Synergistic Engineering of Energy Band Alignment and Interfacial Electric Field Distribution over Bi-bismuth-Based Hetero-nanofibers for Boosting Visible-Light-Driven Photocatalytic Ammonia Synthesis and Antibiotic Removal.

Synergistic engineering of energy band alignment and interfacial electric field distribution is essential for photocatalyst design but is still challenging because of the limitation on refined regulation in the nanoscale. This study addresses the issue by employing surface modification and thermal-induced phase transformation in Bi2MoO6/BixOyIz hetero-nanofiber frameworks. The energy band alignment switches from a type-II interface to a Z-scheme contact with stronger redox potentials and inhibited electron traps, and the optimized built-in electric field distribution could be reached based on experimental and theoretical investigations. The engineered hetero-nanofibers exhibit outstanding visible-light-driven photocatalytic nitrogen reduction activity (605 µmol/g/h) and tetracycline hydrochloride removal rate (81.5% within 30 min), ranking them among the top-performing bismuth series materials. Furthermore, the photocatalysts show promise in activating advanced oxidants for efficient organic pollutant degradation. Moreover, the Bi2MoO6/Bi5O7I hetero-nanofibers possess good recycling stability owing to their three-dimensional network structure. This research offers valuable insights into heterojunction design for environmental remediation and industrial applications.

Rate and management of tympanic membrane perforations in children with Down syndrome and middle ear disorder.

OBJECTIVE: To characterize the management and outcomes of observation versus surgical intervention of tympanic membrane (TM) perforations in children with Down syndrome (DS). In addition, to estimate the prevalence of TM perforations in children with DS. METHODS: Retrospective case review analysis of TM perforation rate in children with DS with history of tympanostomy tube (TT) insertion at a tertiary pediatric referral center. Patients were divided into observation or surgical intervention groups and then further evaluated for the type of intervention, the number of required procedures, and success rate of hearing improvement. Risk factors contributing to perforations were analyzed, including TT type, number of TT surgeries, and perforation size. RESULTS: The TM perforation rate in children with DS with TT history was 7.0 %. Tympanoplasty was performed in 41.5 % of perforated ears with a success rate of 53.1 %. There was no statistical difference between the surgical intervention and observation groups regarding perforation characteristics or TT number and type, but the surgical intervention cohort was older. Hearing improvement based on postoperative pure tone average (PTA) threshold was noted in the successful surgical intervention group. CONCLUSION: The rate of TM perforations in children with DS after TTs is comparable to the general population. Improved PTA thresholds were noted in the surgical success group influencing speech development. The overall lower success rate of tympanoplasty in patients with DS emphasizes the need to factor in the timing of surgical intervention based on the predicted age of Eustachian tube maturation.

Precision Identification of Locally Advanced Rectal Cancer in Denoised CT Scans Using EfficientNet and Voting System Algorithms.

BACKGROUND AND OBJECTIVE: Local advanced rectal cancer (LARC) poses significant treatment challenges due to its location and high recurrence rates. Accurate early detection is vital for treatment planning. With magnetic resonance imaging (MRI) being resource-intensive, this study explores using artificial intelligence (AI) to interpret computed tomography (CT) scans as an alternative, providing a quicker, more accessible diagnostic tool for LARC. METHODS: In this retrospective study, CT images of 1070 T3-4 rectal cancer patients from 2010 to 2022 were analyzed. AI models, trained on 739 cases, were validated using two test sets of 134 and 197 cases. By utilizing techniques such as nonlocal mean filtering, dynamic histogram equalization, and the EfficientNetB0 algorithm, we identified images featuring characteristics of a positive circumferential resection margin (CRM) for the diagnosis of locally advanced rectal cancer (LARC). Importantly, this study employs an innovative approach by using both hard and soft voting systems in the second stage to ascertain the LARC status of cases, thus emphasizing the novelty of the soft voting system for improved case identification accuracy. The local recurrence rates and overall survival of the cases predicted by our model were assessed to underscore its clinical value. RESULTS: The AI model exhibited high accuracy in identifying CRM-positive images, achieving an area under the curve (AUC) of 0.89 in the first test set and 0.86 in the second. In a patient-based analysis, the model reached AUCs of 0.84 and 0.79 using a hard voting system. Employing a soft voting system, the model attained AUCs of 0.93 and 0.88, respectively. Notably, AI-identified LARC cases exhibited a significantly higher five-year local recurrence rate and displayed a trend towards increased mortality across various thresholds. Furthermore, the model's capability to predict adverse clinical outcomes was superior to those of traditional assessments. CONCLUSION: AI can precisely identify CRM-positive LARC cases from CT images, signaling an increased local recurrence and mortality rate. Our study presents a swifter and more reliable method for detecting LARC compared to traditional CT or MRI techniques.

Submicron-Thickness Ultraflexible Organic Light-Emitting Diodes via a Photoregulated Stripping Strategy.

With the rapid advances in imperceptible and epidermal electronics, the research on ultraflexible organic light-emitting diodes (OLEDs) has become increasingly significant, owing to their excellent flexibility and conformability to the human body. It is highly desirable to develop submicrometer-thick ultraflexible OLEDs to enable the devices to seamlessly conform to the surface of arbitrary-shaped objects and still function properly. However, it remains a huge challenge for currently reported OLEDs due to the lack of an appropriate stripping strategy. Here, for the first time, we develop a facile photoregulated stripping strategy for the fabrication of high-performance ultraflexible OLEDs with submicron thickness. Under ultraviolet (UV) irradiation, the surface adhesion force of the ultrathin photopolymer membrane can be adjusted from 16.9 to 5.1 N/m, thereby effectively controlling the laminating and detaching process. Based on this strategy, the resultant device thickness is as low as 0.821 µm, which is the lowest record among flexible OLEDs reported to date. More remarkably, excellent electrical properties with a maximum current efficiency (CE) of 62.5 cd/A, an external quantum efficiency (EQE) of 17.8%, and a low turn-on voltage of 2.5 V are realized, which are superior to almost all of the reported ultraflexible OLEDs with thicknesses below 10 µm. Based on versatile ultraflexible OLEDs, all-organic and skin-mounted displays are successfully realized by employing a conformable organic thin-film transistor (OTFT) as the driver. This work offers a feasible strategy for advancing OLEDs from flexible to ultraflexible, showing significant application potential in future epidermal electronics and conformal displays.

Sleep Duration and Kidney Function - Does Weekend Sleep Matter?

Objective: Weekend sleep duration is linked to health issues, including mortality. However, how weekend sleep duration can impact chronic kidney disease (CKD) still needs to be understood. Therefore, we aimed to analyze how weekend sleep duration is associated with kidney function. Methods: This is a cross-sectional study. Data were obtained from the 2017-2018 National Health and Nutrition Examination Survey. We included 5362 study participants and categorized them into nine subgroups by sleep duration (short: ≤6 hours, normal: 6-9 hours, and long: ≥9 hours) on weekdays and weekends and analyzed for the respective association with renal function using stratified multivariable linear regression. Results: Weekend sleep duration for 9 hours or more was associated with decreasing estimated glomerular filtration rate (eGFR) levels by 2.8 to 6.4 mL/min/1.73 m2 among people with long to short weekday sleep duration compared with short weekday and weekend sleep durations (control group) after adjusting for demographic characteristics, body measurement, sleep quality, smoking, and comorbidities. The study population with short weekday sleep duration (sWK) and long weekend sleep duration (lWD) had the most significant decline in eGFR. For the study population with sWK, eGFR level significantly decreased by 1.1 mL/min/1.73 m2 as sleep duration on weekends increased by one hour. Conclusion: The underlying mediators of lWD and CKD could be the dysregulation of human behaviors, metabolism, or biological functions. Longer weekend sleep duration was linked to a decrease in eGFR levels. It warrants further study to clarify the mediators.

Transfer-Printing of Insoluble Conducting Polymer for Soft 3D Conformal All-Organic Transistors.

The development of high-precision insoluble conducting polymer patterns for soft electronics is extremely challenging, mainly because of the incompatibility of the synthesis process with the underlying layers. In this study, a novel transfer-printing method is designed that enables the fabrication of photolithographic insoluble conducting polypyrrole (PPy) electrode patterns on soft substrates with high precision, demonstrating compatibility with various soft organic functional layers. Excellent mechanical stability, good biocompatibility, ultra-smooth surface, and outstanding conformability are observed. The photolithographic PPy electrode patterns, combined with an elastic organic semiconductor and dielectric, produce conformal all-organic transistors with mobility of 1.8 cm2 V-1 s-1 . This study paves the way to use insoluble conducting polymers to develop complex, high-density flexible patterns and offers a promising organic electrode for the new-generation soft all-organic electronics.

Clinical outcomes of cetuximab-based treatment for distant metastatic head and neck squamous cell carcinoma: A real-world study using Taiwan Head Neck Society registry database.

BACKGROUND: For R/M HNSCC, the differences in prognosis and treatment options between distant metastasis (DM) and locoregional recurrence, especially in the DM group, remain unclear. METHODS: From the Taiwan Head Neck Society registry database, patients who were diagnosed with R/M HNSCC and received cetuximab-based frontline therapy were collected for analysis. RESULTS: Among the enrolled patients, 59.3% (491/827) belonged to the DM group. The DM group had less primary site of oral cavity, less betel nut chewing, higher lactate dehydrogenase (LDH) levels, and higher LDH/albumin ratio compared with the non-DM group. For the patients with primary site of oral cavity and current smokers, DM coexisted with poorer outcomes. In the DM group, EXTREME-like regimen was more suitable for older patients, those with elevated LDH, and those with higher LDH/albumin ratio than TPExtreme-like regimen. CONCLUSION: DM coexisted with poorer prognosis in certain groups. LDH-associated biomarkers may aid treatment options for DM patients.

A surface strategy boosting the ethylene selectivity for CO2 reduction and in situ mechanistic insights.

Electrochemical reduction of carbon dioxide into ethylene, as opposed to traditional industrial methods, represents a more environmentally friendly and promising technical approach. However, achieving high activity of ethylene remains a huge challenge due to the numerous possible reaction pathways. Here, we construct a hierarchical nanoelectrode composed of CuO treated with dodecanethiol to achieve elevated ethylene activity with a Faradaic efficiency reaching 79.5%. Through on in situ investigations, it is observed that dodecanethiol modification not only facilitates CO2 transfer and enhances *CO coverage on the catalyst surfaces, but also stabilizes Cu(100) facet. Density functional theory calculations of activation energy barriers of the asymmetrical C-C coupling between *CO and *CHO further support that the greatly increased selectivity of ethylene is attributed to the thiol-stabilized Cu(100). Our findings not only provide an effective strategy to design and construct Cu-based catalysts for highly selective CO2 to ethylene, but also offer deep insights into the mechanism of CO2 to ethylene.

General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy.

Introduction: Postoperative pain and complications pose significant challenges following a hemorrhoidectomy. Attaining effective anesthesia with minimal complications is crucial. The ideal anesthesia method for ambulatory hemorrhoidectomy remains uncertain. This study aimed to investigate whether the combination of general anesthesia plus local infiltration (GAL) is associated with lower complications and reduced pain compared to spinal anesthesia (SA) in the context of hemorrhoidectomy. Methods: This retrospective single-center cohort study, conducted in a tertiary medical center in East Asia, evaluated excisional hemorrhoidectomies performed between January 1, 2017, and March 31, 2023, utilizing GAL or SA. Data on the six most common complications-pain, constipation, acute urine retention (AUR), bleeding, nausea, and headache-were extracted from medical records. A total of 550 hemorrhoidectomies were included: 220 in the GAL group and 330 in the SA group. Patient characteristics were comparable between the two groups. Results: The AUR rate was significantly lower in the GAL group compared to the SA group (15.5% vs. 32.1%, P < 0.001). Although the proportion of pain scores ≥4 did not differ significantly between the GAL and SA groups (36.2% vs. 39.8%, P = 0.429), the pain score curve indicated a stable trend. Overall, the GAL group exhibited a lower rate of adverse effects (56.9% vs. 67.4%, P = 0.023). There were no significant differences in the rates of other complications and emergency department readmission between the GAL and SA groups. Discussion: GAL emerges as a favorable choice for anesthesia in hemorrhoidectomy, demonstrating a lower incidence of urine retention and a prolonged analgesic effect in multiple hemorrhoidectomies. These findings support the conclusion that GAL represents an optimal anesthetic method for enhancing the postoperative experience in patients undergoing hemorrhoidectomy.

Dielectric Design of High Dielectric Constant Poly(Urea-Urethane) Elastomer for Low-Voltage High-Mobility Intrinsically Stretchable All-Solution-Processed Organic Transistors.

Stretchable organic transistors for skin-like biomedical applications require low-voltage operation to accommodate limited power supply and safe concerns. However, most of the currently reported stretchable organic transistors operate at relatively high voltages. Decreasing their operational voltage while keeping the high mobility still remains a key challenge. Here, the study presents a new dielectric design to achieve high-dielectric constant poly(urea-urethane) (PUU) elastomer, by incorporating a flexible small-molecular diamine crosslinking agent 4-aminophenyl disulfide (APDS) into the main chain of (poly (propylene glycol), tolylene 2,4-diiso-cyanate terminated) (PPG-TDI). Compared with commercial elastomers, the PUU elastomer as dielectric of the stretchable organic transistors shows the outstanding advantages including lower surface roughness (0.33 nm), higher adhesion (45.18 nN), higher dielectric constant (13.5), as well as higher stretchability (896%). The PUU dielectric enables the intrinsically stretchable, all-solution-processed organic transistor to operate at a low operational voltage down to -10 V, while preserving a substantial mobility of 1.39 cm2  V-1  s-1 . Impressively, the transistor also demonstrates excellent electrical stability under repeated switching of 10 000 cycles, and remarkable mechanical robustness when stretched up to 100%. The work opens up a new molecular engineering strategy to successfully realize low-voltage high-mobility stretchable all-solution-processed organic transistors.

Oleanolic acid alleviate intestinal inflammation by inhibiting Takeda G-coupled protein receptor (TGR) 5 mediated cell apoptosis.

Oleanolic acid (OA) is a bioactive compound present in plant-based foods known for its beneficial impact on gastrointestinal health, specifically in alleviating diarrhea. Nonetheless, the underlying mechanisms by which OA mitigates gut epithelial damage have yet to be elucidated. In this study, OA significantly markedly ameliorated adverse effects induced by Dextran Sulfate Sodium (DSS), including weight loss and epithelial morphological damage in a murine model. Remarkably, compared to normal mice, standalone administration of OA had no discernible impact on the animals. Concurrently, we identified a significant up-regulation in the expression levels of TGR5 and BAX in the intestines of DSS-exposed mice, coupled with a decline in Bcl2 expression. Correlation analyses revealed a robust association between TGR5 and BAX expression. Oral administration of OA efficaciously counteracted these alterations. To probe the role of TGR5 in cellular apoptosis, further, a lentivirus transfection approach was utilized to induce TGR5 overexpression in intestinal epithelial cells (IPEC-J2). RNA sequencing indicated that TGR5 overexpression significantly influenced biological processes, particularly in modulating cellular activation and intercellular adhesion, in contrast to the control group cells. Functional assays substantiated that TGR5 overexpression compromised cell viability and accelerated apoptosis. Notably, OA treatment in TGR5-overexpressed cells restored cell viability, suppressed TGR5 and BAX expression, and augmented Bcl2 expression. In sum, our data suggest that OA mitigates intestinal epithelial apoptosis and bolsters cellular proliferation by downregulating TGR5. This research provides valuable insights into the prospective utility of OA as a functional food supplement or adjunctive therapeutic agent for enhancing gastrointestinal health.

Bile Acid Metabolic Profiles and Their Correlation with Intestinal Epithelial Cell Proliferation and Barrier Integrity in Suckling Piglets.

Bile acids (BAs) are crucial for maintaining intestinal epithelial homeostasis. However, the metabolic changes in BAs and the communication between intestinal epithelial cells (IECs) in infants after birth remain unclear. This study aims to elucidate the BA profiles of newborn piglets (NPs) and suckling piglets (SPs), and to investigate their regulatory effects on IEC proliferation and barrier integrity, as well as the potential underlying mechanisms. In this study, compared with NPs, there were significant increases in serum triglycerides, total cholesterol, glucose, and albumin levels for SPs. The total serum BA content in SPs exhibited an obvious increase. Moreover, the expression of BA synthase cytochrome P450 27A1 (CYP27A1) was increased, and the ileal BA receptor Takeda G-coupled protein receptor 5 (TGR5) and proliferation marker Ki-67 were upregulated and showed a strong positive correlation through a Spearman correlation analysis, whereas the expression of farnesoid X receptor (FXR) and occludin was markedly downregulated in SPs and also revealed a strong positive correlation. These findings indicate that the increased synthesis and metabolism of BAs may upregulate TGR5 and downregulate FXR to promote IEC proliferation and influence barrier function; this offers a fresh perspective and evidence for the role of BAs and BA receptors in regulating intestinal development in neonatal pigs.

Novel intertypic recombination of Echovirus 11 in the Enterovirus species B.

Enteroviruses (EVs), single-stranded, positive-sense RNA viruses, can be classified into four species (A-D), which have previously been linked to a diverse range of disease manifestations and infections affecting the central nervous system. In the Enterovirus species B (EV-B), Echovirus type 11 (E11) has been observed to occasionally circulate in Taiwan, which was responsible for an epidemic of enterovirus infections in 2018. Here, 48 clinical specimens isolated in 2003, 2004, 2009, and 2018 were collected for the high-throughput sequencing. Notably, we identified 2018 Taiwanese strains having potential recombinations in the 3D gene, as well as one 2003 strain having a double recombination with E6 and Coxsackievirus B5 in the P2 and P3 regions, respectively. Additionally, one amino acid signature mutated from the Histidine (H) in throat swab specimens to the Tyrosine (Y) in cerebral spinal fluid specimens was detected at position 1496 (or 57) of the genomic coordinate (or 3A gene) to further demonstrate intra-host evolution in different organs. In conclusion, this study identifies potential intertypic recombination events and an intra-host signature mutation in E11 strains, isolated during a 2018 neurological disease outbreak in Taiwan, contributing to our understanding of its evolution and pathogenesis.

Ti3C2Tx MXene- and Sulfuric Acid-Treated Double-Network Hydrogel with Ultralow Conductive Filler Content for Stretchable Electromagnetic Interference Shielding.

Hydrogels are emerging as stretchable electromagnetic interference (EMI) shielding materials because of their tissue-like mechanical properties and water-rich porous cellular structures. However, achieving high-performance hydrogel shields remains a challenge because enhancing conductivity often results in a compromise in deformation adoptability. This work proposes a treatment strategy involving sulfuric acid/titanium carbide MXene, which can simultaneously enhance the conductivity and stretchability of poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS)/poly(vinyl alcohol) (PVA) double-network hydrogels. Multiple spectroscopic characterizations reveal that sulfuric acid promotes the linear conformation transition of the PEDOT molecular chain, while MXene increases charge delocalization and hydrogen bond cross-linking sites. The hydrogels, synthesized with a combined content of 0.6 wt % of MXene and PEDOT:PSS, exhibit an average X-band EMI SE of 41 dB. This performance is sustained at 94.5%, even following stretching and release at a strain of 200%. Interestingly, the EMI SE is found to linearly increase, reaching a value of 99 dB as the frequency is increased to 26.5 GHz. This increase is attributed to the enhanced water molecular polarization process, as supported by theoretical calculations of the impedance and attenuation constant. This work introduces a post-treatment technique that optimizes double-network hydrogels, providing deep insights into their EMI shielding mechanism and enabling high-performance EMI shielding with an ultralow conductive filler content.

Low-Dimensional-Materials-Based Photodetectors for Next-Generation Polarized Detection and Imaging.

The vector characteristics of light and the vectorial transformations during its transmission lay a foundation for polarized photodetection of objects, which broadens the applications of related detectors in complex environments. With the breakthrough of low-dimensional materials (LDMs) in optics and electronics over the past few years, the combination of these novel LDMs and traditional working modes is expected to bring new development opportunities in this field. Here, the state-of-the-art progress of LDMs, as polarization-sensitive components in polarized photodetection and even the imaging, is the main focus, with emphasis on the relationship between traditional working principle of polarized photodetectors (PPs) and photoresponse mechanisms of LDMs. Particularly, from the view of constitutive equations, the existing works are reorganized, reclassified, and reviewed. Perspectives on the opportunities and challenges are also discussed. It is hoped that this work can provide a more general overview in the use of LDMs in this field, sorting out the way of related devices for "more than Moore" or even the "beyond Moore" research.

Photolithographic Rugged Electrode for High-Density Low-Contact-Resistance Coplanar Organic Transistors.

The realization of high-performance photolithographic coplanar organic thin film transistors (OTFTs) is fundamental to boost cosmically commercial applications of organic electronics. However, photolithographic coplanar OTFTs generally suffer from poor charge injection and therefore poor filed-effect performance. Here, a simple and effective strategy is developed to fabricate photolithographic rugged electrodes, and successfully achieve high-density low-contact-resistance photolithographic coplanar OTFTs. Based on this versatile electrode, the wafer-scale photolithographic rugged electrode can be easily achieved, and the device density of the coplanar OTFTs is as high as 28000 cm-2 . The device shows excellent electrical properties with mobility up to 2.01 cm2  V-1  s-1 and Rc as low as 7.8 kΩ cm, which is superior to all the reported Ag-electrode coplanar OTFTs. This work shows a reliable strategy to reduce the contact resistance of photolithographic coplanar OTFTs and elucidates the effect of injection resistance (Rinj ) and access resistance (Racc ) on coplanar OTFTs.

Association Between Maternal Mood Disorders and Schizophrenia and the Risk of Type 1 Diabetes in Offspring: A Nationwide Cohort Study.

Objective: Our study aimed to determine whether mothers with bipolar disorder, major depressive disorder, schizophrenia, or schizoaffective disorder affected the risk of type 1 diabetes (T1D) in their offspring. Methods: We conducted a nationwide cohort study by using data from Taiwan's National Health Insurance Research Database and the Maternal and Child Health Database from 2004 to 2018. A total of 2,556,640 mother-child pairs were identified. Cox proportional hazards models were used to compare the risk of T1D between children born to mothers with mood disorders and schizophrenia and those without. Results: No significant difference in risk of T1D was observed between the offspring of mothers with major psychiatric disorders and those without (adjusted hazard ratio (aHR) of 0.86 with a 95% confidence interval (CI) of 0.58-1.24). In subgroup analysis, we found an aHR of 1.81 with a 95% CI of 0.83-3.82 in the maternal bipolar disorder on the risk of T1D in offspring and an aHR of 0.87 (95% CI: 0.59-1.25) in maternal major depressive disorder. In the schizophrenia/schizoaffective disorder group, aHR cannot be obtained due to lesser than three events in the analysis. Conclusion: The risk of T1D in offspring of mothers with mood disorders and schizophrenia was not significant. However, children born to mothers with bipolar disorder may have a tendency to develop T1D. The relationship between maternal psychiatric disorders and the risk of T1D in offspring warrants further investigation in studies with longer follow-up periods.

Dietary puerarin supplementation improves immune function in the small intestines of oxidized oil-challenged broilers.

Puerarin has possessed a wide range of pharmacological activities. However, little is known about the protective effects of puerarin on the oxidized oil-induced injury. Here, we describe the anti-inflammatory effects of puerarin in chickens. A total of 360 broilers were arranged in four treatments. Diets included two types of soybean oil (fresh or oxidized) and two levels of puerarin (0 or 750 mg/kg). Results showed that puerarin alleviated oxidized soybean oil-induced intestinal immune injury by decreasing the expressions of HSP and pro-inflammatory factor (P < 0.05) and enhancing the mRNA levels of anti-inflammatory factor and CATH-1 (P < 0.05) in broilers. Moreover, puerarin supplementation decreased the mRNA abundances of TLR4 and MyD88 (P < 0.05) and upregulated the expressions of A20 and SOCS-1 (P < 0.05) in the small intestine of oxidized soybean oil-challenged broilers. Collectively, this study demonstrates puerarin may be a potential nutrient supplement in the treatment of oxidized oil-induced damage in poultry.

Toripalimab Plus Chemotherapy for Recurrent or Metastatic Nasopharyngeal Carcinoma: The JUPITER-02 Randomized Clinical Trial.

Importance: There are currently no therapies approved by the US Food and Drug Administration for nasopharyngeal carcinoma (NPC). Gemcitabine-cisplatin is the current standard of care for the first-line treatment of recurrent or metastatic NPC (RM-NPC). Objective: To determine whether toripalimab in combination with gemcitabine-cisplatin will significantly improve progression-free survival and overall survival as first-line treatment for RM-NPC, compared with gemcitabine-cisplatin alone. Design, Setting, and Participants: JUPITER-02 is an international, multicenter, randomized, double-blind phase 3 study conducted in NPC-endemic regions, including mainland China, Taiwan, and Singapore. From November 10, 2018, to October 20, 2019, 289 patients with RM-NPC with no prior systemic chemotherapy in the RM setting were enrolled from 35 participating centers. Interventions: Patients were randomized (1:1) to receive toripalimab (240 mg [n = 146]) or placebo (n = 143) in combination with gemcitabine-cisplatin for up to 6 cycles, followed by maintenance with toripalimab or placebo until disease progression, intolerable toxicity, or completion of 2 years of treatment. Main Outcome: Progression-free survival as assessed by a blinded independent central review. Secondary end points included objective response rate, overall survival, progression-free survival assessed by investigator, duration of response, and safety. Results: Among the 289 patients enrolled (median age, 46 [IQR, 38-53 years; 17% female), at the final progression-free survival analysis, toripalimab treatment had a significantly longer progression-free survival than placebo (median, 21.4 vs 8.2 months; HR, 0.52 [95% CI, 0.37-0.73]). With a median survival follow-up of 36.0 months, a significant improvement in overall survival was identified with toripalimab over placebo (hazard ratio [HR], 0.63 [95% CI, 0.45-0.89]; 2-sided P = .008). The median overall survival was not reached in the toripalimab group, while it was 33.7 months in the placebo group. A consistent effect on overall survival, favoring toripalimab, was found in subgroups with high and low PD-L1 (programmed death-ligand 1) expression. The incidence of all adverse events, grade 3 or greater adverse events, and fatal adverse events were similar between the 2 groups. However, adverse events leading to discontinuation of toripalimab or placebo (11.6% vs 4.9%), immune-related adverse events (54.1% vs 21.7%), and grade 3 or greater immune-related adverse events (9.6% vs 1.4%) were more frequent in the toripalimab group. Conclusions and Relevance: The addition of toripalimab to chemotherapy as first-line treatment for RM-NPC provided statistically significant and clinically meaningful progression-free survival and overall survival benefits compared with chemotherapy alone, with a manageable safety profile. These findings support the use of toripalimab plus gemcitabine-cisplatin as the new standard of care for this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT03581786.

Puerarin Alleviates Oxidized Oil-Induced Oxidative Injury and Inflammation via Inhibition of the Nrf2/Keap1 and HMGB1/TLR4/MAPK Signaling Pathways: An Investigation in a Chicken Model.

SCOPE: Puerarin has possessed a wide range of pharmacological activities. However, little is known about the protective effects of puerarin on the oxidized oil-induced injury. Here, the antioxidant and anti-inflammatory effects of puerarin are described using a chicken model. METHODS AND RESULTS: A total of 360 broilers are arranged in four treatments. Diets include two types of soybean oil (fresh or oxidized) and two levels of puerarin (0 or 750 mg kg-1 ). Results show that puerarin alleviates oxidized soybean oil-induced hepatic and thymic oxidative injury. This effect is observed by increasing the SOD activity and the expressions of Nrf2 signaling pathway-related genes and reducing the MDA content in the liver and thymus. Moreover, puerarin supplementation decreases the concentrations and mRNA levels of pro-inflammatory factors in the liver and thymus. The potential mechanism responsible for this is the decrease in the mRNA or protein levels of HMGB1, TLR4, MyD88, and p65 in the liver or thymus. Western blotting results indicate that puerarin also decreases the phosphorylation of JNK1/2, ERK1/2, and p38 in the liver and thymus. CONCLUSION: This study demonstrates puerarin may be a potential nutrient supplement in the treatment of oxidized oil-induced damage, and the Nrf2/Keap1 and HMGB1/TLR4/MAPK signaling pathways might be its important target.