Endothelin-1 induces connective tissue growth factor expression in human lung fibroblasts by disrupting HDAC2/Sin3A/MeCP2 corepressor complex.

BACKGROUND: Reduction of histone deacetylase (HDAC) 2 expression and activity may contribute to amplified inflammation in patients with severe asthma. Connective tissue growth factor (CTGF) is a key mediator of airway fibrosis in severe asthma. However, the role of the HDAC2/Sin3A/methyl-CpG-binding protein (MeCP) 2 corepressor complex in the regulation of CTGF expression in lung fibroblasts remains unclear. METHODS: The role of the HDAC2/Sin3A/MeCP2 corepressor complex in endothelin (ET)-1-stimulated CTGF production in human lung fibroblasts (WI-38) was investigated. We also evaluated the expression of HDAC2, Sin3A and MeCP2 in the lung of ovalbumin-induced airway fibrosis model. RESULTS: HDAC2 suppressed ET-1-induced CTGF expression in WI-38 cells. ET-1 treatment reduced HDAC2 activity and increased H3 acetylation in a time-dependent manner. Furthermore, overexpression of HDAC2 inhibited ET-1-induced H3 acetylation. Inhibition of c-Jun N-terminal kinase, extracellular signal-regulated kinase, or p38 attenuated ET-1-induced H3 acetylation by suppressing HDAC2 phosphorylation and reducing HDAC2 activity. Overexpression of both Sin3A and MeCP2 attenuated ET-1-induced CTGF expression and H3 acetylation. ET-1 induced the disruption of the HDAC2/Sin3A/MeCP2 corepressor complex and then prompted the dissociation of HDAC2, Sin3A, and MeCP2 from the CTGF promoter region. Overexpression of HDAC2, Sin3A, or MeCP2 attenuated ET-1-stimulated AP-1-luciferase activity. Moreover, Sin3A- or MeCP2-suppressed ET-1-induced H3 acetylation and AP-1-luciferase activity were reversed by transfection of HDAC2 siRNA. In an ovalbumin-induced airway fibrosis model, the protein levels of HDAC2 and Sin3A were lower than in the control group; however, no significant difference in MeCP2 expression was observed. The ratio of phospho-HDAC2/HDAC2 and H3 acetylation in the lung tissue were higher in this model than in the control group. Overall, without stimulation, the HDAC2/Sin3A/MeCP2 corepressor complex inhibits CTGF expression by regulating H3 deacetylation in the CTGF promoter region in human lung fibroblasts. With ET-1 stimulation, the HDAC2/Sin3A/MeCP2 corepressor complex is disrupted and dissociated from the CTGF promoter region; this is followed by AP-1 activation and the eventual initiation of CTGF production. CONCLUSIONS: The HDAC2/Sin3A/MeCP2 corepressor complex is an endogenous inhibitor of CTGF in lung fibroblasts. Additionally, HDAC2 and Sin3A may be of greater importance than MeCP2 in the pathogenesis of airway fibrosis.

Comparison of clinical characteristics and prognosis in endometrial carcinoma with different pathological types: a retrospective population-based study.

BACKGROUND: Endometrial carcinoma (EC) is the second most common gynecological malignancy, and the differences between different pathological types are not entirely clear. Here, we retrospectively collected eligible EC patients to explore their differences regarding clinical characteristics and prognosis. METHODS: Five hundred seventy EC patients from the First Affiliated Hospital of Zhengzhou University were included. Prognostic factors were measured using the univariate/multivariate Cox models. Overall survival (OS) and progression-free survival (PFS) were the primary and secondary endpoints, respectively. RESULTS: In total, 396 patients with uterine endometrioid carcinoma (UEC), 106 patients with uterine serous carcinoma (USC), 34 patients with uterine mixed carcinoma (UMC), and 34 patients with uterine clear cell carcinoma (UCCC) were included. Comparison of baseline characteristics revealed patients diagnosed with UEC were younger, had more early clinical stage, and had lower incidence of menopause and lymph node metastasis. Compared to UEC, other pathological EC obtained more unfavorable OS (UCCC: HR = 12.944, 95%CI = 4.231-39.599, P < 0.001; USC: HR = 5.958, 95%CI = 2.404-14.765, P < 0.001; UMC: HR = 1.777, 95%CI = 0.209-15.114, P = 0.599) and PFS (UCCC: HR = 8.696, 95%CI = 1.972-38.354, P = 0.004; USC: HR = 4.131, 95%CI = 1.243-13.729, P = 0.021; UMC: HR = 5.356, 95%CI = 0.935-30.692, P = 0.060). Compared with UEC patients, the OS of UCCC patients in stage I-II and USC patients in stage III-IV were significantly worse, while UMC patients in stage I-II favored poorer PFS. The OS of UCCC patients receiving no postoperative adjuvant therapy or chemotherapy alone were significantly worse. CONCLUSIONS: The baseline characteristics of UEC and other rare EC types varied greatly, and the prognostic significance of different pathological types on EC patients depended on clinical tumor stages and therapeutic options.

The comparative study for survival outcome of locally advanced cervical cancer treated by neoadjuvant arterial interventional chemotherapy or intravenous chemotherapy followed by surgery or concurrent chemoradiation.

OBJECTIVE: This study aimed to compare the survival outcome of 3 different treatment groups (arterial interventional chemotherapy or intravenous chemotherapy or concurrent chemoradiotherapy) for locally advanced cervical cancer. METHODS: A total of 187 patients with pathological stage IB3-IIB cervical cancer (cervical squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma) hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2013 to May 2019 were included. Therefore, this article is a retrospective study. We collected data from all eligible patients. And all according to the treatment methods at that time, they were divided into three subgroups: (1) 40 patients who received neoadjuvant arterial interventional chemotherapy + surgery + postoperative chemotherapy (IA-NAC + RS), (2) 63 patients who received neoadjuvant intravenous chemotherapy + surgery + postoperative chemotherapy (IV-NAC + RS), (3) 84 patients who only received concurrent chemoradiotherapy (CCRT). Notably, 108 of these patients met the 5-year follow-up period, and 187 patients met the 3-year follow-up period only. Consequently, we compared 5-year survival and 3-year survival separately. The prognosis (5-year survival and 3-year survival) of the three groups and the chemotherapy efficacy, intraoperative blood loss, operation time, and postoperative pathological risk factors of different subgroups were compared. RESULTS: (1) There were no significant differences in the 3-year overall survival (OS) rate, 3-year progression-free survival (PFS) rate, 5-year OS rate, and 5-year PFS rate among the three subgroups (p > 0.05). (2) The chemotherapy response rates of IA-NAC+RS group (37.5%) and IV-NAC+RS group (25.4%) were comparable (p > 0.05). (3) The intraoperative blood loss in the IA-NAC+RS group (average 92.13±84.09 mL) was significantly lower than that in the IV-NAC+RS group (average 127.2±82.36 mL) (p < 0.05). (4) The operation time of the IA-NAC+RS group (average 231.43±63.10 min) and the IV-NAC+RS group (average 219.82±49.11 min) were comparable (p > 0.05). (5) There were no significant differences between the IA-NAC+RS group and IV-NAC+RS group in pathological lymph node metastasis, parametrial invasion, and involvement of lymphovascular space (p > 0.05). CONCLUSIONS: Neoadjuvant chemotherapy combined with surgery had the same long-term survival benefit as concurrent chemoradiotherapy.

Laser-assisted LED for adaptive-driving-beam headlights employing ultra-reliable single crystal phosphor for autonomous vehicles.

A novel laser-assisted LED for adaptive-driving-beam (ADB) headlights employing an ultra-reliable Ce3+: YAG-based single crystal phosphor (SCP)-converter layer for use in autonomous vehicles is demonstrated. The SCP fabricated at a high-temperature of 1,940°C exhibited better thermal stability than other phosphor-converter materials, evidenced by a thermal aging test. The high-beam pattern of the ADB is measured at a luminous intensity of 88,436 cd at 0°, 69,393 cd at ± 2.5°, and 42,942 cd at ± 5°, which well satisfies the ECE R112 class B regulation. The advantage of introducing the laser-assisted LED system employing the highly reliable SCP is to produce the high intensity for the ADB, which enables the increase of the field of view by 20% and the brightness by 28% for the ADB headlight and results in improving the visibility from ± 7° to ± 8.5° and the illumination distance up to 200 m. This proposed advance ADB headlight with the ultra-reliable SCP and the novel laser-assisted LED is favorable as one of the most promising ADB light source candidates for use in the next-generation autonomous vehicle applications.

Excess of ovarian nerve growth factor impairs embryonic development and causes reproductive and metabolic dysfunction in adult female mice.

Nerve growth factor (NGF) is critical for the development and maintenance of the peripheral sympathetic neurons. NGF is also involved in the ovarian sympathetic innervation and in the development and maintenance of folliculogenesis. Women with the endocrine disorder, polycystic ovary syndrome (PCOS), have an increased sympathetic nerve activity and increased ovarian NGF levels. The role of ovarian NGF excess in the PCOS pathophysiology and in the PCOS-related features is unclear. Here, using transgenic mice overexpressesing NGF in the ovarian theca cells (17NF mice), we assessed the female embryonic development, and the reproductive and metabolic profile in adult females. Ovarian NGF excess caused growth restriction in the female fetuses, and a delayed gonocyte and primary oocyte maturation. In adulthood, the 17NF mice displayed irregular estrous cycles and altered ovarian expression of steroidogenic and epigenetic markers. They also exhibited an increased sympathetic output with increased circulating dopamine, and metabolic dysfunction reflected by aberrant adipose tissue morphology and function, impaired glucose metabolism, decreased energy expenditure, and hepatic steatosis. These findings indicate that ovarian NGF excess leads to adverse fetal development and to reproductive and metabolic complications in adulthood, mirroring common features of PCOS. This work provides evidence that NGF excess may be implicated in the PCOS pathophysiology.

Anti-IgE therapy inhibits chemotaxis, proliferation and transformation of circulating fibrocytes in patients with severe allergic asthma.

BACKGROUND AND OBJECTIVE: Circulating fibrocytes act as precursors of myofibroblasts, contribute to airway remodelling in chronic asthma and migrate to injured tissues by expressing CXCR4 and CCR7. Anti-IgE therapy improves severe allergic asthma (SAA) control and airway remodelling in T2-high SAA. The effects of anti-IgE therapy on fibrocyte activities were investigated in this study. METHODS: The expression of CCR7, CXCR4, ST2 and α-SMA (α-smooth muscle actin) in both circulating and cultured fibrocytes from all patients with asthma was measured, and was repeated after omalizumab treatment in SAA. Fibrocytes recruitment, proliferation and transformation were also measured in response to anti-IgE therapy. RESULTS: Omalizumab effectively improved asthma control and pulmonary function in T2-high SAA, associated with a decline in serum levels of IL-33 and IL-13. Omalizumab down-regulates CXCR4 and CCR7 expression of fibrocytes, which could suppress fibrocyte recruitment into the lungs. Omalizumab also suppressed the increased number of fibrocytes and α-SMA+ fibrocytes within the cultured non-adherent non-T (NANT) cells after 3-7 days of culture. The decrease in serum levels of IL-33 by omalizumab contributed to the effectiveness in inhibiting fibrocyte recruitment, proliferation and myofibroblast transformation through IL-33/ST2 axis. The elevated IL-13 expression in SAA patients potentiated the effects of IL-33 by increasing ST2 expression. CONCLUSION: Omalizumab reduced the number of circulating fibrocytes, cell and number of fibrocytes as well as α-SMA+ fibrocytes after 3-7 days of culture in SAA patients. IL-33 and IL-13 may be implicated in the effectiveness of omalizumab in inhibiting fibrocyte activation contributing partly to the clinical benefits in reducing lamina propria and basement membrane thickening.

Structural insights into the interaction between phytoplasmal effector causing phyllody 1 and MADS transcription factors.

Phytoplasmas are bacterial plant pathogens which can induce severe symptoms including dwarfism, phyllody and virescence in an infected plant. Because phytoplasmas infect many important crops such as peanut and papaya they have caused serious agricultural losses. The phytoplasmal effector causing phyllody 1 (PHYL1) is an important phytoplasmal pathogenic factor which affects the biological function of MADS transcription factors by interacting with their K (keratin-like) domain, thus resulting in abnormal plant developments such as phyllody. Until now, lack of information on the structure of PHYL1 has prevented a detailed understanding of the binding mechanism between PHYL1 and the MADS transcription factors. Here, we present the crystal structure of PHYL1 from peanut witches'-broom phytoplasma (PHYL1PnWB ). This protein was found to fold into a unique α-helical hairpin with exposed hydrophobic residues on its surface that may play an important role in its biological function. Using proteomics approaches, we propose a binding mode of PHYL1PnWB with the K domain of the MADS transcription factor SEPALLATA3 (SEP3_K) and identify the residues of PHYL1PnWB that are important for this interaction. Furthermore, using surface plasmon resonance we measure the binding strength of PHYL1PnWB proteins to SEP3_K. Lastly, based on confocal images, we found that α-helix 2 of PHYL1PnWB plays an important role in PHYL1-mediated degradation of SEP3. Taken together, these results provide a structural understanding of the specific binding mechanism between PHYL1PnWB and SEP3_K.

Differential associations of proinflammatory and anti-inflammatory cytokines with depression severity from noncancer status to breast cancer course and subsequent chemotherapy.

BACKGROUND: In this study, we examined the differential associations of various proinflammatory and anti-inflammatory cytokines with depression severity from the development of breast cancer to subsequent chemotherapy treatment. METHODS: A cross-sectional study was conducted on a sample of 116 women: 29 controls without cancer, 55 patients with breast cancer who were not receiving chemotherapy, and 32 patients with breast cancer who were receiving chemotherapy. Blood samples were assayed to evaluate serum levels of the following cytokines: interferon-γ, interleukin (IL)-12 (p70), IL-1ß, IL-2, tumor necrosis factor (TNF)-α, IL-4, IL-5, IL-10, IL-13, IL-6, and IL-17A. Depression severity was assessed using the Patient Health Questionnaire. RESULTS: After adjustment for sociodemographics, consistent patterns of the association between cytokine and depression were noted in the different groups. No significant associations were observed in the controls. Inverse associations were observed between cytokines levels and depression severity in patients with breast cancer who were not receiving chemotherapy, whereas positive associations were noted in patients with breast cancer who were receiving chemotherapy. Specific differential relationships between IL-5 levels and depression severity were found between patients with breast cancer who were receiving and not receiving chemotherapy. CONCLUSIONS: Our study revealed differential relationships between cytokine levels and depression severity with the development of cancer. Immunostimulation and immunosuppression in breast cancer and cancer treatment may account for the differential responses with the development of breast cancer.

Spectra manipulation with the photorefractive effect via the spatial-spectral correspondence relationship.

We propose a scheme based on the photorefractive effect to manipulate polychromatic spectra. A sinusoidal phase grating can be obtained by exposing photorefractive material to light, and it is used to diffract monochromatic or polychromatic light. The resultant diffracted spatial intensity distribution for monochromatic light is mapped to spectrum distribution for polychromatic light via the spatial-spectral correspondence relationship for mono-polychromatic light diffraction. Theoretical analyses and numerical examples show that for different detection angles, the diffracted spectrum exhibits different features, and that specific spectral line selection or line filter effects can be achieved. We also discuss the possibility of applying this spectral scheme to detect temperature or the grating's period changes.

Hypoventilation patterns during bronchoscopic sedation and their clinical relevance based on capnographic and respiratory impedance analysis.

Capnography involves the measurement of end-tidal CO2 (EtCO2) values to detect hypoventilation in patients undergoing sedation. In a previous study, we reported that initiating a flexible bronchoscopy (FB) examination only after detecting signs of hypoventilation could reduce the risk of hypoxemia without compromising the tolerance of the patient for this type of intervention. We hypothesize that hypoventilation status could be determined with greater precision by combining thoracic impedance-based respiratory signals, RESP, and EtCO2 signals obtained from a nasal-oral cannula. Retrospective analysis was conducted on RESP and EtCO2 waveforms obtained from patients during the induction of sedation using propofol for bronchoscopic examination in a previous study. EtCO2 waveforms associated with hypoventilation were then compared with RESP patterns, patient variables, and sedation outcomes. Signals suitable for analysis were obtained from 44 subjects, 42 of whom presented indications of hypoventilation, as determined by EtCO2 waveforms. Two subtypes of hypoventilation were identified by RESP: central-predominant (n = 22, flat line RESP pattern) and non-central-predominant (n = 20, RESP pattern indicative of respiratory effort with upper airway collapse). Compared to cases of non-central-predominant hypoventilation, those presenting central-predominant hypoventilation during induction were associated with a lower propofol dose (40.2 ± 18.3 vs. 60.8 ± 26.1 mg, p = 0.009), a lower effect site concentration of propofol (2.02 ± 0.33 vs. 2.38 ± 0.44 µg/ml, p = 0.01), more rapid induction (146.1 ± 105.5 vs. 260.9 ± 156.2 s, p = 0.01), and lower total propofol dosage (96.6 ± 41.7 vs. 130.6 ± 53.4 mg, p = 0.04). Hypoventilation status (as revealed by EtCO2 levels) could be further classified by RESP into central-predominant or non-central-predominant types. It appears that patients with central-predominant hypoventilation are more sensitive to propofol during the induction of sedation. RESP values could be used to tailor sedation management specifically to individual patients.

Endotypes of severe allergic asthma patients who clinically benefit from anti-IgE therapy.

BACKGROUND: Omalizumab, a recombinant monoclonal anti-IgE antibody, was developed for the treatment of severe allergic asthma. Not all these patients respond to omalizumab. OBJECTIVE: This study aimed to evaluate whether the proinflammatory cytokine profiles in the severe allergic asthma patients were different between who responded and nonresponded to omalizumab therapy. METHODS: A prospective study was conducted to examine type 2 cytokines and epithelium-derived cytokines in the bronchial tissues by immunohistochemistry, Western blot and PCR analysis among patients with severe allergic asthma before and after omalizumab therapy. RESULTS: Fourteen of 23 patients with unstable severe allergic asthma improved their asthma control after 4 months of omalizumab treatment (Responders), while nine failed to improve (Non-Responders). Most of Responders were type 2-high endotype (12/14) with upregulated expression of IL-33, IL-25 and TSLP in their bronchial tissues, while most of Non-Responders were type 2-low endotype (8/9). Repeated bronchoscopic biopsy was done in nine responders after omalizumab treatment and showed a decline in IL-13, IL-33, IL-25 and TSLP expression in the bronchial tissues. Among 14 Responders who continued omalizuamb treatments to a total 12 months, six patients achieved a well control of asthma (ACT ≥ 23), while eight patients required additional treatment for asthma symptoms and had more rhinosinusitis comorbidities and a mixed eosinophilic and neutrophilic inflammation in their bronchial tissues. CONCLUSION: Most of the severe allergic asthma patients who benefited from omalizumab treatment were IL-33, IL-25 and TSLP aggravated type 2-high endotype. Rhinosinusitis or with a mixed eosinophilic and neutrophilic airway inflammation should be evaluated in patients who partially responded to omalizumab treatment.

An advanced laser headlight module employing highly reliable glass phosphor.

An advanced laser headlight module (LHM) employing highly reliable glass phosphor is demonstrated. The novel glass-based YAG phosphor-converter layers fabricated by low-temperature of 750°C exhibited better thermal stability. The LHM consisted of a 5 × 1 blue laser diode array, an aspherical lens, a glass phosphor-converter layer with an aluminum thermal dissipation substrate, and a dichroic filter to allow pass blue light and reflect yellow phosphor light. The 5 × 1 blue laser array was packaged with five blue lasers having optical power of 1.2 W per laser. The LHM exhibited total output optical power of 6 W, luminous flux of 1860 lm, relative color temperature of 4100 K, and efficiency of more than 310 lm/W. The high-beam patterns of the LHMs were measured to be 45,000 luminous intensity (cd) at 0°, 31,000 cd at ± 2.5°, and 12,500 cd at ± 5°, which were well satisfied the ECE R112 class B regulation. The proposed high-performance LHM with highly reliable glass-based phosphor-converter layer fabricated by low temperature is favorable as one of the promising LHM candidates for use in the next-generation automobile headlight applications.

New scheme of LiDAR-embedded smart laser headlight for autonomous vehicles.

A new scheme of LiDAR-embedded smart laser headlight module (LHM) for autonomous vehicles is proposed and demonstrated. The LiDAR sensor was fabricated by LeddarTech with the wavelength of 905-nm, whereas the LHM was fabricated by a highly reliable glass phosphor material that exhibited excellent thermal stability. The LHM consisted of two blue laser diodes, two blue LEDs, a yellow glass phosphor-converter layer with a copper thermal dissipation substrate, and a parabolic reflector to reflect the blue light and the yellow phosphor light combined into white light. The LHM exhibited a total output optical power of 9.5 W, a luminous flux of 4,000 lm, a relative color temperature of 4,300 K, and an efficiency of 421 lm/W. The high-beam patterns of the LHMs were measured to be 180,000 luminous intensity (cd) at 0° (center), 84,000 cd at ± 2.5°, and 29,600 cd at ± 5°, which met the ECE R112 class B regulation. The low-beam patterns also satisfied the ECE R112 class B regulation as well. Integrating the signals received from the Lidar detection and CCD image by a smart algorithm, we demonstrated the generation of smart on/off signals for controlling the laser headlights. The recognition rate of the objects was evaluated to be more than 86%. This novel LiDAR-embedded smart LHM with the unique highly reliable glass phosphor-converter layer is favorable as one of the most promising candidates for use in the next-generation high-performance autonomous vehicle applications.

Spectra restoration and image reconstruction of a J0 amplitude transmittance object with circular symmetry.

It is known that image reconstruction (Talbot images) and spectra restoration (Talbot spectra) phenomena can be found for light diffraction of linear periodic structures. In this work the possibility of finding similar effects for a circular symmetric object, especially for one with amplitude transmittance J0(ρ) (zero-order Bessel function of the first kind) is discussed theoretically. The transfer function approach and the spatial-spectral correspondence relationship are used to investigate these effects, and conditions for image reconstruction and spectra restoration in the near field are obtained. The discussion of a more general form of amplitude transmittance is also included, and a comparison between the two types (linear periodic and circular symmetric structures) is made.

Using design of experiment for parameter optimization on smart headlamp optics design.

This research focuses on the design of the optical microstructure, and the design of four kinds of light distribution for vehicles' passing beam and driving beam optical structures under the regulation ECE R123. The results show that the passing beam achieves the target light distribution with multiple light patterns superimposed by reflectors, and can meet the four segment light types under the regulations: Class C, Class V, Class E, and Class W. With the structural design method of the reflector, a cutoff line is formed under the structure without a visor to reduce the energy waste caused by the shielding structure, so that the maximum luminosity of the passing beam under the road section can reach 75,980.7 cd and the simulated maximum photometric value can reach 69,705.9 cd under Class W. The driving beam uses the total internal reflection (TIR) lens design to find the optimal 36° angle of the lens to effectively achieve the straightening and brightness enhancement of the light, and then uses the response surface methodology to optimize the optical divergence of the parameters of the microlenticular lens structure on the TIR lens to adjust the width and flatness of the light type. Among them, the radius of curvature, the thickness of the lens, and the length of the single lens are selected as the factors. Using the experimental design method of the reaction surface, the optimal solution of the driving beam design is found. The optimal solution is combined into a radius of curvature of 14.99 mm in the X direction and 25.22 mm in the Y direction, the overall thickness is 1.5 mm, and the length of a single curved surface is 2.43. Each factor is within the limit, and the maximum brightness in the center is 213,866 cd.

Two-handed tying technique in vocal fold mucosa microsuture for the treatment of Reinke's edema.

BACKGROUND: Removal of Reinke's edema may result in moderate to large-sized mucosal defect on the vocal fold, which heals by secondary intention. Microsuturing this defect may lead to primary wound healing with fastened recovery and less scar, but costs extra time and effort. Exploring methods that can shorten microsuture time is helpful for the wider application of this technology. STUDY DESIGN: Retrospective. METHODS: 57 patients with Reinke's edema, who were admitted from November 2010 to June 2018, were enrolled as research subjects for the retrospective analysis. 27 patients were the knot pusher group (from November 2010 to March 2015), and 30 patients were the two-handed tying group (from April 2015 to June 2018). Evaluation indicators include the number of knots, the average time for suturing and tying the knot for each patient, and the occurrence of complications, subjective and objective voice assessments. RESULTS: All patients underwent successful operation. The average time for making knots in the knot pusher group and two-handed tying group was 668.40 ± 173.73 s and 328.73 ± 121.0 s, respectively, and there was a statistically significant difference between the two groups (p < 0.001). No significant difference was noted in the mucosal avulsion, overall incidence of complications between the groups, and no significant difference was found between the two groups in terms of the preoperative and 3-month postoperative subjective and objective indicators. CONCLUSION: Microsuturing of Reinke's edema microflaps using the two-handed tying technique can achieve the similar effect with the knot pusher method, and save operation time while the surgeon is well trained. LEVEL OF EVIDENCE: 4.

Correction to: Two-handed tying technique in vocal fold mucosa microsuture for the treatment of Reinke's edema.

In the original publication, the patient number was incorrectly published under the "Methods" heading in the abstract section. The incorrect sentence reads as "55 patients with Reinke's edema, who were admitted from November 2010 to June 2018, were enrolled as research subjects for the retrospective analysis."

Differences between COPD patients and their families regarding willingness toward life-sustaining treatments.

BACKGROUND/PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) receive more life-sustaining treatments (LSTs) than those with other diseases. The aims of this study were to explore the willingness of COPD patients and their families to consent to LSTs and compare the differences between their levels of willingness. METHODS: A cross-sectional survey was conducted, and structured questionnaires were used for data collection. RESULTS: A total of 219 valid samples were collected, including 109 patients and 110 families. Sixty percent of family members indicated that they did not know the intentions of the patient. Families were significantly more willing for patients to receive LSTs than the patients themselves. The level of willingness of patients and families varied according to the situation and LST interventions. When patients were in a vegetative state or medical treatments were futile, the willingness of COPD patients and their families to receive LSTs significantly decreased. Endotracheal intubation and external defibrillation were the least likely to be requested, whereas the willingness to receive medication injections and noninvasive ventilation was greatest. CONCLUSION: Communication between families and patients on the issue of LST should be facilitated. Adequate information on the patient's condition and possible LSTs should be provided to avoid COPD patients receiving inappropriate LSTs.

Effects of a Web-based Health Education Program on Quality of Life and Symptom Distress of Initially Diagnosed Advanced Non-Small Cell Lung Cancer Patients: A Randomized Controlled Trial.

Advanced non-small cell lung cancer (NSCLC) patients treated with chemotherapy experience functional decline and decreased quality of life. The purpose of this study was to evaluate the effects of a web-based health education program on global quality of life, quality of life-related functional dimensions, and symptom distress of initially diagnosed advanced non-small cell lung cancer patients. This study used a randomized, pre- and post-repeated measures design. A total of 55 participants were randomly assigned to an experimental group (n = 27) and a control group (n = 28). The experimental group participated in a web-based health education program, and the control group received usual care. Patients were assessed at 4 time points: baseline assessment (T0), and then 1, 2, and 3 months (T1, T2, and T3) after participating in the web-based health education program or receiving usual care. Patients in the experimental group had significantly greater global quality of life and emotional function, and significantly less top ten significant symptom distresses compared to those in the control group. There were no differences between the groups and within groups with respect to physical function, role function, cognitive function, and social function. The web-based health education can improve global quality of life, emotional function, and top ten significant symptom distresses in patients receiving chemotherapy during the first 3 months after initial diagnosis of advanced NSCLC. Web-based health education can improve quality of life and lessen distress of initially diagnosed NSCLC patients treated with chemotherapy.