Clinical efficacy of Gamma Knife® combined with transarterial chemoembolization and immunotherapy in the treatment of primary liver cancer

BACKGROUND This study was designed to investigate the clinical efficacy and safety of Gamma Knife®combined with transarterial chemoembolization(TACE)and immunotherapy in the treatment of primary liver cancer.AIM To investigate the clinical efficacy and safety of Gamma Knife®combined with TACE and immune-targeted therapy in the treatment of primary liver cancer.METHODS Clinical data from 51 patients with primary liver cancer admitted to our hospital between May 2018 and October 2022 were retrospectively collected.All patients underwent Gamma Knife®treatment combined with TACE and immunotherapy.The clinical efficacy,changes in liver function,overall survival(OS),and progression-free survival(PFS)of patients with different treatment responses were evaluated,and adverse reactions were recorded.RESULTS The last follow-up for this study was conducted on October 31,2023.Clinical evaluation of the 51 patients with primary liver cancer revealed a partial response(PR)in 27 patients,accounting for 52.94%(27/51);stable disease(SD)in 16 patients,accounting for 31.37%(16/51);and progressive disease(PD)in 8 patients,accounting for 15.69%(8/51).The objective response rate was 52.94%,and the disease control rate was 84.31%.Alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,and alpha-fetoprotein isoform levels decreased after treatment compared with pretreatment(all P=0.000).The median OS was 26 months[95%confidence interval(95%CI):19.946-32.054]in the PR group and 19 months(95%CI:14.156-23.125)in the SD+PD group,with a statistically significant difference(P=0.015).The median PFS was 20 months(95%CI:18.441-34.559)in the PR group and 12 months(95%CI:8.745-13.425)in the SD+PD group,with a statistically significant difference(P=0.002).Common adverse reactions during treatment included nausea and vomiting(39.22%),thrombocytopenia(27.45%),and leukopenia(25.49%),with no treatment-related deaths reported.CONCLUSION Gamma Knife®combined with TACE and immune-targeted therapy is safe and effective in the treatment of primary liver cancer and has a good effect on improving the clinical benefit rate and liver function of patients.

食管黏膜病变内镜黏膜下剥离术前和术后的临床病理分析

目的回顾性分析早期食管癌和癌前病变的内镜下特征及临床病理特征,探讨内镜黏膜下剥离术(ESD)治疗的必要性、安全性和有效性。方法纳入2013年5月-2016年4月经白光内镜及病理活检诊断为早期食管癌及上皮内瘤变的患者51例,分析毛细血管袢(IPCL)、碘染色、术前术后病理结果及相关并发症的发生情况。结果 51例患者共58处病变,IPCL分类58处病变中A型8处(13.79%),B1型44处(75.86%),B2型6处(10.34%);术前活检结果 11处(18.97%)为低级别上皮内瘤变(LGIN),42处(72.41%)为高级别上皮内瘤变(HGIN),5处(8.62%)为鳞状细胞癌,术后病理结果 10处(17.54%)病变为LGIN,27处(46.55%)为HGIN,21处(36.21%)病变为鳞状细胞癌,术前术后病理结果符合率为60.34%。微穿孔、狭窄和术后迟发性出血的概率分别为0.00%(0/58)、8.62%(5/58)和3.45%(2/58)。结论 ESD术后食管早癌的检出率显著增加,术前活检对诊断和治疗有指导意义,ESD治疗能减少食管早癌的漏诊。

内镜下切除大肠息肉术后迟发性出血的危险因素分析

目的探讨大肠息肉内镜下切除术后迟发性出血(DPPB)的危险因素。方法对2014年7月-2017年7月在湖北省肿瘤医院行内镜下切除术治疗的大肠息肉1 098例患者的临床资料进行回顾性分析,研究术后DPPB的危险因素。结果纳入研究的患者1 098例,治疗息肉2 169枚,18例患者(1.6%)出现术后DPPB,单因素分析发现患者有高血压病史(P=0.007)、息肉直径≥10 mm(P=0.009)、右半结肠息肉(P=0.015)、腺瘤性息肉(P=0.045)是DPPB的危险因素。多因素分析显示高血压病史(P=0.002,O■=4.654,95%CI:1.755~12.343)、息肉直径≥10 mm(P=0.009,O■=3.637,95%CI:1.390~9.517)、右半结肠息肉(P=0.016,O■=3.656,95%CI:1.273~10.504)是内镜下切除术后DPPB的独立危险因素。结论有高血压病史、息肉直径≥10 mm、息肉位于右半结肠的患者内镜下切除术后易出现迟发性出血,建议采取措施进行预防性止血。

Novel conductive polypyrrole/silk fibroin scaffold for neural tissue repair

Three dimensional（3D） bioprinting, which involves depositing bioinks（mixed biomaterials） layer by layer to form computer-aided designs, is an ideal method for fabricating complex 3D biological structures. However, it remains challenging to prepare biomaterials with micro-nanostructures that accurately mimic the nanostructural features of natural tissues. A novel nanotechnological tool, electrospinning, permits the processing and modification of proper nanoscale biomaterials to enhance neural cell adhesion, migration, proliferation, differentiation, and subsequent nerve regeneration. The composite scaffold was prepared by combining 3D bioprinting with subsequent electrochemical deposition of polypyrrole and electrospinning of silk fibroin to form a composite polypyrrole/silk fibroin scaffold. Fourier transform infrared spectroscopy was used to analyze scaffold composition. The surface morphology of the scaffold was observed by light microscopy and scanning electron microscopy. A digital multimeter was used to measure the resistivity of prepared scaffolds. Light microscopy was applied to observe the surface morphology of scaffolds immersed in water or Dulbecco＇s Modified Eagle＇s Medium at 37℃ for 30 days to assess stability. Results showed characteristic peaks of polypyrrole and silk fibroin in the synthesized conductive polypyrrole/silk fibroin scaffold, as well as the structure of the electrospun nanofiber layer on the surface. The electrical conductivity was 1 × 10^-5–1 × 10^-3 S/cm, while stability was 66.67%. A 3-（4,5-dimethyl-2-thiazolyl）-2,5-diphenyl-2-H-tetrazolium bromide assay was employed to measure scaffold cytotoxicity in vitro. Fluorescence microscopy was used to observe Ed U-labeled Schwann cells to quantify cell proliferation. Immunohistochemistry was utilized to detect S100β immunoreactivity, while scanning electron microscopy was applied to observe the morphology of adherent Schwann cells. Results demonstrated that the polypyrrole/silk fibroin scaffold was not cytotoxic and did not affect Schwann cell proliferation. Moreover, filopodia formed on the scaffold and Schwann cells were regularly arranged. Our findings verified that the composite polypyrrole/silk fibroin scaffold has good biocompatibility and may be a suitable material for neural tissue engineering.

The history, hotspots, and trends of electrocardiogram

The electrocardiogram （ECG） has broad applications in clinical diagnosis and prognosis of cardiovascular disease. Many researchers have contributed to its progressive development. To commemorate those pioneers, and to better study and promote the use of ECG, we reviewed and present here a systematic introduction about the history, hotspots, and trends of ECG. In the historical part, information including the invention, improvement, and extensive applications of ECG, such as in long QT syndrome （LQTS）, angina, and myocardial infarction （MI）, are chronologi- cally presented. New technologies and applications from the 1990s are also introduced. In the second part, we use the bibliometric analysis me- thod to analyze the hotspots in the field of ECG-related research. By using total citations and year-specific total citations as our main criteria, four key hotspots in ECG-related research were identified from 11 articles, including atrial fibrillation, LQTS, angina and MI, and heart rate variability. Recent studies in those four areas are also reported. In the final part, we discuss the future trends concerning ECG-related research. The authors believe that improvement of the ECG instrumentation, big data mining for ECG, and the accuracy of diagnosis and application will be areas of continuous concern.

Accumulated Clinical Experiences from Successful Treatment of 1377 Severe and Critically Ill COVID-19 Cases

Summary:In late December 2019,COVID-19 was firstly recognized in Wuhan,China and spread rapidly to all of the provinces of China.The West Campus of Wuhan Union Hospital,the designated hospital to admit and treat the severe and critically ill COVID-19 cases,has treated a large number of such patients with great success and obtained lots of valuable experiences based on the Chinese guideline(V7.0).To standardize and share the treatment procedures of severe and critically ill cases,Wuhan Union Hospital has established a working group and formulated an operational recommendation,including the monitoring,early warning indicators,and several treatment principles for severe and critically ill cases.The treatment experiences may provide some constructive suggestions for treating the severe and critically ill COVID-19 cases all over the world.

Synthesis and tumor resistance reverse activities of α-hederagenin-type ring-A fused pyrazine derivatives

α-Hederagenin(H),derived from Hedera nepalensis var.sinensis,is a pentacyclic oleane-type triterpenoid that exhibits clear cytotoxicity to different tumor cell lines.In this study,a series of novel C-28 derivatives of hederagenin(H) were designed and synthesized in attempt to develop potent tumor resistance reverse activities agents.Previous research showed that H6 displayed robust reverse activity for paclitaxel resistance in KBV cells.Importantly,Co-treatment of paclitaxel with H6 significantly reduced the tumor weight to 42%.Pleasingly,H6 enhanced the efficacy of paclitaxel against KBV cancer cell-derived xenograft tumors in nude mice.Mechanism studies had found that H6 activated permeability glycoprotein(P-gp) ATPase,reduced intracellular ATP levels and inhibited efflux of P-gp substrates,thus enhancing the antitumor activity of paclitaxel on KBV cells.Molecular docking analysis of homology P-gp and H6 then conducted using the Surflex-Dock module.H6 showed a high binding affinity docking score with a total score of 5.4148,much higher than that of H(0.1414).The nov.el C-28 derivatives of H was synthesized from H6 via three-step reaction.The reversal activity of all synthesized H derivatives were tested using the MTT assay.The results showed that the derivatives of nitrogen groups at C-28 displayed same even potent activity than parent compound H6.In addition,its underlying mechanism of action and in vivo activity are in explore.

Efficient WENOCU4 scheme with three different adaptive switches

Although classical WENOCU schemes can achieve high-order accuracy by introducing a moderate constant parameter C to increase the contribution of optimal weights,they exhibit distinct numerical dissipation in smooth regions.This study presents an extension of our previous research which confirmed that adaptively adjusting parameter C can indeed overcome the inadequacy of the usage of a constant small value.Cmin is applied near a discontinuity while Cmax is used elsewhere and they are switched according to the variation of the local flow-field property.This study provides the reference values of the adaptive parameter C of WENOCU4 and systematically evaluates the comprehensive performance of three different switches(labeled as the binary,continuous,and hyperbolic tangent switches,respectively)based on an optimized efficient WENOCU4 scheme(labeled as EWENOCU4).Varieties of 1D scalar equations,empirical dispersion relation analysis,and multi-dimensional benchmark cases of Euler equations are analyzed.Generally,the dissipation and dispersion properties of these three switches are similar.Especially,employing the binary switch,EWENOCU4 achieves the best comprehensive properties.Specifically,the binary switch can efficiently filter more misidentifications in smooth regions than others do,particularly for the cases of 1 D scalar equations and Euler equations.Also,the computational efficiency of the binary switch is superior to that of the hyperbolic tangent switch.Moreover,the optimized scheme exhibits high-resolution spectral properties in the wavenumber space.Therefore,employing the binary switch is a more cost-effective improvement for schemes and is particularly suitable for the simulation of complex shock/turbulence interaction.This study provides useful guidance for the reference values of parameter C and the evaluation of adaptive switches.

Microstructure and nanoindentation hardness of shot-peened ultrafine-grained low-alloy steel

The effect of shot peening (SP) on microstructure and hardness of ultrafine-grained (UFG) low-alloy steel was investigated. With increasing shot-peening time from 0.5 to 1.5 h, grain size of UFG low-alloy steel decreases from 400 to 280 nm at surface whilst that of the layer with a depth of 160μm decreases from (230 ± 15) to (75 ± 5) nm. Interestingly, nanoindentation shows that hardness increases linearly with increasing the SP duration, reaching a value as high as (7.10 ± 0.1) GPa at the depth of 160 μm after the SP duration of 1.5 h. The thickness of the SP treated layer is measured as^300 μm. The Hall-Petch (H-P) relationship was established for the hardening layer. Correspondingly, abrasion resistance should be ~51% higher than that of as-prepared UFG low-alloy steel. As shown in SP processing, grain refinement is the key factor responsible for the strengthening of the studied steel.

Hepatic Resection Versus Stereotactic Body Radiation Therapy Plus Transhepatic Arterial Chemoembolization for Large Hepatocellular Carcinoma:A Propensity Score Analysis

Background and Aims:There are no comparative studies on the efficacy of hepatic resection(HR)and CyberKnife stereotactic body radiation therapy(CK-SBRT)plus transhepatic arterial chemotherapy embolization(TACE)in the treatment of large hepatocellular carcinoma(HCC).Therefore,this study aimed to compare the efficacy of HR and CKSBRT+TACE in large HCC.Methods:A total of one hundred and sixteen patients were selected from November 2011 to December 2016.Among them,50 were allocated to the CKSBRT+TACE group and 66 were allocated to the HR group.The Kaplan-Meier method was applied to calculate overall survival(OS)and progression-free survival(PFS)rates.Propensity score matching was performed to control for baseline differences between the groups.Results:Thirtysix paired patients were selected from the CK-SBRT+TACE and HR groups.After propensity score matching,the 1-,2-and 3-year OS rates were 83.3%,77.8%and 66.7%in the HR group and 80.6%,72.2%and 52.8%in the CKSBRT+TACE group,respectively.The 1-,2-and 3-year PFS rates were 71.6%,57.3%and 42.3%in the HR group and 66.1%,45.8%and 39.3%in the CK-SBRT+TACE group,respectively(OS:p=0.143;PFS:p=0.445).Both a high platelet count and low alpha-fetoprotein value were revealed as influencing factors in improving OS and PFS.Conclusions:CK-SBRT+TACE brought local effects that were similar to those of HR in HCC patients with a large and single lesion.Moreover,the liver injury occurrence rate was acceptable in both groups.

Stabilization mechanisms of lifted flames in a supersonic stepped-wall jet combustor

Flame stabilization is the key to extending scramjets to hypersonic speeds;accordingly,this topic has attracted much attention in theoretical research and engineering design.This study performed large eddy simulations(LESs)of lifted hydrogen jet combustion in a stepped-wall combustor,focusing on the flame stabilization mechanisms,especially for the autoignition effect.An assumed probability density function(PDF)approach was used to close the subgrid chemical reaction source.The reliability of the solver was confirmed by comparing the LES results with experimental data and published simulated results.The hydrogen jet and the incoming stream were first mixed by entraining large-scale vortices in the shear layer,and stable combustion in the near-wall region was achieved downstream of the flame induction region.The autoignition cascade is a transition of fuel-rich flame to stoichiometric ratio flame that plays a role in forming the flame base,which subsequently causes downstream flame stabilization.Three cases with different jet total temperatures are compared,and the results show that the increase in the total temperature reduces the lift-off distance of the flame.In the highest total temperature case,an excessively large scalar dissipation rate inhibits the autoignition cascade,resulting in a fuel-rich low-temperature flame.

Application of Parallel Mechanism in Varistructured Quadruped/Biped Human-carrying Walking Chair Robot

For the existing problems of walking chair robot such as simple function,lower bearing capacity and not walking in complex environment,a novel varistructured quadruped / biped human-carrying walking chair robot is proposed.The proposed robot could be used as biped and quadruped walking chair robots.Considering the conversion of the walking chair robot from the quadruped to the biped or vice versa,6-UPS and 2-UPS＋UP（U,P and S are universal joint,the prismatic pair,and sphere joint,respectively） parallel mechanisms are selected as the leg mechanism of the biped walking robot and quadruped walking robot,respectively.Combining the screw theory and theory of mechanism,the degrees of freedom of the leg mechanism and the body mechanism in diferent motion states are computed so as to meet the requirements of mechanism design.The motion characteristics of the 2-UPS＋UP parallel mechanism which is the key part of the walking chair robot are analyzed.Then,the workspace of the moving platform is drawn and the efect of the structural parameters on the workspace volume is studied.Finally,it is found that the volume of the workspace of the moving platform is bigger when the side length ratio and the vertex angle ratio of the fxed platform and the moving platform which are isosceles triangles are close to 1.This study provides a theoretical foundation for the prototype development.

High-pressure polymorphs of LiPN2： A first-principles study

In this work, high-pressure phase behavior of LiPN2 within 0-300 GPa was studied by using an unbiased structure searching method in combination with first-principles calculations. Three pressure- induced phase transitions were predicted, as tI16 →hR4 →cF64 → oP8 at 44, 136, and 259 GPa, respectively. The six-fold coordination environments were found for all high-pressure polymorphs, which are substantially different from the four-fold coordination environments observed in the tI16 structure. The hR4 and cF64 structures consist of close-packed PN6 and LiN6 octahedra connected by edge-sharing, whereas the oP8 structure is built up from edge- and face-sharing PN6 and LiN6 octahedra with N lying in the center of the trigonal prisms. The electronic structure analysis reveals that LiPN2 is a semiconductor within the pressure range studied and P-N and Li-N bonds are covalent and ionic, respectively. The results obtained are expected to provide insight and guidance for future experiments on LiPN2 and other alkali metal nitridophosphates.