Accidental placement of venous return catheter in the superior vena cava during venovenous extracorporeal membrane oxygenation for severe pneumonia: A case report.

BACKGROUND: Venovenous extracorporeal membrane oxygenation (V-V ECMO) has become an important treatment for severe pneumonia, but there are various complications during the treatment. This article describes a case with severe pneumonia successfully treated by V-V ECMO, but during treatment, the retrovenous catheter, which was supposed to be in the right internal vein, entered the superior vena cava directly in the mediastinum. The ECMO was safely withdrawn after multidisciplinary consultation. Our experience with this case is expected to provide a reference for colleagues who will encounter similar situations. CASE SUMMARY: A 64-year-old man had severe pulmonary infection and respiratory failure. He was admitted to our hospital and was given ventilation support (fraction of inspired oxygen 100%). The respiratory failure was not improved and he was treated by V-V ECMO, during which the venous return catheter, which was supposed to be in the right internal vein, entered the superior vena cava directly in the mediastinum. There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn. Finally, the patient underwent vena cava angiography + balloon attachment + ECMO withdrawal in the operating room (prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery) after multidisciplinary consultation. ECMO was safely withdrawn, and the patient recovered and was discharged. CONCLUSION: Patients may have different vascular conditions. Multidisciplinary cooperation can ensure patient safety. Our experience will provide a reference for similar cases.

Morphological and vascular evidence of glaucomatous damage in myopic guinea pigs with scleral crosslinking.

Guinea pigs are often used as models for myopia studies. However, the imaging structure and vasculature of the optic nerve head (ONH) in guinea pigs are tentative. This study investigated morphological parameters and vascular characteristics of the ONH in guinea pigs with form deprivation (FD) myopia before and after scleral crosslinking (CXL), using optical coherence tomography (OCT) and OCT angiography (OCTA). Refractive error, axial length (AL), intraocular pressure (IOP), and OCT-based structural parameters of the ONH were measured at baseline and 3 weeks after the FD + CXL procedure in guinea pigs. The 88 guinea pigs analysed in this study were aged 3 (n = 29), 4 (n = 51), and 5 (n = 8) weeks. The IOP, AL, average and vertical cup-to-disc ratio (C/D), circumpapillary retinal nerve fibre layer, disc area, and cup volume increased at 3 weeks compared to baseline values (all p < 0.001). The refractive error and rim area decreased at 3 weeks compared to baseline values (all p < 0.001). After adjustment for age, IOP was correlated positively with average C/D (p = 0.039) and negatively with rim area (p = 0.009). The severity of blood signal defects was positively associated with the average C/D at 3 weeks (p = 0.027). These findings may facilitate further research on myopia using guinea pigs.

A case report of chest wall desmoplastic small round cell tumor in children.

INTRODUCTION: Desmoplastic small round cell tumor (DSRCT) is a rare sarcoma predominantly afflicting young males. CASE PRESENTATION: In this current report, a two-year-old boy was admitted to the hospital for the evaluation of a left chest wall mass. Imaging revealed the tumor's presence in the left chest, compressing lung tissue. Subsequently, histological analysis confirmed the DSRCT diagnosis following a biopsy. The patient underwent a comprehensive management strategy centered around surgery, successfully completing the entire treatment course without experiencing relapse during subsequent follow-up assessments. DISCUSSION: When chest wall tumors are inoperable upon initial diagnosis, a biopsy is essential to clarify the pathology and assist in the diagnostic process. If a patient is diagnosed with DRSCT and conventional chemotherapy fails with surgical resection still not feasible, timely adjustment of the chemotherapy regimen coupled with targeted drug administration can reduce the tumor, enable complete resection, and improve the overall prognosis. CONCLUSION: DSRCT is a rare malignancy associated with a generally poor prognosis. The administration of a combined treatment approach involving oral targeted medication (anlotinib), chemotherapy, radiotherapy, and aggressive surgical resection holds the potential to enhance the prognosis for pediatric patients with this condition.

A nonsense mutation in VHL causing Von Hippel-Lindau syndrome in a large Chinese family-a genetic study of familial neoplastic disease.

Von Hippel-Lindau (VHL) syndrome is a multi-organ neoplastic disease characterized by highly vascular and cystic tumors in the central nervous system (CNS), retina, and visceral lesions, which are mainly caused by germline mutations in VHL. We aimed to detect novel mutations in VHL gene in families with VHL. Here, a large consanguineous four-generation family with variant phenotypes of VHL syndrome was recruited, and its molecular genetics were tested via Sanger sequencing. And various tools and databases were used to predict the variant pathogenicity, frequency, and protein function. Genetic investigation detected a c.351G > A nonsense mutation in VHL that altered the downstream reading frame and created a premature TGA stop signal, resulting in severely truncated pVHL (p.Trp117Ter). This mutation is absent from most public databases, and functional prediction bioinformatic tools demonstrated that this residue is conserved and that this variant is highly likely to be deleterious. The c.315G > A nonsense mutation in VHL is the causal mutation of this kindred that may lead to clear familial aggregation of VHL syndrome because of the dysfunction of the truncated pVHL.

Promoting Nucleic Acid Synthesis in Saccharomyces cerevisiae through Enhanced Expression of Rrn7p, Rrn11p, IMPDH, and Pho84p.

Saccharomyces cerevisiae has emerged as a preferred source for industrial production of ribonucleic acids (RNAs) and their derivatives, which find wide applications in the food and pharmaceutical sectors. In this study, we employed a modified RNA polymerase I-mediated green fluorescent protein expression system, previously developed by our team, to screen and identify an industrial S. cerevisiae strain with an impressive 18.2% increase in the RNA content. Transcriptome analysis revealed heightened activity of genes and pathways associated with rRNA transcription, purine metabolism, and phosphate transport in the high nucleic acid content mutant strains. Our findings highlighted the crucial role of the transcription factor Sfp1p in enhancing the expression of two key components of the transcription initiation factor complex, Rrn7p and Rrn11p, thereby promoting rRNA synthesis. Moreover, elevated expression of 5'-inosine monophosphate dehydrogenases, regardless of the specific isoform (IMD2, 3, or 4), resulted in increased rRNA synthesis through heightened GTP levels. Additionally, exogenous phosphate application, coupled with overexpression of the phosphate transporter PHO84, led to a 61.4% boost in the RNA yield, reaching 2050.4 mg/L. This comprehensive study provides valuable insights into the mechanism of RNA synthesis and serves as a reference for augmenting RNA production in the food industry.

Initial experience of the treatment of large glioma with microwave ablation-assisted surgical resection.

Aim: This study aimed to investigate the preliminary clinical outcomes of microwave ablation (MWA)-assisted surgical treatment for large glioma. Materials and Methods: In total, six cases of large glioma (diameter >4 cm) were described. All cases were treated with MWA-assisted surgical resection, which was performed using ultrasound to guide the accurate placement of the antenna in the central region of the tumor. The MWA power was 40-45 W, and 6 min was applied. Changes in the ablation area were observed using intraoperative Doppler ultrasound and contrast-enhanced ultrasound (CEUS). Ten patients treated with surgical resection alone were included in the control group. Data on surgical times (i.e., the time from the incision of the dura to the removal of the tumor), intraoperative blood loss, and complications were recorded. Results: The median patient age was 45 years (range: 36.5-60.3 years). The median lesion diameter was 4.9 cm (range: 4.3-5.8). The microwave power was 40-45 W, and the median ablation time was 240 s (range: 208-297 s). The intra-tumoral vascular flow was significantly reduced after MWA. The median surgical time was shorter (38.5 min [range: 34.3-42.8 min]) and the median intraoperative blood loss was less (400 mL, [range: 400-450 mL]) in the combination treatment group than in the surgery-alone group. During the ablation process, no obvious additional neurological deficits were detected; however, a tube-shaped carbonide was found after the operation. Conclusion: MWA may be a useful complement to conventional techniques for the surgical resection of large glioma.

Efficacy and Safety Evaluation of Scleral Cross-Linking Using Genipin in the Treatment of Juvenile Guinea Pigs with High Myopia.

Purpose: To investigate the efficacy and safety of scleral cross-linking (CXL) using Genipin in the treatment of juvenile guinea pigs with high myopia. Methods: Twenty-four 4-week-old tricolor guinea pigs with high myopia of diopter ≤ -6.0 DS in the right eye were randomly divided into two groups: Genipin CXL group and control group (n = 12 for each group). They received separately form-deprivation (FD) combined with sub-tenon injection, and the former was 0.5% Genipin solution, while the latter was 0.9% saline solution. Refractive error, axial length (AL), intraocular pressure (IOP), and structural and vasculature optic disc changes in optical coherence tomography (OCT) and OCT angiography (OCTA) were analyzed at baseline and at 3 weeks after injection. Results: Baseline parameters were similar between the two groups (P > 0.05). After 3 weeks of the intervention, the difference of AL between the two groups was statistically significant (t = -11.28, P < 0.001). Besides, IOP increased in both groups, and the changes of IOP between the two groups were statistically significant (t = 2.80, P = 0.01). The average cup-disc ratio (C/D) (t = 3.11, P = 0.006) and the vertical C/D (t = 2.96, P = 0.009) of OCT-related optic disc parameters in the Genipin CXL group increased, and the differences were statistically significant compared with the control group. Conclusion: The CXL method of sub-tenon injection of Genipin solution could effectively inhibit the progression of myopia in juvenile guinea pigs with highly myopic eyes combined with FD. The slightly elevated IOP and increased C/D of some fundus optic discs should be further assessed.

One-pot preparation of supramolecularly functionalized silver nanoparticles for surface plasmon resonance based dual-modal sensing of phytotoxic polychlorinated biphenyl.

Polychlorinated biphenyls (PCBs), as a member of persistent organic pollutants (POPs), have posed a risk to humans and the environment until today. The monitoring of phytotoxic PCB which is toxic to plants, is especially important for ecological early warning and pollution management. In this work, ß-cyclodextrin modified silver nanoparticles are prepared in a one-pot method, integrating the synthesis and surface modification in one step. The nanoparticles can supramolecularly immobilize 2,4,4'-trichlorobiphenyl (PCB 28) on their surface and construct a surface plasmon resonance-based nanosensor. Surface plasmon-resonance light scattering and surface-enhanced Raman scattering sensing of PCB 28 are realized using the nanosensor. The dual-modal sensing shows excellent performance for the potential practical monitoring of phytotoxic POPs in the plant and its growing environment.

Comparative interleukins and chemokines analysis of mice mesenchymal stromal cells infected with Mycobacterium tuberculosis H37Rv and H37Ra.

Inflammatory pathways involving Mesenchymal stromal cells (MSCs) play an important role in Mycobacterium tuberculosis (Mtb) infection. H37Rv (Rv) is a standard virulent strain, however, H37Ra (Ra) is a strain with reduced virulence. Interleukins and chemokines production are known to promote inflammation resistance in mammalian cells and is recently reported to regulate mycobacterial immunopathogenesis via inflammatory responses. MSCs are very important cells during Mtb infection. However, the different expressions of interleukins and chemokines in the process of Mtb-infected MSCs between Ra and Rv remain unclear. We used the techniques of RNA-Seq, qRT-PCR, ELISA, and Western Blotting. We have shown that Rv infection significantly increased mRNA expressions of Mndal, Gdap10, Bmp2, and Lif, thereby increasing more differentiation of MSCs compared with Ra infection in MSCs. Further investigation into the possible mechanisms, we found that Rv infection enhanced more inflammatory response (Mmp10, Mmp3, and Ptgs2) through more activation of the TLR2-MAP3K1-JNK pathway than did Ra infection in MSCs. Further action showed that Rv infection enhanced more Il1α, Il6, Il33, Cxcl2, Ccl3, and Ackr3 production than did Ra infection. Rv infection showed more expressions of Mmp10, Mmp3, Ptgs2, Il1α, Il6, Il33, Cxcl2, Ccl3, and Ackr3 possibly through more active TLR2-MAP3K1-JNK pathway than did Ra infection in MSCs. MSCs may therefore be a new candidate for the prevention and treatment of tuberculosis.

Transmembrane protein 117 knockdown protects against angiotensin-II-induced cardiac hypertrophy.

Mitochondrial dysfunction plays a critical role in the pathogenesis of pathological cardiac hypertrophy. Transmembrane protein 117 modulate mitochondrial membrane potential that may be involved in the regulation of oxidative stress and mitochondrial function. However, its role in the development of angiotensin II (Ang-II)-induced cardiac hypertrophy is unclear. Cardiac-specific TMEM117-knockout and control mice were subjected to cardiac hypertrophy induced by Ang-II infusion. Small-interfering RNAs against TMEM117 or adenovirus-based plasmids encoding TMEM117 were delivered into left ventricles of mice or incubated with neonatal murine ventricular myocytes (NMVMs) before Ang-II stimulation. We found that TMEM117 was upregulated in hypertrophic hearts and cardiomyocytes and TMEM117 deficiency attenuated Ang-II-induced cardiac hypertrophy in vivo. Consistently, the in vitro data demonstrated that Ang-II-induced cardiomyocyte hypertrophy significantly alleviated by TMEM117 knockdown. Conversely, overexpression of TMEM117 exacerbated cardiac hypertrophy and dysfunction. An Ang II-induced increase in cardiac (cardiomyocyte) oxidative stress was alleviated by cardiac-specific knockout (knockdown) of TMEM117 and was worsened by TMEM117 supplementation (overexpression). In addition, TMEM117 knockout decreased endoplasmic reticulum stress induced by Ang-II, which was reversed by TMEM117 supplementation. Furthermore, TMEM117 deficiency mitigated mitochondrial injury in hypertrophic hearts and cardiomyocyte, which was abolished by TMEM117 supplementation (overexpression). Taken together, these findings suggest that upregulation of TMEM117 contributes to the development of cardiac hypertrophy and the downregulation of TMEM117 may be a new therapeutic strategy for the prevention and treatment of cardiac hypertrophy.

Study on Physical Properties of Desulfurized Electrolytic Manganese Residue Cement and Properties of Mortar.

The desulfurized electrolytic manganese residue (DMR) was prepared by calcination and desulfurization of industrial waste electrolytic manganese residue, and the original DMR was ground to prepare DMR fine powder (GDMR) with specific surface areas of 383 m2/kg, 428 m2/kg, and 629 m2/kg. The effects of particle fineness and content of GDMR (GDMR content=0%, 10%, 20%, 30%) on the physical properties of cement and the mechanical properties of mortar were studied. After that, the leachability of heavy metal ions was tested, and the hydration products of GDMR cement were analyzed using XRD and SEM. The results show that the addition of GDMR can regulate the fluidity and water requirement for the normal consistency of cement, delay the hydration process of cement, increase the initial setting and final setting time of cement, and reduce the strength of cement mortar, especially the strength of early age mortar. As the fineness of GDMR increases, the reduction of bending strength and compressive strength decreases, and the activity index increases. The content of GDMR has a significant effect on short-term strength. With the increase in GDMR content, the strength reduction degree becomes higher and the activity index decreases. When the content of GDMR was 30%, the 3D compressive strength and bending strength decreased by 33.1% and 29%. When the content of GDMR in cement is less than 20%, the maximum limit of leachable heavy metal content in cement clinker can be met.

Research on the Construction of Grain Food Multi-Chain Blockchain Based on Zero-Knowledge Proof.

As the main food source of the world's population, grain quality safety is of great significance to the healthy development of human beings. The grain food supply chain is characterized by its long life cycle, numerous and complex business data, difficulty defining private information, and difficult managing and sharing. In order to strengthen the ability of information application processing and coordination of the grain food supply chain under many risk factors, an information management model suitable for the grain food supply chain is studied based on the blockchain multi-chain technology. First, the information on key links in the grain food supply chain is analyzed to obtain privacy data classifications. Second, a multi-chain network model of the grain food supply chain is constructed, and based on this model, the hierarchical encryption and storage mode of private data as well as the relay cross-chain communication mode, are designed. In addition, a complete consensus process, including CPBFT, ZKP, and KZKP algorithms, is designed for the global information collaborative consensus under the multi-chain architecture. Finally, the model is verified through performance simulation, theory analysis, and prototype system verification in terms of its correctness, security, scalability, and consensus efficiency. The results show that this research model effectively reduces the storage redundancy and deals with problems of data differential sharing in traditional single-chain research, as well as provides a secure data protection mechanism, a credible data interaction mechanism, and an efficient multi-chain collaborative consensus mechanism. By attempting to apply blockchain multi-chain technology to the grain food supply chain, this study provides new research ideas for the trusted protection of data and information collaborative consensus in this field.

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test.

BACKGROUND: Epstein-Barr virus (EBV) infection plays a crucial role in the progression of acquired immunodeficiency syndrome related primary central nervous system lymphoma (AR-PCNSL). This study aimed at evaluating the diagnostic value of cerebrospinal spinal fluid (CSF) EBV-deoxyribonucleic acid (DNA) for PCNSL in patients with infection of human immunodeficiency (HIV) virus through a meta-analysis of diagnostic test. METHODS: A systematic search in PubMed, Embase, Web of Science, Wanfang, Chinese Biomedical Database and Chinese National Knowledge Infrastructure was conducted before May 10, 2022. Heterogeneity among the studies was assessed using Q test and I2 statistics. Publication bias was assessed using the Deek's funnel plot asymmetry test. Statistical analyses were performed using Stata 16.0 software. The pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were caculated to evaluate the diagnostic value. A symmetric receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC) were constructed to evaluate the test-performance. RESULTS: Twelve studies were included in the final analyses, with a total of 141 patients with AR-PCNSL and 590 controls. The pooled diagnostic values were sensitivity of 0.83 (95% CI: 0.73-0.90), specificity of 0.95 (95%CI: 0.89-0.98), PLR of 17.8 (95%CI: 6.8-46.1), NLR of 0.17 (95%CI: 0.10-0.30), DOR of 102 (95%CI: 28-379), and AUC of 0.94 (95%CI: 0.91-0.96). CONCLUSION: In summary the overall diagnostic value of CSF EBV-DNA is very high and it can be a reliable diagnostic biomarker for AR-PCNSL.

Microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach: operative technique and a series of 6 patients.

OBJECTIVE: To investigate the surgical techniques and postoperative therapeutic effectiveness of microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach. METHODS: The clinical data of 6 cases with lumbar paravertebral tumors treated by lateral retroperitoneal approach in the Neurosurgery department of Xuanwu Hospital, Capital Medical University were analyzed retrospectively. The mean operation time, blood loss, incision length, length of hospital stay, and the resection rate of paravertebral tumors were collected, and the score of The Ability to Perform Activities of Daily Living (ADL) and incidence of postoperative complications was recorded. RESULTS: The operation time ranged from 56 to 181 min, with an average of (94.8 ± 48.3) minutes. The blood loss was between 5 and 100 ml, with an average of (31.7 ± 37.5) ml. The incision length was 6-7 cm, with an average of (6.7 ± 0.5) cm. The hospitalization length was between 5 and 11 days, with an average of (8.7 ± 2.6) days. The resection rate of paravertebral tumors was 100%. Postoperative pathological diagnosis results revealed 4 cases of schwannoma, 1 case of ganglioneuroma, and 1 case of malignant small round cell tumor. During the 3-month follow-up, there were no tumor recurrence, abdominal infection, incision infection, incisional hernia, or death, and there was no significant decrease in the ADL score compared with that before the operation. CONCLUSION: The surgical treatment of lumbar paravertebral tumors via the lateral retroperitoneal approach has the advantages of the short operation time, minimally invasive procedures, quick postoperative recovery, and fewer complications.

Capsaicin Prevents Contrast-Associated Acute Kidney Injury through Activation of Nrf2 in Mice.

Capsaicin, a transient receptor potential vanilloid 1 channel agonist, possesses antioxidative properties through activating nuclear factor-erythroid 2-related factor 2 (Nrf2). As oxidative stress is a major contributor to the development of contrast-associated acute kidney injury (CA-AKI), we investigated the protective effect of capsaicin against CA-AKI via Nrf2. C57BL/6J mice were treated with dehydration and iodixanol to establish the model of CA-AKI. For pretreatment, capsaicin (0.3 mg/kg) was given via intraperitoneal injection one hour before iodixanol injection. Nrf2-specific siRNA was given through the tail vein to knock down Nrf2. The CA-AKI mouse model had remarkable mitochondrial fragmentation and dysfunction and apoptosis of tubular cells, overproduction of superoxide in renal tubules, increased renal malondialdehyde, tubular epithelial cell injury, and renal dysfunction. Importantly, pretreatment with capsaicin significantly ameliorated tubular cell injury and renal dysfunction with decreased superoxide, renal malondialdehyde, and apoptotic tubular cells and improved mitochondrial morphology and function in the CA-AKI mouse model. The expression of Nrf2 was increased in the kidney from the CA-AKI mouse model and was further enhanced by capsaicin. Administration of siRNA through the tail vein successfully decreased Nrf2 expression in the kidney, and knockdown of Nrf2 by siRNA abolished the beneficial effects of capsaicin on CA-AKI. The present study demonstrated a protective effect of capsaicin pretreatment against CA-AKI via Nrf2.

Morphological and vascular characteristics of the optic nerve head of normal guinea pigs.

The morphological and vascular characteristics of the optic nerve head (ONH) of normal guinea pigs have not been fully recognized. Therefore, we aimed to investigate them using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). We measured the refractive error, axial length, and intraocular pressure (IOP) and performed OCT and OCTA of the ONH of 3- and 4-week-old tricolour guinea pigs. A total of 208 right eyes from 208 normal guinea pigs were examined. The refractive error (both myopic and hyperopic) of the 3-week group was significantly higher than that of the 4-week group (p < 0.001), the IOP of the 3-week group was significantly lower than that of the 4-week group (p = 0.014), and the circumpapillary retinal nerve fibre layer (cpRNFL) of the 3-week group was significantly thicker than that of the 4-week group (p = 0.048). There were no significant differences in the average vessel area, vascular density, total number of junctions, total vessel length, total number of endpoints, and vascular diameter between the two groups. However, an age-adjusted linear regression analysis revealed that the total vessel length was positively associated with the cpRNFL thickness (p = 0.024) and negatively associated with IOP (p = 0.016). This is the first report on morphological and vascular characteristics of the ONH in normal guinea pigs based on in vivo OCT and OCTA imaging and quantification of ONH parameters. These results may contribute to further research on myopia using guinea pig models.

Realizing Target Detection in SAR Images Based on Multiscale Superpixel Fusion.

For target detection in complex scenes of synthetic aperture radar (SAR) images, the false alarms in the land areas are hard to eliminate, especially for the ones near the coastline. Focusing on the problem, an algorithm based on the fusion of multiscale superpixel segmentations is proposed in this paper. Firstly, the SAR images are partitioned by using different scales of superpixel segmentation. For the superpixels in each scale, the land-sea segmentation is achieved by judging their statistical properties. Then, the land-sea segmentation results obtained in each scale are combined with the result of the constant false alarm rate (CFAR) detector to eliminate the false alarms located on the land areas of the SAR image. In the end, to enhance the robustness of the proposed algorithm, the detection results obtained in different scales are fused together to realize the final target detection. Experimental results on real SAR images have verified the effectiveness of the proposed algorithm.

Recent Advances in Collaborative Scheduling of Computing Tasks in an Edge Computing Paradigm.

In edge computing, edge devices can offload their overloaded computing tasks to an edge server. This can give full play to an edge server's advantages in computing and storage, and efficiently execute computing tasks. However, if they together offload all the overloaded computing tasks to an edge server, it can be overloaded, thereby resulting in the high processing delay of many computing tasks and unexpectedly high energy consumption. On the other hand, the resources in idle edge devices may be wasted and resource-rich cloud centers may be underutilized. Therefore, it is essential to explore a computing task collaborative scheduling mechanism with an edge server, a cloud center and edge devices according to task characteristics, optimization objectives and system status. It can help one realize efficient collaborative scheduling and precise execution of all computing tasks. This work analyzes and summarizes the edge computing scenarios in an edge computing paradigm. It then classifies the computing tasks in edge computing scenarios. Next, it formulates the optimization problem of computation offloading for an edge computing system. According to the problem formulation, the collaborative scheduling methods of computing tasks are then reviewed. Finally, future research issues for advanced collaborative scheduling in the context of edge computing are indicated.

Prognostic Value and Risk Factors of Treatment-Related Lymphopenia in Malignant Glioma Patients Treated With Chemoradiotherapy: A Systematic Review and Meta-Analysis.

Background: Immunotherapy has shown promising therapeutic efficacy in various cancers but not gliomas. Circulating lymphocytes play critical roles in cancer control and responses to immune checkpoint inhibitors. Treatment-related lymphopenia has been associated with poor survival in patients with various tumors. This meta-analysis evaluated the risk and impact of lymphopenia in patients with glioma. Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were comprehensively searched. Eligible studies were included if they reported the incidence and risk factors of lymphopenia and the impact of lymphopenia on survival. Stata 16.0 was used for this meta-analysis. Results: A total of 21 studies were included in the final systematic review and 20 were included in the quantitative analysis. The overall incidence of grade III/IV lymphopenia was 31.6% [95% confidence interval (CI), 22.3-40.8%]. Pooled results based on pathology of glioma revealed that the incidence in astrocytoma and astrocytoma oligodendroglioma patients was 20.2% (95% CI:5.9-34.4%), and the incidence in glioblastoma patients was 27.6% (95% CI:16.2-38.9%). Lymphopenia was associated with poor overall survival (hazard ratio, 1.99; 95% CI, 1.74-2.27; P< 0.001) compared to no lymphopenia. Brain receiving radiation dose of 20 or 25 Gy, female sex, older age, lower baseline lymphocyte count, and dexamethasone dose > 2 mg instead of baseline use were risk factors for lymphopenia. Conclusions: Treatment-related lymphopenia was associated with decreased survival in patients with glioma. Optimization of chemoradiation regimens, particularly in patients with concurrent risk factors, can reduce lymphopenia and potentially improve survival in the era of immunotherapy.