Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study.

BACKGROUND: To evaluate the safety and efficacy of US-guided microwave ablation in patients with thyroid nodules at Zuckerkandl tubercle. METHODS: 103 consecutive patients with thyroid nodules at Zuckerkandl tubercle (ZTTN) were enrolled in this study from November 2017 to August 2021. Prior to the surgery or US-guided microwave ablation (MWA), preoperative ultrasound visualization of the recurrent laryngeal nerve (RLN) and ZTTN was performed, the size and the position relationship between them were observed. Patients were followed up at 1, 3, 6, and 12 months after MWA and the volume reduction rates (VRR) of the thyroid nodules were analyzed. RESULTS: All patients successfully had the RLN and ZTTN detected using ultrasound before surgery or ablation with a detection rate of 100%. For the 103 patients, the majority of ZTTN grades were categorized as grade 2, with the distance from the farthest outside of ZTTN to the outer edge of thyroid ranging between 6.0 and 10.0 mm. The position relationship between ZTTN and RLN was predominantly type A in 98 cases, with type D observed in 5 cases. After MWA, the median nodule volume had significantly decreased from 4.61 (2.34, 8.70) ml to 0.42 (0.15, 1.41) ml and the VRR achieved 84.36 ± 13.87% at 12 months. No nodules regrew throughout the 12-month follow-up period. Of the 11 patients experienced hoarseness due to RLN entrapment before ablation, 7 recovered immediately after separation of the RLN and ZTTN during MWA, 2 recovered after one week, and the other 2 recovered after two months. CONCLUSIONS: The RLN is closely related to ZTTN and mainly located at the back of ZTTN. The RLN can be separated from ZTTN by hydrodissection during MWA. US-guided MWA is a safe and effective treatment for ZTTN.

Comparison of Micro-flow Imaging and Contrast-Enhanced Ultrasound in Ultrasound-Guided Microwave Ablation of Benign Thyroid Nodules.

OBJECTIVE: The study described here was aimed at ascertaining the utility of micro-flow imaging (MFI) during ultrasound (US)-guided microwave ablation (MWA) of thyroid nodules by contrasting its effectiveness with that of contrast-enhanced ultrasound (CEUS). METHODS: Seventy-three patients with eighty-eight thyroid nodules who underwent US-guided MWA were included in our study from January 2020 to June 2023. Thirty-five patients underwent CEUS during the MWA process, and thirty-eight patients underwent MFI during the MWA process. We compared the two groups' baseline characteristics, tumor volume (V), volume reduction rate (VRR), complications and clinical characteristics. RESULTS: Both groups exhibited similar outcomes with respect to V and VRR at 1, 3, 6, 12 and 18 mo after MWA (p > 0.05). Consistency was observed with respect to post-operative complications, supplementary ablation times and surgical duration (p > 0.05). It is worth noting that the MFI group had lower treatment costs compared with the CEUS group (11,337.64 ± 80.93 yuan for the MFI group versus 12,971.23 ± 254.89 yuan for the CEUS group, p < 0.05). CONCLUSION: In the MWA procedure for thyroid nodules, MFI is similar to CEUS with respect to safety and efficacy. Simultaneously, it offers the advantage of reducing surgical expenses, which lessens the economic burden for patients.

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis.

BACKGROUND: Frailty is a common condition in elderly patients who receive percutaneous coronary intervention (PCI). However, how frailty affects clinical outcomes in this group is unclear. AIM: To assess the link between frailty and the outcomes, such as in-hospital complications, post-procedural complications, and mortality, in elderly patients post-PCI. METHODS: The PubMed/MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were screened for publications up to August 2023. The primary outcomes assessed were in-hospital and all-cause mortality, major adverse cardiovascular events (MACEs), and major bleeding. The Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Twenty-one studies with 739693 elderly patients undergoing PCI were included. Frailty was consistently associated with adverse outcomes. Frail patients had significantly higher risks of in-hospital mortality [risk ratio: 3.45, 95% confidence interval (95%CI): 1.90-6.25], all-cause mortality [hazard ratio (HR): 2.08, 95%CI: 1.78-2.43], MACEs (HR: 2.92, 95%CI: 1.85-4.60), and major bleeding (HR: 4.60, 95%CI: 2.89-7.32) compared to non-frail patients. CONCLUSION: Frailty is a pivotal determinant in the prediction of risk of mortality, development of MACEs, and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Ultrasound-guided percutaneous thermal ablation of parotid tumors: experience from two-centers.

Objective: To evaluate the efficacy and feasibility of ultrasound-guided percutaneous thermal ablation (TA) for treating benign parotid tumors.Methods: Patients with benign parotid tumors who underwent ultrasound-guided microwave ablation (MWA) or radiofrequency ablation (RFA) between January 2020 and March 2023 were included in this retrospective study. Change in tumor size (maximum diameter, tumor volume(V), volume reduction rate (VRR)) and cosmetic score (CS) were evaluated during a one-year follow-up period. We also recorded the incidence of any complications associated with TA.Results: A total of 23 patients (13 males and 10 females; median age 65 years, range 5-91 years) were included. The mean VRR at 1, 3, 6, and 12 months after TA was 37.03%±10.23%, 56.52%±8.76%, 82.28%±7.89%, and 89.39%±6.45%, respectively. Mean CS also changed from 3.39 ± 0.66 to 1.75 ± 0.93 (p < 0.001) by the end of follow-up time. Subgroup analysis showed that tumors with smaller initial maximum diameter had a faster CS reduction rate than those with larger initial diameter. The incidence of facial nerve dysfunction was 8.70%.Conclusion: Ultrasound-guided percutaneous TA is an effective and safe treatment option for patients with benign parotid tumors.

Combined multiple regional anesthesia for microwave ablation of liver Tumors: Initial experience.

OBJECTIVE: This study aims to assess the feasibility and safety of combined multiple regional anesthesia (CMRA) as a potential strategy to decrease pain and reliance on intravenous analgesics during and after ultrasound-guided microwave ablation (US-guided-MWA) of liver tumors. METHODS: A cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain. RESULTS: All patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups. CONCLUSION: CMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.

Aluminum phytotoxicity induced structural and ultrastructural changes in submerged plant Vallisneria natans.

Aluminum (Al) is a concentration-dependent toxic metal found in the crust of earth that has no recognized biological use. Nonetheless, the mechanism of Al toxicity to submerged plants remains obscure, especially from a cell/subcellular structure and functional group perspective. Therefore, multiple dosages of Al3+ (0, 0.3, 0.6, 1.2, and 1.5 mg/L) were applied hydroponically to the submerged plant Vallisneria natans in order to determine the accumulation potential of Al at the subcellular level and their ultrastructural toxicity. More severe structural and ultrastructural damage was determined when V. natans exposed to ≥ 0.6 mg/L Al3+. In 1.2 and 1.5 mg/L Al3+ treatment groups, the total chlorophyll content of leaves significantly reduced 3.342, 3.838 mg/g FW, some leaves even exhibited chlorosis and fragility. Under 0.3 mg/L Al3+ exposure, the middle-age and young leaves were potent phytoexcluders, whereas at 1.5 mg/L Al3+, a large amount of Al could be transferred from the roots to other parts, among which the aged leaves were the most receptive tissues (7.306 mg/g). Scanning/Transmission electron microscopy analysis displayed the Al-mediated disruption of vascular bundle structure in leaf cells, intercellular space and several vegetative tissues, and demonstrated that Al in vacuole and chloroplast subcellular segregation into electron dense deposition. Al and P accumulation in the roots, stolons and leaves varied significantly among treatments and different tissues (P < 0.05). Fourier transform infrared spectroscopy of plant biomass also indicated possible metabolites (amine, unsaturated hydrocarbon, etc.) of V. natans that may bind Al3+. Conclusively, results revealed that Al3+ disrupts the cellular structure of leaves and roots or binds to functional groups of biological tissues, thereby affecting plant nutrient uptake and photosynthesis. Findings might have scientific and practical significance for the restoration of submerged vegetation in Al-contaminated lakes.

The efficacy of Azotobacter chroococcum in altering maize plant-defense responses to armyworm at elevated CO2 concentration.

Elevated atmospheric carbon dioxide (eCO2) concentrations can alter the carbon:nitrogen ratio and palatability of host plants for herbivorous insects, but rhizobacteria likely mitigate the alteration and influence physiological adaptation of insects. In this study, we conducted transcriptomic analysis of maize (Zea mays) response to Azotobacter chroococcum (AC) inoculation under eCO2 conditions in contrast to ambient CO2 (aCO2), and studied the effects of plant-defense change of maize under eCO2 on the oriental armyworm, Mythimna separata. Results showed that there were 16, 14, 16 and 135 differentially expressed genes that were associated with plant-defense response in maize leaves between aCO2-CK and aCO2-AC, eCO2-CK and eCO2-AC, aCO2-CK and eCO2-CK, aCO2-AC and eCO2-AC, respectively. Moreover, A. chroococcum inoculation and eCO2 influenced plant hormone signal transduction of maize. Interestingly, A. chroococcum inoculation significantly decreased the contents of JA (jasmonic acid) and JA-Ile (isoleucine conjugate of JA) in leaves, but eCO2 markedly increased contents of JA-Ile, JA and SA (salicylic acid). Compared to aCO2, eCO2 significantly decreased activity of protective enzyme (catalase), and increased activities of digestive (lipase and protease), protective (peroxidase) and detoxifying enzymes (carboxylesterase, Mixed-functional oxidase and glutathione s-transferase), prolonged developmental time, and decreased survival rate and body weight of larvae (P < 0.05). A. chroococcum inoculation significantly increased the activity of protective enzyme (catalase), and decreased the activities of detoxifying enzymes (carboxylesterase, glutathione s-transferase and mixed-functional oxidase), thus increased the growth rate and body weight of larvae in comparison with no-inoculation of A. chroococcum (P < 0.05). The indices of M. separata were significantly correlated with the foliar contents of JA, JA-Ile and SA (|r| = 0.44-0.85, P < 0.05), indicating that A. chroococcum inoculation altered the physiological adaptation of M. separata under eCO2 by disturbing defense substances in maize. Our results in understanding effects of A. chroococcum inoculation on maize resistance to herbivorous insects will be valuable for agricultural pest control in the future at eCO2 conditions.

Caspofungin at sub-inhibitory concentration promotes the formation of Candida albicans persister cells.

AIMS: Low caspofungin exposure is frequently encountered in patients with invasive candidiasis caused by Candida albicans. This study aimed to investigate the effects of caspofungin on C. albicans at sub-inhibitory concentrations. METHODS AND RESULTS: First, a comparative transcriptomics analysis was performed on C. albicans receiving caspofungin at sub-minimum inhibitory concentrations (sub-MICs). The results showed that caspofungin significantly changed the mRNA expression profile in DAY185, with DE-mRNAs enriched in the functions of cell wall biosynthesis, metabolism, etc. Subsequently, cellular fitness, cell aggregation, energy metabolism activity and the proportion of persister cells of C. albicans were quantitatively and/or qualitatively assessed after sub-MIC caspofungin exposure. No significant changes in cell fitness and aggregation formation were observed during treatment of C. albicans with sub-MIC caspofungin. In C. albicans aggregation treated with sub-MIC caspofungin, we observed a decrease in respiratory metabolism and an increase in persister cells; this effect was more pronounced in als1ΔΔ than in DAY185. CONCLUSIONS: Pre-exposure to sub-MIC caspofungin suppresses C. albicans respiratory metabolism and promotes persister cell development. SIGNIFICANCE AND IMPACT OF THE STUDY: Caspofungin should be used with caution in patients with C. albicans infections, as anti-infection therapy may fail due to persister cells.

Antimicrobial Susceptibility Characteristics and Risk Factors Associated with Adult Sepsis in Wenzhou, China.

Purpose: To clarify the distribution of pathogenic bacteria by analyzing the bacterial susceptibility characteristics and risk factors for adult sepsis in The Wenzhou city, Zhejiang province, China, and to aid early diagnosis, monitoring, and prognosis prediction in cases of bacterial sepsis. Patients and Methods: We retrospectively analyzed 329 patients with sepsis admitted to the Second Affiliated Hospital of Wenzhou Medical University between January 2018 and March 2021. Laboratory data were collected before and after treatment; moreover, the bacterial susceptibility characteristics and risk factors for sepsis were comprehensively analyzed using the Sequential Organ Failure Assessment (SOFA) score. Results: The SOFA score was negatively correlated with the prognosis (P < 0.05). We isolated 47 pathogenic strains from blood culture samples, including 29 gram-positive strains, 18 gram-negative strains. The most common gram-negative pathogens in blood cultures are Klebsiella pneumoniae and Escherichia coli, while the most common gram-positive pathogens are Staphylococcus aureus and Staphylococcus h omini s. Gram-negative pathogens had resistance rates of 77% and 62.5% to ciprofloxacin and ceftriaxone, respectively. Gram-positive bacteria had a high resistance to penicillin at 100%. Prognostic factors for sepsis included patients' consciousness, SOFA score, prothrombin time, international normalized ratio, fibrinogen, D-dimer, and aspartate aminotransferase (P < 0.05). Of these, the D-dimer level could predict the outcome of patients with sepsis (AUC = 0.661, P < 0.05). Conclusion: The pathogens detected in adult sepsis in Wenzhou are mainly Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Staphylococcus hominis. The pathogens exhibited differences in drug susceptibility. The optimal antibiotics should be chosen based on the principles of rational use and drug susceptibility. Combined with D-dimer levels, these parameters can be used to determine the optimal strategy for preventing and treating pathogenic bacteria.

Effects and mechanisms of land-types conversion on greenhouse gas emissions in the Yellow River floodplain wetland.

The mechanism and extent of changes in greenhouse gas (GHG) emissions from seasonal river-floodplain wetlands subjected to land-type conversion are unknown. We monitored GHG fluxes and characterized soil microbial communities in four types of wetland (Riverside lower-beach wetland (RLW), Riverside higher-beach wetland (RHW), Cultivated wetland (CW), Mesophytic wetland (MW)) in the Yellow River flood land. Results revealed that land reclamation activities altered the distribution patterns of carbon (C) and nitrogen (N) in soil, as well as the structure and activities of microbial communities, leading to changes in the GHG emissions. Cumulative CO2 and N2O emissions were highest in CW, which were 2.10-10.71 times and 3.19-8.61 times greater than the other three wetlands, respectively, whereas cumulative CH4 emissions were highest in RLW (1850.192 mg·m-2). CW exhibited the highest 100-years-scale Global Warming Potential (GWP100-CO2-eq) (81.175 t CO2-eq·ha-1), which was 9.93, 3.12, and 2.11 times greater than RLW, RHW, and MW. Moreover, reclaiming riverside wetland as farmland will increase CO2 and N2O emission fluxes by 54.546-72.684 t·ha-1 and 2.615-2.988 kg·ha-1, respectively. 16S rRNA high throughput sequencing revealed that bacterial community composition changed significantly overtime and seasons. GHG fluxes showed a significant positive linear correlation with bacterial OTUs (y = 0.71x-319.4, R2 = 0.304) and Shannon index (y = 228.62x-796.6, R2 = 0.336). Structure equation models indicated that soil C, N and moisture content were the primary factors influencing bacterial community evolution, which had an impact on GHG fluxes. Actinomycetes were significantly affected by total carbon (TC) content, dissolved organic carbon (DOC), and C/N, while ammonia oxidizing and nitrifying bacteria were greatly influenced by NO3--N rather than TN and NH4+-N content. Opportunities exist to reduce GHG emissions and mitigate climate change by maintaining the original state of riverside wetland or restoring cultivated land to wetland in the Yellow River floodplain wetland.

Stability and bifurcation analysis of SIQR for the COVID-19 epidemic model with time delay.

Based on the SIQR model, we consider the influence of time delay from infection to isolation and present a delayed differential equation (DDE) according to the characteristics of the COVID-19 epidemic phenomenon. First, we consider the existence and stability of equilibria in the above delayed SIQR model. Second, we analyze the existence of Hopf bifurcations associated with two equilibria, and we verify that Hopf bifurcations occur as delays crossing some critical values. Then, we derive the normal form for Hopf bifurcation by using the multiple time scales method for determining the stability and direction of bifurcation periodic solutions. Finally, numerical simulations are carried out to verify the analytic results.

Mathematical modeling and dynamic analysis of SIQR model with delay for pandemic COVID-19.

On the basis of the SIQR epidemic model, we consider the impact of treatment time on the epidemic situation, and we present a differential equation model with time-delay according to the characteristics of COVID-19. Firstly, we analyze the existence and stability of the equilibria in the modified COVID-19 epidemic model. Secondly, we analyze the existence of Hopf bifurcation, and derive the normal form of Hopf bifurcation by using the multiple time scales method. Then, we determine the direction of Hopf bifurcation and the stability of bifurcating periodic solutions. Finally, we carry out numerical simulations to verify the correctness of theoretical analysis with actual parameters, and show conclusions associated with the critical treatment time and the effect on epidemic for treatment time.

[A case of inherited afibrinogenemia caused by an IVS7-12A>G splice mutation of FGG gene].

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with inherited afibrinogenemia. METHODS: For the proband and his family members, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrin(ogen) degradation products (FDPs), D-dimer (D-D), plasminogen activity (PLG:A) and the TT mixed experiment with protamine sulfate were determined with a STAGO-R automatic coagulation analyzer. The activity and antigen of fibrinogen (Fg) in plasma were measured with the Clauss method and immunonephelometry method, respectively. All exons and flanking regions of the fibrinogen genes (FGA, FGB and FGG) were amplified by PCR and directly sequenced. Human Splicing Finder software was used to predict and score the change of splicing site caused by the mutation. RESULTS: The proband showed normal FDPs and D-D but significantly prolonged TT, PT and APTT. The activity and antigen of fibrinogen in plasma were significantly decreased (<0.1 g/L). His young sister and parents showed slightly prolonged TT (18.20-18.50 s) and decreased fibrinogen activity (1.27-1.54 g/L) and fibrinogen antigenic content (1.34-1.56 g/L). Genetic testing revealed that the proband has carried homozygous IVS7-12A>G (g.4147A>G) mutations of the FGG gene, for which his parents and young sister were heterozygous. As predicted by Human Splicing Finder and Mutation Taster software, the variant may generate a new splicing site which can extend the sequence of exon 7 by 11 bp, with alteration of the coding sequence. PROVEAN suggested the variant to be deleterious. CONCLUSION: The afibrinogenemia of the proband may be attributed to the FGG IVS7-12A>G variant, which was unreported previously.