Combination of Minimally Invasive Methods for the Treatment of Varicose Veins.

OBJECTIVE: The aim of the study was to evaluate the efficacy and safety of the combination of minimally invasive methods for the treatment of incompetent great saphenous vein and perforating veins. METHODS: Between December 2019 and October 2020, F-care radiofrequency ablation combined with ultrasound-guided foam sclerotherapy and residual perforator ligation and concomitant microphlebectomy were adopted for all eligible patients. The clinical symptoms scores, complications, and quality of life were recorded. RESULTS: 49 patients (64 limbs) with a mean age of 63.29 ± 10.14 years, and 60.9%4 were male. The 1-year truncal closure rate was 63/64 (98.4%).1 A significant improvement in the Venous Disability Score, the Venous Segmental Disease Score, the Venous Clinical Severity Score and Chronic Venous Disease Quality of Life Questionnaire Score, at 12 months after the combination of minimally invasive treatment, were observed in the study. One patient developed intermuscular vein thrombosis that was successfully managed with rivaroxaban. CONCLUSIONS: The combination of minimally invasive methods is a safe and effective method for the treatment of lower extremity varicose veins. Further large-scale, prospective, multi-center studies are needed to further verify the findings of this study.

Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and the third leading cause of cancer-related deaths globally. Hepatic arterial infusion chemotherapy (HAIC) treatment is widely accepted as one of the alternative therapeutic modalities for HCC owing to its local control effect and low systemic toxicity. Nevertheless, although accumulating high-quality evidence has displayed the superior survival advantages of HAIC of oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) compared with standard first-line treatment in different scenarios, the lack of standardization for HAIC procedure and remained controversy limited the proper and safe performance of HAIC treatment in HCC. Therefore, an expert consensus conference was held on March 2023 in Guangzhou, China to review current practices regarding HAIC treatment in patients with HCC and develop widely accepted statements and recommendations. In this article, the latest evidence of HAIC was systematically summarized and the final 22 expert recommendations were proposed, which incorporate the assessment of candidates for HAIC treatment, procedural technique details, therapeutic outcomes, the HAIC-related complications and corresponding treatments, and therapeutic scheme management.

Performance of two-dimensional shear wave elastography for detecting advanced liver fibrosis and cirrhosis in patients with biliary atresia: a systematic review and meta-analysis.

BACKGROUND: Two-dimensional shear wave elastography (2D-SWE) has been proposed for detecting liver fibrosis in biliary atresia. OBJECTIVES: To assess the performance of 2D-SWE for detecting advanced liver fibrosis and cirrhosis in patients with biliary atresia. MATERIALS AND METHODS: Five electronic databases were searched to identify studies investigating the performance of 2D-SWE for diagnosing liver fibrosis in biliary atresia in children. We constructed the summary receiver operating characteristic (SROC) curves of 2D-SWE for detecting advanced liver fibrosis and cirrhosis, and then calculated the area under the SROC curves (AUROCs). RESULTS: Six studies with 470 patients (ages 55 days to 6.6 years) were included. The median correlation coefficient of 2D-SWE with pathological liver fibrosis stages was 0.779 (range: 0.443‒0.813). The summary AUROCs for advanced liver fibrosis and cirrhosis were 0.929 and 0.883, respectively. The summary sensitivity and specificity of 2D-SWE for advanced liver fibrosis were 88% (95% confidence interval [CI]: 80‒94%) and 85% (95% CI: 77‒91%) with I values of 0% and 45.6%, respectively, and for cirrhosis were 80% (95% CI: 72‒87%) and 82% (95% CI: 77‒86%) with I values of 12.9% and 0%, respectively. The diagnostic odds ratio (DOR) of 2D-SWE for advanced liver fibrosis and cirrhosis were 40.3 (95% CI: 18.2‒89.4) and 18.9 (95% CI: 11.2‒31.7), respectively. For preoperative detection of cirrhosis, the pooled AUROC, sensitivity, specificity, and DOR based on the four 2D-SWE studies were 0.877, 79% (95% CI: 71‒86%), 82% (95% CI: 77‒86%), and 17.58 (95% CI: 10.35‒29.85), respectively. CONCLUSIONS: Results show that 2D-SWE has potential as a non-invasive tool for detecting advanced liver fibrosis and cirrhosis in patients with biliary atresia.

Maternal body fluid lncRNAs serve as biomarkers to diagnose ventricular septal defect: from amniotic fluid to plasma.

Background: Maternal body fluids contain abundant cell-free fetal RNAs which have the potential to serve as indicators of fetal development and pathophysiological conditions. In this context, this study aimed to explore the potential diagnostic value of maternal circulating long non-coding RNAs (lncRNAs) in ventricular septal defect (VSD). Methods: The potential of lncRNAs as non-invasive prenatal biomarkers for VSD was evaluated using quantitative polymerase chain reaction (qPCR) and receiver operating characteristic (ROC) curve analysis. The biological processes and regulatory network of these lncRNAs were elucidated through bioinformatics analysis. Results: Three lncRNAs (LINC00598, LINC01551, and GATA3-AS1) were found to be consistent in both maternal plasma and amniotic fluid. These lncRNAs exhibited strong diagnostic performance for VSD, with AUC values of 0.852, 0.957, and 0.864, respectively. The bioinformatics analysis revealed the involvement of these lncRNAs in heart morphogenesis, actin cytoskeleton organization, cell cycle regulation, and protein binding through a competitive endogenous RNA (ceRNA) network at the post-transcriptional level. Conclusion: The cell-free lncRNAs present in the amniotic fluid have the potential to be released into the maternal circulation, making them promising candidates for investigating epigenetic regulation in VSD.

Differential lncRNA/mRNA expression profiling and ceRNA network analyses in amniotic fluid from foetuses with ventricular septal defects.

Background: Long noncoding RNAs (lncRNAs) have been shown to be involved in the regulation of numerous biological processes in embryonic development. We aimed to explore lncRNA expression profiles in ventricular septal defects (VSDs) and reveal their potential roles in heart development. Methods: Microarray analyses were performed to screen differentially expressed lncRNAs (DE-lncRNAs) and mRNAs (DE-mRNAs) in the amniotic fluid between the VSD group and the control group. Bioinformatics analyses were further used to identify the functional enrichment and signaling pathways of important mRNAs. Then, a coding-noncoding gene coexpression (CNC) network and competitive endogenous RNAs (ceRNA) network were drawn. Finally, qRT‒PCR was performed to verify several hub lncRNAs and mRNAs in the network. Results: A total of 710 DE-lncRNAs and 397 DE-mRNAs were identified in the VSD group. GO and KEGG analyses revealed that the DE-mRNAs were enriched in cardiac development-related biological processes and pathways, including cell proliferation, cell apoptosis, and the Sonic Hedgehog signaling pathway. Four VSD related mRNAs was used to construct the CNC network, which included 149 pairs of coexpressing lncRNAs and mRNAs. In addition, a ceRNA network, including 15 lncRNAs, 194 miRNAs, and four mRNAs, was constructed to reveal the potential regulatory relationship between lncRNAs and protein-coding genes. Finally, seven RNAs in the ceRNA network were validated, including IDS, NR2F2, GPC3, LINC00598, GATA3-AS1, PWRN1, and LINC01551. Conclusion: Our study identified some lncRNAs and mRNAs may be potential biomarkers and therapeutic targets for foetuses with VSD, and described the lncRNA-associated ceRNA network in the progression of VSD.

Use of Sound Touch Elastography and Sound Touch Quantification for the Noninvasive Evaluation of Portal Hypertension in a Rat Model.

OBJECTIVES: In this study, we used the recently developed ultrasound elastography techniques sound touch elastography (STE) and sound touch quantification (STQ) to quantify portal hypertension (PHT) severity in a rat model of carbon tetrachloride (CCl4 )-induced cirrhotic PHT. METHODS: In total, 60 rats were used. Various degrees of PHT were established. Liver and spleen stiffness were measured by STE (L-STE and S-STE, respectively) and STQ (L-STQ and S-STQ, respectively). We measured portal pressure (PP) after ultrasonographic examination. The performance of the STE and STQ parameters in the identification of PHT was evaluated using receiver operating characteristic (ROC) analyses. RESULTS: Liver and spleen stiffness measurements obtained with STE and STQ correlated positively with the PP (r = 0.566-0.882, all P < .001). The areas under ROC curves for L-STE, S-STE, L-STQ, and S-STQ values were 0.931 (95% confidence interval [CI], 0.847-1.000), 0.982 (95% CI, 0.956-1.000), 0.796 (95% CI, 0.680-0.912), and 0.925 (95% CI, 0.858-0.993), respectively, for PP ≥5 mmHg; 0.937 (95% CI, 0.865-1.000), 0.938 (95% CI, 0.864-1.000), 0.967 (95% CI, 0.923-1.000), and 0.960 (95% CI, 0.897-1.000), respectively, for PP ≥10 mmHg; and 0.954 (95% CI, 0.897-1.000), 0.790 (95% CI, 0.652-0.928), 0.808 (95% CI, 0.680-0.935), and 0.740 (95% CI, 0.595-0.885), respectively, for PP ≥12 mmHg. CONCLUSIONS: STE and STQ are reliable noninvasive tools for the assessment of PHT severity, especially for PP ≥10 mmHg, in a rat model of CCl4 -induced cirrhotic PHT.

Chromosomal abnormalities in fetuses with congenital heart disease: a meta-analysis.

PURPOSE: The aim of this meta-analysis was to evaluate the risk of chromosomal abnormalities in fetuses with congenital heart disease (CHD). METHODS: Four literature databases were searched until 17th January 2022 using the relevant medical subject heading terms, word variants, and keywords for "congenital heart defect, fetal, and chromosomal abnormalities". The prevalence of overall chromosomal abnormality, aneuploidy, 22q11 deletion, other copy number variants (CNVs), and variants of unknown significance (VOUS) was analyzed. RESULTS: 45 studies met the inclusion criteria for the analysis. The pooled proportion of overall chromosomal abnormalities, aneuploidy, 22q11 deletion, and other CNVs in fetuses with CHD was 23% (95% CI: 20-26%), 19% (95% CI, 16-22%), 2% (95% CI, 2-3%), and 4% (95% CI, 3-5%), respectively. The incidence of overall chromosomal abnormalities, aneuploidy, and other CNVs in non-isolated CHD was higher than in isolated CHD, with odds ratios of 3.08, 3.45, and 4.02, respectively. The incidence of overall chromosomal abnormalities in septal defects was higher than in conotruncal defects and other defects, with odds ratios of 1.60 and 3.61, respectively. In addition, the pooled proportion of VOUS in CHD was 4%. CONCLUSION: CHD is commonly associated with chromosomal abnormalities. If karyotyping or fluorescence in situ hybridization is normal, chromosomal microarray should be performed to look for submicroscopic abnormalities, especially in fetuses with non-isolated CHD and septal defects.

Nanocomposites of epoxy with one-dimensional fibrous poly(ε-caprolactam) nanocrystals via crystallization-driven self-assembly.

In this contribution, we reported the preparation of nanocomposites of epoxy with one-dimensional (1D) poly(ε-caprolactam) (PA6) nanocrystals via crystallization-driven self-assembly. First, a novel diblock copolymer composed of poly(ethylene oxide) and poly(ε-caprolactam) subchains (PEO-b-PA6) was synthesized via the anionic ring-opening polymerization (ROP) of ε-caprolactam. It was found that the PEO-b-PA6 diblocks displayed crystallization-driven self-assembly (CDSA) behavior in the selective solvents (e.g., water); the 1D fibrous nanocrystals of PA6 were obtained via CDSA approach. Such a CDSA behavior was utilized to generate 1D fibrous PA6 nanocrystals into epoxy thermosets. In this case, the epoxy precursors were used as the solvent selective for PEO subchain of the diblock. Notably, the 1D fibrous PA6 nanocrystals were generated in the epoxy precursors via the CDSA approach. Upon curing, the nanocomposites (i.e., the nanostructured thermosets containing PA6 nanocrystals) were successfully obtained. It was found that epoxy thermoset was significantly nanoreinforced by the PA6 nanocrystals. In the meantime, the fracture toughness of the materials was significantly improved with the incorporation of 1D fibrous PA6 nanocrystals.

The value of CT-based radiomics in early assessment of chemotherapeutic effect in patients with advanced lung adenocarcinoma: a preliminary study.

BACKGROUND: Computed tomography (CT) is the preferred method for evaluating the therapeutic effect of lung cancer. Radiomics parameters can provide a lot of supplementary information for clinical diagnosis and treatment. PURPOSE: To investigate the value of radiomics features of CT imaging to predict and evaluate the early efficacy of chemotherapy in patients with advanced lung adenocarcinoma. MATERIAL AND METHODS: A total of 101 patients with advanced lung adenocarcinoma were enrolled. Patients were classified into a response group and non-response group according to RECIST 1.1 standard. All patients underwent chest CT examination before and after two cycles of chemotherapy. A total of 293 radiomics features were calculated. The features between response group and non-response group were compared before and after chemotherapy. The diagnostic efficacy was evaluated using the receiver operating characteristic curve. RESULTS: The six pre-chemotherapy radiomics features were selected, with area under the curve (AUC), sensitivity, and specificity at 0.720, 68.3%, and 69.0% in the training group and 0.573, 50.0%, and 76.9% in the test group, respectively. The eleven post-chemotherapy radiomics features were selected, with AUC, sensitivity, specificity at 0.789, 75.6%, and 75.9% in the training group and 0.718, 61.1%, and 76.9% in the test group, respectively. The prognostic value of △f8, △f16, %f8, and %f16 were higher than the other features with AUCs of 0.787, 0.837, 0.763, and 0.877, respectively. CONCLUSION: Radiomics is expected to provide more valuable information for evaluating the chemotherapy efficacy of lung adenocarcinoma.

Diagnostic accuracy of liver stiffness on two-dimensional shear wave elastography for detecting clinically significant portal hypertension: a meta-analysis.

PURPOSE: Two-dimensional shear wave elastography (2D-SWE) has recently been proposed to detect clinically significant portal hypertension (CSPH), we aimed to perform a meta-analysis based on the published data to assess the diagnostic accuracy of 2D-SWE for detecting CSPH. METHOD: Literature databases were searched up until 1 August 2021. The summary area under receiver operating characteristics curve (AUROC), the summary diagnostic odds ratio (DOR), and the summary sensitivity and specificity were used to examine the accuracy of 2D-SWE for evaluating CSPH. Heterogeneity was explored using meta-regression. RESULTS: Finally 9 studies with 956 patients were included in this study for evaluation and meta-analysis. 2D-SWE showed good diagnostic performance for detecting CSPH with a summary sensitivity of 83% (95% confidence interval [CI]: 76%-88%) and summary specificity of 78% (95% CI: 65%-87%); the summary AUROC was 0.88 (95% CI: 0.84-0.90). Summary positive likelihood ratio (LR), negative LR, and DOR of 2D-SWE for detecting CSPH were 3.7 (95% CI: 2.4-5.9), 0.22 (95% CI: 0.16-0.30), and 17 (95% CI: 10-29), respectively. CONCLUSIONS: 2D-SWE showed good performance in diagnosing CSPH and can be considered as an important and noninvasive adjunctive approach in the management of patients with CSPH.

Impact Factors in Chinese Construction Enterprises' Carbon Emission-Reduction Intentions.

The reduction in carbon emissions in the construction industry plays an important role in the realization of the goal of carbon peaking and carbon neutrality, especially in China. Construction enterprises' personnel's intentions to reduce their carbon emissions are closely related to low-carbon behavior. However, the research on the impact factors of carbon emission-reduction intention (CERI) is still limited. In order to understand the factors that affect the intentions of construction enterprises' personnel to reduce carbon emissions, and to put forward valuable suggestions for reducing construction enterprises' carbon emissions, it is necessary to explore the impact factors in carbon emission-reduction intention through empirical tests. This study adopted the theory of planned behavior (TPB) based on the three impact factors of behavioral attitude (BA), subjective norms (SNs) and perceived behavioral control (PBC), introduced the two potential impact factors of moral obligation (MO) and government supervision (GS), and also uses structural equation modeling (SEM) to test the impact factors in construction enterprises' personnel's carbon emission-reduction intention. The results show that BA, MO and GS have a significant positive impact on carbon emission-reduction intention (CERI). Among them, BA plays an intermediary role between MO and CERI, and BA and MO play a chain intermediary role between GS and CERI. The research conclusions will help to provide a theoretical reference for governments and construction enterprises to implement carbon emission-reduction development strategies and policies.

The diagnostic performance of ultrasound elastography for biliary atresia: A meta-analysis.

Background: Biliary atresia (BA) is a severe inflammatory obliterative cholangiopathy of infancy that requires early diagnosis and prompt surgical intervention. In this study, we aimed to obtain comprehensive evidence on the diagnostic performance of liver stiffness measurement by ultrasound elastography in the detection of BA through a meta-analysis. Methods: The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for studies that investigated the diagnostic performance of ultrasound elastography in the detection of BA up to January 10, 2022. In this study, in order to summarize the diagnostic performance of ultrasound elastography, the summary receiver operating characteristic (SROC) modeling was constructed. Heterogeneity was estimated with the I 2 statistic. Multiple subgroup analyses were also performed. Results: Fourteen studies from eleven articles, including 774 BA patients, 850 non-BA patients, and 173 controls were included in the present meta-analysis. The summary sensitivity and specificity of ultrasound elastography for liver stiffness were 85% [95% confidence interval (CI): 79-89%] and 82% (95% CI: 73-88%) with the I 2 value of 82.90 and 84.33%, respectively. The area under the SROC curve (AUROC) using ultrasound elastography for diagnosing BA was 0.90 (95% CI: 0.87-0.92). In addition, a subgroup analysis of 9 two-dimensional shear wave elastography studies was also performed. Subgroup analysis revealed that the summary sensitivity and specificity were 85% (95% CI: 77-91%) and 79% (95% CI: 71-86%), respectively, and the summary AUROC was 0.89 (95% CI: 0.86-0.92). Conclusions: Ultrasound elastography exhibits good diagnostic accuracy for BA and can be served as a non-invasive tool to facilitate the differential diagnosis of BA.

Generation of One-Dimensional Fibrous Polyethylene Nanocrystals in Epoxy Thermosets.

The one-dimensional (1D) polyethylene (PE) nanocrystals were generated in epoxy thermosets via crystallization-driven self-assembly. Toward this end, an ABA triblock copolymer composed of PE midblock and poly(ε-caprolactone) (PCL) endblocks was synthesized via the ring opening metathesis polymerization followed by hydrogenation approach. The nanostructured thermosets were obtained via a two-step curing approach, i.e., the samples were cured first at 80 °C and then at 150 °C. Under this condition, the one-dimensional (1D) fibrous PE microdomains with the lengths up to a couple of micrometers were created in epoxy thermosets. In contrast, only the spherical PE microdomains were generated while the thermosets were cured via a one-step curing at 150 °C. By the use of the triblock copolymer, the generation of 1D fibrous PE nanocrystals is attributable to crystallization-driven self-assembly mechanism whereas that of the spherical PE microdomains follows traditional self-assembly mechanism. Compared to the thermosets containing the spherical PE microdomains, the thermosets containing the 1D fibrous PE nanocrystals displayed quite different thermal and mechanical properties. More importantly, the nanostructured thermosets containing the 1D fibrous PE nanocrystals displayed the fracture toughness much higher than those only containing the spherical PE nanocrystals; the KIC value was even three times as that of control epoxy.

Shear wave elastography as a quantitative biomarker of diabetic peripheral neuropathy: A systematic review and meta-analysis.

Background: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes and the strongest initiating risk factor for diabetic foot ulceration. Early diagnosis of DPN through screening measures is, therefore, of great importance for diabetic patients. Recently, shear wave elastography (SWE) has been used as a method that is complementary to neuroelectrophysiological examination in the diagnosis of DPN. We aimed to conduct a meta-analysis based on currently available data to evaluate the performance of tibial nerve stiffness on SWE for diagnosing DPN. Methods: Both PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for studies that investigated the diagnostic performance of SWE for DPN up to March 1th, 2022. Three measures of diagnostic test performance, including the summary area under receiver operating characteristics curve (AUROC), the summary sensitivity and specificity, and the summary diagnostic odds ratios were used to assess the diagnostic accuracy of SWE. All included studies were published between 2017 and 2021. Results: Six eligible studies (with 170 DPN patients, 28 clinically defined DPN patients, 168 non-DPN patients, and 154 control participants) that evaluated tibial nerve stiffness were included for meta-analysis. The summary sensitivity and specificity of SWE for tibial nerve stiffness were 75% (95% confidence interval [CI]: 68-80%) and 86% (95% CI: 80-90%), respectively, and the summary AUROC was 0.84 (95% CI: 0.81-0.87), for diagnosing DPN. A subgroup analysis of five two-dimensional SWE studies revealed similar diagnostic performance, showing the summary sensitivity and specificity of 77% (95% CI: 69-83%) and 86% (95% CI: 79-91%), respectively, and a summary AUROC value of 0.86 (95% CI: 0.83-0.89). Conclusions: SWE is found to have good diagnostic accuracy for detecting DPN and has considerable potential as an important and noninvasive adjunctive tool in the management of patients with DPN.

Model Analysis and Experimental Investigation of Soft Pneumatic Manipulator for Fruit Grasping.

With the superior ductility and flexibility brought by compliant bodies, soft manipulators provide a nondestructive manner to grasp delicate objects, which has been developing gradually as a rising focus of soft robots. However, the unexpected phenomenon caused by environmental effects, leading to high internal nonlinearity and unpredictable deformation, makes it challenging to design, model, and control soft manipulators. In this paper, we designed a soft pneumatically actuated manipulator consisting of four soft actuators, as well as a flange, and investigated the influence of structural parameters on the output characteristics of the manipulator through finite element analysis (FEA). To enhance the bending deformation of the soft actuator, annular rings were employed on the soft actuator. A mathematical model for the bending deformation of air cavities was established to explore the relationship between the driving pressure and the bending angle based on the Yeoh strain energy function. Moreover, an end-output force model was established to depict the variation of the force output with the bending angle of the soft actuator, which was then experimentally validated by adopting the manufactured manipulator. The soft actuator studied in this paper can bend from 0° to 110° under an applied pressure of 0-60 kPa, and the maximum grasping load of the soft manipulator is 5.8 N. Finally, practical tests were conducted to assess the adaptability of the soft manipulator when grasping delicate fruits, such as apples, pears, tomatoes, and mangoes, demonstrating its broad application prospects in nondestructive fruit harvesting.

Rs4911154 of circ-ITCH aggravated tumor malignancy of thyroid nodules via the circ-ITCH/miR-22-3p/CBL axis.

Recent evidence revealed an inhibitory effect of circ-ITCH on the progression of papillary thyroid cancer via affecting the circ-ITCH/miR-22-3p/CBL axis. Rs4911154, an SNP located in circ-ITHC, was previously reported to be significantly associated with an increased risk of hepatocellular carcinoma. Ultrasound testing was used to evaluate the doubling time of thyroid nodules. 202 patients diagnosed with thyroid nodule disorders were divided into three groups according to their genotypes at rs4911154. We found that the A allele was correlated with a shortening doubling time of thyroid nodules. Moreover, the A allele contributed to reduced expression of circ-ITCH/CBL and increased expression of miR-22-3p. Besides, decreased tissue apoptosis was linked to the A allele. Luciferase assays indicated that miR-22-3p could effectively suppress the luciferase activities of CBL and circ-ITCH. Furthermore, manual up-regulation of miR-22-3p effectively suppressed the expression of CBL, while CBL siRNA apparently abolished circ-ITCH induced CBL upregulation, reduced proliferation and increased apoptosis of K1 and TPC-1 cells. A signaling pathway of circ-ITCH/miR-22-3p/CBL axis was established to explain the effect of SNP of circ-ITCH in thyroid tumor malignancy. Compared with the G allele, the A allele in rs4911154 contributed to the malignancy of thyroid nodules with decreased doubling time and down-regulated CBL expression.

Menarche age exceed 17 years and menopausal age smaller than 48 years may affect prevalence of osteoporosis for Chinese women.

In this work, we used a cross-sectional study to evaluate influence of menarche age, menstrual cycle, menstrual period, menopausal age, and menopause years for osteoporosis in women from China. We found that different menarche age, menstrual cycle, menopausal years, and menopausal age are related with the prevalence of osteoporosis. However, menarche age exceeds 17 years and menopausal age smaller than 48 years are risk factors for osteoporosis in women. STUDY DESIGN: A cross-sectional, population-based study. PURPOSE: The purpose of this study was to explore relationship between prevalence of osteoporosis and menarche age, menstrual cycle, menstrual period, menopausal age, and menopause years for women. METHODS: From March to October 2016, the cluster sampling method was used to conduct an osteoporosis-related questionnaire survey on women aged 40-80 in two communities in Lanzhou City, Gansu, China, and bone mineral density(BMD)was carried out using the DTX-200 dual-energy X-ray absorptiometer produced by the US OSTEOMETER company. The relationship between prevalence of osteoporosis and menarche age, menstrual cycle, menstrual period, menopausal age, and menopause years were analyzed using logistic regression analysis. RESULTS: There were 2224 female participates enrolled in this study and average age was 61.60 ± 8.05 years and total rate of prevalence was 32.73%; among them, different menarche age, menstrual cycle, menopausal years, and menopausal age have statistical differences with the prevalence of osteoporosis, but there is no statistical difference between different menstruation and the prevalence of osteoporosis. Single logistic regression analysis found that older menarche age, earlier menopausal age, and longer menopausal years were related factors for the prevalence of osteoporosis, while menarche age exceed 17 years and menopausal age smaller than 48 years are risk factors for osteoporosis for women in multivariate regression analysis. CONCLUSIONS: In China, ages at menarche and menopause are associated with prevalence of osteoporosis. Later, menarche and earlier menopause are associated with higher osteoporosis risk. Menarche and menopause history may help identify women with increased risk of developing osteoporosis.

Efficiency enhancement of a new cellulase cocktail at low enzyme loading for high solid digestion of alkali catalyzed atmospheric glycerol organosolvent pre-treated sugarcane bagasse.

The acquisition during biomass saccharification of elevated levels of fermentable sugars with lower cellulase concentration is central to ensuring an economically viable and industrially relevant hydrolytic process. Thus, using a new cellulase preparation (LT4) at low cellulase loading (2 mg protein/g dried substrate), this study assessed the possible boosting effect of integrating accessory enzymes and additives on high-solids hydrolysis of sugarcane bagasse via fed-batch feeding. Hydrolysis which commenced with initial 8% solids loading and subsequent substrate feeding of 4% solids at 6 h, 18 h, and 24 h respectively, proved optimal for the 20% high-solids saccharification producing 158 g/L total sugars and 83% glucose yield after 72 h with the combined optimized additives and accessory enzymes. The results obtained indicate that the integration of accessory enzymes and additives offers a benignant approach to minimizing the enzyme load and cost of high solids saccharification of lignocellulosic heteropolymers while also boosting enzyme hydrolytic performance.

Apatinib as second-line or later therapy in patients with advanced hepatocellular carcinoma (AHELP): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial.

BACKGROUND: Inhibition of vascular endothelial growth factor receptor (VEGFR) has shown antitumour activity in advanced hepatocellular carcinoma, but few studies of VEGFR inhibitors have been done in populations with a high prevalence of hepatitis B virus infection. The aim of this study was to evaluate the efficacy and safety of apatinib in patients with pretreated advanced hepatocellular carcinoma. METHODS: AHELP was a randomised, double-blind, placebo-controlled, phase 3 trial done at 31 hospitals in China, in patients (aged ≥18 years) with advanced hepatocellular carcinoma who had previously been refractory or intolerant to at least one line of systemic chemotherapy or targeted therapy. Patients were randomly assigned (2:1) to receive apatinib 750 mg or placebo orally once daily in 28-day treatment cycles. Group allocation was done with a central randomisation system, with a block size of six, and was stratified by Eastern Cooperative Oncology Group performance status, previous sorafenib treatment, and presence of vascular invasion or extrahepatic metastasis. The primary endpoint was overall survival, which was defined as time from randomisation to death from any cause, and was analysed in patients who were randomly assigned and received at least one dose of the study drug. Safety analyses were done in patients who received at least one dose of the study treatment and had post-dose safety assessments. This trial is registered with ClinicalTrials.gov, NCT02329860. FINDINGS: Between April 1, 2014, and May 3, 2017, 400 eligible patients were randomly assigned to receive apatinib (n=267) or placebo (n=133). Seven patients (six in the apatinib group and one in the placebo group) did not receive study treatment and were excluded from efficacy analyses. Overall survival was significantly improved in the apatinib group compared with the placebo group (median 8·7 months [95% CI 7·5‒9·8] vs 6·8 months [5·7‒9·1]; hazard ratio 0·785 [95% CI 0·617‒0·998], p=0·048). 387 patients (257 in the apatinib group and 130 in the placebo group) had a safety assessment after study treatment and were included in safety analyses. The most common treatment-related adverse events of grade 3 or 4 were hypertension (71 [28%] patients in the apatinib group vs three [2%] in the placebo group), hand-foot syndrome (46 [18%] vs none), and decreased platelet count (34 [13%] vs one [1%]). 24 (9%) patients in the apatinib group and 13 (10%) in the placebo group died due to adverse events, but none of these deaths were deemed to be related to treatment by investigators. INTERPRETATION: Apatinib significantly improved overall survival in patients with pretreated advanced hepatocellular carcinoma compared with placebo, with a manageable safety profile. FUNDING: Jiangsu Hengrui Medicine.