Trends and Disparities in Stage-Specific Incidence of Hepatocellular Carcinoma among US Adults, 2004-2019.

Introduction: The aim of this study was to determine the stage-specific incidence trend of hepatocellular carcinoma (HCC) among US adults. Methods: The age-adjusted incidence rate was extracted from Surveillance, Epidemiology, and End Results database for localized, regional, and distant HCC. Trend analyses were conducted in the overall population and stratified by demographic and sociodemographic variables. The annual percentage change (APC) in 2014-2019 was estimated to determine the stage-specific incidence trend. Results: Although the incidence of localized HCC significantly declined, the incidence for regional and distant HCC plateaued in 2014-2019 (APCs, 4.4% [95% CI, -0.2% to 9.3%] and -0.7% [95% CI, -1.8% to 0.5%], respectively) with age and race/ethnicity disparities. More pronounced increases for regional and distant HCC were observed among the elderly (APCs, 8.4% [95% CI, 4.8-12.2%] and 2.2% [95% CI, 1.7-2.7%] for regional and distant HCC, respectively), non-Hispanic white individuals (APCs, 4.0% [95% CI, 2.9-5.1%] and 1.5% [95% CI, 0.7-2.4%] for regional and distant HCC, respectively). Conclusions: Disparities in incidence trends may reflect the inequalities in access to primary health care. More efforts are still in great demand for the vulnerable population.

Gamma-Aminobutyric Acid-Producing Levilactobacillus brevis Strains as Probiotics in Litchi Juice Fermentation.

Levilactobacillus brevis strains can be isolated from traditional Chinese pickles and used as the starter cultures to improve the nutritional profiles of fermented juices. Three L. brevis strains (LBG-29, LBG-24, LBD−14) that produce high levels of gamma-aminobutyric acid (GABA; >300 mg/L) were isolated from traditional Chinese pickles. The strains showed tolerance to low pH and high bile salts and exhibited safety in vitro. Litchi juice was fermented using each strain at 37 °C for 48 h. The litchi juice was determined to be a good substrate for fermentation as the process enhanced its functional profile. Overall, cell vitality increased (above 8.7 log10 CFU/mL), the antioxidant activities of 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric ion-reducing antioxidant power (FRAP) were significantly increased, and the antioxidant capacity of the 2,2'-amino-di(3-ethyl-benzothiazoline sulphonic acid-6)ammonium salt (ABTS) was decreased. There was also a significant increase in the GABA and acetic acid content after LBG-29 and LBG-24 fermentation. It was thus determined that the LBG-29 and LBG-24 strains could be used to improve beverage functionality and aid in the development of new products. This is the first report of litchi fermentation using L. brevis as a starter culture. Further research is required to elucidate the functional benefits for the human body and the nutritional and functional properties during its shelf life.

The role of deep learning in urban water management: A critical review.

Deep learning techniques and algorithms are emerging as a disruptive technology with the potential to transform global economies, environments and societies. They have been applied to planning and management problems of urban water systems in general, however, there is lack of a systematic review of the current state of deep learning applications and an examination of potential directions where deep learning can contribute to solving urban water challenges. Here we provide such a review, covering water demand forecasting, leakage and contamination detection, sewer defect assessment, wastewater system state prediction, asset monitoring and urban flooding. We find that the application of deep learning techniques is still at an early stage as most studies used benchmark networks, synthetic data, laboratory or pilot systems to test the performance of deep learning methods with no practical adoption reported. Leakage detection is perhaps at the forefront of receiving practical implementation into day-to-day operation and management of urban water systems, compared with other problems reviewed. Five research challenges, i.e., data privacy, algorithmic development, explainability and trustworthiness, multi-agent systems and digital twins, are identified as key areas to advance the application and implementation of deep learning in urban water management. Future research and application of deep learning systems are expected to drive urban water systems towards high intelligence and autonomy. We hope this review will inspire research and development that can harness the power of deep learning to help achieve sustainable water management and digitalise the water sector across the world.

Effects of genetic and nongenetic factors on hyperuricemia in Chinese patients with coronary artery disease.

Aim: The relationship between hyperuricemia and polymorphisms of transporter genes in coronary artery disease (CAD) patients in China remains unclear. Materials & methods: A total of 258 hyperuricemia patients with CAD and 242 control patients with CAD were recruited in this case-control study. Twenty-four SNPs in genes of ABCG2, PDZK1, URAT1, OAT4, GLUT9, ABCC4, NPT1 and NPT4 were genotyped using direct sequencing in all subjects. Results: The mutation of ABCG2 rs2231142 locus increases the risk of hyperuricemia, and there is a gene dose effect in the influence of mutant heterozygotes and homozygotes. rs3825017 in URAT1 and rs62293298 in GLUT9 were also confirmed to be associated with hyperuricemia. Conclusion: Age, weight, creatinine clearance rate, diuretics and SNPs on ABCG2, URAT1 and GLUT9 were all risk factors of hyperuricemia.

Do Microsurgical Outcomes Differ Based on Which Specialty Does the Operation? A NSQIP Analysis.

BACKGROUND: Because plastic surgeons do not "own" a specific anatomic region, other surgical specialties have increasingly assumed procedures historically performed by plastic surgery. Decreased case volume is postulated to be associated with higher complication rates. Herein, we investigate whether volume and surgical specialty have an impact on microsurgical complications, specifically surgical site infection (SSI) and reoperation rates. METHODS: The 2005-2015 National Surgical Quality Improvement Program participant use file was queried by Current Procedural Terminology code for breast and head/neck microsurgeries. Multivariate logistic regression was performed to compare the outcomes between surgical specialties. A cumulative frequency variable was introduced to investigate the effect of case volume on complication rates. RESULTS: We captured 6,617 microsurgical cases. Multivariate logistic regression revealed that although the rate of SSI was lower in plastic surgery compared with otolaryngology for head and neck reconstructions (13.3% versus 10.5%) and compared with general surgery for breast reconstructions (5.4% versus 4.7%), there was no significant difference between specialties (P = 0.13; P = 0.96). Increased case volume is negatively correlated with complications. CONCLUSIONS: Plastic surgery is at risk given case cannibalization by other specialties. We conclude that surgical specialty does not affect the rates of SSI and reoperation. We demonstrate a correlation between lower volumes and increased complications, implying that, once a specialty has amassed critical case experience, complication rates may decrease, and outcomes can be equivalent or superior. Case breadth and volumes should be maintained to preserve skills, optimize outcomes, and maintain the specialty as it currently exists.

High-Risk Plastic Surgery: An Analysis of 108,303 Cases From the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

BACKGROUND: There is a lack of large-scale data that examine complications in plastic surgery. A description of baseline rates and patient outcomes allows better understanding of ways to improve patient care and cost-savings for health systems. Herein, we determine the most frequent complications in plastic surgery, identify procedures with high complication rates, and examine predictive risk factors. METHODS: A retrospective analysis of the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Program plastic surgery data set was conducted. Complication rates were calculated for the entire cohort and each procedure therein. Microsurgical procedures were analyzed as a subgroup, where multivariate logistic regression models determined the risk factors for surgical site infection (SSI) and related reoperation. RESULTS: We identified 108 303 patients undergoing a plastic surgery procedure of which 6 264 (5.78%) experienced ≥1 complication. The outcome with the highest incidence was related reoperation (3.31%), followed by SSI (3.11%). Microsurgical cases comprised 6 148 (5.68%) of all cases, and 1211 (19.33%) experienced ≥1 complication. Similar to the entire cohort, the related reoperation (12.83%) and SSI (5.66%) were common complications. Increased operative time was a common independent risk factor predictive of a related reoperation or development of an SSI (P < 001). Of all microsurgeries, 23.3% had an operative time larger than 10 hours which lead to faster increase in reoperation likelihood. CONCLUSIONS: The complication rate in plastic surgery remains relatively low but is significantly increased for microsurgery. Increased operative time is a common risk factor. Two-team approaches and staged operations could be explored, as a large portion of microsurgeries are vulnerable to increased complications.

HISTORIQUE: Les données à grande échelle sur les complications de la chirurgie plastique font défaut. Une description des taux de référence et des résultats cliniques des patients permettrait de mieux déterminer comment améliorer les soins aux patients et réaliser des économies dans les systèmes de santé. Dans le présent article, les chercheurs recensent les complications les plus fréquentes en chirurgie plastique, dégagent les interventions aux taux de complication élevés et examinent les facteurs de risque prédictifs. MÉTHODOLOGIE: Les chercheurs ont réalisé une analyse rétrospective des données de chirurgie plastique tirées du programme national d'amélioration de la qualité chirurgicale de l'American College of Surgeons entre 2012 et 2016. Ils ont calculé les taux de complications de toute la cohorte et de chaque intervention recensée. Ils ont analysé les interventions microchirurgicales en sous-groupe, où ils ont utilisé des modèles de régression logistique multivariée pour déterminer les facteurs de risque d'infection des plaies opératoires (IPO) et de réopérations s'y rapportant. RÉSULTATS: Les chercheurs ont dénombré 108 303 patients qui avaient subi une intervention en chirurgie plastique, dont 6 264 (5,78 %) avaient souffert d'au moins une complication. Les réopérations (3,31 %), suivies des IPO (3,11 %) étaient les résultats à la plus forte incidence. Les cas de microchirurgie représentaient 6 148 (5,68 %) de toutes les occurrences, et 1211 (19,33 %) ont souffert d'au moins une complication. Tout comme dans l'ensemble de la cohorte, les réopérations (12,83 %) et les IPO (5,66 %) étaient des complications courantes. La plus longue durée de l'opération était un facteur de risque indépendant fréquent, prédicteur d'une réopération ou d'une IPO (p<0,001). Ainsi, 23,3 % des microchirurgies duraient plus de dix heures, ce qui s'associait à une plus forte augmentation du risque de réopération. CONCLUSIONS: Le taux de complications demeure relativement faible en chirurgie plastique, mais est significativement plus élevé en microchirurgie. La longue durée des opérations représente un facteur de risque courant. On pourrait explorer les approches à deux équipes et les opérations échelonnées, car une forte proportion des microchirurgies sont vulnérables à un accroissement des complications.

Pediatric Autoimmune Encephalitis: Case Series From Two Chinese Tertiary Pediatric Neurology Centers.

Background and purpose: We retrospectively analyzed the clinical characteristics of children with autoimmune encephalitis (AE) in two Chinese tertiary pediatric neurology centers. We also compared anti-NMDAR encephalitis with and without co-positive MOG antibody, as well as specific autoantibody-positive AE and autoantibody-negative but probable AE. Methods: A retrospective study of children (0-18 years old) with AE in Peking University First Hospital and Children's Hospital Affiliated to Capital Institute of Pediatrics was carried out from May 2012 to January 2017. Demographics, clinical features, laboratory, and imaging findings, outcome, and co-positivity with MOG antibody were analyzed. Results: A total of 103 children had AE, 89 (86.4%) had anti-NMDAR encephalitis, 2 (1.9%) had anti-LGI1 encephalitis, 1 (0.9%) had anti-CASPR2 encephalitis, and 11 (10.7%) were diagnosed as autoantibody-negative but probable AE. Among the 89 children with anti-NMDAR encephalitis, 35 were males and 54 were females. The follow-up time was 1-3 years. A total of 15 cases (15/89, 16.9%) with anti-NMDAR encephalitis had co-positive MOG antibody (serum or cerebrospinal fluid or both). These patients were more likely to experience relapse later in life (P = 0.014). We had two cases with anti-LGI1 encephalitis, that is, one with sleep disorder onset, and the other one with seizure onset, both of whom recovered after treatment. One case with anti-CASPR2 encephalitis was treated with an antiepileptic drug and fully recovered. There were 11 cases diagnosed as autoantibody-negative but probable AE who had relatively poorer outcome than those with autoantibody-positive AE (15.2%, 14/89). However, the difference was not significant (P = 0.08). Only one 12-year-old girl with NMDAR-antibody AE had ovarian teratoma. Conclusion: Most subjects with AE in our Chinese cohort had anti-NMDAR AE, which had relatively good prognosis. Children with anti-LGI1 or anti-CASPR2 encephalitis were rare and showed good response on immunotherapy. Co-positive MOG antibody was relatively common in anti-NMDAR encephalitis, which was related to high relapse rate. In our study, the prognosis of autoantibody-negative but probable AE seemed worse than that of specific autoantibody-positive AE.

Follow-up study on Chinese children with relapsing MOG-IgG-associated central nervous system demyelination.

BACKGROUND: Some studies have reported clinical features of relapsing MOG-IgG-associated CNS demyelination principally in Caucasians children. It is not clear whether Chinese children share the same phenotype. OBJECTIVE: To delineate the clinical characteristics in Chinese children with relapsing MOG-IgG-associated demyelination. METHODS: A follow-up study on 23 Children with relapsing MOG-IgG-associated demyelination from two Chinese tertiary hospitals was performed. Phenotypic features at each demyelinating attacks, neuroimaging characteristics, autoimmune antibodies in CSF/serum, response to disease modifying drugs and functional deficits during the disease course were analyzed. RESULTS: The median age at disease onset was 5.38 (2.33-12.75) years. The male to female ratio was 1:1.30. The disease duration was 2.33(1.00-8.92) years at the last follow-up. (1) Clinical phenotypes: ADEM was the most common initial presentation (12/23, 52.17%). In 82 attacks during disease course, ADEM was also the most common phenotype (30/82, 36.59%), followed by ON (24/82, 29.27%). (2) Imaging findings: 57/70 (81.43%) brain MRI scans during acute attacks showed new lesions. The most common location of new lesions in brain was the juxtacortical white matter (45/57, 78.95%). In 46 brain MRI scans with supratentorial white matter lesions, ADEM-like patterns were most common (25/46, 54.35%), and 5/46 (10.87%) scans exhibited leukodystrophy-like patterns. (3) Laboratory examinations: Anti-NMDA receptor IgG in CSF was detected in two patients (2/12, 16.67%), with one patient presented with anti-NMDAR encephalitis associated symptoms. (4) Therapeutic responses and outcomes: In 19 patients treated with disease-modifying drugs (including rituximab, mycophenolate mofetil, azathioprine and so on) longer than 6 months, median annualised relapse rates decreased from 1.71 before treatment to 0.44 during treatment (P < 0.05), with eleven patients (11/19, 57.89%) having no relapses. Median EDSS score at the last follow-up was 1.0(0-3.5). Visual dysfunction (12/23, 52.17%) was the most common neurological sequela, with cognitive dysfunction and epilepsy in some of patients. CONCLUSIONS: The phenotypic features of Chinese children with relapsing MOG-IgG-associated CNS demyelination were similar to that in Caucasian children. ADEM was the most common phenotype in all demyelinating attacks, followed by ON. Cerebral lesions were common and extensive, manifested as ADEM-like or even leukodystrophy-like patterns. Visual dysfunction was the most common neurological sequela. Although some disease-modifying drugs could reduce ARR, optimal treatment needs future study.

Quantum Effects Allow the Construction of Two-Dimensional Co3 O4 -Embedded Nitrogen-Doped Porous Carbon Nanosheet Arrays from Bimetallic MOFs as Bifunctional Oxygen Electrocatalysts.

In terms of promising candidates for high-performance fuel cells and water splitting electrocatalysts, two-dimensional (2D) materials refer to a class of materials with high electrical conductivity along 2D conducting channels and possessing abundant active sites in the form of surface atoms and edge sites. Herein, we report an ammonia-modulated method for the synthesis of nanosized bimetallic ZnCo-ZIF, and owing to quantum effects, the nanosized ZnCo-ZIF can be transformed into novel 2D nanosheet arrays, which can be used as a bifunctional electrocatalyst. The size of the ZnCo-ZIF crystals can be controlled to less than 10 nm by increasing the ammonia amount. The products from the nanosized particles through calcination have a distinct structure from the microsized nanoparticles owing to quantum effects and appear to be well-aligned 2D mono-crystalline Co3 O4 -embedded nitrogen-doped porous carbon nanosheet arrays (2D-MCo3 O4 -NCNAs). These novel 2D nanosheet arrays lead to large active surface areas, enhanced mass/charge transport capability, numerous active sites, and strong structure stability. When used as bifunctional catalysts for oxygen reduction reaction (ORR) and oxygen evolution reaction (OER), the 2D-MCo3 O4 -NCNAs exhibit superior ORR activity as well as efficient OER activity in alkaline electrolyte, in comparison to the state-of-the-art precious metal catalysts.

Fed-batch strategy for enhancing cell growth and C-phycocyanin production of Arthrospira (Spirulina) platensis under phototrophic cultivation.

The C-phycocyanin generated in blue-green algae Arthrospira platensis is gaining commercial interest due to its nutrition and healthcare value. In this study, the light intensity and initial biomass concentration were manipulated to improve cell growth and C-phycocyanin production of A.platensis in batch cultivation. The results show that low light intensity and high initial biomass concentration led to increased C-phycocyanin accumulation. The best C-phycocyanin productivity occurred when light intensity and initial biomass concentration were 300µmol/m(2)/s and 0.24g/L, respectively. The fed-batch cultivation proved to be an effective strategy to further enhance C-phycocyanin production of A.platensis. The results indicate that C-phycocyanin accumulation not only requires nitrogen-sufficient condition, but also needs other nutrients. The highest C-phycocyanin content (16.1%), production (1034mg/L) and productivity (94.8mg/L/d) were obtained when using fed-batch strategy with 5mM medium feeding.

[Hot spot mutation screening of RYR1 gene in diagnosis of congenital myopathies].

OBJECTIVE: To detect hot spot mutation of RYR1 gene in 15 cases of congenital myopathy with different subtypes, and to discuss the value of RYR1 gene hot spot mutation detection in the diagnosis of the disease. METHODS: Clinical data were collected in all the patients, including clinical manifestations and signs, serum creatine kinase, electromyography. Fourteen of the patients accepted the muscle biopsy. Hot spot mutation in the C-terminal of RYR1 gene (extron 96-106) had been detected in all the 15 patients. RESULTS: All the patients presented with motor development delay, and they could walk at the age of 1 to 3.5 years,but were always easy to fall and could not run or jump. There were no progressive deteriorations. Physical examination showed different degrees of muscle weakness and hypotonia.High arched palates were noted in 3 patients. The serum levels of creatine kinase were mildly elevated in 3 cases, and normal in 12 cases. Electromyography showed "myogenic" features in 11 patients, being normal in the other 4 patients. Muscle biopsy pathologic diagnosis was the central core disease in 3 patients, the central nuclei in 2 patients, the congenital fiber type disproportion in 2 patients, the nameline myopathy in 3 patient, the multiminicore disease in 1 patient, and nonspecific minimal changes in the other 3 patients; one patient was diagnosed with central core disease according to positive family history and gene mutation. In the family case (Patient 2) of central core disease, the c.14678G>A (p.Arg4893Gln) mutation in 102 extron of RYR1 was identified in three members of the family, which had been reported to be a pathogenic mutation. The c.14596A>G(p.Lys4866Gln) mutation in 101 extron was found in one patient with central core disease(Patient 1), and the c.14719G>A(p.Gly4907Ser) mutation in 102 extron was found in another case of the central core disease(Patient 3).The same novel mutation was verified in one of the patients' (Patient 3) asymptomatic father. CONCLUSION: Congenital myopathies in the different subtype have the similar clinical manifestations, signs, enzyme detection and electromyography changes. Muscle biopsy plays an important role in the selection of genes to be detected. Hot spot mutation in C-terminal of the RYR1 gene can only be identified in patients with central core disease, so we suggest this hot spot gene mutation screening apply to the suspicious patient with central core disease only.

Clinical features and ryanodine receptor type 1 gene mutation analysis in a Chinese family with central core disease.

Central core disease is a rare inherited neuromuscular disorder caused by mutations in ryanodine receptor type 1 gene. The clinical phenotype of the disease is highly variable. We report a Chinese pedigree with central core disease confirmed by the gene sequencing. All 3 patients in the family presented with mild proximal limb weakness. The serum level of creatine kinase was normal, and electromyography suggested myogenic changes. The histologic analysis of muscle biopsy showed identical central core lesions in almost all of the muscle fibers in the index case. Exon 90-106 in the C-terminal domain of the ryanodine receptor type 1 gene was amplified using polymerase chain reaction. One heterozygous missense mutation G14678A (Arg4893Gln) in exon 102 was identified in all 3 patients. This is the first report of a familial case of central core disease confirmed by molecular study in mainland China.

[The laboratorial study about relation of balance between trestle and cervical spine of cervical type spondylosis patients].

When 85 cervical type spondylosis patients randomly lay on one's back and on one's right side the 8 different tresles and pillows. We survey indexes of the cervical spine anatomy, for example cervical arcs and angles of cervical spine and level line. We appraise relation of balance between different trestle or pillow and cervical spine. liquid needle-free injection, jet power, stagnation pressure