Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Vascular endothelial growth factor protein and gene delivery by novel nanomaterials for promoting liver regeneration after partial hepatectomy

Partial hepatectomy(PH)can lead to severe complications,including liver failure,due to the low regenerative capacity of the remaining liver,especially after extensive hepatectomy.Liver sinusoidal endothelial cells(LSECs),whose proliferation occurs more slowly and later than hepatocytes after PH,compose the lining of the hepatic sinusoids,which are the smallest blood vessels in the liver.Vascular endothelial growth factor(VEGF),secreted by hepatocytes,promotes LSEC proliferation.Supplementation of exogenous VEGF after hepatectomy also increases the number of LSECs in the remaining liver,thus promoting the reestablishment of the hepatic sinusoids and accelerating liver regeneration.At present,some shortcomings exist in the methods of supplementing exogenous VEGF,such as a low drug concentration in the liver and the reaching of other organs.Moreover,VEGF should be administered multiple times and in large doses because of its short half-life.This review summarized the most recent findings on liver regeneration and new strategies for the localized delivery VEGF in the liver.

含钴三元硫化物常压硫酸浸出钴的动力学研究

开展含钴三元硫化物常压硫酸浸出的实验研究。考察搅拌速度、浸出温度、硫酸浓度和粒度对钴浸出率的影响,并分析从含钴三元硫化物中浸出钴的动力学。结果表明,在最佳条件下,钴和铁被选择性浸出,且浸出率均大于99%,而钼和铜则富集于浸出渣。通过对实验数据的分析可知,钴的浸出符合由固体产物层产生的收缩核模型,且浸出过程受内扩散控制。浸出反应的活化能为49.86k J/mol,硫酸浓度和粒度的反应级数分别为0.57和-1.4。

同心圆式反应器中精确调控和连续制备β-四钼酸铵

采用同心圆式反应器制备β-四钼酸铵,研究制备过程中Mo离子聚合形态和微观结构受溶液酸度影响的变化规律。结果表明,将溶液的pH值控制在2.5以下可以得到四钼酸铵晶体;采用NH_(3)·H_(2)O将溶液pH值调回至3.0有利于细粒钼酸铵结晶的溶解,并促进七钼酸铵向四钼酸铵结晶的转变;降低(NH_(4))_(4)Mo_(4)O_(12)(O_(2))2·2H_(2)O晶体与结晶母液的接触时间有利于获得β-(NH_(4))_(2)Mo_(4)O_(13)结晶。基于钼的聚合机理,设计多个格区的同心圆反应器,实现钼酸铵结晶的分区域调控。通过调控硝酸、氨水和含晶种的母液在各格区中加入的位置和时机,可制备出优质的β-(NH_(4))_(2)Mo_(4)O_(13)结晶。

Value of early diagnosis of sepsis complicated with acute kidney injury by renal contrast-enhanced ultrasound

BACKGROUND The incidence of acute kidney injury(AKI)in patients with sepsis is high,and the prognosis of patients with septic AKI is poor.The early diagnosis and treatment of septic AKI is of great significance in improving the prognosis of patients with sepsis.AIM To explore the value of contrast-enhanced ultrasound(CEUS),serum creatinine(Scr),and other indicators in the early diagnosis of septic AKI.METHODS Ninety patients with sepsis during hospitalization at Tongji Hospital of Tongji University were recruited as subjects.Each patient was recorded with relevant basic data,clinical indicators,and CEUS results.The patients were divided into AKI group and non-AKI group according to the results of renal function diagnosis after 48 h.On the 7th day,the renal function of the non-AKI group was re-evaluated and the patients were further divided into AKI subgroup and non-AKI subgroup.The differences of the indicators in different groups were compared,and the diagnostic value of each indicator and their combination for septic AKI was analyzed.RESULTS Systemic inflammatory response score(2.58±0.75),blood lactic acid(3.01±1.33 mmol/L),Scr(141.82±27.19μmol/L),blood urea nitrogen(4.41±0.81mmol/L),and rise time(10.23±2.63 s)in the AKI group were higher than those in the non-AKI group.Peak intensity(PI)(10.78±3.98 dB)and wash in slope(WIS)(1.07±0.53 dB/s)were lower than those in the non-AKI group.The differences were statistically significant(P<0.05).The PI(12.83±3.77 dB)and WIS(1.22±0.68 dB/s)in the AKI subgroup were lower than those in the non-AKI subgroup,and the differences were statistically significant(P<0.05).The area under curve(AUC)of Scr for the diagnosis of septic AKI was 0.825 with a sensitivity of 56.76% and a specificity of 100%.The AUCs of WIS and PI(0.928 and 0.912)were higher than those of Scr.Their sensitivities were 100%,but the specificities were 71.70% and 75.47%.The AUC of the combination of three indicators for the diagnosis of septic AKI was 0.943,which was significantly higher than the AUC diagnosed by each single indicator.The sensitivity was 94.59%,and the specificity was 81.13%.CONCLUSION The combination of Scr,PI,and WIS can improve the diagnostic accuracy of septic AKI.PI and WIS are expected to predict the occurrence of early septic AKI.

Evolution of associating liver partition and portal vein ligation for staged hepatectomy: Simpler, safer and equally effective methods

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) has been recently demonstrated as a method to induce rapid and extensive hypertrophy within a short time and has been employed for a variety of primary and metastatic liver tumors. However, controversies remain due to its high morbidity and mortality. To enable safer surgery, liver surgeons have searched for better technical modifications, such as partial ALPPS, mini-ALPPS, minimally invasive ALPPS, and Terminal branches portal vein Embolization Liver Partition for Planned hepatectomy(TELPP). It seems that TELPP is very promising, because it has the main advantage of ALPPS-the rapid increase of future liver remnant volume, but the morbidity and mortality are much lower because only one surgical operation is required.

Anatomic isolated caudate lobectomy: Is it possible to establish a standard surgical flow?

AIM To establish the surgical flow for anatomic isolated caudate lobe resection. METHODS The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine(SAHZU). From April 2004 to July 2014, 20 patients were enrolled who underwent anatomic isolated caudate lobectomy at SAHZU. Clinical and postoperative pathological data were analyzed. RESULTS Of the total 20 cases, 4 received isolated complete caudate lobectomy(20%) and 16 received isolated partial caudate lobectomy(80%). There were 4 caseswith the left approach(4/20, 20%), 6 cases with the right approach(6/20, 30%), 7 cases with the bilateral combined approach(7/20, 35%), 3 cases with the anterior approach(3/20, 15%), and the hanging maneuver was also combined in 2 cases. The median tumor size was 5.5 cm(2-12 cm). The median intraoperative blood loss was 600 m L(200-5700 m L). The median intra-operative blood transfusion volume was 250 m L(0-2400 m L). The median operation time was 255 min(110-510 min). The median post-operative hospital stay was 14 d(7-30 d). The 1-and 3-year survival rates for malignant tumor were 88.9% and 49.4%, respectively. CONCLUSION Caudate lobectomy was a challenging procedure. It was demonstrated that anatomic isolated caudate lobectomy can be done safely and effectively.

Gastric foregut cystic developmental malformation: Case series and literature review

Foregut cystic developmental malformation(FCDM) is a very rare lesion of the alimentary tract, especially in the stomach. We discuss the concepts of gastric duplication cyst, bronchogenic cysts, and FCDM. Nomenclature has been inconsistent and confusing, but, by some definitions, gastric duplication cysts involve gastric mucosa and submucosal glands, bronchogenic cysts involve respiratory mucosa with underlying cartilage and glands, and FCDM lacks gastric mucosa or underlying glands or cartilage but has pseudostratified ciliated columnar epithelium(PCCE). We searched our departmental case files from the past 15 years and identified 12 cases of FCDM in the alimentary tract. We summarize the features of these 12 cases including a report in detail on a 52-year-old man with a submucosal cyst lined with simple PCCE and irregular and stratified circular muscle layers that merged with gastric smooth muscle bundles near the lesser curvature of the gastric cardia. A literature review of cases with this histology yielded 25 cases. We propose the term gastric-FCDM for such cases. Our own series of 12 cases confirms that preoperative recognition of the entity is infrequent and problematic. The rarity of this developmental disorder, as well as a lack of understanding of its embryologic origins, may contribute to missing the diagnosis. Not appreciating the diagnosis preoperatively can lead to an inappropriate surgical approach. In contrast, presurgical recognition of the entity will contribute to a good outcome and reduced risk of complications.

Malignant solitary fibrous tumor of the pancreas with systemic metastasis: A case report and review of the literature

BACKGROUND Pancreatic solitary fibrous tumor(SFT) is a rare neoplasm of intermediate biological potential. So far, only 22 cases have been reported since 1999. All the cases, except one, exhibited benign features. Here, we report the first case of malignant pancreatic SFT with typical Doege-Potter syndrome, along with the clinical and pathologic evidence of its systemic metastasis.CASE SUMMARY The patient was a 48-year-old man with a 1-year history of pancreatic and liver masses and refractory hypoglycemia. Increased uptake of the tracer fluorodeoxyglucose(FDG) was found in the liver and bones by fluorine-18 FDG positron emission tomography/computed tomography. After multidisciplinary discussion, a distal pancreatectomy procedure was performed, and histological examination showed a lesion composed of abundant heterogeneous spindle cells with localized necrosis. On immunohistochemistry evaluation, STAT6 was found to be diffusely expressed in the tumor. Based on the overall evidence, the patient was diagnosed with malignant pancreatic SFT with liver and bone metastases.CONCLUSION The diagnosis of malignant SFT requires comprehensive evidence including clinical, immunohistochemistry, and histological features. This case may be presented as a reference for diagnoses and management of malignant pancreatic SFTs with systemic metastasis.

Solitary fibrous tumor of the liver:A case report and review of the literature

BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocellular carcinoma.CASE SUMMARY A 42-year-old male had a two-year history of a gradually enlarging intrahepatic nodule.The preoperative imaging revealed a mass with a size of 2.7 cm×2.3 cm located in the segment IV of the liver.The patient was subjected to the resection of the segment IV,such as the medial segment of the left lobe of the liver.The histological examination of the mass showed various spindled cells irregularly arranged in the stroma.The immunohistochemistry of this mass revealed a positive staining for CD34 and STAT6.The history of intracranial tumor and postoperative pathological results led to the diagnosis of SFT of the liver(SFTL)due to a metastasis from the brain.CONCLUSION SFTL is an uncommon mesenchymal neoplasm that can be easily overlooked or misdiagnosed.The best treatment choice is the complete surgical resection of the mass.A regular follow-up after the surgery should be performed due to the poor prognosis of metastatic or recurrent SFT.

Phase Equilibria of Hydrogen Bonding Fluid in a Slit Pore with Broken Symmetry

液体与破对称在一个裂缝毛孔限制了的氢结合的阶段 equilibria (HB ) 被功能的理论与修改基本措施理论合并了的密度调查，在碎的对称从在液体分子和裂缝毛孔的二面墙之间的不同相互作用发源的地方。以吸附解吸附作用等温线和相应宏大潜力，在各种各样的条件下面的 HB 液体的阶段图被论述。通过放转变和毛状的冷凝作用的阶段共存，而且，阶段平衡性质上的 HB 相互作用，毛孔宽度，液体毛孔相互作用和破对称的效果被探讨。因为在分子间的相互作用和液体毛孔相互作用之间的比赛，这些因素能在限制 HB 液体的阶段 equilibria 上产生明显的影响，这被显示出。有趣地，裂缝毛孔的破对称的重要影响被发现，并且因此，碎的对称能提供一个新方法调整各种各样的限制液体的阶段行为。

Patient-centered developments in colon-and rectal cancer with a multidisciplinary international team:From translational research to national guidelines

Rarely,scientific developments centered around the patient as a whole arepublished.Our multidisciplinary group,headed by gastrointestinal surgeons,applied this research philosophy considering the most important aspects of thediseases“colon-and rectal cancer”in the long-term developments.Good expertcooperation/knowledge at the Comprehensive Cancer Center Ulm(CCCU)wereapplied in several phase III trials for multimodal treatments of primary tumors(MMT)and metastatic diseases(involving nearly 2000 patients and 64 centers),fortreatment individualization of MMT and of metastatic disease,for psychooncology/quality of life involving the patients’wishes,and for disease prevention.Most of the targets initially were heavily rejected/discussed in thescientific communities,but now have become standards in treatments andnational guidelines or are topics in modern translational research protocolsinvolving molecular biology for e.g.,“patient centered individualized treatment”.In this context we also describe the paths we had to tread in order to realize ournew goals,which at the end were highly beneficial for the patients from manypoints of view.This description is also important for students and youngresearchers who,with an actual view on our recent developments,might want toknow how medical progress was achieved.

Patchy胶体粒子的结晶、玻璃化和凝胶化问题（英文）

本文探讨了中性多缔合位点Patchy胶体粒子系统的相图及其相关问题.在研究中,计入了分子间的硬芯Lennard-Jones势和缔合作用,进而阐明了系统的流体相(F),无规密积相(RCP)和面心立方相(FCC)之间转变的相态结构.在体系丰富的相结构中,F-F,F-RCP及F-FCC相转变以及描述粒子间联结性的溶胶-凝胶转变相互影响,致使一些相态在不同相互作用强度时可以呈现亚稳态和稳态.同时,本文重点阐述了缔合能量以及patch数目对体系的临界温度、临界密度、临界三相点以及溶胶-凝胶转变等的调控机制.

Better surgical treatment method for hepatocellular carcinoma with portal vein tumor thrombus

Hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT) is a disease that is not uncommon, but the treatments vary drastically between Eastern and Western countries. In Europe and America, the first line of treatment is systemic therapy such as sorafenib and the surgical treatment is not a recommend option. While an increasing number of studies from China and Japan have suggested that surgical treatment results in better outcomes when compared to transcatheter arterial chemoembolization(TACE), sorafenib, or other nonsurgical treatments, and two classification systems, Japanese Vp classification and Chinese Cheng's classification, were very useful to guide the surgical treatment. We have also found that surgical treatment may be more effective, as we have performed surgical treatment for HCC-PVTT patients over a period of approximately 15 years and achieved good results with the longest surviving time being 13 years and onward. In this study, we review the efficacy and principles of current surgical treatments and introduce our new, more effective surgical technique named "thrombectomy first", which means the tumor thrombus in the main portal vein, the bifurcation or the contralateral portal vein should be removed prior to liver resection. Thus, compression and crushing of PVTT during the operation could be avoided and new intrahepatic metastases caused by tumor thrombus to the remnant liver minimized. The new technique is even beneficial to the prognosis of Cheng's classification Types Ⅲ and Ⅳ PVTT. The vital tips and tricks for the surgical approach are described.

湿法冶金研究趋势:基于1975-2019年《Hydrometallurgy》文献的综述

当代湿法冶金已发展一百多年,相关领域的论文越来越多。《Hydrometallurgy》是湿法冶金领域最有代表性的期刊,基于对该期刊的文献计量分析,从全局角度获得湿法冶金的研究发展趋势。首先,关键词突发性筛查结果显示,稀土、回收循环、锂、离子液体和钍是近些年的研发热点,对这些热点的经济和技术背景进行探讨。其次,生物冶金文献的比例从早期的5%快速增长到近些年的13%,且相关论文主要是生物浸出。在湿法冶金过程中直接制备材料和离子印迹技术是近些年出现的新技术。第三,新出现的仪器分析方法如X射线吸收精细结构谱、基因测序和高分辨断层扫描能促进人们对湿法冶金机理的深入理解。最后,绘制并分析世界主要研究机构的合作图谱。

Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: An updated meta-analysis of RCTs and our experience

BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrostomy(PG).METHODS This meta-analysis was performed using Review Manager 5.3.All clinical randomized controlled trials,in which patients underwent PD with pancreaticodigestive tract reconstruction via PJ or PG,were included.RESULTS The search of PubMed,Wanfang Data,EMBASE,and the Cochrane Library provided 125 citations.After further analysis,11 trials were included from nine counties.In all,909 patients underwent PG and 856 underwent PJ.Meta-analysis showed that pancreatic fistula(PF)was a significantly lower morbidity in the PG group than in the PJ group(odds ratio[OR]=0.67,95%confidence interval[CI]:0.53-0.86,P=0.002);however,grades B and C PF was not significantly different between the two groups(OR=0.61,95%CI:0.34-1.09,P=0.09).Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group(OR=1.47,95%CI:1.05-2.06,P=0.03).Delayed gastric emptying was not significantly different between the two groups(OR=1.09,95%CI:0.83-1.41,P=0.54).CONCLUSION There is no difference in the incidence of grades B and C PF between the two groups.However,postoperative bleeding is significantly higher in PG than in PJ.Binding PJ or binding PG is a safe and secure technique according to our decades of experience.

Preparation of WC/CoCrFeNiAl0.2 high-entropy-alloy composites by high-gravity combustion synthesis

The WC/CoCrFeNiAl0.2 high-entropy alloy(HEA)composites were prepared through high-gravity combustion synthesis.The preparation method is presented below.First,using a designed suitable multiphase thermite system,the molten CoCrFeNiAl0.2 HEA was fabricated using low-cost metal oxides.The molten HEA was subsequently infiltrated into the WC layer to fabricate WC/CoCrFeNiAl0.2 composites in a highgravity field.The porosity of the WC/CoCrFeNiAl0.2 composites was down-regulated,and their compressive yield strength was up-regulated when the high-gravity field was increased from 600g to 1500g because this infiltration process of a HEA melt into the WC layer is driven by centrifugal force.The WC particles in the composites exhibited a gradient distribution along the direction of the centrifugal force,which was attributed to the combined action of the high-gravity field and the temperature gradient field.The Vickers hardness of the sample was down-regulated from 9.53 to 7.41 GPa along the direction of the centrifugal force.

A new method of preparing high-performance high-entropy alloys through high-gravity combustion synthesis

A new method of high-gravity combustion synthesis(HGCS)followed by post-treatment(PT)is reported for preparing high-performance high-entropy alloys(HEAs),Cr0.9FeNi2.5V0.2Al0.5 alloy,whereby cheap thermite powder is used as the raw material.In this process,the HEA melt and the ceramic melt are rapidly formed by a strong exothermic combustion synthesis reaction and completely separated under a high-gravity field.Then,the master alloy is obtained after cooling.Subsequently,the master alloy is sequentially subjected to conventional vacuum arc melting(VAM),homogenization treatment,cold rolling,and annealing treatment to realize a tensile strength,yield strength,and elongation of 1250 MPa,1075 MPa,and 2.9%,respectively.The present method is increasingly attractive due to its low cost of raw materials and the intermediate product obtained without high-temperature heating.Based on the calculation of phase separation kinetics in the high-temperature melt,it is expected that the final alloys with high performance can be prepared directly across master alloys with higher high-gravity coefficients.

Evaluation of Rapid Detection of Nasopharyngeal Colonization with MRSA by Real-Time PCR

Objective To investigate the clinical application of Real-Time PCR for rapid detection of methicillin-resistant Staphylococcus aureus(MRSA) directly from nasopharyngeal swab specimens.Methods We collected the nasal and throat swab specimens from patients or medical staffs in 3 intensive care units,blood laminar flow ward and respiratory ward in Beijing Hospital,Ministry of Health from December 2010to April 2011.Each sample was tested by RT-PCR and conventional culture-based method for the presence of MRSA.Results The total number of the specimens was 206.Compared with the conventional culture-based method,we demonstrated the diagnostic values for Real-Time PCR were 96.4%sensitivity,96.6%specificity,81.8%positive predictive rate,and 99.4%negative predictive rate.And the limit of detection was 10~2CFU/ml.Conclusions This Real-Time PCR is a simple,rapid,sensitive and specific method.With the high negative predictive value,it can be used for the exclusion of MRSA colonization or infection.However,the application of its low positive predictive value should be further evaluated.

Elevated Levels of Soluble ST2 were Associated with Rheumatoid Arthritis Disease Activity and Ameliorated Inflammation in Synovial Fibroblasts

Background：Much evidence has demonstrated that interleukin （IL）-33 plays an important role in rheumatoid arthritis （RA）.However,there have been limited studies about soluble ST2,a receptor for 1L-33,in RA.The aims of this study were to detect the levels of ST2 in the serum and synovial fluid of RA patients and to reveal the association of these levels with disease activity and the function of ST2 in RA.Methods：A total of 56 RA patients and 38 age-matched healthy controls were enrolled in this study.Synovial fluid samples were collected from another 30 RA patients and 20 osteoartbritis patients.Serum and synovial fluid levels of ST2 were measured by ELISA.In addition,the levels of ST2 in the serum of RA patients before and after therapy were detected.The function of ST2 in RA was revealed by the results of an in vitro cell assay,where recombinant ST2 proteins were used to treat peripheral blood mononuclear cells （PBMCs） and RA synovial fibroblasts （RASFs）.Results：Serum-soluble ST2 levels were significantly higher in RA patients （127.14 ± 61.43 pg/ml） than those in healthy controls （78.37 ± 41.93 pg/ml,P 〈 0.01）.Synovial fluid-soluble ST2 levels （41.90 ± 33.58 pg/ml） were much higher in RA patients than those in osteoarthritis patients （19.71 ± 16.72 pg/ml,P 〈 0.05）.RA patients who received effective therapy for 6 months showed decreased serum-soluble ST2 levels （113.01 ± 53.90 pg/ml） compared to baseline （139.59 ± 68.36 pg/ml） （P =0.01）.RA patients with high disease activity had higher serum-soluble ST2 levels （162.02 ± 56.78 pg/ml） than those with low disease activity （94.67 ± 40.27 pg/ml,P =0.001）.Soluble ST2 did not affect IL-1β,IL-6,IL-8,or tumor necrosis factor-α （TNF-o） expression in PBMCs from RA patients.However,soluble ST2 ameliorated the expressions of IL-33 and IL-1 β but not that of IL-6,IL-8,or TNF-α in resting RASFs.Interestingly,in the RASFs stimulated by TNF-α plus IL-1 β,soluble ST2 showed extensive suppressive effects on the expression of IL-6,IL-8,and TNF-α.Conclusion：Elevated levels of ST2 in the serum and synovial fluid were associated with disease activity and ameliorated IL-33 expression and IL-33-induced inflammation in RASFs,suggesting that soluble ST2 might be a potential therapeutic candidate for RA.