Response to Comment“Standardizing R-E-NSM Surgical Protocols:A Critical Appraisal for Breast Cancer Patients”

To the editors:We appreciate the detailed and constructive comments provided by the commenters.We adopted some suggestions and responded to all comments.The responses are as follows.1.Table 1 presents lymph node status following PSM but does not detail the total lymph nodes resected.

From Knowledge Transfer to Capability Development:The Future of PBL+CBL Teaching Method in Operating Room Nursing Education

Concomitant with the advancement of contemporary medical technology,the significance of perioperative nursing has been increasingly accentuated,necessitating elevated standards for the pedagogy of perioperative nursing.Presently,the PBL(problem-based learning)pedagogical approach,when integrated with CBL(case-based learning),has garnered considerable interest.An extensive literature review has been conducted to analyze the application of the PBL-CBL fusion in the education of perioperative nursing.Findings indicate that this integrative teaching methodology not only enhances students’theoretical knowledge,practical competencies,and collaborative skills but also contributes to the elevation of teaching quality.In conclusion,the PBL-CBL teaching approach holds immense potential for broader application in perioperative nursing education.Nevertheless,it is imperative to continually refine this combined pedagogical strategy to further enhance the caliber of perioperative nursing instruction and to cultivate a greater number of exceptional nursing professionals in the operating room setting.

Sedimentary evolution and control factors of the Rizhao Canyons in the Zhongjiannan Basin, western South China Sea

Submarine canyon is an important channel for long-distance sediment transport, and an important part of deepwater sedimentary system. The large-scale Rizhao Canyons have been discovered for the first time in 2015 in the continental slope area of the western South China Sea. Based on the interpretation and analysis of multi-beam bathymetry and two-dimensional multi-channel seismic data, the geology of the canyons has however not been studied yet. In this paper, the morphology and distribution characteristics of the canyon are carefully described,the sedimentary filling structure and its evolution process of the canyon are analyzed, and then its controlling factors are discussed. The results show that Rizhao Canyons group is a large slope restricted canyon group composed of one east-west west main and nine branch canyons extending to the south. The canyon was formed from the late Miocene to the Quaternary. The east-west main canyon is located in the transition zone between the northern terrace and the southern Zhongjiannan Slope, and it is mainly formed by the scouring and erosion of the material source from the west, approximately along the slope direction. Its development and evolution is mainly controlled by sediment supply and topographic conditions, the development of 9 branch canyons is mainly controlled by gravity flow and collapse from the east-west main canyon. This understanding result is a supplement to the study of “source-channel–sink” sedimentary system in the west of the South China Sea, and has important guiding significance for the study of marine geological hazards.

Computer Use among Different Gender Medical Students in Inner Mongolia Medical University in China

Objective: The purpose of this study was to evaluate the difference of computer use and the negative effects for different gender in the Medical University of Inner Mongolia. Methods: A cross-sectional census was conducted on medical students on campus in 2013. Descriptive results were expressed as percentage, prevalence and means ± S.D. Gender differences of using computer time and using computer purpose for male and female students were analyzed by chi-square test. Results: Students using computer more than three hours per day had higher headache prevalence and poor academic performance prevalence than that less than three hours per day. The prevalence of male students using computer more than three hours per day was significantly higher than female students (x2 = 72.92, p p < 0.001). Conclusion: Using computer for long time brings more students headache and poor academic performance. These results suggest that using computer time reasonably and learning efficiently among university students are necessary, especially for male.

Fetuin-A is an immunomodulator and a potential therapeutic option in BMP4-dependent heterotopic ossification and associated bone mass loss

Heterotopic ossification(HO)is the abnormal formation of bone in extraskeletal sites.However,the mechanisms linking HO pathogenesis with bone mass dysfunction remain unclear.Here,we showed that mice harboring injury-induced and BMP4-dependent HO exhibit bone mass loss similar to that presented by patients with HO.Moreover,we found that injury-induced hyperinflammatory responses at the injury site triggered HO initiation but did not result in bone mass loss at 1 day post-injury(dpi).In contrast,a suppressive immune response promoted HO propagation and bone mass loss by 7 dpi.Correcting immune dysregulation by PD1/PDL1 blockade dramatically alleviated HO propagation and bone mass loss.We further demonstrated that fetuin-A(FetA),which has been frequently detected in HO lesions but rarely observed in HO-adjacent normal bone,acts as an immunomodulator to promote PD1 expression and M2 macrophage polarization,leading to immunosuppression.Intervention with recombinant FetA inhibited hyperinflammation and prevented HO and associated bone mass loss.Collectively,our findings provide new insights into the osteoimmunological interactions that occur during HO formation and suggest that FetA is an immunosuppressor and a potential therapeutic option for the treatment of HO.

Experimental study on interaction between a positive mass and a negative effective mass through a mass–spring system

We investigate the interaction between a positive mass and a negative effective mass through a three- mass chain connected with elastic springs, a pair of masses is designed to have an effective negative mass, and it interacts with the third positive one as if an equivalent two-mass chain. The dynamics of the equivalent two-mass chain shows that the two bodies may be self-accelerated in same direction when the effective mass becomes negative, the experiment is also conducted to demonstrate this type of motion. We further show that the energy principle （Hamilton＇s principle） is applicable if the energy of the negative mass unit is properly characterized. The result may be relevant to composite with cells of effective negative mass, their interaction with matrix may lead to more richer unexpected macroscopic responses.

Synthesis of vertical graphene nanowalls by cracking n-dodecane using RF inductively-coupled plasma-enhanced chemical vapor deposition

A facile and controllable one-step method to treat liquid hydrocarbons and synthesize vertical graphene nanowalls has been developed by using the technique of inductively-coupled plasma-enhanced chemical vapor deposition for plasma cracking of n-dodecane.Herein,the morphology and microstructure of solid carbon material and graphene nanowalls are characterized in terms of different operating conditions,i.e.input power,H2/Ar ratio,injection rate and reaction temperature.The results reveal that the optimal operating conditions were 500 W,5:10,30μl min^-1 and 800℃ for the input power,H2/Ar ratio,injection rate and reaction temperature,respectively.In addition,the degree of graphitization and the gaseous product are analyzed by Raman spectroscopy and gas chromatography detection.It can be calculated from the Raman spectrum that the relative intensity of ID/IG is approximately 1.55,and I2D/IG is approximately 0.48,indicating that the graphene prepared from n-dodecane has a rich defect structure and a high degree of graphitization.By calculating the mass loading and detecting the outlet gas,we find that the cracking rate of n-dodecane is only 6%-7%and that the gaseous products below C2 mainly include CH4,C2H2,C2H4,C2H6 and H2.Among them,the proportion of hydrogen in the outlet gas of n-dodecane cracking ranges from 1.3%-15.1%under different hydrogen flows.Based on our research,we propose a brand new perspective for both liquid hydrocarbon treatment and other value-added product syntheses.

Effect Observation of Clinical Treatment with Oxaliplatin and Tiggio for Biliary Tract Tumors on Advanced Stage

Objective:To investigate the effect of oxaliplatin combined with tiggio in the treatment of advanced biliary tract tumors.Methods:The research period was from November 2019 to November 2020.80 patients with advanced biliary tumor disease were enrolled.They were divided into groups according to the order of admission,with 40 cases in each group.The control group received oxaliplatin combined with gemcitabine,and the experimental group received oxaliplatin combined with tiggio.Incidence of adverse reactions,time to disease progression,survival time and clinical efficacy were checked and assessed.Results:Compared with the incidence of adverse reaction of the experimental group,which was 5.00%(2/40),the incidence of adverse reaction of the control group was 25.00%(10/40).The chi-square value=6.2745,p-value=0.0122.The time to progression and survival time of patients in the experimental group were shorter than those of the control group,with significant differences between the groups(p<0.05);the clinical efficacy of the experimental group and the control group were 97.50%(39/40)and 77.50%(31/40)respectively,the comparative chi-square value=7.3143,p-value=0.0068.Conclusion:The combined treatment of oxaliplatin and Tiggio in the treatment of advanced biliary tract tumors has higher safety and reduces the incidence of adverse reactions.

Morphology-dependent activation of hydrogen peroxide with Cu_(2)O for tetracycline hydrochloride degradation in bicarbonate aqueous solution

The design of efficient heterogeneous catalysts in bicarbonate-activated hydrogen peroxide systems(BAP)is a hot topic in wastewater treatment.In this work,Cu_(2)O nanoparticles with different morphologies including cubic shape(c-Cu_(2)O),octahedron shape(o-Cu_(2)O)and spherical shape(s-Cu_(2)O),were applied in BAP for the first time to degrade tetracycline hydrochloride(TC).Compared with Cu^(2+)ions and CuO,TC degradation was boosted in the presence of Cu_(2)O in the BAP system,with the degradation rate following the order c-Cu_(2)O>o-Cu_(2)O>s-Cu_(2)O.The morphology-dependent effects could be linearly correlated with the ratio of surface oxygen species(O_S),but not with the surface area or Cu(Ⅰ)ratio.The c-Cu_(2)O catalyst with exposure of(100)facets contained 76.6%O_Sas the active site for H_(2)O_(2)adsorption and activation,while the value was much lower for o-Cu_(2)O and s-Cu_(2)O with dominant(111)facets.The presence of HCO_(3)-enhanced the interactions among Cu_(2)O,H_(2)O_(2)and TC,leading to facile oxidation of Cu(Ⅰ)to Cu(Ⅱ)by H_(2)O_(2),and the formation of various reactive species such as hydroxyl radicals and Cu(Ⅲ)contributed to TC degradation.This work provides a new method for enhancing H_(2)O_(2)activation with heterogeneous catalysts by crystal facet engineering.

Comparative analysis of the Monochamus alternatus immune system

The pine sawyer beetle, Monochamus alternatus, is regarded as a notorious for- est pest in Asia, vectoring an invasive pathogenic nematode, Bursaphelenchus xylophilus, which is known to cause pine wilt disease. However, little sequence information is available for this vector beetle. This hampered the research on its immune system. Based on the transcriptome of M. alternatus, we have identified and characterized 194 immunity-related genes in M. alternatus, and compared them with homologues molecules from other species known to exhibit immune responses against invading microbes. The lower number of puta- tive immunity-related genes in M. alternatus were attributed to fewer C-type lectin, serine protease （SP） and anti-microbial peptide （AMP） genes. Phylogenetic analysis revealed that M. alternatus had a unique recognition gene, galectin3, orthologues of which were not identified in Tribolium castaneum, Drosophila melanogastor, Anopheles gambiae and Apis mellifera. This suggested a lineage-specific gene evolution for coleopteran insects. Our study provides the comprehensive sequence resources of the immunity-related genes ofM. alternatus, presenting valuable information for better understanding of the molecular mechanism of innate immunity processes in M. alternatus against B. xylophilus.

Differential immune responses of Monochamus alternatus against symbiotic and entomopathogenic fungi

Monochamus alternatus, the main vector beetles of invasive pinewood nematode, has established a symbiotic relationship with a native ectotrophic fungal symbiont, Sporothrix sp. 1, in China. The immune response ofM. alternatus to S. sp. 1 in the coexistence of beetles and fungi is, however, unknown. Here, we report that immune responses ofM. alternatus pupae to infection caused by ectotrophic symbiotic fungus S. sp. 1 and entomopathogenic fungus Beauveria bassiana differ significantly. The S. sp. 1 did not kill the beetles while B. bassiana killed all upon injection. The transcriptome results showed that the numbers of differentially expressed genes in M. aIternatus infected with S. sp. 1 were 2-fold less than those infected with B. bassiana at 48 hours post infection. It was noticed that Toll and IMD pathways played a leading role in the beetle＇s immune system when infected by symbiotic fungus, but upon infection by entomopathogenic fimgus, only the Toll pathway gets triggered actively. Furthermore, the beetles could tolerate the infection of symbiotic fungi by retracing their Toll and IMD pathways at 48 h. This study provided a comprehensive sequence resource ofM. alternatus transcriptome for further study of the immune interactions between host and associated fungi.