BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
BACKGROUND Dysphagia requires prompt evaluation but data regarding referral-to-assessment intervals and its association with outcomes in tertiary care are scarce,especially in Saudi Arabia.AIM To investigate the asses...BACKGROUND Dysphagia requires prompt evaluation but data regarding referral-to-assessment intervals and its association with outcomes in tertiary care are scarce,especially in Saudi Arabia.AIM To investigate the assessment and outcome of consecutive dysphagia referrals to a tertiary gastroenterology practice.METHODS This retrospective single-center study analyzed 207 consecutive dysphagia referrals to King Saud Medical City(2022-2023).Data collection included referral timelines,diagnostic investigations,etiologies and outcomes.Statistical Package for the Social Sciences version 28.0,employing χ^(2) tests and analysis of variance,with P<0.05 considered statistically significant.RESULTS Total 168 patients included in this study(mean age 45.7±17.7 years,50% male),referral delays>2 weeks occurred in 44%for clinical assessment and 50%for endoscopy.Gastroesophageal reflux disease was most common(45.2%),followed by eosinophilic esophagitis(14.8%)and malignancy(6.5%).Patients receiving endoscopy within 2 weeks showed an 84.6%improvement,compared to 76.0%with delayed referral(P=0.012).All malignant cases were referred within 2 weeks,compared to 52.7% of non-malignant cases(P=0.013).However,67%of the malignant cases worsened,and 33%died.CONCLUSION Early endoscopy within 2 weeks provides significant benefit.Optimised management of dysphagia should consist of more direct referral pathways.展开更多
Background:Tertiary lymphoid structure(TLS),ectopic lymphoid aggregates formed in response to chronic inflammation,have emerged as potential prognostic biomarkers and mediators of anti-tumor immunity in various cancer...Background:Tertiary lymphoid structure(TLS),ectopic lymphoid aggregates formed in response to chronic inflammation,have emerged as potential prognostic biomarkers and mediators of anti-tumor immunity in various cancers.However,the heterogeneity of TLS spatial distribution,maturity,and their prognostic and immunological significance in prostate cancer(PCa)remain poorly characterized.Methods:We utilized immunohistochemistry,multispectral fluorescence immunohistochemistry(mIHC)and spatial multi-omics analyses to evaluate the heterogeneity of TLS and its relationship with immune components in the tumor microenvironment(TME).Prognostic implications were assessed in 701 PCa patients from the TCGA and Fudan University Shanghai Cancer Center cohorts.The association between TLS heterogeneity and immunoreactivity was assessed through the quantification of immune cell infiltration.CellTreck and robust cell type decomposition deconvolution algorithms were used to decipher the colocalization features of each cell,cell-cell communication and ligand-receptor features within TLS regions.Results:In PCa,TLSs were detected in approximately 20%of patients across both cohorts,with intratumoral TLS(intra-TLS)being twice as prevalent as peritumoral TLS(peri-TLS).Patients harboring intra-TLS exhibited significantly longer disease-free and progression-free survival.Compared to peri-TLS,intra-TLS were more mature,characterized by increased T-effector cell infiltration,activation of interferon pathways,and the presence of follicular dendritic cell centers and B cell aggregates.Notably,compared with immature TLS,mature TLS were markedly associated with reduced PD-L1 expression,lower regulatory T cells(Tregs)infiltration,and increased high endothelial venules(HEVs)density,indicative of an immunologically active microenvironment.Spatial multi-omics analysis revealed that mature TLS exhibited enriched immune cell diversity and HEVs density,suggesting enhanced anti-tumor immunity.Furthermore,cell-cell communication analysis identified significant interactions between CCL5+dendritic cells and ACKR1+activated B cells within mature TLS,reflecting the enhanced capacity of mature TLS to orchestrate robust antigen presentation and B-cell-driven immune responses.Conclusions:In conclusion,this study highlights the prognostic and immunological implications of TLS heterogeneity in PCa,demonstrating that the spatial distribution and maturity of TLSs are closely linked to TME activation and improved clinical outcomes.These findings provide novel insights into the immune landscape of PCa and establish a foundation for immune-based precision stratification and therapeutic development.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
Objective Cigarette smoking exacerbates the progression of pulmonary tuberculosis(TB).The role of tertiary lymphoid structures(TLS)in chronic lung diseases has gained attention;however,it remains unclear whether smoki...Objective Cigarette smoking exacerbates the progression of pulmonary tuberculosis(TB).The role of tertiary lymphoid structures(TLS)in chronic lung diseases has gained attention;however,it remains unclear whether smoking-exacerbated lung damage in TB is associated with TLS.This study aimed to analyze the characteristics of pulmonary TLS in smokers with TB and to explore the possible role of TLS in smoking-related lung injury in TB.Methods Lung tissues from 36 male patients(18 smokers and 18 non-smokers)who underwent surgical resection for pulmonary TB were included in this study.Pathological and immunohistological analyses were conducted to evaluate the quantity of TLS,and chest computed tomography(CT)was used to assess the severity of lung lesions.The correlation between the TLS quantity and TB lesion severity scores was analyzed.The immune cells and chemokines involved in TLS formation were also evaluated and compared between smokers and non-smokers.Results Smoker patients with TB had significantly higher TLS than non-smokers(P<0.001).The TLS quantity in both the lung parenchyma and peribronchial regions correlated with TB lesion severity on chest CT(parenchyma:r=0.5767;peribronchial:r=0.7373;both P<0.001).Immunohistochemical analysis showed increased B cells,T cells,and C-X-C motif chemokine ligand 13(CXCL13)expression in smoker patients with TB(P<0.001).Conclusion Smoker TB patients exhibited increased pulmonary TLS,which was associated with exacerbated lung lesions on chest CT,suggesting that cigarette smoking may exacerbate lung damage by promoting TLS formation.展开更多
Changes in the intestinal immune micro-environment of the gastrointestinal tract are indispensable in the occurrence and development of gastrointestinal cancer.Tertiary lymphoid structure(TLS)is an immune cell aggrega...Changes in the intestinal immune micro-environment of the gastrointestinal tract are indispensable in the occurrence and development of gastrointestinal cancer.Tertiary lymphoid structure(TLS)is an immune cell aggregation structure found around gastrointestinal cancer in recent years.More and more research proves that tertiary lymphoid structure plays a key biological role and clinical value in disease progression,patient prognosis,and adjuvant treatment.This review aims to explore the research progress,biological significance,and potential clinical applications of TLSs in gastrointestinal tumors.The formation,development,and interaction of TLSs with tumor microenvironment have been reviewed and analyzed in recent years.Meanwhile,this review not only evaluates the clinical value of TLSs as prognostic biomarkers and predictors of treatment response but also explores their role in guiding the formulation of immunotherapy strategies for gastrointestinal tumors.In addition,this review points out the main problems in the current research of TLSs and looks forward to their future development,especially their broad application prospects in the diagnosis,treatment,and prognostic evaluation of gastrointestinal tumors.展开更多
The collecting power of tertiary amines（DRN,DEN and DPN） on kaolinite follows the order of DENDPNDRN.After reacting with DRN,DEN and DPN,the surface potentials of kaolinite increase remarkably,and the recruitments c...The collecting power of tertiary amines（DRN,DEN and DPN） on kaolinite follows the order of DENDPNDRN.After reacting with DRN,DEN and DPN,the surface potentials of kaolinite increase remarkably,and the recruitments caused by collectors also follow the order of DENDPNDRN.The results of dynamics simulation show that the geometries of substituent groups bonding to N are deflected and twisted,and some of bond angles are changed when tertiary amines cations adsorb on kaolinite（001） surface.Based on the results of dynamics simulations and quantum chemistry calculations,the electrostatic forces between three tertiary amines cations and 4×4×3（001） plane of kaolinite are 1.38×10？7 N（DRN12H＋）,1.44×10-6 N（DEN12H＋）,1.383×10-6 N（DPN12H＋）,respectively.展开更多
The special issue deals with the Cretaceous-Tertiary deserts in southwestern China and relevant sedimentological problems about deserts. The study area is located between 101°10＇- 107°00＇E and 28°00＇...The special issue deals with the Cretaceous-Tertiary deserts in southwestern China and relevant sedimentological problems about deserts. The study area is located between 101°10＇- 107°00＇E and 28°00＇-30°40′ N. The ancient desert study is so little in China that there has not been a systematic report about it up to now. Based on the study in many ways on Cretaceous-Tertiary deserts in southwestern China, plentiful data have been obtained. Though it is still a bit rough, the study is a good beginning of the ancient desert study in China. The main ideas and conclusions are summarized as follows.展开更多
Effective teaching has always been a goal pursued by teachers as a part of education both from the western and eastern society,for it to some extend is considered an effective way to improve society.In this essay,both...Effective teaching has always been a goal pursued by teachers as a part of education both from the western and eastern society,for it to some extend is considered an effective way to improve society.In this essay,both Chinese and western conceptions of teaching and learning will be discussed.In doing so,their differences and similarities can be seen clearly,which will help the cross-cultural educators to understand their teaching environment and learning styles.展开更多
Starch/polyvinyl alcohol （PVA） blended materials for using as a solid carbon source （SCS） were prepared by blending PVA and gelatinized starch in an aqueous solution system, in which PVA served as framework materi...Starch/polyvinyl alcohol （PVA） blended materials for using as a solid carbon source （SCS） were prepared by blending PVA and gelatinized starch in an aqueous solution system, in which PVA served as framework material and starch as carbon source. The optimization of starch content and temperature effects were investigated. It was indicated that higher denitrification efficiency could be achieved with more starch in the materials. The average specific denitrification rates were 0.93, 0.66, 0.37 and 0.36 mg/（g·day） corresponding to starch content of 70%, 60%, 40% and 30% respectively at 37℃. The denitrification rates increased when operating temperature was raised from 23℃ to 30℃ and then 37℃. The mechanism of carbon release was analyzed incorporating the experimental results of abiotic release in deionized water. The organic carbon was mainly hydrolyzed by microbes, and the biological release efficiencies were at the range of 89.2% to 96.0%. A long-term experiment with a continuous flow reactor with SCS material containing 70% starch was conducted to gain some experience for practical application. When the influent nitrate concentration was in the range of 35.2 to 39.1 mg/L, hydraulic retention time of 4 hr, and operating temperature of 30℃, a nitrogen removal efficiency up to 94.6% and denitrification rate of 0.217 kg/（m3.day） was achieved. The starch-based materials developed in this study can be used as a solid carbon source for tertiary nitrogen removal from secondary effluent.展开更多
The stretching process of some Tertiary rift basins in eastern China is characterized by multiphase rifting. A multiple instantaneous uniform stretching model is proposed in this paper to simulate the formation of the...The stretching process of some Tertiary rift basins in eastern China is characterized by multiphase rifting. A multiple instantaneous uniform stretching model is proposed in this paper to simulate the formation of the basins as the rifting process cannot be accurately described by a simple (one episode) stretching model. The study shows that the multiphase stretching model, combined with the back-stripping technique, can be used to reconstruct the subsidence history and the stretching process of the lithosphere, and to evaluate the depth to the top of the asthenosphere and the deep thermal evolution of the basins. The calculated results obtained by applying the quantitative model to the episodic rifting process of the Tertiary Qiongdongnan and Yinggehai basins in the South China Sea are in agreement with geophysical data and geological observations. This provides a new method for quantitative evaluation of the geodynamic process of multiphase rifting occurring during the Tertiary in eastern China.展开更多
Tertiary amine cationic polyacrylamide with high cationization degree was used as a new cationic agent to pretreat cotton with dip-pad-bake method. The obtained cationic cotton was dyed with reactive dyes in the ab-se...Tertiary amine cationic polyacrylamide with high cationization degree was used as a new cationic agent to pretreat cotton with dip-pad-bake method. The obtained cationic cotton was dyed with reactive dyes in the ab-sence of electrolyte. The effects of the characteristics of the cationic agent and the pretreatment conditions on dye-ability of reactive dye were investigated. The results showed that the fixation and K/S values of the reactive dyes on the cationic cotton were improved compared with those on the untreated one in the presence of salt. Tests on fast-ness properties of the dyed cotton and fabric quality of the pretreated cotton were carried out and the results showed that wash and rub fastness of the salt-free dyeing were both satisfactory. And anti-crease property,tensile and tear strength,and handling of the cationic cotton were also good compared with that of the untreated one.展开更多
Potassium-ion batteries(KIBs)are a potential candidate to lithium-ion batteries(LIBs)but possess unsatisfactory capacity and rate properties.Herein,the metallic cobalt selenide quantum dots(Co0.85Se-QDs)encapsulated i...Potassium-ion batteries(KIBs)are a potential candidate to lithium-ion batteries(LIBs)but possess unsatisfactory capacity and rate properties.Herein,the metallic cobalt selenide quantum dots(Co0.85Se-QDs)encapsulated in mesoporous carbon matrix were designed via a direct hydrothermal method.Specifically,the cobalt selenide/carbon composite(Co0.85Se-QDs/C)possesses tertiary hierarchical structure,which is the primary quantum dots,the secondary petals flake,and the tertiary hollow micropolyhedron framework.Co0.85Se-QDs are homogenously embedded into the carbon petals flake,which constitute the hollow polyhedral framework.This unique structure can take the advantages of both nanoscale and microscale features:Co0.85Se-QDs can expand in a multidimensional and ductile carbon matrix and reduce the K-intercalation stress in particle dimensions;the micropetals can restrain the agglomeration of active materials and promote the transportation of potassium ion and electron.In addition,the hollow carbon framework buffers volume expansion,maintains the structural integrity,and increases the electronic conductivity.Benefiting from this tertiary hierarchical structure,outstanding K-storage performance(402 mAh g?1 after 100 cycles at 50 mA g?1)is obtained when Co0.85Se-QDs/C is used as KIBs anode.More importantly,the selenization process in this work is newly reported and can be generally extended to prepare other quantum dots encapsulated in edge-limited frameworks for excellent energy storage.展开更多
For high strength interstitial free （IF） steel containing P element, the salt and pepper （SP） defects exist on the strip surface and could not be eliminated effectively by optimizing the hot rolling process, such ...For high strength interstitial free （IF） steel containing P element, the salt and pepper （SP） defects exist on the strip surface and could not be eliminated effectively by optimizing the hot rolling process, such as temperature and cooling water. The combination effect of Si and P on the characteristic of tertiary scale has been studied comprehensively by scanning electron microscopy （SEM） and electron probe microanalysis （EPMA）, and the concept is proposed firstly that Si and P are of combination effect which can be utilized to eliminate the SP defect. The results show that the SP defects were induced by the rolled-in scale during finish rolling. P can be enriched at the interface between substrate and tertiary scale, which is easy to decrease the adhesion of tertiary scale. However, Si enrichment at the interface between substrate and tertiary scale can increase the adhesion. The SP defects can be eliminated completely, which is attributed to the accompanying enrichment of Si and P.展开更多
Analysis of 2 D seismic data over 4 500 km in length from the Madura Strait Basin in the East Java Sea reveals seismic re?ection characteristics of reefs and associated sedimentary bodies, including asymmetrical or sy...Analysis of 2 D seismic data over 4 500 km in length from the Madura Strait Basin in the East Java Sea reveals seismic re?ection characteristics of reefs and associated sedimentary bodies, including asymmetrical or symmetrical dome re?ections, slope progradational re?ections, chaotic re?ections and discontinuous strong re?ections inside the reef, which onlap the ?ank of the reef. It is concluded that the developmental paleo-environment of most reefs is mainly conducive to shallow marine carbonate platform facies and platform margin facies, based on well core data, variations in seismic facies and strata thickness.The formation and evolution of all reefs are primarily in?uenced by the tectonic framework of the Madura Strait Basin. Platform margin reefs are principally controlled by two types of structures: one is a series of E-W trending Paleogene normal faults, and the other is an E-W trending Neogene inversion structures. In addition, wave actions, tidal currents and other ocean currents play an accelerated role in sorting, rounding and redeposition for the accumulation and evolution of reefs. Tertiary reefs in the MSB can be divided into four types: 1) an open platform coral reef of Late Oligocene to Early Miocene, 2) a platform margin coral reef controlled by normal faults in Late Oligocene to Early Miocene, 3) a platform margin Globigerina moundreef controlled by a "hidden" inversion structure in Early Pliocene, and 4) a platform margin Globigerina mound-reef controlled by thrust faults in the early Pliocene. Patterns of the formation and evolution of reefs are also suggested.展开更多
Objective:Recent studies have highlighted the distinct value of tertiary lymphoid structure(TLS)for immunotherapeutic response prediction.However,it remains unclear whether TLS could play such roles in gastric cancer(...Objective:Recent studies have highlighted the distinct value of tertiary lymphoid structure(TLS)for immunotherapeutic response prediction.However,it remains unclear whether TLS could play such roles in gastric cancer(GC).Methods:In this study,tumor tissue slices from 292 GC patients from Zhongshan Hospital were firstly reviewed to explore the correlation between TLS and clinical characteristics.Subsequently,we curated 38 reported genes that may function as triggers of TLS and performed consensus molecular subtyping in public RNA-seq datasets to determine TLS patterns in GC.Based on the differentially expressed genes acquired from two TLS patterns,we quantified TLS-related genes on the principal component analysis(PCA)algorithm to develop TLS score.A Zhongshan immunotherapy cohort including 13 patients who received programmed cell death 1(PD1)blockade therapy was established to conduct RNA sequencing analysis and multiplex immunohistochemistry(mIHC)tests using formalin-fixed and paraffin-embedded(FFPE)tissues.The corresponding TLS score and immune cell counts were further compared based on therapeutic response variations.Results:Mature TLS was revealed as an independent prognostic factor in 292 GC patients.Patients with higher TLS score was characterized by prolonged survival time and superior response to immunotherapy.TLS score was correlated with immunotherapy-related characters,such as microsatellite instability(MSI)and tumor mutation burden(TMB).In addition,RNA-seq data analysis in the Zhongshan immunotherapy cohort indicated that a higher TLS score was correlated with a superior response to PD1 blockade therapy.mIHC tests also revealed that PD1+CD8+T cell counts were significantly increased in the high-TLS score group.Conclusions:This study highlighted that TLS was significantly associated with immune landscape diversity and complexity.Quantitatively evaluating TLS patterns of individual tumor will strengthen our understanding of TME characteristics and promote more effective immunotherapy strategies.展开更多
AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of pa...AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.展开更多
Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,B...Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.展开更多
AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. METHODS: Retrospective analysis of contrast enhanced ultrasound (...AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. METHODS: Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. RESULTS: About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemoembolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2(4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2(4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc.CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions. CONCLUSION: CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.展开更多
Problems associated with water eutrophication due to high phosphorus concentrations and related environmentally safe solutions have attracted wide attention.A novel bis(diallyl alkyl tertiary ammonium salt)polymer,par...Problems associated with water eutrophication due to high phosphorus concentrations and related environmentally safe solutions have attracted wide attention.A novel bis(diallyl alkyl tertiary ammonium salt)polymer,particularly poly(N1,N1,N6,N6-tetraallylhexane-1,6-diammonium dichloride)(PTAHDADC),was synthesized and characterized by Fourier transform infrared spectroscopy,nuclear magnetic resonance,scanning electron microscopy,mercury intrusion method,and thermogravimetric analysis.The adsorption characteristics in phosphorus were evaluated in dilute solution,and the recycling properties of PTAHDADC were investigated.Results showed that PTAHDADC possessed macropores with a size distribution ranging from 30 to 130μm concentrating at 63μm in diameter and had 46.52%of porosity,excellent thermal stability below 530 K,and insolubility.PTAHDADC could effectively remove phosphorus at p H=7–11 and had a removal efficiency exceeding 98.4%at pH=10–11.The adsorption equilibrium data of PTAHDADC for phosphorus accorded well with the Langmuir and pseudo-second-order kinetic models.Maximum adsorption capacity was 52.82 mg/g at 293 K.PTAHDADC adsorbed phosphorus rapidly and reached equilibrium within 90 min.Calculated activation energy Eawas 15.18 k J/mol.PTAHDADC presented an excellent recyclability with only 8.23%loss of removal efficiency after five adsorption–desorption cycles.The morphology and structure of PTAHDADC slightly changed as evidenced by the pre-and post-adsorption of phosphorus,but the process was accompanied by the partial deprotonation of the(–CH2)3-NH+group of PTAHDADC.The adsorption was a spontaneous exothermic process driven by entropy through physisorption,electrostatic attraction,and ion exchange.Survey results showed that PTAHDADC was a highly efficient and fast-adsorbing phosphorus-removal material prospective in treating wastewater.展开更多
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
文摘BACKGROUND Dysphagia requires prompt evaluation but data regarding referral-to-assessment intervals and its association with outcomes in tertiary care are scarce,especially in Saudi Arabia.AIM To investigate the assessment and outcome of consecutive dysphagia referrals to a tertiary gastroenterology practice.METHODS This retrospective single-center study analyzed 207 consecutive dysphagia referrals to King Saud Medical City(2022-2023).Data collection included referral timelines,diagnostic investigations,etiologies and outcomes.Statistical Package for the Social Sciences version 28.0,employing χ^(2) tests and analysis of variance,with P<0.05 considered statistically significant.RESULTS Total 168 patients included in this study(mean age 45.7±17.7 years,50% male),referral delays>2 weeks occurred in 44%for clinical assessment and 50%for endoscopy.Gastroesophageal reflux disease was most common(45.2%),followed by eosinophilic esophagitis(14.8%)and malignancy(6.5%).Patients receiving endoscopy within 2 weeks showed an 84.6%improvement,compared to 76.0%with delayed referral(P=0.012).All malignant cases were referred within 2 weeks,compared to 52.7% of non-malignant cases(P=0.013).However,67%of the malignant cases worsened,and 33%died.CONCLUSION Early endoscopy within 2 weeks provides significant benefit.Optimised management of dysphagia should consist of more direct referral pathways.
基金supported by grants from Non-communicable Chronic Diseases-National Science and Technology Major Project(grant number:2023ZD0510300)National Natural Science Foundation of China(grant numbers:82403377,82473192,82474506,81760463)+4 种基金China Postdoctoral Science Foundation(grant number:2024M750538)Shanghai Anticancer Association EYAS PROJECT(grant numbers:SACA-CY23A02,SACA-CY23C04)Beijing Xisike Clinical Oncology Research Foundation(grant numbers:Y-Young2024-0138,Y-HR2020MS-0948)Central Government Funds for Guiding Local Scientific and Technological Development(grant number:2021ZY0037)Natural Science Found of In-ner Mongolia(grant number:2023MS08015).
文摘Background:Tertiary lymphoid structure(TLS),ectopic lymphoid aggregates formed in response to chronic inflammation,have emerged as potential prognostic biomarkers and mediators of anti-tumor immunity in various cancers.However,the heterogeneity of TLS spatial distribution,maturity,and their prognostic and immunological significance in prostate cancer(PCa)remain poorly characterized.Methods:We utilized immunohistochemistry,multispectral fluorescence immunohistochemistry(mIHC)and spatial multi-omics analyses to evaluate the heterogeneity of TLS and its relationship with immune components in the tumor microenvironment(TME).Prognostic implications were assessed in 701 PCa patients from the TCGA and Fudan University Shanghai Cancer Center cohorts.The association between TLS heterogeneity and immunoreactivity was assessed through the quantification of immune cell infiltration.CellTreck and robust cell type decomposition deconvolution algorithms were used to decipher the colocalization features of each cell,cell-cell communication and ligand-receptor features within TLS regions.Results:In PCa,TLSs were detected in approximately 20%of patients across both cohorts,with intratumoral TLS(intra-TLS)being twice as prevalent as peritumoral TLS(peri-TLS).Patients harboring intra-TLS exhibited significantly longer disease-free and progression-free survival.Compared to peri-TLS,intra-TLS were more mature,characterized by increased T-effector cell infiltration,activation of interferon pathways,and the presence of follicular dendritic cell centers and B cell aggregates.Notably,compared with immature TLS,mature TLS were markedly associated with reduced PD-L1 expression,lower regulatory T cells(Tregs)infiltration,and increased high endothelial venules(HEVs)density,indicative of an immunologically active microenvironment.Spatial multi-omics analysis revealed that mature TLS exhibited enriched immune cell diversity and HEVs density,suggesting enhanced anti-tumor immunity.Furthermore,cell-cell communication analysis identified significant interactions between CCL5+dendritic cells and ACKR1+activated B cells within mature TLS,reflecting the enhanced capacity of mature TLS to orchestrate robust antigen presentation and B-cell-driven immune responses.Conclusions:In conclusion,this study highlights the prognostic and immunological implications of TLS heterogeneity in PCa,demonstrating that the spatial distribution and maturity of TLSs are closely linked to TME activation and improved clinical outcomes.These findings provide novel insights into the immune landscape of PCa and establish a foundation for immune-based precision stratification and therapeutic development.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
基金supported by the Peking University Medicine Fund of Fostering Young Scholars'Scientific&Technological Innovation[grant number BMU2024YFJHPY014]the Fundamental Research Funds for the Central Universities+1 种基金the Key Clinical Projects of Peking University Third Hospital[grant number BYSYZD2022014]the Capital’s Funds for Health Improvement and Research[grant number 2022-2G-40910]。
文摘Objective Cigarette smoking exacerbates the progression of pulmonary tuberculosis(TB).The role of tertiary lymphoid structures(TLS)in chronic lung diseases has gained attention;however,it remains unclear whether smoking-exacerbated lung damage in TB is associated with TLS.This study aimed to analyze the characteristics of pulmonary TLS in smokers with TB and to explore the possible role of TLS in smoking-related lung injury in TB.Methods Lung tissues from 36 male patients(18 smokers and 18 non-smokers)who underwent surgical resection for pulmonary TB were included in this study.Pathological and immunohistological analyses were conducted to evaluate the quantity of TLS,and chest computed tomography(CT)was used to assess the severity of lung lesions.The correlation between the TLS quantity and TB lesion severity scores was analyzed.The immune cells and chemokines involved in TLS formation were also evaluated and compared between smokers and non-smokers.Results Smoker patients with TB had significantly higher TLS than non-smokers(P<0.001).The TLS quantity in both the lung parenchyma and peribronchial regions correlated with TB lesion severity on chest CT(parenchyma:r=0.5767;peribronchial:r=0.7373;both P<0.001).Immunohistochemical analysis showed increased B cells,T cells,and C-X-C motif chemokine ligand 13(CXCL13)expression in smoker patients with TB(P<0.001).Conclusion Smoker TB patients exhibited increased pulmonary TLS,which was associated with exacerbated lung lesions on chest CT,suggesting that cigarette smoking may exacerbate lung damage by promoting TLS formation.
文摘Changes in the intestinal immune micro-environment of the gastrointestinal tract are indispensable in the occurrence and development of gastrointestinal cancer.Tertiary lymphoid structure(TLS)is an immune cell aggregation structure found around gastrointestinal cancer in recent years.More and more research proves that tertiary lymphoid structure plays a key biological role and clinical value in disease progression,patient prognosis,and adjuvant treatment.This review aims to explore the research progress,biological significance,and potential clinical applications of TLSs in gastrointestinal tumors.The formation,development,and interaction of TLSs with tumor microenvironment have been reviewed and analyzed in recent years.Meanwhile,this review not only evaluates the clinical value of TLSs as prognostic biomarkers and predictors of treatment response but also explores their role in guiding the formulation of immunotherapy strategies for gastrointestinal tumors.In addition,this review points out the main problems in the current research of TLSs and looks forward to their future development,especially their broad application prospects in the diagnosis,treatment,and prognostic evaluation of gastrointestinal tumors.
基金Project (2005CB623701) supported by the National Basic Research Program of China Project (201011031) supported by National Department Public Benefit Research Foundation from Ministry of Land and Resources of China+1 种基金 Project (2935) supported by the Foundation for the Author of Zhengzhou Institute of Multipurpose Utilization of Mineral Resources CAGS, China Project (1212011120304) supported by the Geological Surrey Program
文摘The collecting power of tertiary amines（DRN,DEN and DPN） on kaolinite follows the order of DENDPNDRN.After reacting with DRN,DEN and DPN,the surface potentials of kaolinite increase remarkably,and the recruitments caused by collectors also follow the order of DENDPNDRN.The results of dynamics simulation show that the geometries of substituent groups bonding to N are deflected and twisted,and some of bond angles are changed when tertiary amines cations adsorb on kaolinite（001） surface.Based on the results of dynamics simulations and quantum chemistry calculations,the electrostatic forces between three tertiary amines cations and 4×4×3（001） plane of kaolinite are 1.38×10？7 N（DRN12H＋）,1.44×10-6 N（DEN12H＋）,1.383×10-6 N（DPN12H＋）,respectively.
文摘The special issue deals with the Cretaceous-Tertiary deserts in southwestern China and relevant sedimentological problems about deserts. The study area is located between 101°10＇- 107°00＇E and 28°00＇-30°40′ N. The ancient desert study is so little in China that there has not been a systematic report about it up to now. Based on the study in many ways on Cretaceous-Tertiary deserts in southwestern China, plentiful data have been obtained. Though it is still a bit rough, the study is a good beginning of the ancient desert study in China. The main ideas and conclusions are summarized as follows.
文摘Effective teaching has always been a goal pursued by teachers as a part of education both from the western and eastern society,for it to some extend is considered an effective way to improve society.In this essay,both Chinese and western conceptions of teaching and learning will be discussed.In doing so,their differences and similarities can be seen clearly,which will help the cross-cultural educators to understand their teaching environment and learning styles.
基金supported by the Ministry of Science and Technology of China (No.2009AA063805)
文摘Starch/polyvinyl alcohol （PVA） blended materials for using as a solid carbon source （SCS） were prepared by blending PVA and gelatinized starch in an aqueous solution system, in which PVA served as framework material and starch as carbon source. The optimization of starch content and temperature effects were investigated. It was indicated that higher denitrification efficiency could be achieved with more starch in the materials. The average specific denitrification rates were 0.93, 0.66, 0.37 and 0.36 mg/（g·day） corresponding to starch content of 70%, 60%, 40% and 30% respectively at 37℃. The denitrification rates increased when operating temperature was raised from 23℃ to 30℃ and then 37℃. The mechanism of carbon release was analyzed incorporating the experimental results of abiotic release in deionized water. The organic carbon was mainly hydrolyzed by microbes, and the biological release efficiencies were at the range of 89.2% to 96.0%. A long-term experiment with a continuous flow reactor with SCS material containing 70% starch was conducted to gain some experience for practical application. When the influent nitrate concentration was in the range of 35.2 to 39.1 mg/L, hydraulic retention time of 4 hr, and operating temperature of 30℃, a nitrogen removal efficiency up to 94.6% and denitrification rate of 0.217 kg/（m3.day） was achieved. The starch-based materials developed in this study can be used as a solid carbon source for tertiary nitrogen removal from secondary effluent.
文摘The stretching process of some Tertiary rift basins in eastern China is characterized by multiphase rifting. A multiple instantaneous uniform stretching model is proposed in this paper to simulate the formation of the basins as the rifting process cannot be accurately described by a simple (one episode) stretching model. The study shows that the multiphase stretching model, combined with the back-stripping technique, can be used to reconstruct the subsidence history and the stretching process of the lithosphere, and to evaluate the depth to the top of the asthenosphere and the deep thermal evolution of the basins. The calculated results obtained by applying the quantitative model to the episodic rifting process of the Tertiary Qiongdongnan and Yinggehai basins in the South China Sea are in agreement with geophysical data and geological observations. This provides a new method for quantitative evaluation of the geodynamic process of multiphase rifting occurring during the Tertiary in eastern China.
基金Supported by the National Science Foundation for Distinguished Young Scholar of China（20525620） the National Natural Science Foundation of China（20806013） the Program for Changjiang Scholar and Innovative Research Team in University（IRT 0711）
文摘Tertiary amine cationic polyacrylamide with high cationization degree was used as a new cationic agent to pretreat cotton with dip-pad-bake method. The obtained cationic cotton was dyed with reactive dyes in the ab-sence of electrolyte. The effects of the characteristics of the cationic agent and the pretreatment conditions on dye-ability of reactive dye were investigated. The results showed that the fixation and K/S values of the reactive dyes on the cationic cotton were improved compared with those on the untreated one in the presence of salt. Tests on fast-ness properties of the dyed cotton and fabric quality of the pretreated cotton were carried out and the results showed that wash and rub fastness of the salt-free dyeing were both satisfactory. And anti-crease property,tensile and tear strength,and handling of the cationic cotton were also good compared with that of the untreated one.
基金financially supported by Beijing Natural Science Foundation(No.2192034)China Postdoctoral Science Foundation(No.2018M631335)National Key R&D Program of China(No.2018YFB0905600).
文摘Potassium-ion batteries(KIBs)are a potential candidate to lithium-ion batteries(LIBs)but possess unsatisfactory capacity and rate properties.Herein,the metallic cobalt selenide quantum dots(Co0.85Se-QDs)encapsulated in mesoporous carbon matrix were designed via a direct hydrothermal method.Specifically,the cobalt selenide/carbon composite(Co0.85Se-QDs/C)possesses tertiary hierarchical structure,which is the primary quantum dots,the secondary petals flake,and the tertiary hollow micropolyhedron framework.Co0.85Se-QDs are homogenously embedded into the carbon petals flake,which constitute the hollow polyhedral framework.This unique structure can take the advantages of both nanoscale and microscale features:Co0.85Se-QDs can expand in a multidimensional and ductile carbon matrix and reduce the K-intercalation stress in particle dimensions;the micropetals can restrain the agglomeration of active materials and promote the transportation of potassium ion and electron.In addition,the hollow carbon framework buffers volume expansion,maintains the structural integrity,and increases the electronic conductivity.Benefiting from this tertiary hierarchical structure,outstanding K-storage performance(402 mAh g?1 after 100 cycles at 50 mA g?1)is obtained when Co0.85Se-QDs/C is used as KIBs anode.More importantly,the selenization process in this work is newly reported and can be generally extended to prepare other quantum dots encapsulated in edge-limited frameworks for excellent energy storage.
文摘For high strength interstitial free （IF） steel containing P element, the salt and pepper （SP） defects exist on the strip surface and could not be eliminated effectively by optimizing the hot rolling process, such as temperature and cooling water. The combination effect of Si and P on the characteristic of tertiary scale has been studied comprehensively by scanning electron microscopy （SEM） and electron probe microanalysis （EPMA）, and the concept is proposed firstly that Si and P are of combination effect which can be utilized to eliminate the SP defect. The results show that the SP defects were induced by the rolled-in scale during finish rolling. P can be enriched at the interface between substrate and tertiary scale, which is easy to decrease the adhesion of tertiary scale. However, Si enrichment at the interface between substrate and tertiary scale can increase the adhesion. The SP defects can be eliminated completely, which is attributed to the accompanying enrichment of Si and P.
基金Supported by the Qingdao National Laboratory for Marine Science and Technology(Nos.QNLM201708,QNLM2016ORP0206)the Scientific and Technological Innovation Project Financially Supported by Qingdao National Laboratory for Marine Science and Technology(Nos.2017ASKJ02,2017ASKJ01,2016ASKJ13)+2 种基金the Special Fund for Land&Resources Scientific Research in the Public Interest(No.201511037)the Natural Science Foundation of Shandong Province of China(No.ZR2016DB33)the National Key Research and Development Program(No.2017YFC0306706-04)
文摘Analysis of 2 D seismic data over 4 500 km in length from the Madura Strait Basin in the East Java Sea reveals seismic re?ection characteristics of reefs and associated sedimentary bodies, including asymmetrical or symmetrical dome re?ections, slope progradational re?ections, chaotic re?ections and discontinuous strong re?ections inside the reef, which onlap the ?ank of the reef. It is concluded that the developmental paleo-environment of most reefs is mainly conducive to shallow marine carbonate platform facies and platform margin facies, based on well core data, variations in seismic facies and strata thickness.The formation and evolution of all reefs are primarily in?uenced by the tectonic framework of the Madura Strait Basin. Platform margin reefs are principally controlled by two types of structures: one is a series of E-W trending Paleogene normal faults, and the other is an E-W trending Neogene inversion structures. In addition, wave actions, tidal currents and other ocean currents play an accelerated role in sorting, rounding and redeposition for the accumulation and evolution of reefs. Tertiary reefs in the MSB can be divided into four types: 1) an open platform coral reef of Late Oligocene to Early Miocene, 2) a platform margin coral reef controlled by normal faults in Late Oligocene to Early Miocene, 3) a platform margin Globigerina moundreef controlled by a "hidden" inversion structure in Early Pliocene, and 4) a platform margin Globigerina mound-reef controlled by thrust faults in the early Pliocene. Patterns of the formation and evolution of reefs are also suggested.
基金supported by grants from the National Natural Science Foundation of China(No.82172803 and No.82072679)the 2020 Zhongshan Hospital Clinical Research Special Fund(No.2020ZSLC15)。
文摘Objective:Recent studies have highlighted the distinct value of tertiary lymphoid structure(TLS)for immunotherapeutic response prediction.However,it remains unclear whether TLS could play such roles in gastric cancer(GC).Methods:In this study,tumor tissue slices from 292 GC patients from Zhongshan Hospital were firstly reviewed to explore the correlation between TLS and clinical characteristics.Subsequently,we curated 38 reported genes that may function as triggers of TLS and performed consensus molecular subtyping in public RNA-seq datasets to determine TLS patterns in GC.Based on the differentially expressed genes acquired from two TLS patterns,we quantified TLS-related genes on the principal component analysis(PCA)algorithm to develop TLS score.A Zhongshan immunotherapy cohort including 13 patients who received programmed cell death 1(PD1)blockade therapy was established to conduct RNA sequencing analysis and multiplex immunohistochemistry(mIHC)tests using formalin-fixed and paraffin-embedded(FFPE)tissues.The corresponding TLS score and immune cell counts were further compared based on therapeutic response variations.Results:Mature TLS was revealed as an independent prognostic factor in 292 GC patients.Patients with higher TLS score was characterized by prolonged survival time and superior response to immunotherapy.TLS score was correlated with immunotherapy-related characters,such as microsatellite instability(MSI)and tumor mutation burden(TMB).In addition,RNA-seq data analysis in the Zhongshan immunotherapy cohort indicated that a higher TLS score was correlated with a superior response to PD1 blockade therapy.mIHC tests also revealed that PD1+CD8+T cell counts were significantly increased in the high-TLS score group.Conclusions:This study highlighted that TLS was significantly associated with immune landscape diversity and complexity.Quantitatively evaluating TLS patterns of individual tumor will strengthen our understanding of TME characteristics and promote more effective immunotherapy strategies.
文摘AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.
文摘Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.
文摘AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. METHODS: Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. RESULTS: About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemoembolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2(4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2(4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc.CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions. CONCLUSION: CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.
基金supported by the Scientific Research Fund of Hunan Education Department(No.16A069)the National Nature Science Foundation of China(No.51378201)
文摘Problems associated with water eutrophication due to high phosphorus concentrations and related environmentally safe solutions have attracted wide attention.A novel bis(diallyl alkyl tertiary ammonium salt)polymer,particularly poly(N1,N1,N6,N6-tetraallylhexane-1,6-diammonium dichloride)(PTAHDADC),was synthesized and characterized by Fourier transform infrared spectroscopy,nuclear magnetic resonance,scanning electron microscopy,mercury intrusion method,and thermogravimetric analysis.The adsorption characteristics in phosphorus were evaluated in dilute solution,and the recycling properties of PTAHDADC were investigated.Results showed that PTAHDADC possessed macropores with a size distribution ranging from 30 to 130μm concentrating at 63μm in diameter and had 46.52%of porosity,excellent thermal stability below 530 K,and insolubility.PTAHDADC could effectively remove phosphorus at p H=7–11 and had a removal efficiency exceeding 98.4%at pH=10–11.The adsorption equilibrium data of PTAHDADC for phosphorus accorded well with the Langmuir and pseudo-second-order kinetic models.Maximum adsorption capacity was 52.82 mg/g at 293 K.PTAHDADC adsorbed phosphorus rapidly and reached equilibrium within 90 min.Calculated activation energy Eawas 15.18 k J/mol.PTAHDADC presented an excellent recyclability with only 8.23%loss of removal efficiency after five adsorption–desorption cycles.The morphology and structure of PTAHDADC slightly changed as evidenced by the pre-and post-adsorption of phosphorus,but the process was accompanied by the partial deprotonation of the(–CH2)3-NH+group of PTAHDADC.The adsorption was a spontaneous exothermic process driven by entropy through physisorption,electrostatic attraction,and ion exchange.Survey results showed that PTAHDADC was a highly efficient and fast-adsorbing phosphorus-removal material prospective in treating wastewater.
