A comparison between a gastroesophageal reflux disease questionnaire-based algorithm and multichannel intraluminal impedance-pH monitoring for the treatment of gastroesophageal reflux-induced chronic cough.

BACKGROUND: Empiric therapy with multichannel intraluminal impedance-pH monitoring (MII-pH) has been used for the initial treatment of gastroesophageal reflux-induced chronic cough (GERC). However, an algorithm based on the gastroesophageal reflux disease questionnaire (GerdQ) has the potential to achieve a simple, structured, and effective treatment approach for patients with GERC. OBJECTIVES: This study compared the efficacy of anti-reflux therapy based on GerdQ (new structured pathway, NSP) with medical treatment after MII-pH examination (ordinary clinical pathway, OCP) in the management of GERC. DESIGN: For the NSP, we adapted the GerdQ score to establish the basis for a treatment algorithm. For the OCP, treatment was determined using the MII-pH examination results. METHODS: The non-inferiority (NI) hypothesis was used to evaluate NSP versus OCP. RESULTS: Overall, the NSP and OCP-based therapeutic algorithms have similar efficacy for GERC [NI analysis: 95% confidence interval (CI), -4.97 to 17.73, p = 0.009; superiority analysis: p = 0.420]. Moreover, the cough symptom scores and cough threshold improved faster in the NSP group than in the OCP group at week 8 (p < 0.05). In the subgroup analyses using the GerdQ and GerdQ impact scale (GIS) scores, patients with low-likelihood GERC (GerdQ < 8) were more likely to benefit from OCP (NI analysis: 95% CI, -19.73 to 18.02, p = 0.213). On the other hand, in patients with high-likelihood and low-reflux impact GERC patients (GerdQ > 8 and GIS < 4), the NSP arm was not inferior to the standard treatment of OCP (NI analysis: 95% CI, -8.85 to 28.21%, p = 0.04; superiority analysis: p = 0.339), indicating that GerdQ- and GIS-guided diagnosis and management of patients with GERC could be an alternative to MII-pH management, especially in settings with reduced medical resources. CONCLUSIONS: The use of the GerdQ algorithm should be considered when handling patients with GERC in the primary care setting. TRIAL REGISTRATION: This research was registered in the Chinese Clinical Trials Registry (ChiCTR-ODT-12001899).

Current Perspectives on Biological Therapy for COPD.

Chronic obstructive pulmonary disease (COPD) is a chronic, complex, and heterogeneous condition with significant mortality, morbidity, and socioeconomic burden. Given the heterogeneity, the current management of COPD, which mainly relies on bronchodilators and corticosteroids, cannot consider all COPD populations. Moreover, the present treatment modalities are directed at minimizing symptoms and reducing the risk of a future attack, but they exhibit few meaningful anti-inflammatory activities in preventing and reducing disease progression. Therefore, new anti-inflammatory molecules are needed to manage COPD better. Use of targeted biotherapy may obtain better results by increasing understanding of the underlying inflammatory process and identifying new biomarkers. In this review, we focus briefly on study of the underlying inflammatory process in the pathogenesis of COPD for better identification of novel target biomarkers, and we describe a novel class of anti-inflammatory biologics that are already under evaluation for their use in managing COPD.

Deep neural network training method based on vectorgraphs for designing of metamaterial broadband polarization converters.

In this work, we proposed a method of extracting feature parameters for deep neural network prediction based on the vectorgraph storage format, which can be applied to the design of electromagnetic metamaterials with sandwich structures. Compared to current methods of manually extracting feature parameters, this method can automatically and precisely extract the feature parameters of arbitrary two-dimensional surface patterns of the sandwich structure. The position and size of surface patterns can be freely defined, and the surface patterns can be easily scaled, rotated, translated, or transformed in other ways. Compared to the pixel graph feature extraction method, this method can adapt to very complex surface pattern design in a more efficient way. And the response band can be easily shifted by scaling the designed surface pattern. To illustrate and verify the method, a 7-layer deep neural network was built to design a metamaterial broadband polarization converter. Prototype samples were fabricated and tested to verify the accuracy of the prediction results. In general, the method is potentially applicable to the design of different kinds of sandwich-structure metamaterials, with different functions and in different frequency bands.

Evaluation methods and influencing factors of cough sensitivity.

Increased cough sensitivity is an important mechanism of chronic cough, and the evaluation of cough sensitivity helps understand the mechanism of cough and explore better methods to reduce cough. Evaluation methods may be direct or indirect. Direct methods include mechanical stimulation and chemical stimulation, and indirect methods include laryngeal reflex test, questionnaires, and brain functional magnetic resonance imaging (fMRI). Chemical stimulation is the most common method, while the capsaicin cough challenge test is proven and widely used. In this article, we will compare evaluation methods and explore influencing factors of cough sensitivity.

A Method That Precisely Pressurizes the Local Limb.

Pressure garment treatment (PGT) is currently recognized as an effective method to prevent scar formation or treat scar hyperplasia. Research on PGT remains controversial. These controversies indicate that PGT lacks reliable evidence of evidence-based medicine. Different studies on PGT need to be conducted under the same "gold standard" so that different studies can be compared. We consider this "gold standard" to be that the pressure remains stable within a confidence interval during treatment. We calibrated and verified the reference value of the sensor using a cuff of sphygmomanometer. A pressure-adjustable pressure system was obtained by installing a soft tissue expander on the pressure garment. Local pressure was adjusted by charging and releasing air. Subsequently, the flexible pressure sensor was placed on the upper arm of the healthy volunteers. We validated the compression system on healthy volunteers' forearms and AO standard prostheses (forearms). The reference value of the sensor was calibrated on Volunteer 1. Measuring repeated on Volunteers 2 and 3. The measurement was very reproducible. The test results in the experimental group showed that the local pressure gradually increased with the increase of the inflation of the airbag. However, the pressure at the opposite position of the forearm changed little. Real-time pressure monitoring and pressure adjustment enable the pressure to be maintained at a certain value. Our study provides a new idea for the production of elastic clothing with the function of pressure measurement and pressure regulation, which may promote the accuracy and reliability of PGT.

A new flexible pressure sensor contributes to the early diagnosis of acute compartment syndrome.

Acute compartment syndrome (ACS) is a surgical emergency, caused by the sharp increase of interstitial pressure within a closed osteofascial compartment, which can impair local circulation and functions. A non-invasive sensor is needed of satisfactory sensitivity to continuously monitor the alterations of the ACS pressure, which could be used as a supplementary means in the early diagnosis of ACS. A prepared "pasting-type" flexible pressure sensor was used to establish an extracorporeal pig-skin model with a soft-tissue expander device to simulate compartment syndrome conditions. An acrylic panel was inserted into the pig skin, allowing the soft-tissue expander to expand in one direction, which is similar to the movements of a patient's bones in real life. The touch spot of the flexible pressure sensor was attached to the rind by medical tape, to record the internal and external pressure data. Relationships between the internal and external pressures at different thickness (0.87 mm, 3.53 mm and 3.97 mm), as well as that of the 3.97 mm thickness under various initial internal pressures (0.5 mmHg, 25 mmHg and 44 mmHg) were measured. Significant differences were observed in the range of internal pressures at various pig-skin thickness. After adding the acrylic panel, the measured ranges were significantly increased, with the lowest measurable internal pressure being 5 mmHg. Moreover, alterations in external pressure were also greater than in models without acrylic panels. The external pressure measured by the sensor was able to reflect an increase in intra-organizational pressure. This may be a new non-invasive and sustainable method for early diagnosis of ACS.

Freestanding symmetrical SiN/Si/SiN composite coated on carbon nanotube paper for a high-performance lithium-ion battery anode based on synergistic effects.

Direct coating of Si on an elastic carbon nanotube (CNT) network effectively addresses the rapid capacity fading of the Si anode. However, this strategy is hindered by the low Si tap density (Si < 50 nm) since sufficient void space has to be left for accommodating the Si volume change. Also, the mechanical properties of the CNT network as the elastic buffer matrix degrade significantly caused by side reactions of CNT with electrolyte. This work presents a freestanding paper-like anode consisting of a symmetrical sandwich-structured SiN/Si/SiN composite grown on CNT paper. This anode works well (∼259 µA h cm-2 under the current rate of 0.6C after 350 cycles, with a capacity retention of 73.8%) even when the CNT is filled by the composite without void space left for accommodating volume expansion. This is mainly due to the following synergistic effects: on one hand, the stress-compensation phenomenon in the symmetrical sandwich-structured composite balances the volume change-induced stress and thus the composite has a robust mechanical stability with an intact morphology during cycling. On the other hand, the intact composite avoids reaction of CNT with the electrolyte and thus the CNT retains excellent mechanical properties and serves well as the elastic buffer matrix. These two sides interact with each other, enabling the high anode performance.

A General Grid-Less Design Method for Location and Pressure Sensors with High Precision.

Bionic electronic skin can accurately sense and locate surface pressure, which is widely demanded in many fields. Traditional electronic skin design usually relies on grid-architecture sensor arrays, requiring complex grid and interconnection arrangements as well as high cost. Grid-less planar sensors can solve the problem by using electrodes only at the edges, but they usually require the use of mapping software such as electrical impedance tomography to achieve high precision. In this work, a design method of high-precision grid-less planar pressure sensors based on the back-propagation (BP) neural network is proposed. The measurement precision of this method is demonstrated to be over two orders of magnitude higher than that of a grid-structure sensor array with the same electrode distribution density. Moreover, this method can be used for irregularly-shaped and non-uniform sensors, which further reduces the manufacturing difficulty and increases the application flexibility.

A Retrospective Case Series Of High-Intensity Focused Ultrasound (HIFU) In Combination With Gemcitabine And Oxaliplatin (Gemox) On Treating Elderly Middle And Advanced Pancreatic Cancer.

PURPOSE: This retrospective study was conducted to evaluate the safety and efficacy of high-intensity focused ultrasound (HIFU) ablation combined with Gemcitabine and Oxaliplatin (Gemox) for the treatment of middle and advanced pancreatic cancer in elderly patients. METHODS: Forty-seven patients with pancreatic cancer treated with HIFU and Gemox were evaluated for inclusion, and 38 cases were finally included. The primary endpoint was safety. Secondary endpoints included the response rate, the clinical benefit response (CBR), overall survival (OS), progression-free survival (PFS). RESULTS: After combination therapy of HIFU and Gemox, severe complications were rarely reported, and no treatment-related death occurred. The rate of three or four-degree myelosuppression was low, and no obvious impairment of hepatorenal function was observed. Pancreatitis and gastrointestinal injury did not occurred. The disease control rate (DCR) was estimated to be 76.3%, including complete remission (CR), partial remission (PR), stable disease (SD) in 1, 6, 22 cases, respectively. And the objective response rate (ORR) was 18.4%. The clinical benefit rate (CBR) was 68.4%, with the pain significantly relieved (P<0.01). The serum level of CA19-9 showed significant changes after HIFU treatment. The median overall survival (OS) was 12.5 months, with a 6-month and 12-month OS rate of 82.13% and 59.34%, respectively. Stratified analyses did not reveal any significant difference between patients in different stages. CONCLUSION: Elderly patients (≥ 60 years old) with pancreatic cancer would experience tolerable toxicity and obtain good clinical benefits from the combination therapy of HIFU ablation and Gemox.

Conductivity Size Effect of Square Cross-Section Polycrystalline Nanowires.

A theoretical model for the electrical conductivity size effect of square nanowires is proposed in this manuscript, which features combining the three main carrier scattering mechanisms in polycrystalline nanowires together, namely, background scattering, external surface scattering, as well as grain boundary scattering. Comparisons to traditional models and experiment data show that this model achieves a higher correlation with the experiment data.

A quantum mechanical theory for single molecule-single nanoparticle surface enhanced Raman scattering.

Single molecule-single nanoparticle surface enhanced Raman scattering event is analyzed using a quantum mechanical approach, resulting in an analytical expression for the electromagnetic enhancement factor that succinctly elucidates the fundamental aspects of SERS. The nanoparticle is treated as a dielectric spherical cavity, and the resulting increase in the spontaneous emission rate of a molecule adsorbed onto the surface of the nanoparticle is examined. The overall enhancement in Raman scattering is due to both the increased local electromagnetic field and the Purcell effect. The predictions of the present model are in agreement with the simulation results of the classical model.

Transient increased expression of VEGF and MMP-1 in a rat liver tumor model after hepatic arterial occlusion.

BACKGROUND/AIMS: This study investigates the influence of hepatic arterial occlusion (HAO) on blood perfusion of transplanted cancer in rat's liver, and the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-1 (MMP-1) and explores the mechanisms involved in transcatheter arterial embolization (TAE)-induced metastasis of liver cancer preliminarily. METHODOLOGY: Walker 256 carcinosarcoma was transplanted into rat's liver to create the liver cancer model. Hepatic arterial ligation (HAL) was used to block the hepatic arterial blood supply and simulate TAE. Rats bearing tumor were divided into three groups: control, laparotomy control, and HAL groups. Blood perfusion of tumor was analyzed by a Hoechst 33342 labeling assay. The level of serum VEGF was assayed by ELISA; and the expression of VEGF and MMP-1 mRNA was detected by in situ hybridization. RESULTS: Two days after HAL, the number of Hoechst 33342 labeled cells which represent the blood perfusion of the tumor directly and hypoxia of tumor indirectly in the HAL group decreased significantly compared with that in the control group (329.1+/-29.3 vs. 383.6+/-19.2, P<0.01). The level of serum VEGF in the HAL group increased significantly compared with that of the control group (92.5+/-43.9 pg/mL vs. 54.9+/-19.3 pg/mL, P<0.05). The expression of VEGF and MMP-1 mRNA in the tumor tissue of the HAL group increased significantly compared with that of the control and the laparotomy control groups (P<0.05). The blood perfusion data of the tumor, represented by number of Hoechst 33342 labeled cells, showed an inverse correlation with the expression of VEGF mRNA in tumor tissue (P<0.05). While 6 days after HAL, the blood perfusion of tumor in HAL group decreased and the expression of VEGF and MMP-1 increased only slightly, not significantly, compared with that in the control group. CONCLUSIONS: In conclusion, blockage of hepatic arterial blood supply results in transient decreased blood perfusion and increased expression of metastasis-associated genes VEGF and MMP-1 of transplanted liver cancer in rats. Decreased blood perfusion and hypoxia may be the major reason for up-regulated expression of VEGF. Better understanding of the mechanisms involved with TAE-induced metastasis may lead to the enhancement of the long-term effects of TAE for liver cancer.

Influence of hepatic arterial blockage on blood perfusion and VEGF, MMP-1 expression of implanted liver cancer in rats.

AIM: To investigate the influence of hepatic arterial blockage on blood perfusion of transplanted cancer in rat liver and the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-1 (MMP-1), and to explore the mechanisms involved in transarterial embolization (TAE)-induced metastasis of liver cancer preliminarily. METHODS: Walker 256 carcinosarcoma was transplanted into rat liver to establish the liver cancer model. Hepatic arterial ligation (HAL) was used to block the hepatic arterial blood supply and simulate TAE. Blood perfusion of tumor in control, laparotomy control, and HAL group was analyzed by Hoechst 33342 labeling assay, the serum VEGF level was assayed by ELISA, the expression of VEGF and MMP-1 mRNA was detected by in situ hybridization. RESULTS: Two days after HAL, the number of Hoechst 33342 labeled cells which represent the blood perfusion of tumor directly and hypoxia of tumor indirectly in HAL group decreased significantly compared with that in control group (329+/-29 vs 384+/-19, P<0.01). The serum VEGF level in the HAL group increased significantly as against that of the control group (93 ng.L(-1)+/-44 ng.L(-1) vs 55 ng.L(-1)+/-19 ng.L(-1), P<0.05). The expression of VEGF and MMP-1 mRNA in the tumor tissue of the HAL group increased significantly compared with that of the control and the laparotomy control groups (P<0.05). The blood perfusion data of the tumor, represented by the number of Hoechst 33342 labeled cells, showed a good linear inverse correlation with the serum VEGF level (r=-0.606, P<0.05) and the expression of VEGF mRNA in the tumor tissue ( r =-0.338, P<0.01). CONCLUSION: Blockage of hepatic arterial blood supply results in decreased blood perfusion and increased expression of metastasis-associated genes VEGF and MMP-1 of transplanted liver cancer in rats. Decreased blood perfusion and hypoxia may be the major cause of up-regulated expression of VEGF.