An Intermolecular Hydroarylation of Unactivated Arylcyclopropane via Re2O7/HFIP-Mediated Ring Opening.

In this paper, we describe a Re2O7-mediated ring-opening arylation of unactivated arylcyclopropane because of its functionalization with various arenes via Friedel-Crafts-type reactivity. This protocol allows facile access to functionalized 1,1-diaryl alkanes and is characterized by a broad substrate scope, mild reaction conditions, high efficiency, and high atom economy. Both density functional theory calculations and deuterium labeling experiments were carried out to justify the indispensable role of HFIP in this transformation and pointed to Re2O7-mediated ring opening being the rate-determining step.

Research progress of intra-aortic balloon counterpulsation in the treatment of acute myocardial infarction with cardiogenic shock: A review.

The mortality rate of patients with acute myocardial infarction complicated with cardiogenic shock is very high, and in recent years, intra-aortic balloon counterpulsation has been used more and more. It plays a very important role in improving left ventricular ejection, increasing coronary artery perfusion pressure and reducing myocardial oxygen consumption. This article reviews the development of intra-aortic balloon counterpulsation in the treatment of acute myocardial infarction with cardiogenic shock in recent years.

Breast cancer is associated with coronary heart disease: a cross-sectional survey of NHANES 1999-2018.

Background: Understanding the correlation between female breast cancer (BC) and the prevalence of coronary heart disease (CHD) is important for developing prevention strategies and reducing the burden of female social disease. This study aimed to evaluate the relationship between BC and CHD using data from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018. Methods: The study cohort included 16,149 eligible non-pregnant female participants aged 20 years or older. Logistic regression was used to analyze the relationship between BC and CHD, excluding the interaction between covariates and BC through hierarchical subgroup analysis. Results: The study found that participants with BC had a 2.30 times greater risk of developing CHD compared to those without BC [95% confidence interval (CI): 2.29-2.31]. After adjusting for all included covariates, BC was still significantly associated with CHD risk (odds ratio: 1.11, 95% CI: 1.10-1.12). When participants were stratified by age, education level, and prevalence of hypertension, it was evident that participants with BC had a higher risk of developing CHD compared to those without BC, although the effect of BC on CHD varied across stratification. Conclusions: Our study demonstrates the close relationship between CHD and female BC. Therefore, it is necessary to screen patients with CHD for BC and monitor BC survivors for the long-term risk of developing CHD.

New method for measuring the pore sizes and pore size distributions of filter membranes-the fluorescence probe method.

A novel, simple, and rapid method is demonstrated for measuring the pore size and pore size distribution of filtration membranes (FMs) used in aqueous applications with fluorescence probes. Because the selected fluorescent probes are mixable and have strong signals, combined with the operation of dead-end filtration, this method only requires small amounts of reagents; additionally, it is time-efficient by avoiding multiple rounds of filtration. This method detects the size of a FM pore throat (i.e., the narrowest position of a pore tunnel), which is more consistent with the actual filtration situation. The conditions, such as probe concentration, temperature, transmembrane pressure difference, and types of surfactants, have been optimized. The experimental results show that the fluorescence probe method has good accuracy and reproducibility for measuring the pore size and pore size distribution of both organic and inorganic FMs. The method is particularly suitable for rapid testing of the filtration performance (nominal pore size≥0.02 µm) of purchased or synthetic membranes in the laboratory.

The association between monocyte to high-density lipoprotein cholesterol ratio and clinical prognosis of acute ischemic stroke after intravenous thrombolysis therapy.

The monocyte-to-high-density lipoprotein cholesterol (HDL) ratio (MHR) is accepted as a novel marker for demonstrating inflammation. We investigated whether the monocyte-to-HDL ratio is related to the 90-day clinical prognosis of acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). Patients with AIS treated with alteplase IVT were included consecutively, and clinical information and laboratory data were collected. The 90-day prognosis of all patients was determined with a clinical assessment using the modified Rankin Scale (mRS). The optimal cutoff values for patients were evaluated by the receiver operating characteristic (ROC) curve method. Then, a multivariate logistic regression model was used to evaluate the risk factors for poor prognosis of IVT in AIS. We retrospectively enrolled 192 patients who were diagnosed with AIS and received IVT between February 2020 and July 2022, with final follow-up on September 30, 2022. The patients in the poor prognosis group had significantly higher monocyte counts, lower HDL levels, and higher MHR values than the good prognosis group. The optimal cutoff value of the MHR for predicting the 3-month outcome of acute pontine infarction was 0.621. Multivariate logistic regression revealed that the MHR (OR = 4.626, 95% CI: 1.156-18.512, P = .030) was strongly associated with poor prognosis in AIS. The MHR is an independent risk factor for the clinical prognosis of AIS patients receiving IVT therapy and shows a certain predictive value.

Synthesis of 1-Aryltetralins via Re2O7/HReO4 Mediated Intramolecular Hydroarylations.

Here, we describe highly efficient intramolecular hydroarylations mediated by Re2O7/HReO4. Styrene derivatives of different electronic properties have been activated to effect a challenging intramolecular hydroarylation for the facile access to various substituted 1-aryltetralin structures. This method is characterized by mild reaction conditions, broad substrate scope, high chemical yields, and 100% atom economy. The potential synthetic application of this methodology was exemplified by the efficient total synthesis of an isoCA-4 analogue.

Prognostic value and mode selection of locoregional treatment in Stage-IV breast cancer patients.

PURPOSE: This study aimed to assess the actual prognostic significance of different locoregional treatment (LRT) (surgery and radiotherapy) modalities for stage-IV  breast cancer (BC) patients and construct a competing risk nomogram to make precise predictions of the breast cancer-specific death (BCSD) risk among LRT recipients. METHODS: A total of 9279 eligible stage-IV BC patients from the Surveillance Epidemiology and End Results (SEER) database were included in this study. Initially, we evaluated the impact of LRT on survival both before and after the propensity score matching (PSM). Then, we used the Cox hazard proportional model and competing risk model to identify the independent prognostic factors for LRT recipients. Based on the screened variables, a comprehensive nomogram was established. RESULTS: Kaplan-Meier curves demonstrated that LRT significantly prolonged overall survival (OS) and breast cancer-specific survival (BCSS) (P < 0.001). In addition, patients treated with surgery combined with postoperative radiotherapy (PORT) possessed the optimal survival (P < 0.001). Regardless of the surgical modalities, primary tumor resection combined with radiotherapy could ameliorate the prognosis (P < 0.05). Subgroup analysis showed that in patients with T2-T4 stage, PORT had a survival benefit compared with those undergoing surgery combined with preoperative radiotherapy (PRRT) and surgery only. Based on the screened independent prognostic factors, we established a comprehensive nomogram to forecast BCSD in 1 year, 2 years and 3 years, which showed robust predictive ability. CONCLUSION: PORT was associated with a lower BCSD in stage-IV BC patients. The practical nomogram could provide a precise prediction of BCSD for LRT recipients, which was meaningful for patients' individualized management.

Patient-specific 3D printed models for enhanced learning of immediate implant procedures and provisionalization.

INTRODUCTION: This study aimed to describe the fabrication, implementation and evaluation of 3D-printed patient-specific models for unskilled students to enhance learning in immediate implant procedures and provisionalization. MATERIALS AND METHODS: The individualized simulation models were designed and processed based on CT and digital intraoral scanning of a patient. Thirty students performed simulation implant surgery and provisionalized the implant sites on the models and answered questionnaires to assess their perceptions before and after the training. The scores of the questionnaires were analysed using the Wilcoxon signed-rank test. RESULTS: Significant differences before and after training were found in the students' responses. Students reported better results in understanding of surgical procedures, knowledge in prosthetically driven implantology, understanding of minimally invasive tooth extraction, confirming the accuracy of surgical template, usage of the guide rings and usage of the surgical cassette after simulation training. The overall expenditure on the simulation training involving 30 students amounted to 342.5 USD. CONCLUSIONS: The patient-specific and cost-efficient 3D printed models are helpful for students to improve theoretical knowledge and practical skills. Such individualized simulation models have promising application prospects.

Chronic Administration of Methamphetamine Aggravates Atherosclerotic Vulnerable Plaques in Apolipoprotein E Knockout Mice Fed with a High-cholesterol Diet.

BACKGROUND: It has been observed previously that chronic methamphetamine (METH) administration could upregulate neuropeptide Y (NPY) expression and promote atherosclerotic formation in apolipoprotein E knockout (ApoE-/-) mice fed with a normal cholesterol or high diet and NPY might be involved in the pathogenesis of METH-induced atherogenic effects through NPY Y1 receptor pathway. Vulnerable coronary atherosclerotic plaque (VP) is a critical pathological finding responsible for the acute coronary syndrome (ACS). In this study, we explored whether METH abuse could aggravate the formation of VP in ApoE-/- mice fed with high cholesterol diet. OBJECTIVE: The purpose of this study was to observe if chronic METH administration could aggravate vulnerable plaque (VP) formation in ApoE-/- mice fed with a high-cholesterol diet. METHODS: Male ApoE-/- mice fed with a high-cholesterol diet were intraperitoneally injected with normal saline (NS) or 8 mg/kg/day METH (M8) for 24 weeks. Body weight was monitored from baseline to 24 weeks at 2 weeks intervals. After 24 weeks of treatment, plasma lipid variables were measured. Movat's staining and immunohistochemical staining were performed on frozen sections of the aortic roots to calculate VP percentage and intraplaque hemorrhage (IPH) percentage and detect expression of NPY, vascular endothelial growth factor (VEGF), and CD31. In vitro, the expressions of Y2R, VEGF, and CD31 were detected by immunofluorescence staining in aortic endothelial cells incubated with PBS, 100µM METH, 10nmol NPY, or 100µM METH plus 10nmol NPY for 12 hours. RESULTS: The CD31 positive area, percentage of IPH, VP, and the expressions of NPY and VEGF were significantly increased in the M8 group than in the NS group. In vitro, the expressions of Y2R, VEGF, and CD31 were significantly increased in the METH+NPY group than in the PBS, METH, and NPY groups and these effects could be blunted by treatment with a Y2R antagonist or DPPIV inhibitor. CONCLUSION: Chronic METH administration could aggravate VP in ApoE-/- mice fed with a high-cholesterol diet, possibly through upregulating vascular NPY and VEGF expression and promoting angiogenesis and vessel rupture in atherosclerotic plaques. Our findings indicated that increased VP formation might contribute to the development of acute coronary syndrome post-chronic METH abuse by activating DPPIV/NPY/Y2R pathway.

Silk fibroin-chitosan aerogel reinforced by nanofibers for enhanced osteogenic differentiation in MC3T3-E1 cells.

Proper bone scaffolds should be biocompatible, mechanically robust and porous for cell migration. Here, pure silk fibroin (SF)- chitosan (CS) aerogel scaffolds reinforced with different amount of SF nanofibers (SF-CS/NF1%, SF-CS/NF2% and SF-CS/NF3%) are prepared for bone regeneration. Surface morphology and composition were analyzed to ensure successful integration of each component. Incorporating 3 % nanofibers endowed the aerogels with a resistance to 3.5 times the compressive stress of the pure SF-CS aerogels. The benefits of nanofibers were also confirmed by the high porosity of 72.3 ± 1.3 %, the regulated pore size and the high-water uptake ratio of 1770.4 ± 156.8 %. Enhanced cell viability of the aerogel scaffolds was verified with Cell Counting Kit-8 (CCK-8) assays, and confocal microscopy and scanning electron microscopy (SEM) images were taken to assess the cell migration and distribution. The cell differentiation on the aerogel scaffolds was evaluated with enzyme-linked immunosorbent assay (ELISA). Significantly higher level of Collagen type I (Col-I), osteocalcin (OCN), osteopontin (OPN), and alkaline phosphatase (ALP) expression was observed on SF-CS/NF3% aerogels. This biocompatible nanofiber-reinforced aerogel scaffold facilitates osteogenic differentiation by rougher surface, enhanced mechanical strength and well-regulated pores. Thus, as-prepared scaffolds may be further applied in bone regeneration field.

Calibration of Inverted Asphalt Pavement Rut Prediction Model, Based on Full-Scale Accelerated Pavement Testing.

This study investigates the establishment and calibration method of the rut depth (RD) prediction model of inverted asphalt pavements (IAPs), based on full-scale accelerated pavement testing (APT), which facilitates the accurate and reliable design or maintenance of IAPs. A power function is adopted for the prediction model construction of the rut progression before the failure stage, based on the typical permanent deformation progression curve of flexible pavements. The APT loading history is divided into units, according to the difference in physical conditions, providing the basis for a cumulative RD analysis and model calibration. The nonlinear incremental recursive (IR) principle is applied in the RD analysis to consider the influence of the nonlinear material property, performance deterioration, and loading history on the RD development. Further, the rut shift function relating prediction models obtained from laboratory tests and full-scale APT is established to introduce the APT data in the calibration process. Accordingly, the mechanistic-empirical RD prediction model calibration method, based on APT and the IR principle, is proposed and applied in a case study of a IAP RD prediction model calibration. Four 3.5 m × 4 m IAP test sections S1-S4 are constructed and instrumented and 700,000- and 900,000-wheel loads are applied on test sections S1-S2 and S3-S4, respectively, using the heavy vehicle simulator. The test data from the different APT load units are utilized for the model calibration, and the resultant prediction errors range from -2.16 mm to 1.18 mm. The calibrated model can also be used for the RD prediction of IAPs with other design schemes, by updating the corresponding material-related coefficients and the finite element model, which is essential for the design and maintenance of IAPs. The proposed calibration method could be a useful reference for the establishment of flexible pavement performance prediction models.

The relationship between immediate postmastectomy reconstruction modalities and survival benefits in patients with triple negative breast cancer.

INTRODUCTION: Immediate postmastectomy reconstruction for breast cancer has been widely used due to its unique esthetic and psychological effects. However, no other population-based study has investigated the effects of different reconstruction types on the survival in patients with triple negative breast cancer (TNBC). METHODS: We selected patients who met the eligibility criteria from the Surveillance, Epidemiology, and End Results cancer registry (N = 9760). We then assessed the effect of different reconstructive surgical approaches (implant, autologous, implant and autologous combined reconstruction) on the overall survival (OS) and breast cancer-specific survival (BCSS) by using the Kaplan-Meier survival curve and Cox proportional hazard regression analyses. The nomograms were used to predict OS and BCSS. And the competitive risk model was used to assess breast cancer-specific death (BCSD) and non-breast cancer-specific death (NBCSD). RESULTS: Statistical analysis suggested that the three reconstruction methods had better OS and BCSS with lower hazard than mastectomy alone (log-rank test, p < 0.05). Multivariate stratified analysis showed that patients aged 40-60 years had the greatest improvement in OS (Adjusted hazard ratio [AHR], 0.646; 95% Confidence Interval [CI], 0.439-0.950; p = 0.026) with combined reconstruction. BCSS could be improved only by implant reconstruction (AHR, 0.672; 95% CI, 0.514-0.878; p = 0.004). In addition, autologous reconstruction (AHR, 0.570; 95% CI, 0.350-0.929; p = 0.024) and implant reconstruction (AHR, 0.538; 95% CI, 0.339-0.853; p = 0.008) improved OS in patients >60 years of age. The survival prediction model quantified the survival benefits of TNBC patients undergoing different surgeries. Moreover, the C-indexes showed the good predictive ability of the nomograms. CONCLUSIONS: Our results suggest that for TNBC patients, there is a survival benefit of immediate postmastectomy reconstruction compared with mastectomy alone. Among them, implant reconstruction has the most obvious advantage.

Re2O7/HReO4 Mediated Intramolecular Hydroacyloxylation of Unactivated Alkenes: A Dual Hydrogen-Bonding Effect.

This publication describes the application of Re2O7 in hexafluoroisopropanol (HFIP) for the activation of inert as well as electronically deactivated olefins to facilitate a challenging intramolecular hydroacyloxylation reaction. Both HFIP and an internal carboxy group have been proven to be crucial for the successful implementation of this transformation; these are proposed to assist the formation and stabilization of the key cationic intermediate via hydrogen-bonding interactions with perrhenate anion (ReO4-).

Effects and related mechanism of alpha-adrenergic receptor inhibitor phentolamine in a rabbit model of acute pulmonary embolism combined with shock.

BACKGROUND: To observe the effect and mechanism of alpha-adrenergic receptor inhibitor phentolamine (PTL) in a rabbit model of acute pulmonary embolism (APE) combined with shock. METHODS: Twenty-four New Zealand rabbits were randomly divided into sham operation group (S group, n = 8), model group (M group, n = 8) and PTL group (n = 8), the model of APE combined with shock was established. Mean pulmonary arterial pressure (MPAP), peripheral mean arterial pressure (MAP) and pulmonary circulation time were evaluated. The expression levels of α1 receptor, α2 receptor and their downstream molecules in pulmonary embolism (PE) and non-pulmonary embolism (non-PE) regions lung tissues were detected and compared, respectively. RESULTS: In M group, α receptor-related signaling pathways were significantly activated in both PE and non-PE areas as expressed by up-regulated α1, α2 receptor and phospholipase C (PLC); the expression level of phosphorylated protein kinase A (p-PKA) was significantly down-regulated; myosin light chain kinase (MLCK) and α-smooth muscle actin (α-SMA) levels were up-regulated. PTL treatment significantly improved pulmonary as well as systemic circulation failure: decreased MPAP, restored blood flow in non-PE area, shortened pulmonary circulation time, increased MAP, and restored the circulation failure. PTL induced significantly down-regulated expression of α1 receptor and its downstream molecule PLC in both PE and non-PE area, the expression level of α2 receptor was also down-regulated, the expression level of p-PKA was significantly up-regulated. PTL treatment can inhibit both α1 and α2 receptor-related signaling pathways in whole lung tissues, and inhibit Ca2+ signaling pathways. The expression level of MLCK and α-SMA were significantly down-regulated. Compared with PE area, the changes of expression levels of α receptor and its downstream molecules were more significant in the non-PE region. CONCLUSION: In this model of APE combined with shock, the sympathetic nerve activity was enhanced in the whole lung, α1 and α2 receptor and their downstream signaling activation might mediate blood flow failure in the whole lung. PTL treatment can effectively restore pulmonary blood flow in non-PE area and improve pulmonary as well as systemic circulation failure possibly through down-regulating α1 and α2 receptor and their downstream signaling pathways.

Prognostic effect of radiotherapy in breast cancer patients underwent immediate reconstruction after mastectomy.

Introduction: It is still unclear whether radiotherapy affects the long-term survival of breast cancer (BC) patients after immediate breast reconstruction (IBR). This study aims to evaluate the actual prognostic impact of radiotherapy on BC patients undergoing IBR, and to construct survival prediction models to predict the survival benefit of radiotherapy. Methods: Data on eligible BC patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Competing risk models were used to assess breast cause-specific death (BCSD) and non-breast cancer cause-specific death (NBCSD). Kaplan-Meier curve, Cox risk regression model and forest map were used to evaluate and demonstrate overall survival (OS) and breast cancer-specific survival (BCSS). Survival prediction nomograms were used to predict OS and BCSS probabilities. Results: A total of 22,218 patients were selected, 24.9% received radiotherapy and 75.1% were without radiotherapy. Competing risk models showed that whether BCSD or NBCSD, the cumulative long-term risk of death in the radiotherapy group was higher than that in the non-radiotherapy group. The Kaplan-Meier curve showed that patients with different lymph node metastasis had different radiotherapy benefits. Multivariate stratified analysis showed that radiotherapy after autologous reconstruction was associated with poor BCSS in patients with stage N0, and radiotherapy after autologous reconstruction and combined reconstruction improved OS and BCSS in patients with stage N3. The C-indexes of nomogram (between 0.778 and 0.847) and calibration curves showed the good prediction ability of survival prediction model. Conclusions: Radiotherapy can improve OS and BCSS in N3 stage BC patients undergoing immediate autologous reconstruction after mastectomy. The practical nomograms can be used to predict OS and BCSS of patients with or without radiotherapy, which is helpful for individualized treatment.

Associations between two conceptualizations of materialism and subjective wellbeing in China: A meta-analysis of studies from 1998 to 2022.

This meta-analysis examines the relationship between materialism (materialistic values and extrinsic aspirations) and subjective wellbeing in the Chinese population. Fifty-six relevant studies covering the period from 1998 to 2022 were included in the meta-analysis. Fifty-eight independent effect sizes from a total of 52,368 participants were obtained to calculate the mean effect sizes. Materialistic values correlated with significantly lower subjective wellbeing (r = -0.205), while the mean effect size for extrinsic aspirations was found to be not significant (r = -0.048). The effect sizes varied across different types of wellbeing outcomes (materialistic values: rs = -0.095 to -0.202; extrinsic aspirations: rs = 0.066 to -0.125). The associations were also moderated by certain demographic factors (age and gender), methodological factors (study design and scoring method), publication features (type of publication and publication year), and economic indicators (economic growth and wealth inequality). We discuss our limitations and the implications for future research.

Clinical Comparative Study of Different Fundus Imaging Methods in the Acute Phase of Vogt-Koyanagi-Harada Disease.

Background: The diversification of follow-up ophthalmic imaging examination methods, and whether there are differences in clinical characteristics of VKH at the acute stage under different images. Our study aims to compare the imaging characteristics of the acute phase of Vogt-Koyanagi-Harada disease (VKH) under different fundus imaging methods to deepen clinical knowledge. Methods: A retrospective case study was performed on fundus images of 62 eyes from 31 patients with acute phase VKH and a disease duration ≤2 months who were treated at Ganzhou People's Hospital from January 2013 to December 2020. Fundus photography (FP), optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) were performed on all 62 eyes. The fundus presentations were divided into an optic disc swelling (ODS) group, a serous retinal detachment (SRD) group, and a mixed type (MT) group (both ODS and SRD), and the proportions of patients in these groups and the coincidence rate of ODS, SRD, and MT identified by the three fundus imaging modes were determined. Results: The proportion of patients with ODS was highest under FP, and the proportion of patients with MT was highest under OCT. The proportions of patients with ODS and MT in the three fundus imaging modes differed significantly (P < 0.05), while the proportion of patients with SRD did not (P > 0.05). The proportion of patients with subretinal fluid with positive OCT results was significantly higher than those with positive FFA results (81.08% vs. 59.46%) (P < 0.05). Conclusion: Clinically significant positive signs could be obtained for acute VKH under different imaging methods. However, compared with FP and FFA, OCT tomography is more intuitive for the observation of lesions.

Efficacy of Shexiang Tongxin Dropping Pills in a Swine Model of Coronary Slow Flow.

Objective: Preliminary clinical studies have confirmed that Shexiang Tongxin dropping pills (STDPs) could improve angina pectoris and attenuate vascular endothelial dysfunction in patients with slow coronary flow, but the underlying mechanism is not fully unclear. We aimed to investigate the impact of STDP in a swine model of coronary slow flow (SF) and related mechanisms. Methods: SF was induced by coronary injection of 40 µ m microspheres, and pigs were randomly divided into the SF group and SF plus STDP group. Pigs in the STDP group received sublingual STDP for 10 min, followed by 1 g STDP oral administration daily for 6 days. Coronary angiography was performed, the TIMI frame count (TFC) was determined, and hemodynamic measurements were performed before, at 30 min, and 7 days post-SF. Serum levels of total NO, NOS, ET-1, C-TNI, and BNP were measured. Myocardial expressions of TNF and IL-6, eNOS, VEGF, CD31, and α-SMA were analyzed by immunohistochemistry and Western blotting. Results: Compared to the SF group, LVEF and TFC were significantly improved at 7 days post-SF in the STDP group. The serum ET-1 level was significantly reduced at 7 days, and NO and NOS levels were significantly higher in the STDP group. Seven days post-SF, myocardial TNF and IL-6 expressions were significantly downregulated, while the expressions of eNOS and VEGF, CD31, and ɑ-SMA were significantly upregulated in the STDP group. Conclusion: Our results showed that STDP improved cardiac function and coronary flow, possibly through reducing inflammatory responses and upregulating myocardial eNOS and VEGF, CD31, and the ɑ-SMA expression.

Nomogram Predicts the Role of Primary Tumor Surgery on De Novo Stage-IV Breast Cancer Patients: A SEER-Based Competing Risk Analysis Model.

Objective: The efficacy of primary tumor surgery on survival in female patients with de novo stage IV breast cancer (BC) remains unclear. Our study endeavored to develop comprehensive competing risk nomograms to predict clinical outcomes and guide precision treatment in these patients. Participants and Methods: A total of 12281 patients who had distant metastasis at initial BC diagnosis between 2010 and 2017 in the Surveillance Epidemiology and End Results (SEER) database, were enrolled in this study. First, we assessed the impacts of primary tumor surgery on overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan-Meier curves. Then subgroup analyses stratified by different metastatic patterns were performed using Cox and competing risk models (CRM). Based on the filtered independent prognostic parameters by CRM, we established two nomograms to predict the probability of breast cancer-specific death (BCSD) at 1-,2- and 3-year intervals. Furthermore, calibration curves and area under the curves (AUC) were conducted for validation. Results: Kaplan-Meier analysis revealed that surgery was associated with better OS and BCSS (P<0.001). Subgroup analyses demonstrated that in bone-only metastases pattern, relative to breast-conserving surgery (BCS), patients receiving mastectomy had worse prognosis and the poorest survival belonged to non-surgery individuals (BCSS: mastectomy: HR=1.35; 95%CI=1.15-1.60; non-surgery: 2.42; 2.08-2.82; OS: mastectomy: 1.44; 1.23-1.68; non-surgery: 2.40; 2.08-2.78). Additionally, no survival difference was observed between BCS and reconstruction recipients (BCSS: HR=1.10; 95%CI=0.85-1.43; OS: 1.11; 0.86-1.44). Furthermore, patients undergoing BCS possessed similar BCSS with mastectomy recipients as well as reconstruction recipients in viscera metastases pattern, whereas non-surgery individuals had a worse survival (mastectomy: HR=1.04; 95%CI=0.92-1.18; reconstruction: 0.86; 0.69-1.06; non-surgery: 1.83; 1.63-2.05). Two competing risk nomograms of distinct metastatic patterns were established to comprehensively predict the survival of patients. Calibration curves indicated the terrific consistency of the models. Moreover, the AUC values in the training and validation sets were in the range of 0.70-0.80, exhibiting good specificity and sensitivity. Conclusion: The surgery implementation was associated with a lower probability of BCSD in de novo stage-IV BC patients. Our nomograms could offer a relatively accurate and individualized prediction of the cumulative incidence rate of BCSD after primary tumor resection.

A Digital Technique to Manage Restoration of Severely Tilted Adjacent Implants: A Dental Technique.

Implant placement in close proximity with adverse angulations may result in difficulty with impression making. With the lock surface function provided by intraoral scanning software programs, severely tilted adjacent implants can be digitized one by one without interfering with the accuracy of the digital cast. This article presents a straightforward digital impression technique for severely mesiodistally tilted adjacent implants in a clinical case.