Evaluation of transrectal ultrasound-guided tru-cut biopsy as a complementary method for predicting pathological complete response in rectal cancer after neoadjuvant treatment: a phase II prospective and diagnostic trial.

IMPORTANCE: Patients with pCR of rectal cancer following neoadjuvant treatment had better oncological outcomes. However, reliable methods for accurately predicting pCR remain limited. OBJECTIVE: To evaluate whether transrectal ultrasound-guided tru-cut biopsy (TRUS-TCB) adds diagnostic value to conventional modalities for predicting pathological complete response (pCR) in patients with rectal cancer after neoadjuvant treatment. DESIGN, SETTING, AND PARTICIPANTS: This study evaluated data of patients with rectal cancer who were treated with neoadjuvant treatment and reassessed using TRUS-TCB and conventional modalities before surgery. This study is registered with ClinicalTrials.gov. MAIN OUTCOMES AND MEASURES: The primary outcome was accuracy, along with secondary outcomes including sensitivity, specificity, negative predictive value, and positive predictive value in predicting tumor residues. Final surgical pathology was used as reference standard. RESULTS: Between June 2021 and June 2022, a total of 74 patients were enrolled, with 63 patients ultimately evaluated. Among them, 17 patients (28%) exhibited a complete pathological response. TRUS-TCB demonstrated an accuracy of 0.71 (95% CI, 0.58-0.82) in predicting tumor residues. The combined use of TRUS-TCB and conventional modalities significantly improved diagnostic accuracy compared to conventional modalities alone (0.75 vs. 0.59, P=0.02). Furthermore, TRUS-TCB correctly reclassified 52% of patients erroneously classified as having a complete clinical response by conventional methods. The occurrence of only one mild adverse event was observed. CONCLUSIONS AND RELEVANCE: Transrectal ultrasound-guided tru-cut biopsy (TRUS-TCB) proves to be a safe and accessible tool for reevaluation with minimal complications. The incorporation of TRUS-TCB alongside conventional methods leads to enhanced diagnostic performance.

The FIB-4 scores in the emergency department to predict the outcomes of COVID-19 patients in taiwan.

Objective: We aimed to determine the reliability of using the Fibrosis-4 (FIB-4) index in COVID-19 patients without underlying liver illness. Method: We employed multivariate logistic regression to identify variables that exhibited statistically significant influence on the ultimate outcome. Multilayer perceptron analysis was employed to develop a prediction model for the FIB-4 index concerning ICU admission and intubation rates. However, the scarcity of cases rendered the assessment of the mortality rate unfeasible. We plotted ROC curves to analyze the predictive strength of the FIB-4 index across various age groups. Result: In univariate logistic regression, only the FIB-4 index and respiratory rate demonstrated statistical significance on all poor outcomes. The FIB-4 index for mortality prediction had an ROC and AUC of 0.863 (95% CI: 0.781-0.9444). It demonstrates predictive power across age groups, particularly for age ≥65 (AUC: 0.812, 95% CI: 0.6571-0.9673) and age <65 (AUC: 0.878, 95% CI: 0.8012-0.9558). Its sensitivity for intubation and ICU admission prediction is suboptimal. Conclusion: FIB-4 index had promising power in prediction of mortality rate in all age groups.

Circulating cell-free DNA correlate to disease activity and treatment response of patients with radiographic axial spondyloarthritis.

Microdamage and its related inflammation contribute to the development of radiographic axial spondyloarthritis (r-axSpA). Inflammation and cell death in damaged tissues are associated with cell-free DNA (cfDNA) release. Here we investigated whether circulating cfDNA could be a potential biomarker for evaluating disease activity and treatment response in r-axSpA. Circulating cfDNA was detected in the discovery and validation cohort with 79 and 60 newly diagnosed r-axSpA patients respectively and 42 healthy controls using the Quant-iT PicoGreen dsDNA reagent and kit. As a result, cfDNA levels were significantly higher in r-axSpA patients compared with healthy controls in the discovery and validation cohort. Moreover, cfDNA levels were positively correlated with CRP, ASDAS-CRP and neutrophil counts. Additionally, non-steroid anti-inflammatory drugs (NSAIDs) combined with disease-modifying anti-rheumatic drugs or tumor necrosis factor inhibitors but not NSAIDs alone could reduce cfDNA levels. Moreover, a decrease of cfDNA levels after treatment was associated with an effective therapeutic response. Intriguingly, patients with higher levels of cfDNA at diagnosis responded better to combination therapy rather than NSAIDs. However, patients with lower levels of cfDNA displayed similar responses to combination or mono-NSAID treatment. In conclusion, circulating cfDNA levels showed a significant correlation with disease activity as well as treatment efficacy in patients with r-axSpA. Moreover, cfDNA at diagnosis might predict the response to different therapy. Consequently, cfDNA may serve as a useful biomarker of inflammation in r-axSpA.

Spontaneous Pneumocephalus: A Case Report with a Literature Review.

BACKGROUND: Pneumocephalus is defined as gas in the intracranial space. Common causes include head trauma, surgery, and diagnostic/therapeutic procedures resulting from the direct disruption of the dura. Spontaneous or nontraumatic pneumocephalus is an uncommon condition, often caused by infection, either due to insidious disruption of the dura or gas-forming pathogens. CASE REPORT: Herein, we report a rare case of spontaneous pneumocephalus associated with meningitis in a patient who received conservative treatment without surgical intervention. Blood culture revealed group A streptococcus. The pneumocephalus subsided gradually with antibiotic treatment, and no neurological deficits remained. A follow-up brain computed tomography scan showed the absence of pneumocephalus, but it showed progressive hydrocephalus. The patient was discharged on the 21st day of hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous pneumocephalus associated with meningitis is rare. It should always raise the suspicion of meningitis and prompt suitable treatment. Emergency physicians should always be vigilant for this particular possibility on brain computed tomography.

Compared with physician overread, computer is less accurate but helpful in interpretation of electrocardiography for ST-segment elevation myocardial infarction.

INTRODUCTION: Previous studies have demonstrated varying sensitivity and specificity of computer-interpreted electrocardiography (CIE) in identifying ST-segment elevation myocardial infarction (STEMI). This study aims to evaluate the accuracy of contemporary computer software in recognizing electrocardiography (ECG) signs characteristic of STEMI compared to emergency physician overread in clinical practice. MATERIAL AND METHODS: In this retrospective observational single-center study, we reviewed the records of patients in the emergency department (ED) who underwent ECGs and troponin tests. Both the Philips DXL 16-Lead ECG. Algorithm and on-duty emergency physicians interpreted each standard 12­lead ECG. The sensitivity and specificity of computer interpretation and physician overread ECGs for the definite diagnosis of STEMI were calculated and compared. RESULTS: Among the 9340 patients included in the final analysis, 133 were definitively diagnosed with STEMI. When "computer-reported infarct or injury" was used as the indicator, the sensitivity was 87.2% (95% CI 80.3% to 92.4%) and the specificity was 86.2% (95% CI 85.5% to 86.9%). When "physician-overread STEMI" was used as the indicator, the sensitivity was 88.0% (95% CI 81.2% to 93.0%) and the specificity was 99.9% (95% CI 99.8% to 99.9%). The area under the receiver operating characteristic curve for physician-overread STEMI and computer-reported infarct or injury were 0.939 (95% CI 0.907 to 0.972) and 0.867 (95% CI 0.834 to 0.900), respectively. CONCLUSIONS: This study reveals that while the sensitivity of the computer in recognizing ECG signs of STEMI is similar to that of physicians, physician overread of ECGs is more specific and, therefore, more accurate than CIE.

The correlation between Th17/Treg immune dysregulation and the disease severity in chronic spontaneous urticaria patients.

OBJECTIVE: Chronic spontaneous urticaria (CSU) has a profound impact on the sleep quality, productivity and overall quality of life of affected individuals. This study aimed to investigate the correlation between serum Th17/Treg immune dysregulation and the severity of CSU in patients. METHODS: Clinical baseline data of 120 CSU patients and matched healthy controls were recorded. The pruritus level, disease severity, and quality of life of CSU patients were assessed using the visual analogue scale, weekly Urticaria Activity Score and chronic urticaria quality of life questionnaire, respectively. The Th17/Treg cell ratio was detected by flow cytometry. ELISA was used to measure the levels of serum Th17 cytokines (IL-17, IL-21) and Treg cytokines (TGF-ß1, IL-35). Pearson's correlation analysis was conducted to examine the associations between these indicators. RESULTS: No significant differences were identified in terms of sex, age, and BMI between the two groups. However, CSU patients exhibited a significant increase in the Th17 cell ratio, as well as the elevated serum levels of TGF-ß1, IL-17 and, IL-21. Conversely, the proportion of Treg cells and the levels of IL-35 were remarkably decreased in CSU patients. Peripheral blood Th17 cells were negatively correlated with Treg cells. The severity of pruritus, life quality, and disease severity in CSU patients were positively correlated to Th17 cell ratio, and inversely correlated with Treg cell proportion. CONCLUSIONS: A positive correlation was found between the percentage of peripheral blood Th17 cell in CSU patients and the pruritus level, life quality, and disease severity. In constrast, there was a negative correlation between the proportion of peripheral blood Treg cells and these clinical parameters.

Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy alone for patients with locally advanced rectal cancer: a propensity-score-matched analysis combined with SEER validation.

BACKGROUND: Neoadjuvant therapy followed by radical surgery is recommended for locally advanced rectal cancer (LARC). But radiotherapy can cause potential adverse effects. The therapeutic outcomes, postoperative survival and relapse rates between neoadjuvant chemotherapy (N-CT) and neoadjuvant chemoradiotherapy (N-CRT) patients have rarely been studied. METHODS: From February 2012 to April 2015, patients with LARC who underwent N-CT or N-CRT followed by radical surgery at our center were included. Pathologic response, surgical outcomes, postoperative complications and survival outcomes (including overall survival [OS], disease-free survival [DFS], cancer-specific survival [CSS] and locoregional recurrence-free survival [LRFS]) were analyzed and compared. Concurrently, the Surveillance, Epidemiology, and End Results Program (SEER) database was used to compare OS in an external source. RESULTS: A total of 256 patients were input into the propensity score-matching (PSM) analysis, and 104 pairs remained after PSM. After PSM, the baseline data were well matched and there was a significantly lower tumor regression grade (TRG) (P < 0.001), more postoperative complications (P = 0.009) (especially anastomotic fistula, P = 0.003) and a longer median hospital stay (P = 0.049) in the N-CRT group than in the N-CT group. No significant difference was observed in OS (P = 0.737), DFS (P = 0.580), CSS (P = 0.920) or LRFS (P = 0.086) between the N-CRT group and the N-CT group. In the SEER database, patients who received N-CT had similar OS in both TNM II (P = 0.315) and TNM III stages (P = 0.090) as those who received N-CRT. CONCLUSION: N-CT conferred similar survival benefits but caused fewer complications than N-CRT. Thus, it could be an alternative treatment of LARC.

Prediction of coronary heart disease in gout patients using machine learning models.

Growing evidence shows that there is an increased risk of cardiovascular diseases among gout patients, especially coronary heart disease (CHD). Screening for CHD in gout patients based on simple clinical factors is still challenging. Here we aim to build a diagnostic model based on machine learning so as to avoid missed diagnoses or over exaggerated examinations as much as possible. Over 300 patient samples collected from Jiangxi Provincial People's Hospital were divided into two groups (gout and gout+CHD). The prediction of CHD in gout patients has thus been modeled as a binary classification problem. A total of eight clinical indicators were selected as features for machine learning classifiers. A combined sampling technique was used to overcome the imbalanced problem in the training dataset. Eight machine learning models were used including logistic regression, decision tree, ensemble learning models (random forest, XGBoost, LightGBM, GBDT), support vector machine (SVM) and neural networks. Our results showed that stepwise logistic regression and SVM achieved more excellent AUC values, while the random forest and XGBoost models achieved more excellent performances in terms of recall and accuracy. Furthermore, several high-risk factors were found to be effective indices in predicting CHD in gout patients, which provide insights into the clinical diagnosis.

Prevalent Pseudoprogression and Pseudoresidue in Patients With Rectal Cancer Treated With Neoadjuvant Immune Checkpoint Inhibitors.

BACKGROUND: Immune checkpoint inhibitor (ICI) treatment in patients with microsatellite instability-high/mismatch repair deficient (MSI-H/dMMR) tumors holds promise in reshaping organ preservation in rectal cancer. However, the benefits are accompanied by distinctive patterns of response, introducing a dilemma in the response evaluation for clinical decision-making. PATIENTS AND METHODS: Patients with locally advanced rectal cancer with MSI-H/dMMR tumors receiving neoadjuvant ICI (nICI) treatment (n=13) and matched patients receiving neoadjuvant chemoradiotherapy (nCRT; n=13) were included to compare clinical response and histopathologic features. RESULTS: Among the 13 patients receiving nICI treatment, in the final radiologic evaluation prior to surgery (at a median of 103 days after initiation of therapy), progressive disease (n=3), stable disease (n=1), partial response (n=7), and complete response (n=2) were observed. However, these patients were later confirmed as having pathologic complete response, resulting in pseudoprogression and pseudoresidue with incidences of 23.1% (n=3) and 76.9% (n=10), respectively, whereas no pseudoprogression was found in the 13 patients receiving nCRT. We further revealed the histopathologic basis underlying the pseudoprogression and pseudoresidue by discovering the distinctive immune-related regression features after nICI treatment, including fibrogenesis, dense lymphocytes, and plasma cell infiltration. CONCLUSIONS: Pseudoprogression and pseudoresidue were unique and prevalent response patterns in MSI-H/dMMR rectal cancer after nICI treatment. Our findings highlight the importance of developing specific strategies for response evaluation in neoadjuvant immunotherapy to identify patients with a good response in whom sphincter/organ-preserving or watch-and-wait strategies may be considered.

One-step potentiostatic electrodeposition of NiS-NiS2 on sludge-based biochar and its application for a non-enzymatic glucose sensor.

Conventional nanomaterials are available in electrochemical glucose nonenzymatic sensing, but their broad applications are limited due to their high cost and complicated preparation procedures. In this study, NiS-NiS2/sludge-based biochar/GCE was fabricated by one-step potentiostatic electrodeposition on biochar and used as an interface material for non-enzymatic sensing of glucose in 0.1 M NaOH. With an electrodeposition time of 300 s, the as-prepared sensors delivered the best electrochemical performance toward glucose due to the synergistic effects of NiS-NiS2 and sludge-based biochar. The as prepared NiS-NiS2/sludge-based biochar surface morphology, surface composition, and electrochemical properties were characterized by SEM elemental mapping, XPS and cyclic voltammetry. Under optimized conditions, the linearity between the current response and the glucose concentration has been obtained in the range of 5-1500 µM with a detection limit of 1.5 µM. More importantly, the fabricated sensor was successfully utilized to measure glucose in serum of sweetened beverages and human blood. Accordingly, NiS-NiS2/sludge-based biochar/GCE can hopefully be applied as a normal enzyme-free glucose sensor with excellent properties of sensitivity, reproducibility, stability, as well as sustainability.

Tetracycline Adsorption on Magnetic Sludge Biochar: Effects of pH, Humic Acid (HA), and Fulvic Acid (FA).

Natural organic matters (NOMs) are ubiquitous in the environment, but few systematic studies have examined the influence of NOMs on the sorption ability of magnetic sludge biochar. In this study, magnetic sludge biochar was synthesized, characterized, and used as a sorbent to remove tetracycline (TC) from aqueous solutions. The effects of pH, humic acid (HA), and fulvic acid (FA) on TC adsorption by magnetic sludge biochar were studied using batch experiments. Adding HA and FA can alter the adsorption behavior of TC, except for its pH dependency. The results of this study show that relatively low concentrations of dissolved HA (≤8 ppm) and FA (≤5 ppm) promote the adsorption capacity of TC, but higher concentrations compete against TC for sorption sites on the surface of magnetic sludge biochar. The results of this study promote a better understanding of the application of magnetic sludge biochar in real antibiotic wastewater.

The serum uric acid is longitudinally related to patients global assessment of disease activity in male patients with axial spondyloarthritis.

OBJECTIVES: To investigate longitudinal relationship between serum uric acid (SUA) and disease activity among Chinese males with axial spondyloarthritis (axSpA). METHODS: Two-year data from the NASA study cohort of male patients with axial spondyloarthritis were analyzed. Patients global assessment of disease activity (PtGA), BASDAI, ASDAS-CRP, BASFI, and SF-36 were used as the outcomes. The autoregressive Generalized Estimation Equation (GEE) model was used to investigate the longitudinal relationship between SUA and the above outcomes. Age and gender and symptom duration were tested as effect modifiers or confounders. RESULTS: In total, 102 male axSpA patients were included, 33.3% of who were hyperuricemia at baseline. Over time,serum uric acid levels associated with the global assessment of patient global assessment of disease activity (PtGA)[P=0.041, ß=-2.059,95%CI(-4.032, -0.086)], SF-36: Vitality (VT) [P=0.01, ß=1.751, 95%CI (0.415,3.087)], SF-36: Social Functioning (SF)[P=0.002, ß= 2.968,95%CI (1.067,4.869)]). And these relationgships were independent of age, symptom duration, baseline uric acid levels, and medication use. CONCLUSIONS: In summary, SUA levels is longitudinally related to PtGA and mental health assessment. Age, gender and symptom duration do not have an impact on the relationships.

Composite NiCo2 O4 @CeO2 Microsphere as Cathode Catalyst for High-Performance Lithium-Oxygen Battery.

The large overpotential and poor cycle stability caused by inactive redox reactions are tough challenges for lithium-oxygen batteries (LOBs). Here, a composite microsphere material comprising NiCo2 O4 @CeO2 is synthesized via a hydrothermal approach followed by an annealing processing, which is acted as a high performance electrocatalyst for LOBs. The unique microstructured catalyst can provide enough catalytic surface to facilitate the barrier-free transport of oxygen as well as lithium ions. In addition, the special microsphere and porous nanoneedles structure can effectively accelerate electrolyte penetration and the reversible formation and decomposition process of Li2 O2 , while the introduction of CeO2 can increase oxygen vacancies and optimize the electronic structure of NiCo2 O4 , thereby enhancing the electron transport of the whole electrode. This kind of catalytic cathode material can effectively reduce the overpotential to only 1.07 V with remarkable cycling stability of 400 loops under 500 mA g-1 . Based on the density functional theory calculations, the origin of the enhanced electrochemical performance of NiCo2 O4 @CeO2 is clarified from the perspective of electronic structure and reaction kinetics. This work demonstrates the high efficiency of NiCo2 O4 @CeO2 as an electrocatalyst and confirms the contribution of the current design concept to the development of LOBs cathode materials.

Tetracycline adsorption on magnetic sludge biochar: size effect of the Fe3O4 nanoparticles.

Activated sludge, which is difficult and expensive to treat and dispose of, is a key concern in wastewater treatment plants. In this study, magnetic sludge biochar containing activated sludge and different sizes (14.3, 40.2 and 90.5 nm) of Fe3O4 nanoparticles was investigated as an effective adsorbent for tetracycline (TC) adsorption. Magnetic sludge-based biochar was prepared by a facile cross-linking method and characterized by transmission electron microscopy, Fourier transform infrared spectroscopy (FTIR), X-ray diffraction, X-ray photoelectron spectroscopy (XPS) and zeta potential analysis. The adsorption performances of TC on three kinds of adsorbents were investigated. Although 14.3 nm Fe3O4 nanoparticles could be inclined to aggregate and partially filled with pores of biochar, it turned out that magnetic sludge biochar with 14.3 nm Fe3O4 nanoparticles exhibited optimum performance for TC removal with adsorption capacity up to 184.5 mg g-1, due to the larger amounts of functional groups and the change of zeta potential. Furthermore, the adsorption kinetics of TC on three kinds of adsorbents were studied, which implied that the pseudo-second-order kinetic model exhibited the better fit for the entire sorption process.

A Low Cost Fe3O4-Activated Biochar Electrode Sensor by Resource Utilization of Excess Sludge for Detecting Tetrabromobisphenol A.

Owing to its ubiquity in natural water systems and the high toxicity of its accumulation in the human body, it is essential to develop simple and low-cost electrochemical sensors for the determination of 3,3',5,5'-tetrabromobisphenol A (TBBPA). In this work, Fe3O4-activated biochar, which is based on excess sludge, was prepared and characterized using scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy (FTIR) and BET analysis to analyze its basic features. Subsequently, it was used to fabricate an electrochemical sensor for the detection of TBBPA. The electrochemical test results revealed that the Fe3O4-activated biochar film exhibited a larger active surface area, a lower charge transfer resistance and a higher accumulation efficiency toward TBBPA. Consequently, the peak current of TBBPA was significantly enhanced on the surface of the Fe3O4-activated biochar. The TBBPA sensing platform developed using the Fe3O4-activated biochar composite film, with relatively a lower detection limit (3.2 nM) and a wider linear range (5-1000 nM), was successfully utilized to determine TBBPA levels in water samples. In summary, the effective application of Fe3O4-activated biochar provided eco-friendly and sustainable materials for the development of a desirable high-sensitivity sensor for TBBPA detection.

Phospholipase A2 group IIA correlates with circulating high-density lipoprotein cholesterol and modulates cholesterol efflux possibly through regulation of PPAR-γ/LXR-α/ABCA1 in macrophages.

BACKGROUND: Secretory phospholipase A2 group IIA (sPLA2-IIA) is an independent risk factor for cardiovascular disease, but its role on high-density lipoprotein cholesterol (HDL-C) level has not been clarified. The aim of the present study was to explore the association between circulating sPLA2-IIA and HDL-C, and to evaluate if sPLA2-IIA enhances cholesterol efflux capacity through regulation of peroxisome proliferator-activated receptor γ (PPAR-γ), liver X receptor α (LXR-α), and ATP-binding cassette A1 (ABCA1). METHODS: 131 patients with coronary artery disease were enrolled. The plasma level of sPLA2-IIA was tested with enzyme-linked immunosorbent assay kit, and serum lipids were assessed by biochemical analyzer. Human monocyte-macrophage cell line THP-1 was co-incubated with sPLA2-IIA in the presence/absence of selective PPAR-γ antagonist GW9662 in vitro. Real-time PCR and Western-blot were employed to measure the mRNA and protein expressions of PPAR-γ, LXR-α, and ABCA1, respectively. The cholesterol efflux was evaluated by using an assay kit. RESULTS: In subjects, circulating level of sPLA2-IIA was positively related with that of HDL-C (r = 0.196, p = 0.024). The plasma level of sPLA2-IIA was significantly higher in the high HDL-C (≥ 1.04 mmol/L) group (7477.828 pg/mL) than that in low HDL-C (< 1.04 mmol/L) group (5836.92 pg/mL, p = 0.004). For each increase of 1 pg/µl in sPLA2-IIA level, the adjusted odds ratio for HDL-C ≥ 1.04 mmol/L was 1.143. Co-incubation of THP-1 cells with sPLA2-IIA resulted in increased expressions of PPAR-γ, LXR-α, and ABCA1, as well as enhanced cholesterol efflux capacity, that were all reversed by administration of GW9662. CONCLUSIONS: Circulating sPLA2-IIA was positively associated with HDL-C. PPAR-γ/LXR-α/ABCA1 might be responsible for sPLA2-IIA-regulated cholesterol efflux in macrophages.