Methods: Patients diagnosed with moderate and severe OSAHS combined with RH were recruited from the inpatient clinic of the Department of Endocrinology at Ji'an Central Hospital between October 2020 and April 2023. The included patients were divided into PA and no-PA groups. Diagnostic accuracy measures were calculated for each group, and receiver operating characteristic (ROC) curves were generated. Results: A total of 241 patients were included, of which 103 had positive ARR screening results in the diagnostic accuracy analysis and 66 were diagnosed with PA. PAC and ARR showed moderate predictive capacity for PA, with area under the curve (AUC) values of 0.66 [95% confidence interval (CI): 0.55-0.77] and 0.72 (95% CI: 0.63-0.82), respectively, while PRA exhibited a limited predictive capacity (AUC = 0.51, 95% CI: 0.40-0.63). Using 45 as the optimal cutoff value for ARR, the sensitivity was 86% and the specificity was 52%. The optimal cutoff value for PAC was 17, with a sensitivity of 78% and a specificity of 55%. Notably, in patients with severe OSAHS, ARR at screening demonstrated significant predictive value for PA, with an AUC of 0.84 (95% CI: 0.72-0.96), a sensitivity of 85%, and a specificity of 76%. Conversely, in patients with moderate OSAHS, only ARR demonstrated significant predictive value for PA diagnosis, while PAC did not demonstrate notable diagnostic value. Conclusion: ARR and PAC are initial screening tools for PA, facilitating early detection, particularly in low-resource settings. In patients with OSAHS and RH, the ARR and PAC thresholds for PA diagnosis may require more stringent adjustment.

Platelet dysfunction caused by differentially expressed genes as key pathogenic mechanisms in COVID-19.

At the end of 2019, the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became prevalent worldwide, which brought a heavy medical burden and tremendous economic losses to the world population. In addition to the common clinical respiratory symptoms such as fever, cough and headache, patients with COVID-19 often have hematological diseases, especially platelet dysfunction. Platelet dysfunction usually leads to multiple organ dysfunction, which is closely related to patient severity or mortality. In addition, studies have confirmed significant changes in the gene expression profile of circulating platelets under SARS-CoV-2 infection, which will further lead to changes in platelet function. At the same time, studies have shown that platelets may absorb SARS-COV-2 mRNA independently of ACE2, which further emphasizes the importance of the stability of platelet function in defense against SARS-CoV-2 infection. This study reviewed the relationship between COVID-19 and platelet and SARS-CoV-2 damage to the circulatory system, and further analyzed the significantly differentially expressed mRNA in platelets after infection with SARS-CoV-2 on the basis of previous studies. The top eight hub genes were identified as NLRP3, MT-CO1, CD86, ICAM1, MT-CYB, CASP8, CXCL8 and CXCR4. Subsequently, the effects of SARS-CoV-2 infection on platelet transcript abnormalities and platelet dysfunction were further explored on the basis of 8 hub genes. Finally, the treatment measures of complications caused by platelet dysfunction in patients with COVID-19 were discussed in detail, so as to provide reference for the prevention, diagnosis and treatment of COVID-19.

Value of blood oxygenation level-dependent magnetic resonance imaging in early evaluation of the response and prognosis of esophageal squamous cell carcinoma treated with definitive chemoradiotherapy: a preliminary study.

BACKGROUND: To find a useful hypoxia non-invasive biomarker for evaluating early treatment response and prognosis to definitive chemoradiotherapy (dCRT) in patients with esophageal squamous cell carcinoma (ESCC), using blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI). METHODS: The R2* values were obtained pre- and 2-3 weeks post-dCRT in 28 patients with ESCC using BOLD MRI. Independent samples t-test (normality) or Mann-Whitney U test (non-normality) was used to compare the differences of R2*-related parameters between the complete response (CR) and the non-CR groups. Diagnostic performance of parameters in predicting response was tested with receiver operating characteristic (ROC) curve analysis. The 3-year overall survival (OS) was evaluated using Kaplan Meier curve, log rank test, and Cox proportional hazards regression analysis. RESULTS: The post-R2*, ∆R2*, and ∆%R2* in the CR group were significantly higher than those in the non-CR group (P = 0.002, 0.003, and 0.006, respectively). The R2*-related parameters showed good prediction of tumor response, with AUC ranging from 0.813 to 0.829. The 3-year OS rate in patients with ∆R2* >-7.54 s- 1 or CR were significantly longer than those with ∆R2* ≤ -7.54 s- 1 (72.37% vs. 0.00%; Hazard ratio, HR = 0.196; 95% confidence interval, 95% CI = 0.047-0.807; P = 0.024) or non-CR (76.47% vs. 29.27%; HR = 0.238, 95% CI = 0.059-0.963; P = 0.044). CONCLUSIONS: The preliminary results demonstrated that the R2* value might be a useful hypoxia non-invasive biomarker for assessing response and prognosis of ESCC treated with dCRT. BOLD MRI might be used as a potential tool for evaluating tumor oxygenation metabolism, which is routinely applied in clinical practice and beneficial to clinical decision-making. A large sample size was needed for further follow-up studies to confirm the findings.

CONUT can be a predictor of postoperative complications after laparoscopic-assisted radical gastrectomy for elderly gastric cancer patients.

Compared with young patients, elderly patients with gastric cancer usually have lower muscle mass, poorer nutritional status, lower immunity, and worse cardiopulmonary function. Therefore, how to improve the prognosis of elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy is the focus and difficulty of clinician. The aim of our study was to investigate the risk factors for postoperative complications of these patients. The data of gastric cancer patients aged ≥ 60 years who underwent laparoscopic-assisted radical gastrectomy were analyzed. Univariate was used to determine the potential risk factors and then multivariate analyses was used to determine the independent risk factors for postoperative complications. Univariate analysis showed that age, preoperative red blood cell (RBC), preoperative albumin (ALB), preoperative C-reactive protein (CRP), preoperative hemoglobin (Hb), preoperative blood transfusion, preoperative lymphocytes, total cholesterol, CRP-to-ALB ratio, controlling nutritional status (CONUT) score, TNM stage were all the potential risk factors for postoperative complications. Binary logistic regression showed that CONUT, age and preoperative RBC were correlated with postoperative complications. For elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy, CONUT, age and preoperative RBC were all the independent risk factors for overall postoperative complications and could be used as reliable indicators for judging the short-term prognosis.

An optimized machine learning model for predicting hospitalization for COVID-19 infection in the maintenance dialysis population.

COVID-19 has a high rate of infection in dialysis patients and poses a serious risk to human health. Currently, there are no dialysis centers in China that have analyzed the prevalence of COVID-19 infection in dialysis patients and the mortality rate. Although machine learning-based disease prediction methods have proven to be effective, redundant attributes in the data and the interpretability of the predictive models are still worth investigating. Therefore, this paper proposed a wrapper feature selection classification model to achieve the prediction of the risk of COVID-19 infection in dialysis patients. The method was used to optimize the feature set of the sample through an enhanced JAYA optimization algorithm based on the dispersed foraging strategy and the greedy levy mutation strategy. Then, the proposed method combines fuzzy K-nearest neighbor for classification prediction. IEEE CEC2014 benchmark function experiments as well as prediction experiments on the uremia dataset are used to validate the proposed model. The experimental results showed that the proposed method has a high prediction accuracy of 95.61% for the prevalence risk of COVID-19 infection in dialysis patients. Furthermore, it was shown that proalbumin, CRP, direct bilirubin, hemoglobin, albumin, and phosphorus are of great value for clinical diagnosis. Therefore, the proposed method can be considered as a promising method.

Multi-functional MXene quantum dots enhance the quality of perovskite polycrystalline films and charge transport for solar cells.

Recently, two-dimensional (2D) transition metal carbides/nitrides (MXenes) find applications in perovskite solar cells (PSCs), due to their high conductivity, tunable electronic structures, and rich surface chemistry, etc. However, the integration of 2D MXenes into PSCs is limited by their large lateral sizes and relatively-small surface volume ratios, and the roles of MXenes in PSCs are still ambiguous. In this paper, zero-dimensional (0D) MXene quantum dots (MQDs) with an average size of 2.7 nm are obtained through clipping step by step combining a chemical etching and a hydrothermal reaction, which display rich terminals (i.e., -F, -OH, -O) and unique optical properties. The 0D MQDs incorporated into SnO2 electron transport layers (ETLs) of PSCs exhibit multifunction: 1) increasing the electrical conductivity of SnO2, 2) promoting better alignments of energy band positions at the perovskite/ETL interface, 3) improving the film quality of atop polycrystalline perovskite. Particularly, the MQDs not only tightly bond with the Sn atom for decreasing the defects of SnO2, but also interact with the Pb2+ of perovskite. As a result, the defect density of PSCs is significantly decreased from 5.21 × 1021 to 6.4 × 1020 cm-3, leading to enhanced charge transport and reduced nonradiative recombination. Furthermore, the power conversion efficiency (PCE) of PSCs is substantially improved from 17.44% to 21.63% using the MQDs-SnO2 hybrid ETL compared with the SnO2 ETL. Besides, the stability of the MQDs-SnO2-based PSC is greatly enhanced, with only ～4% degradation of the initial PCE after storage in ambient condition (25 °C, RH: 30-40%) for 1128 h, as compared to that of the reference device with a rapid degradation of ～60% of initial PCE after 460 h. And MQDs-SnO2-based PSC also presents higher thermal stability than SnO2-based device with continuous heating for 248 h at 85 °C. The unique MQDs exhibited in this work might also find other exciting applications such as light-emitting diodes, photodetectors, and fluorescent probes.

An entomopathogenic fungus exploits its host humoral antibacterial immunity to minimize bacterial competition in the hemolymph.

BACKGROUND: The insect hemolymph (blood-equivalent fluid), composed of a large number of hemocytes (blood cells) and a variety of soluble immune effectors, is hostile for pathogens including fungi. In order to survive in the insect hemocoel (body cavity), the entomopathogenic fungus (EPF) has evolved two classical coping strategies, namely evasion and suppression of the host immune reactions. However, it remains unclear whether EPF has other ways of coping with host immunity. RESULTS: In this study, we demonstrated that Metarhizium rileyi (an EPF) infection by injection of blastospores into the hemocoel enhanced the plasma antibacterial activity of cotton bollworm (Helicoverpa armigera), which was partially due to the enhanced expression of antimicrobial peptides (AMPs). The early stage of M. rileyi infection induced the translocation of gut bacteria into the hemocoel, where they were subsequently cleared due to the enhanced plasma antibacterial activity. Further, we showed that the enhanced plasma antibacterial activity and AMP expression were attributable to M. rileyi but not the invasive gut bacteria (opportunistic bacteria). Elevated ecdysone (major steroid hormone in insects) levels in the hemolymph at 48 h post-M. rileyi infection might contribute to the enhanced expression of AMPs. The fungus-elicited AMPs, such as cecropin 3 or lebocin, exhibited potent inhibitory activity against the opportunistic bacteria but not against hyphal bodies. In addition, the opportunistic bacteria competed with hyphal bodies for amino acid nutrients. CONCLUSIONS: M. rileyi infection induced the translocation of gut bacteria, and then the fungi activated and exploited its host humoral antibacterial immunity to eliminate opportunistic bacteria, preventing them from competing for nutrients in the hemolymph. Unlike the classical strategies, EPF utilizes to evade or suppress host immunity, our findings reveal a novel strategy of interaction between EPF and host immunity. Video Abstract.

Sovereign debt responses to the COVID-19 pandemic.

We utilize the global natural experiment created by the COVID-19 outbreak to identify sovereign borrowing capacity in time of need and its determinants. First, we demonstrate that the pandemic creates exogeneous shocks to sovereign borrowing needs-governments borrowed more when hit by more severe pandemic shocks. Second, we show that credible fiscal rules enhance sovereign borrowing capacity, while unsustainable debts in terms of high debt-to-GDP ratio, rollover risk, and sovereign default risk weaken it. Third, we find that, in response to the same pandemic shock, sovereign spreads increase more in emerging economies than advanced economies though the former borrow less during the pandemic. Finally, further analysis reveals that pegged exchange rate regimes, open capital accounts, and monetary dependence improve emerging economies' borrowing capacity.

Renal venous sampling assisted the diagnosis of juxtaglomerular cell tumor: a case report and literature review.

Juxtaglomerular cell tumor (JCT) is an endocrine tumor marked by elevated renin levels and high blood pressure. This case report presents the clinical findings of a 47-year-old woman with a history of recurrent hypokalemia, headaches, hypertension, and increased plasma renin activity (PRA). Dynamic enhanced magnetic resonance imaging (MRI) revealed a small nodule on the upper part of the right kidney. Selective renal venous sampling indicated a higher PRA only in the right upper pole renal vein. The patient underwent surgical removal of the right kidney mass, and the pathology results confirmed the diagnosis of JCT. This case underscores the importance of conducting selective renal venous sampling for accurate JCT diagnosis.

A risk prediction model for contrast-induced nephropathy associated with gadolinium-based contrast agents.

OBJECTIVE: This is the first study to explore the risk factors for nephropathy caused by gadolinium-based contrast agents and establish a prediction model to identify high-risk patients. METHODS: A total of 1404 patients who received gadolinium-based contrast agents in our hospital were included. The participants were randomly assigned in a 7:3 ratio to the modeling and validation groups. The modeling group was divided into a contrast-induced nephropathy group and a non-contrast-induced nephropathy group. The clinical characteristics before the use of contrast agents were compared between the two groups. The risk factors for contrast-induced nephropathy were analyzed by logistic regression. A nomogram that could predict the incidence of contrast-induced nephropathy was plotted. The validation group was used to verify the predictive model. RESULTS: The incidence of contrast-induced nephropathy caused by gadolinium-based contrast agents was 3.92% (55/1404). The logistic stepwise regression analysis showed that sex, systolic pressure (SBP), absolute neutrophil count, albumin, fasting blood glucose level, and furosemide use were significant predictors of contrast-induced nephropathy caused by gadolinium-based contrast agents. The above predictors were then included in the nomogram construction. The area under the receiver operating characteristic (ROC) curve was 0.82 (p < 0.001). The specificity and sensitivity corresponding to the optimal cutoff point (0.039) based on the area under the ROC curve were 71.9% and 80.5%, respectively. CONCLUSION: Sex, SBP, absolute neutrophil count, albumin, fasting blood glucose levels, and furosemide use are significant predictors of contrast-induced nephropathy caused by gadolinium-based contrast agents. Therefore, the incidence of contrast-induced nephropathy may be estimated by the prediction model established in this study before the use of contrast agents.

Water conservation through plumbing and nudging.

In this paper, we investigate two solutions to urban water security challenges: plumbing and nudging. Using anonymized monthly billing data from 1.5 million accounts in Singapore over ten years, our staggered difference-in-differences estimates show that a nationwide Home Improvement Programme that improves the efficiency of plumbing reduces residential water consumption by 3.5%. This effect persists over a decade and is robust across population subgroups. Efficiency improvements could enhance the efficacy of other conservation polices and mitigate the effects of excessive heat, rainfall and air pollution. The savings from efficiency improvements on utility bills are small, but the increase in housing value exceeds the private cost of the Home Improvement Programme. However, an evaluation of a nationwide peer-comparison nudging programme finds no evidence of reduced water consumption. Overall, we show that plumbing improvements generate long-lasting effects on water conservation.

Calcium and integrin-binding protein 1-like interacting with an integrin α-cytoplasmic domain facilitates cellular immunity in Helicoverpa armigera.

Integrins are transmembrane receptor heterodimers composed of α and ß subunits. They are known to mediate extracellular signals to promote cell adhesion and spreading, and are therefore essential for cellular immunity. However, proteins that bind to integrin cytoplasmic domains and mediate intracellular signaling to promote cell adhesion require identification. Calcium and integrin-binding protein 1 (CIB1) that binds to the integrin α-cytoplasmic domain has rarely been examined in insects. In this study, we found that 20-hydroxyecdysone promoted cell phagocytosis and spreading in Helicoverpa armigera. Transcriptomic analyses of hemocytes identified an integrin α gene (HaINTα-PS1) whose expression could be induced by either 20-hydroxyecdysone injection or bead challenge. Isothermal titration calorimetry assays showed that H. armigera CIB1-like (HaCIB1-like) weakly bound to the cytoplasmic domain of HaINTα-PS1 in the presence of calcium. HaINTα-PS1 or HaCIB1-like knockdown inhibited hemocytic encapsulation and phagocytosis, and plasmatocyte spreading. Moreover, HaCIB1-like overexpression in a H. armigera epidermal cell line overexpanded cells and impaired cell phagocytosis. Thus, insect CIB1-like potentially interacted with integrin α-cytoplasmic domain and facilitated cell adhesion. This study enriches our understanding of the molecular mechanism underlying integrin-mediated cellular immunity in insects.

Combination of Estrogen Receptor Alpha and Histological Type Helps to Predict Lymph Node Metastasis in Patients with Stage IA2 to IIA2 Cervical Cancer.

OBJECTIVE: This study aimed to identify a subset of patients with stage IA2 to IIA2 cervical cancer who are at low risk of lymph node metastasis (LNM) using pathological parameters including estrogen receptor alpha (ERα) and progesterone receptor (PR). METHODS: The clinical data of patients with stage IA2 to IIA2 cervical cancer who underwent radical surgery between 2014 and 2015 were retrospectively reviewed. Immunohistochemical staining was used to determine the expression of ERα and PR. A low-risk criterion for LNM was identified using logistic regression analysis, and its performance was estimated through receiver-operating characteristic curve analysis. RESULTS: Of 263 patients, 57 (21.7%) had pathological LNM. ERα (adjusted odds ratio [aOR], 7.582; 95% confidence interval [CI], 2.991-19.222; P < 0.001) and squamous cell carcinoma (aOR, 3.520; 95% CI, 1.887-6.568; P < 0.001) were identified as independent predictors for no LNM by multivariate logistic regression analysis, while PR had no effect on LNM. The rate of LNM was 1.4% for low-risk patients (n = 73) identified as ERα positive with squamous cell carcinoma. The 5-year disease-free survival in low-risk patients was significantly greater than in those negative for ERα and/or those with non-squamous cell carcinoma (96.9% vs 80.1%, P = 0.002). CONCLUSION: ERα positivity and squamous cell carcinoma are associated with a low risk of LNM in patients with stage IA2 to IIA2 cervical cancer. Hence, those patients without a low risk of LNM could be considered for definitive chemoradiotherapy to avoid unnecessary surgery.

Two-Dimensional Transitional Metal Disulfides as Charge Transport Layers in Organic-Inorganic Perovskite Solar Cells.

In the past decade, organic-inorganic perovskite solar cells (PSCs) have received significant attentions due to their high efficiencies and low costs. However, the commercialization of PSCs is stilled hindered by several issues such as device performance (especially for large-area cells) and stability. Recently, two-dimensional (2D) transition metal disulfides (TMDs) show great potentials in solving aforementioned problems due to their unique morphological structure and electrical properties. Herein, we summarize the advancements in the recent applications of various TMDs materials as charge transport layers in PSCs. Although some progress have been made, there are considerable issues to be tackled in this field. The challenges and development directions of these 2D TMDs materials for PSCs are also clarified. Lastly, the most recent advancements about TMDs materials in some other electronic (or optoelectronic) fields are also summarized and discussed.

Effects of postharvest cysteine treatment on sensory quality and contents of bioactive compounds in goji fruit.

Effects of cysteine (Cys) treatments (0, 0.01%, 0.05% and 0.10%) on sensory quality and bioactive compounds in goji fruit stored at 4 °C and 90% RH for 10 d were investigated. Results indicated that 0.05% Cys treatment significantly reduced decay ratio and weight loss, and maintained total soluble solid content in goji fruit. Furthermore, 0.05% Cys treatment increased the contents of total phenolic, ascorbic acid and total glutathione, and the ratio of glutathione/oxidized glutathione, resulting in the higher antioxidant capacity. Determination of five free amino acids showed that 0.05% Cys treatment increased the Pro and Tau contents, while had no significant effect on the Cys, Glu and GABA contents. The increase in Tau content might be due to the up-regulation of two key genes involved in the Tau synthesis including CDO and CSAD. These findings suggested that Cys treatment could improve the storage quality in goji fruit.

Point Mutations in FgSdhC2 or in the 5' Untranslated Region of FgSdhC1 Confer Resistance to a Novel Succinate Dehydrogenase Inhibitor Flubeneteram in Fusarium graminearum.

Fusarium graminearum is one of the phytopathogenic fungi causing cereal fusarium head blight worldwide. Flubeneteram (Flu) is a novel succinate dehydrogenase inhibitor (SDHI) which exhibits strong fungicidal activity against F. graminearum. In this study, four Flu-resistant (FluR) mutants were generated by fungicide domestication from the wildtype strain PH-1. Sequencing alignment results of FgSdh from PH-1 and FluR mutants showed that all the mutations could be categorized into three resistant genotypes. Genotype I had an A-to-T mutation at the -57 bp of the 5' untranslated region (5'UTR) of FgSdhC1, while genotypes II and III carried nonsynonymous mutations conferring T77I or R86C in FgSdhC2, respectively. All the mutations conferring the Flu resistance and causing fitness penalty were validated. The genotype I mutant showed high Flu-resistance, while genotype II and III mutants exhibited low Flu resistance. Additionally, all the FluR genotypes showed distinct cross-resistance patterns among the five SDHIs.

[Screening for UV-C irradiation-enhanced transcription factors that regulate the metabolism of phenolic compounds in tomato fruit].

Solanum lycopersicum phenylalanine ammonia-lyase 5 (SlPAL5) gene regulates the metabolism of phenolic compounds. The study of transcription factors that regulate the expression of SlPAL5 gene is of great significance to elucidate the regulatory mechanism underlying the biosynthesis of phenolic compounds in tomato fruit induced by UV-C irradiation. Here, yeast one-hybrid library of tomato fruit was constructed, and the yeast one-hybrid technology was used to screen the transcription factors that regulate the expression of SlPAL5, the key gene related to the synthesis of phenolic compounds in tomato fruit. As a result, a transcription factor, SlERF7, was obtained and sequenced, followed by the blast homology analysis. Further experiments confirmed that SlERF7 interacted with the promoter of SlPAL5 gene. In addition, UV-C irradiation significantly increased the expression level of SlERF7. These results indicate that SlERF7, which is regulated by UV-C irradiation, might be involved in regulating the transcription of SlPAL5, which provided foundations for further studying the regulation mechanism of the biosynthesis of phenolic compounds in tomato fruit induced by UV-C irradiation.