Point-of-care testing device platform for the determination of creatinine on an enzyme@CS/PB/MXene@AuNP-based screen-printed carbon electrode.

Screen-printed carbon electrodes (SPCE) functionalized with MXene-based three-dimensional nanomaterials are reported for rapid determination of creatinine. Ti3C2TX MXene with in situ reduced AuNPs (MXene@AuNP) were used as a coreactant accelerator for efficient immobilization of enzymes. Creatinine could be oxidized by chitosan-embedded creatinine amidohydrolase, creatine amidinohydrolase, or sarcosine oxidase to generate H2O2, which could be electrochemically detected enhanced by Prussian blue (PB). The enzyme@CS/PB/MXene@AuNP/SPCE detected creatinine within the range 0.03-4.0 mM, with a limit of detection of 0.01 mM, with an average recovery of 96.8-103.7%. This indicates that the proposed biosensor is capable of detecting creatinine in a short amount of time (4 min) within a ± 5% percentage error, in contrast with the standard clinical colorimetric method. With this approach, reproducible and stable electrochemical responses could be achieved for determination of creatinine in serum, urine, or saliva. These results demonstrated its potential for deployment in resource-limited settings for early diagnosis and tracking the progression of chronic kidney disease (CKD).

Prognostic significance of the hs-CRP/Alb ratio for cardiovascular events in patients with end-stage renal disease undergoing maintenance hemodialysis.

OBJECTIVE: To evaluate the predictive power of the high-sensitivity C-reactive protein (hs-CRP) to albumin (Alb) ratio for cardiovascular events in patients receiving maintenance hemodialysis (MHD) for end-stage renal disease (ESRD). METHODS: This retrospective study enrolled 202 ESRD patients undergoing MHD at Bobai County People's Hospital from November 2020 to November 2022, with follow-up extending to November 2023. Patients were divided into two groups based on the occurrence of cardiovascular events during follow-up: the occurrence group (n = 92) and the non-occurrence group (n = 110). Clinical data were compared between these groups. Independent risk factors for cardiovascular events post-MHD were identified using a multivariate logistic regression model. The hs-CRP/Alb ratio's predictive utility was assessed through receiver operating characteristic (ROC) curve analysis, establishing an optimal cutoff value. A decision tree prediction model was developed to further delineate the probability of cardiovascular events. RESULTS: The occurrence group was older and had a longer duration of dialysis compared to the non-occurrence group (P < 0.05). They also showed a higher prevalence of diabetic and hypertensive nephropathy and a higher proportion of smokers (all P < 0.05). Notably lower levels of hemoglobin (HGB), triglycerides, total cholesterol, low-density lipoprotein, albumin (Alb), and calcium were detected (all P < 0.05), whereas ß2-microglobulin (ß2-mg), hs-CRP, phosphorus, and the hs-CRP/Alb ratio were markedly increased (all P < 0.05). Multivariate analysis revealed diabetic nephropathy or hypertensive nephropathy, a high hs-CRP/Alb ratio, and elevated phosphorus levels as risk factors for cardiovascular events, while high hemoglobin levels were protective (P < 0.05). The ROC analysis indicated the hs-CRP/Alb ratio (AUC = 0.884) outperformed other predictors with an optimal cutoff at 0.111. Patients with a hs-CRP/Alb ratio ≥ 0.111 were found to have a 29-fold increased risk of cardiovascular events (95% CI: 11.304-74.842). CONCLUSION: The hs-CRP/Alb ratio is a significant predictive biomarker for cardiovascular events in ESRD patients undergoing MHD. An elevated hs-CRP/Alb ratio is associated with an increased risk of cardiovascular events, underscoring its utility in this patient population.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and obstructive sleep apnea: a cross-sectional study from NHANES.

BACKGROUND: Obstructive Sleep Apnea (OSA) is a widespread sleep disturbance linked to metabolic and cardiovascular conditions. The Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratios (NHHR) has been proposed as being a potential biomarker to gauge cardiovascular risk. However, its relationship with OSA remains unclear. METHODS: This survey investigated the link NHHR to OSA in American citizens aged 20 and older using information collected via the National Health and Nutrition Examination Survey (NHANES) during the years 2017 to 2020. Logistic regression models with multivariable adjustments were employed to assess this relationship. Nonlinear associations were explored using smooth curve fitting, with a two-part linear regression model identifying a threshold effect. Subgroup analyses were conducted to evaluate population-specific differences. RESULTS: The survey encompassed 6763 participants, with an average age of 50.75 ± 17.32. The average NHHR stood at 2.74, accompanied by a standard deviation of 1.34, while the average frequency of OSA was 49.93%. Upon adjusting for covariates, each unit increase in NHHR may be associated with a 9% rise in OSA incidence. (95% confidence intervals 1.04-1.14; P < 0.0001). Notably, a U-shaped curve depicted the NHHR-OSA relationship, with an inflection point at 4.12. Subgroup analyses revealed consistent associations, with educational attainment and diabetes status modifying the NHHR-OSA relationship. CONCLUSION: The study highlights NHHR as a potential tool for OSA prediction, presenting avenues for advanced risk evaluation, tailored interventions, personalized treatment approaches, and preventive healthcare.

All-Fiber Flexible Electrochemical Sensor for Wearable Glucose Monitoring.

Wearable sensors, specifically microneedle sensors based on electrochemical methods, have expanded extensively with recent technological advances. Today's wearable electrochemical sensors present specific challenges: they show significant modulus disparities with skin tissue, implying possible discomfort in vivo, especially over extended wear periods or on sensitive skin areas. The sensors, primarily based on polyethylene terephthalate (PET) or polyimide (PI) substrates, might also cause pressure or unease during insertion due to the skin's irregular deformation. To address these constraints, we developed an innovative, wearable, all-fiber-structured electrochemical sensor. Our composite sensor incorporates polyurethane (PU) fibers prepared via electrospinning as electrode substrates to achieve excellent adaptability. Electrospun PU nanofiber films with gold layers shaped via thermal evaporation are used as base electrodes with exemplary conductivity and electrochemical catalytic attributes. To achieve glucose monitoring, gold nanofibers functionalized by gold nanoflakes (AuNFs) and glucose oxidase (GOx) serve as the working electrode, while Pt nanofibers and Ag/AgCl nanofibers serve as the counter and reference electrode. The acrylamide-sodium alginate double-network hydrogel synthesized on electrospun PU fibers serves as the adhesive and substance-transferring layer between the electrodes. The all-fiber electrochemical sensor is assembled layer-by-layer to form a robust structure. Given the stretchability of PU nanofibers coupled with a high specific surface area, the manufactured porous microneedle glucose sensor exhibits enhanced stretchability, superior sensitivity at 31.94 µA (lg(mM))-1 cm-2, a broad detection range (1-30 mM), and a significantly low detection limit (1 mM, S/N = 3), as well as satisfactory biocompatibility. Therefore, the novel electrochemical microneedle design is well-suited for wearable or even implantable continuous monitoring applications, thereby showing promising significant potential within the global arena of wearable medical technology.

Preclinical Studies on Mechanisms Underlying the Protective Effects of Propranolol in Traumatic Brain Injury: A Systematic Review.

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity amongst trauma patients. Its treatment is focused on minimizing progression to secondary injury. Administration of propranolol for TBI maydecrease mortality and improve functional outcomes. However, it is our sense that its use has not been universally adopted due to low certainty evidence. The literature was reviewed to explore the mechanism of propranolol as a therapeutic intervention in TBI to guide future clinical investigations. Medline, Embase, and Scopus were searched for studies that investigated the effect of propranolol on TBI in animal models from inception until June 6, 2023. All routes of administration for propranolol were included and the following outcomes were evaluated: cognitive functions, physiological and immunological responses. Screening and data extraction were done independently and in duplicate. The risk of bias for each individual study was assessed using the SYCLE's risk of bias tool for animal studies. Three hundred twenty-three citations were identified and 14 studies met our eligibility criteria. The data suggests that propranolol may improve post-TBI cognitive and motor function by increasing cerebral perfusion, reducing neural injury, cell death, leukocyte mobilization and p-tau accumulation in animal models. Propranolol may also attenuate TBI-induced immunodeficiency and provide cardioprotective effects by mitigating damage to the myocardium caused by oxidative stress. This systematic review demonstrates that propranolol may be therapeutic in TBI by improving cognitive and motor function while regulating T lymphocyte response and levels of myocardial reactive oxygen species. Oral or intravenous injection of propranolol following TBI is associated with improved cerebral perfusion, reduced neuroinflammation, reduced immunodeficiency, and cardio-neuroprotection in preclinical studies.

Dual Starvations Induce Pyroptosis for Orthotopic Pancreatic Cancer Therapy through Simultaneous Deprivation of Glucose and Glutamine.

Pancreatic cancer is a highly fatal disease, and existing treatment methods are ineffective, so it is urgent to develop new effective treatment strategies. The high dependence of pancreatic cancer cells on glucose and glutamine suggests that disrupting this dependency could serve as an alternative strategy for pancreatic cancer therapy. We identified the vital genes glucose transporter 1 (GLUT1) and alanine-serine-cysteine transporter 2 (ASCT2) through bioinformatics analysis, which regulate glucose and glutamine metabolism in pancreatic cancer, respectively. Human serum albumin nanoparticles (HSA NPs) for delivery of GLUT1 and ASCT2 inhibitors, BAY-876/V-9302@HSA NPs, were prepared by a self-assembly process. This nanodrug inhibits glucose and glutamine uptake of pancreatic cancer cells through the released BAY-876 and V-9302, leading to nutrition deprivation and oxidative stress. The inhibition of glutamine leads to the inhibition of the synthesis of the glutathione, which further aggravates oxidative stress. Both of them lead to a significant increase in reactive oxygen species, activating caspase 1 and GSDMD and finally inducing pyroptosis. This study provides a new effective strategy for orthotopic pancreatic cancer treatment by dual starvation-induced pyroptosis. The study for screening metabolic targets using bioinformatics analysis followed by constructing nanodrugs loaded with inhibitors will inspire future targeted metabolic therapy for pancreatic cancer.

New Prospects Arising from Dynamically Crosslinked Polymers: Reprogramming Their Properties.

Dynamically crosslinked polymers (DCPs) have gained significant attention owing to their applications in fabricating (re)processable, recyclable, and self-healable thermosets, which hold great promise in addressing ecological issues, such as plastic pollution and resource scarcity. However, the current research predominantly focuses on redefining and/or manipulating their geometries while replicating their bulk properties. Given the inherent design flexibility of dynamic covalent networks, DCPs also exhibit a remarkable potential for various novel applications through postsynthesis reprogramming their properties. In this review, the recent advancements in strategies that enable DCPs to transform their bulk properties after synthesis are presented. The underlying mechanisms and associated material properties are overviewed mainly through three distinct strategies, namely latent catalysts, material-growth, and topology isomerizable networks. Furthermore, the mutual relationship and impact of these strategies when integrated within one material system are also discussed. Finally, the application prospects and relevant issues necessitating further investigation, along with the potential solutions are analyzed.

The Effect of Perioperative Dexamethasone on Postoperative Complications After Pancreaticoduodenectomy: A Multicenter Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy. BACKGROUND: The glucocorticoid dexamethasone has been shown to improve postoperative outcomes in surgical patients, but its effects on postoperative complications after pancreaticoduodenectomy are unclear. METHODS: This multicenter, double-blind, randomized controlled trial was conducted in four Chinese high-volume pancreatic centers. Adults undergoing elective pancreaticoduodenectomy were randomized to receive either 0.2 mg/kg dexamethasone or a saline placebo as an intravenous bolus within 5 minutes after anesthesia induction. The primary outcome was the Comprehensive Complication Index (CCI) score within 30 days after the operation, analyzed using the modified intention-to-treat principle. RESULTS: Among 428 patients for eligibility, 300 participants were randomized and 265 were included in the modified intention-to-treat analyses. One hundred thirty-four patients received dexamethasone and 131 patients received a placebo. The mean (SD) CCI score was 14.0 (17.5) in the dexamethasone group and 17.9 (20.3) in the placebo group (mean difference: -3.8; 95% CI: -8.4 to 0.7; P = 0.100). The incidence of major complications (Clavien-Dindo grade ≥III; 12.7% vs 16.0%, risk ratio: 0.79; 95% CI: 0.44 to 1.43; P = 0.439) and postoperative pancreatic fistula (25.4% vs 31.3%, risk ratio: 0.81; 95% CI: 0.55 to 1.19; P = 0.286) were not significantly different between the two groups. In the stratum of participants with a main pancreatic duct ≤3 mm (n = 202), the CCI score was significantly lower in the dexamethasone group (mean difference: -6.4; 95% CI: -11.2 to -1.6; P = 0.009). CONCLUSIONS: Perioperative dexamethasone did not significantly reduce postoperative complications within 30 days after pancreaticoduodenectomy.

Insight into the chemical compositions of Anhua dark teas derived from identical tea materials: A multi-omics, electronic sensory, and microbial sequencing analysis.

Anhua dark teas (DTs), including Tianjian tea, Qianliang tea, Hei brick tea, and Fu brick tea, are unique fermented teas from China's Anhua County; yet their chemical composition differences remain unclear. Herein, metabolomics, volatolomics, and electronic sensory assessments were employed to analyze and compare chemical compositions and sensory characteristics of five types of Anhua DTs. All of these teas were derived from identical tea materials. Chemical compositions differed significantly among Anhua DTs, with Tianjian tea remarkable. Long-lasting fermentation and complex processing methods led to transformation of multiple compounds, particularly catechins. Eighteen volatile compounds with OVA > 1 were key aroma contributors in Anhua DTs. Internal transcribed spacer and 16S ribosomal DNA sequencing showed that Eurotium, Pseudomonas, and Bacillus are dominant microorganisms in Anhua DTs. Furthermore, this study unveiled notable differences in chemical compositions between Anhua DTs and five other traditional types of tea. This research enhances our understanding of Anhua DTs processing.

Rapid assays of SARS-CoV-2 virus and noble biosensors by nanomaterials.

The COVID-19 outbreak caused by SARS-CoV-2 in late 2019 has spread rapidly across the world to form a global epidemic of respiratory infectious diseases. Increased investigations on diagnostic tools are currently implemented to assist rapid identification of the virus because mass and rapid diagnosis might be the best way to prevent the outbreak of the virus. This critical review discusses the detection principles, fabrication techniques, and applications on the rapid detection of SARS-CoV-2 with three categories: rapid nuclear acid augmentation test, rapid immunoassay test and biosensors. Special efforts were put on enhancement of nanomaterials on biosensors for rapid, sensitive, and low-cost diagnostics of SARS-CoV-2 virus. Future developments are suggested regarding potential candidates in hospitals, clinics and laboratories for control and prevention of large-scale epidemic.

Color liquid crystal grating based color holographic 3D display system with large viewing angle.

Holographic 3D display is highly desirable for numerous applications ranging from medical treatments to military affairs. However, it is challenging to simultaneously achieve large viewing angle and high-fidelity color reconstruction due to the intractable constraints of existing technology. Here, we conceptually propose and experimentally demonstrate a simple and feasible pathway of using a well-designed color liquid crystal grating to overcome the inevitable chromatic aberration and enlarge the holographic viewing angle, thus enabling large-viewing-angle and color holographic 3D display. The use of color liquid crystal grating allows performing secondary diffraction modulation on red, green and blue reproduced images simultaneously and extending the viewing angle in the holographic 3D display system. In principle, a chromatic aberration-free hologram generation mechanism in combination with the color liquid crystal grating is proposed to pave the way for on such a superior holographic 3D display. The proposed system shows a color viewing angle of ~50.12°, which is about 7 times that of the traditional system with a single spatial light modulator. This work presents a paradigm for achieving desirable holographic 3D display, and is expected to provide a new way for the wide application of holographic display.

Integration of non-targeted/targeted metabolomics and electronic sensor technology reveals the chemical and sensor variation in 12 representative yellow teas.

Yellow tea is a lightly fermented tea with unique sensory qualities and health benefits. However, chemical composition and sensory quality of yellow tea products have rarely been studied. 12 representative yellow teas, which were basically covered the main products of yellow tea, were chosen in this study. Combined analysis of non-targeted/targeted metabolomics and electronic sensor technologies (E-eye, E-nose, E-tongue) revealed the chemical and sensor variation. The results showed that yellow big tea differed greatly from yellow bud teas and yellow little teas, but yellow bud teas could not be effectively distinguished from yellow little teas based on chemical constituents and electronic sensory characteristics. Sensor variation of yellow teas might be attributed to some compounds related to bitterness and aftertaste-bitterness (4'-dehydroxylated gallocatechin-3-O-gallate, dehydrotheasinensin C, myricitin 3-O-galactoside, phloroglucinol), aftertaste-astringency (methyl gallate, 1,5-digalloylglucose, 2,6-digalloylglucose), and sweetness (maltotriose). This study provided a comprehensive understanding of yellow tea on chemical composition and sensory quality.

Sketch-Supervised Histopathology Tumour Segmentation: Dual CNN-Transformer With Global Normalised CAM.

Deep learning methods are frequently used in segmenting histopathology images with high-quality annotations nowadays. Compared with well-annotated data, coarse, scribbling-like labelling is more cost-effective and easier to obtain in clinical practice. The coarse annotations provide limited supervision, so employing them directly for segmentation network training remains challenging. We present a sketch-supervised method, called DCTGN-CAM, based on a dual CNN-Transformer network and a modified global normalised class activation map. By modelling global and local tumour features simultaneously, the dual CNN-Transformer network produces accurate patch-based tumour classification probabilities by training only on lightly annotated data. With the global normalised class activation map, more descriptive gradient-based representations of the histopathology images can be obtained, and inference of tumour segmentation can be performed with high accuracy. Additionally, we collect a private skin cancer dataset named BSS, which contains fine and coarse annotations for three types of cancer. To facilitate reproducible performance comparison, experts are also invited to label coarse annotations on the public liver cancer dataset PAIP2019. On the BSS dataset, our DCTGN-CAM segmentation outperforms the state-of-the-art methods and achieves 76.68 % IOU and 86.69 % Dice scores on the sketch-based tumour segmentation task. On the PAIP2019 dataset, our method achieves a Dice gain of 8.37 % compared with U-Net as the baseline network.

Secondary Metabolites from the Genus Eurotium and Their Biological Activities.

Eurotium is the teleomorph genus associated with the section Aspergillus. Eurotium comprises approximately 20 species, which are widely distributed in nature and human environments. Eurotium is usually the key microorganism for the fermentation of traditional food, such as Fuzhuan brick tea, Liupao tea, Meju, and Karebushi; thus, Eurotium is an important fungus in the food industry. Eurotium has been extensively studied because it contains a series of interesting, structurally diverse, and biologically important secondary metabolites, including anthraquinones, benzaldehyde derivatives, and indol diketopiperazine alkaloids. These secondary metabolites have shown multiple biological activities, including antioxidative, antimicrobial, cytotoxic, antitumor, insecticidal, antimalarial, and anti-inflammatory activities. This study presents an up-to-date review of the phytochemistry and biological activities of all Eurotium species. This review will provide recent advances on the secondary metabolites and their bioactivities in the genus Eurotium for the first time and serve as a database for future research and drug development from the genus Eurotium.

Assessing the air pollution abatement effect of prefabricated buildings in China.

Due to the acceleration of urbanization and industrialization, air pollutants has been increasing, posing a major threat to human health and the ecological environment. During the past period of rapid growth, with the booming development of real estate, the air pollutants brought about by the construction of housing buildings have become more and more serious, especially sulfur dioxide, nitrogen dioxide, and dust, which cast a great threat to human life and seriously jeopardize human health. Compared with the traditional construction of houses, prefabricated buildings construction procedures are reduced, to some extent, can reduce air pollutants. Therefore, this paper takes an empirical perspective to include prefabricated buildings and air pollutants into the same research framework and analyze the inherent logical relationship. We found that prefabricated buildings have a substantial role in mitigating urban air pollution. This conclusion remained solid after various robustness tests including constructing instrumental variables. The effect is observed to be greater in cities above the non-sub-provincial level and those positioned within central regions. The conclusions explore new areas for the green and sustainable development of the construction industry, which in the future will have to fill the requirements of green development in order to survive. Else, perspectives from the construction industry, it provides a realistic solution to economic development and ecological protection, helping to alleviate or resolve the conflict between development and survival.

Fast Hologram Calculation Method Based on Wavefront Precise Diffraction.

In this paper, a fast hologram calculation method based on wavefront precise diffraction is proposed. By analyzing the diffraction characteristics of the object point on the 3D object, the effective viewing area of the reproduced image is analyzed. Based on the effective viewing area, the effective hologram size of the object point is obtained, and then the accurate diffraction calculation from the object point to the wavefront recording plane (WRP) is performed. By calculating all the object points on the recorded object, the optimized WRP of the whole 3D object can be obtained. The final hologram is obtained by calculating the diffraction light field from the WRP to the holographic plane. Compared with the traditional method, the proposed method can improve the calculation speed by more than 55%, while the image quality of the holographic 3D display is not affected. The proposed calculation method provides an idea for fast calculation of holograms and is expected to contribute to the development of dynamic holographic displays.

Occurrence and Genotypic Identification of Blastocystis spp., Enterocytozoon bieneusi, and Giardia duodenalis in Leizhou Black Goats in Zhanjiang City, Guangdong Province, China.

Blastocystis spp., Enterocytozoon bieneusi, and Giardia duodenalis are three common zoonotic intestinal parasites that cause severe diarrhea and enteric diseases. Leizhou black goats are characterized by a high reproductive rate, fast growth, and good meat quality, making them one of the pre-eminent goat breeds in China. Goats are reportedly common reservoirs of these three intestinal pathogens, but no information on their prevalence or genotypic distributions in black goats in Guangdong Province, China, is available. A total of 226 fecal samples were collected from goats in Zhanjiang city and genomic DNA was extracted from them. The presence of the three pathogens was detected using nested PCR targeting the sequences encoding SSU rRNA (Blastocystis spp.), the internal transcribed spacer of rRNA (ITS; E. bieneusi), as well as beta-giardin, glutamate dehydrogenase, and triosephosphate isomerase (G. duodenalis). All PCR products were sequenced to determine the species and genotypes of the organisms. The total prevalence rates of Blastocystis spp., E. bieneusi, and G. duodenalis were 33.63% (76/226), 17.70% (40/226), and 24.78% (56/226), respectively. Four subtypes of Blastocystis spp. were detected: ST5 (n = 6), ST10 (n = 50), ST14 (n = 14), and ST21 (n = 6). Among them, ST10 was the dominant genotype, accounting for 65.79% of strains, followed by the genotypes ST14 (18.42%), zoonotic ST5 (7.89%), and ST21 (7.89%). Four genotypes of E. bieneusi were detected: CHG3 (n = 32), CM21 (n = 4), CHG1 (n = 2), and ET-L2 (n = 2). Among these, CHG3 was the dominant genotype. Assemblage E (n = 54) and concurrent assemblages A and E (n = 2) were identified in the G. duodenalis-positive goats using multilocus genotyping. Blastocystis spp., E. bieneusi, and G. duodenalis infections were common in Leizhou black goats, all of which have zoonotic genotypes, indicating the potential risk of zoonotic transmission. Our results provide basic data for the prevention and control of these three intestinal pathogens. Further studies are required to better understand their genetic characteristics and zoonotic potential in Guangdong Province.

Systematic review and meta-analysis to study the outcomes of proactive versus delayed management in children with a congenital neurogenic bladder.

PURPOSE: To review the urological outcomes of proactive versus delayed management of children with a neurogenic bladder (NB). METHODS: We performed a literature search on EMBASE, MEDLINE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials between January 1, 2000 to August 21, 2023 for studies investigating the management of spina bifida-associated NB in pediatric patients (0-18 years of age). Proactive management was defined as use of clean intermittent catheterization, and/or anticholinergics at presentation, or based on initial high-risk urodynamic findings by 1 year of age. Delayed management was defined as beginning management after 1 year of age or no intervention. Outcomes included incidence or diagnosis of secondary vesicoureteral reflux (VUR), urinary tract infection (UTI), and renal deterioration, which included renal scarring, loss of differential renal function on a nuclear scan, or a decrease in renal function defined by glomerular filtration rate or serum creatinine estimation. Forest plots were synthesized using the Inverse Variance method with random-effect model. The Risk of Bias was assessed using the ROBINS-I tool. RESULTS: We included 8 observational studies on 652 pediatric patients with spina bifida-associated NB (mean follow-up - 7 years). Proactive management following initial assessment was associated with significantly lower risks of secondary VUR (OR 0.37 [0.19, 0.74], p = 0.004), non-febrile UTI (OR 0.35 [0.19, 0.62], p = 0.0004), and renal deterioration (OR 0.31 [0.20, 0.47], p < 0.00001). DISCUSSION: Delayed management of NB potentially has 3 times higher risks of secondary VUR, non-febrile UTI, and renal deterioration. However, the evidence is limited by the high risk of bias due to lack of randomization and standardized reporting in observational studies. CONCLUSION: While further well-defined prospective studies with long-term follow-up should be conducted to confirm this finding, this study supports the EAU/ESPU recommendations for early intervention in children with NB.

The effect of perioperative of dexamethasone on postoperative complications after pancreaticoduodenectomy (PANDEX): a study protocol for a pragmatic multicenter randomized controlled trial.

BACKGROUND: Pancreaticoduodenectomy (PD) nowadays serves as a standard treatment for patients with disorders of the pancreas, intestine, and bile duct. Although the mortality rate of patients undergoing PD has decreased significantly, postoperative complication rates remain high. Dexamethasone, a synthetic glucocorticoid with potent anti-inflammatory and metabolic effects, has been proven to have a favorable effect on certain complications. However, the role it plays in post-pancreatectomy patients has not been systematically evaluated. The aim of this study is to assess the effect of dexamethasone on postoperative complications after PD. METHODS: The PANDEX trial is an investigator-initiated, multicentric, prospective, randomized, double-blinded, placebo-control, pragmatic study. The trial is designed to enroll 300 patients who are going to receive elective PD. Patients will be randomized to receive 0.2 mg/kg dexamethasone or saline placebo, administered as an intravenous bolus within 5 min after induction of anesthesia. The primary outcome is the Comprehensive Complication Index (CCI) score within 30 days after the operation. The secondary outcomes include postoperative major complications (Clavien-Dindo≥3), postoperative pancreatic fistula (POPF), post-pancreatectomy acute pancreatitis (PPAP), infection, and unexpected relaparotomy, as well as postoperative length of stay, 30-day mortality, and 90-day mortality. DISCUSSION: The PANDEX trial is the first randomized controlled trial concerning the effect of dexamethasone on postoperative complications of patients undergoing PD, with the hypothesis that the intraoperative use of dexamethasone can reduce the incidence of postoperative complications and improve short-term outcomes after PD. The results of the present study will guide the perioperative use of dexamethasone and help improve the clinical management of post-pancreatectomy patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT05567094. Registered on 30 September 30 2022.

POST-IVUS: A perceptual organisation-aware selective transformer framework for intravascular ultrasound segmentation.

Intravascular ultrasound (IVUS) is recommended in guiding coronary intervention. The segmentation of coronary lumen and external elastic membrane (EEM) borders in IVUS images is a key step, but the manual process is time-consuming and error-prone, and suffers from inter-observer variability. In this paper, we propose a novel perceptual organisation-aware selective transformer framework that can achieve accurate and robust segmentation of the vessel walls in IVUS images. In this framework, temporal context-based feature encoders extract efficient motion features of vessels. Then, a perceptual organisation-aware selective transformer module is proposed to extract accurate boundary information, supervised by a dedicated boundary loss. The obtained EEM and lumen segmentation results will be fused in a temporal constraining and fusion module, to determine the most likely correct boundaries with robustness to morphology. Our proposed methods are extensively evaluated in non-selected IVUS sequences, including normal, bifurcated, and calcified vessels with shadow artifacts. The results show that the proposed methods outperform the state-of-the-art, with a Jaccard measure of 0.92 for lumen and 0.94 for EEM on the IVUS 2011 open challenge dataset. This work has been integrated into a software QCU-CMS2 to automatically segment IVUS images in a user-friendly environment.