Development of a diagnostic nomogram for alpha-fetoproteinnegative hepatocellular carcinoma based on serological biomarkers

BACKGROUND Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related death worldwide.Serum biomarkers play an important role in the early diagnosis and prognosis of HCC.Because a certain percentage of HCC patients are negative for alpha-fetoprotein(AFP),the diagnosis of AFP-negative HCC is essential to improve the detection rate of HCC.AIM To establish an effective model for diagnosing AFP-negative HCC based on serum tumour biomarkers.METHODS A total of 180 HCC patients were enrolled in this study.The expression levels of GP73,des-γ-carboxyprothrombin(DCP),CK18-M65,and CK18-M30 were detected by a fully automated chemiluminescence analyser.The variables were selected by logistic regression analysis.Several models were constructed using stepwise backward logistic regression.The performance of the models was compared using the C statistic,integrated discrimination improvement,net reclassification improvement,and calibration curves.The clinical utility of the nomogram was assessed using decision curve analysis(DCA).RESULTS The results showed that the expression levels of GP73,DCP,CK18-M65,and CK18-M30 were significantly greater in AFP-negative HCC patients than in healthy controls(P<0.001).Multivariate logistic regression analysis revealed that GP73,DCP,and CK18-M65 were independent factors for diagnosing AFP-negative HCC.By comparing the diagnostic performance of multiple models,we included GP73 and CK18-M65 as the model variables,and the model had good discrimination ability(area under the curve=0.946)and good goodness of fit.The DCA curves indicated the good clinical utility of the nomogram.CONCLUSION Our study identified GP73 and CK18-M65 as serum biomarkers with certain application value in the diagnosis of AFP-negative HCC.The diagnostic nomogram based on CK18-M65 combined with GP73 demonstrated good performance and effectively identified high-risk groups of patients with HCC.

Concomitant occurrences of pulmonary embolism and acute myocardial infarction in acute coronary syndrome patient undergoing percutaneous coronary intervention:a case report

Pulmonary embolism(PE),a form of venous thromboembolism,is a relatively frequent car-diovascular emergency,and a potentially life-threatening condition that needs prompt identification and treatment.[1]PE is often misdiagnosed or unrecogn-ized with many patients experiencing atypical sympt-oms.[2,3]Early diagnosis and treatment of PE are import-ant.In this case,PE was found in a 73-year-old male pa-tient with three-vessel coronary artery disease who un-derwent percutaneous coronary intervention(PCI)for concomitant acute myocardial infarction(MI).

热塑体膜联合真空垫在肺癌放疗中的应用

目的分析热塑体膜联合真空垫在肺癌放疗中的临床应用价值。方法将26例肺癌调强放射治疗(IMRT)患者随机分为两组,常规组采用胸部热塑体膜固定,改进组采用热塑体膜联合真空垫固定。治疗过程通过锥形束CT图像引导系统(CBCT)测量摆位数据,与参考图像对比分析。采用二参数法计算由内靶体积(ITV)外扩产生计划靶体积(PTV)间距。结果常规组与改进组比较,在X、Y、Z 3个方向的偏移误差为(2.63±1.53)/(2.26±0.95)mm,(2.39±1.36)/(1.53±1.16)mm,(3.26±2.17)/(2.13±1.14)mm,差异均有统计学意义(P <0.05);常规组ITV外放PTV范围在X、Y、Z轴方向依次为6.33、5.73和8.04 mm,改进组ITV外放PTV范围在X、Y、Z轴方向依次为5.19、3.87和5.06 mm。结论热塑体膜联合真空垫可以更小的减小摆位误差,提高肺癌放疗体位的准确性和重复性。

High-Brightness Low-Divergence Tapered Lasers with a Narrow Taper Angle

High-brightness tapered lasers with photonic crystal structures are designed and fabricated.A narrow taper angle is designed for the tapered section.The device delivers an output power of 3.3 W and a maximum wall-plug efficiency of 43%.The vertical beam divergence is around 110 at different currents.Nearly diffraction-limited beam qualities for the vertical and lateral directions are obtained.The lateral beam quality factor M2 is below 2.5 and the vertical M2 value is around 1.5 across the whole operating current range.The maximum brightness is 85 MW·cm-2sr-1.When the current is above 3.3 A,the brightness is still above 80 MW·cm-2sr-1.

Prognostic significance of multiple triglycerides-derived metabolic indices in patients with acute coronary syndrome

BACKGROUND Triglyceride(TG)and its related metabolic indices,all recognized as surrogates of insulin resistance,have been demonstrated to be relevant to clinical prognosis.However,the relative value of these TG-related indices for predicting cardiovascular events among patients with acute coronary syndrome(ACS)has not been examined.METHODS The TG,the triglyceride-glucose(TyG)index,the atherogenic index of plasma,TG to high-density lipoprotein cholesterol ratio,and the lipoprotein combine index were assessed in 1694 ACS patients undergoing percutaneous coronary intervention.The primary endpoint was major adverse cardiovascular event(MACE),which was the composite of all-cause mortality,stroke,myocardial infarction,or unplanned repeat revascularization.RESULTS During a median follow-up of 31 months,345 patients(20.4%)had MACE.The risk of the MACE was increased with higher TG and the four TG-derived metabolic indices[TG-adjusted hazard ratio(HR)=1.002,95%CI:1.001-1.003;TyG index-adjusted HR=1.736,95%CI:1.398-2.156;atherogenic index of plasma-adjusted HR=2.513,95%CI:1.562-4.043;TG to high-density lipoprotein cholesterol ratio-adjusted HR=1.148,95%CI:1.048-1.258;and lipoprotein combine index-adjusted HR=1.009,95%CI:1.004-1.014;P<0.001 for all indices].TG and all the four indices significantly improved the predictive ability for MACE in addition to the baseline model.Among them,TyG index showed the best ability for predicting MACE compared with the other three indices from all the three measurements(P<0.05 for all comparison).CONCLUSIONS TG and TG-derived metabolic indices were all strongly associated with MACE among ACS patients undergoing percutaneous coronary intervention.Among all the indices,TyG index showed the best ability to predict the risk of MACE.

Experimental investigation on drag reduction in a turbulent boundary layer with a submerged synthetic jet

This work investigates the active control of a fully developed turbulent boundary layer by a submerged synthetic jet actuator.The impacts of the control are explored by measuring the streamwise velocities using particle image velocimetry,and reduction of the skin-friction drag is observed in a certain range downstream of the orifice.The coherent structure is defined and extracted using a spatial two-point correlation function,and it is found that the synthetic jet can efficiently reduce the streamwise scale of the coherent structure.Proper orthogonal decomposition analysis reveals that large-scale turbulent kinetic energy is significantly attenuated with the introduction of a synthetic jet.The conditional averaging results show that the induction effect of the prograde vortex on the low-speed fluid in a large-scale fluctuation velocity field is deadened,thereby suppressing the bursting process near the wall.

Mode Control of Quasi-PT Symmetry in Laterally Multi-Mode Double Ridge Semiconductor Laser

In traditional semiconductor lasers, it is usual to obtain single lateral mode operation by narrowing the ridge of waveguide, which is sensitive to fabrication inaccuracies. To overcome this shortcoming, a quasi-PT(parity-time)symmetric double ridge semiconductor laser is proposed to reach single lateral mode operation for an intrinsic multi-mode stripe laser. The coupled mode theory is used to analyze the non-Hermitian modulation of the gain(or loss) of the PT symmetric double ridge laser to obtain the coupling coefficient between the two ridge waveguides. Finally, the mode field distributions of the quasi-PT symmetric double ridge laser are simulated before and after the spontaneous PT symmetry breaking, which keep the laser operating in single lateral mode.

An optimization method for shale gas gathering system-Consideration of reliability enhancement under earthquake-related uncertainties

Shale gas gathering systems are of great importance in gas fields for the efficient and reliable transportation of gas.In traditional design methods,pipeline layouts are optimized only from an economic point of view,where reliability is evaluated after optimization.However,reliability can be enhanced by spare pipelines so that both economic and reliable aspects are evaluated simultaneously.Based on the idea of enhancing reliability,this research proposes a methodology for optimizing the pipeline layout problem including well clustering,stations site selecting,and piping.Different topology arrangements and spare pipelines are investigated to enhance the production efficiency and reliability of the pipeline network under earthquake-related uncertainties.Reliability evaluation is converted into an economic one so that the objective of this work is to minimize the total annual cost.To solve such a complex problem,genetic algorithm,K-means algorithm,Geo Steiner algorithm,Kruskal algorithm,linear programming and Monte Carlo simulations are combined.A real-world case study illustrates the effectiveness of the proposed methodology and shows a 36.53%reduction in the total annual cost compared with the initial scheme.

Total spinal anesthesia caused by lidocaine during unilateral percutaneous vertebroplasty performed under local anesthesia:A case report

BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.CASE SUMMARY A 71-year-old woman,who suffered from 2 wk of severe back pain with a visual analog score of 8,came to our outpatient clinic.She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department.PVP was initially attempted again under local anesthesia.However,serendipitous intradural anesthesia leading to total spinal anesthesia happened.Fortunately,after successful resuscitation of the patient,PVP was safely and smoothly performed.Great pain relief was achieved postoperatively,and she was safely discharged on postoperative day 4.The patient recovered normally at 3-mo follow-up.CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs.In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia,surgeons should be highly vigilant during the whole procedure.Electrocardiogram monitoring,oxygen inhalation,intravenous cannula set prior to surgery,regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs,etc.should be highly recommended.

Nomograms predicting prognosis of patients with pathological stages T1N2-3 and T3N0 gastric cancer

BACKGROUND Patients with pathological stages T1N2-3(pT1N2-3)and pT3N0 gastric cancer(GC)have not been routinely included in the target population for postoperative chemotherapy according to the Japanese Gastric Cancer Treatment Guideline,and their prognosis is significantly different.AIM To identify the high-risk patients after radical surgery by analyzing biomarkers and clinicopathological features and construct prognostic models for them.METHODS A total of 459 patients with pT1N2-3/pT3N0 GC were retrospectively selected for the study.The Chi-square test was used to analyze the differences in the clinicopathological features between the pT1N2-3 and pT3N0 groups.The Kaplan–Meier analysis and log-rank test were used to analyze overall survival(OS).The independent risk factors for patient prognosis were analyzed by univariate and multivariate analyses based on the Cox proportional hazards regression model.The cutoff values of continuous variables were identified by receiver operating characteristic curve.The nomogram models were constructed with R studio.RESULTS There was no statistically significant difference in OS between the pT1N2-3 and pT3N0 groups(P=0.374).Prealbumin(P=0.040),carcino-embryonic antigen(CEA)(P=0.021),and metastatic lymph node ratio(mLNR)(P=0.035)were independent risk factors for prognosis in the pT1N2-3 group.Age(P=0.039),body mass index(BMI)(P=0.002),and gastrectomy(P<0.001)were independent risk factors for prognosis in the pT3N0 group.The area under the curve values of the nomogram models for predicting the 5-year prognosis of the pT1N2-3 group and pT3N0 group were 0.765 and 0.699,respectively.CONCLUSION Nomogram model combining prealbumin,CEA,and mLNR levels can be used to predict the prognosis of pT1N2-3 GC.Nomogram model combining age,BMI,and gastrectomy can be used to predict the prognosis of pT3N0 GC.

Pressure-Induced Ionic-Electronic Transition in BiVO4

Electrical transport properties of bismuth vanadate(BiVO4) are studied under high pressures with electrochemical impedance spectroscopy. A pressure-induced ionic-electronic transition is found in BiVO4. Below 3.0 GPa, BiVO4 has ionic conduction behavior. The ionic resistance decreases under high pressures due to the increasing migration rate of O2-ions. Above 3.0 GPa the channels for ion migration are closed. Transport mechanism changes from the ionic to the electronic behavior. First-principles calculations show that bandgap width narrows under high pressures, causing the continuous decrease of electrical resistance of BiVO4.

Effects of single synthetic jet on turbulent boundary layer

The turbulent boundary layer(TBL)is actively controlled by the synthetic jet generated from a circular hole.According to the datasets of velocity fields acquired by a time-resolved particle image velocimetry(TR-PIV)system,the average drag reduction rate of 6.2%in the downstream direction of the hole is obtained with control.The results of phase averaging show that the synthetic jet generates one vortex pair each period and the consequent vortex evolves into hairpin vortex in the environment with free-stream,while the reverse vortex decays rapidly.From the statistical average,it can be found that a low-speed streak is generated downstream.Induced by the two vortex legs,the fluid under them converges to the middle.The drag reduction effect produced by the synthetic jet is local,and it reaches a maximum value at x^(+)=400,where the drag reduction rate reaches about 12.2%.After the extraction of coherent structure from the spatial two-point correlation analysis,it can be seen that the synthetic jet suppresses the streamwise scale and wall–normal scale of the large scale coherent structure,and slightly weakens the spanwise motion to achieve the effect of drag reduction.

Prognostic significance of serum inflammation indices for different tumor infiltrative pattern types of gastric cancer

BACKGROUND Inflammatory indices are considered to be potential prognostic biomarkers for patients with gastric cancer(GC).However,there is no evidence defining the prognostic significance of inflammatory indices for GC with different tumor infiltrative pattern(INF)types.AIM To evaluate the significance of inflammatory indices and INF types in predicting the prognosis of patients with GC.METHODS A total of 962 patients who underwent radical gastrectomy were retrospectively selected for this study.Patients were categorized into the expansive growth type(INFa),the intermediate type(INFb),and the infiltrative growth type(INFc)groups.The cutoff values of inflammatory indices were analyzed by receiver operating characteristic curves.The Kaplan–Meier method and log-rank test were used to analyze overall survival(OS).The chi-square test was used to analyze the association between inflammatory indices and clinical characteristics.The independent risk factors for prognosis in each group were analyzed by univariate and multivariate analyses based on logistic regression.Nomogram models were constructed by R studio.RESULTS The INFc group had the worst OS(P<0.001).The systemic immune-inflammation index(P=0.039)and metastatic lymph node ratio(mLNR)(P=0.003)were independent risk factors for prognosis in the INFa group.The platelet-lymphocyte ratio(PLR)(P=0.018),age(P=0.026),body mass index(P=0.003),and postsurgical tumor node metastasis(pTNM)stage(P<0.001)were independent risk factors for prognosis in the INFb group.The PLR(P=0.021),pTNM stage(P=0.028),age(P=0.021),and mLNR(P=0.002)were independent risk factors for prognosis in the INFc group.The area under the curve of the nomogram model for predicting 5-year survival in the INFa group,INFb group,and INFc group was 0.787,0.823,and 0.781,respectively.CONCLUSION The outcome of different INF types GC patients could be assessed by nomograms based on different inflammatory indices and clinicopathologic features.

Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer

BACKGROUND The prognostic value of quantitative assessments of the number of retrieved lymph nodes(RLNs)in gastric cancer(GC)patients needs further study.AIM To discuss how to obtain a more accurate count of metastatic lymph nodes(MLNs)based on RLNs in different pT stages and then to evaluate patient prognosis.METHODS This study retrospectively analyzed patients who underwent GC radical surgery and D2/D2+LN dissection at the Cancer Hospital of Harbin Medical University from January 2011 to May 2017.Locally weighted smoothing was used to analyze the relationship between RLNs and the number of MLNs.Restricted cubic splines were used to analyze the relationship between RLNs and hazard ratios(HRs),and X-tile was used to determine the optimal cutoff value for RLNs.Patient survival was analyzed with the Kaplan-Meier method and log-rank test.Finally,HRs and 95%confidence intervals were calculated using Cox proportional hazards models to analyze independent risk factors associated with patient outcomes.RESULTS A total of 4968 patients were included in the training cohort,and 11154 patients were included in the validation cohort.The smooth curve showed that the number of MLNs increased with an increasing number of RLNs,and a nonlinear relationship between RLNs and HRs was observed.X-tile analysis showed that the optimal number of RLNs for pT1-pT4 stage GC patients was 26,31,39,and 45,respectively.A greater number of RLNs can reduce the risk of death in patients with pT1,pT2,and pT4 stage cancers but may not reduce the risk of death in patients with pT3 stage cancer.Multivariate analysis showed that RLNs were an independent risk factor associated with the prognosis of patients with pT1-pT4 stage cancer(P=0.044,P=0.037,P=0.003,P<0.001).CONCLUSION A greater number of RLNs may not benefit the survival of patients with pT3 stage disease but can benefit the survival of patients with pT1,pT2,and pT4 stage disease.For the pT1,pT2,and pT4 stages,it is recommended to retrieve 26,31 and 45 LNs,respectively.

Static and Dynamic Analysis of Lasing Action from Single and Coupled Photonic Crystal Nanocavity Lasers

The single and coupled photonic crystal nanocavity lasers are fabricated in the InGaAsP material system and their static and dynamic features are compared. The coupled-cavity lasers show a larger lasing e^ciency and generate an output power higher than the single-cavity lasers, results that are consistent with the theoretical results obtained by rate equations. In dynamic regime, the single-cavity lasers produce pulses as short as 113 ps, while the coupled-cavity lasers show a significantly longer lasing duration. These results indicate that the photonic crystal laser is a promising candidate for the light source in high-speed photonic integrated circuit.

湍流边界层中光滑表面和超疏水表面上的均匀动量区

在Re_(τ)=528的湍流边界层中使用时间分辨的二维PIV研究了光滑表面和超疏水表面上的等动量区. 通过局部动能亏损率检测了湍流/非湍流界面, 随后在瞬时速度场中通过流向速度的概率密度函数检测了湍流区域中的等动量区. 使用了两种分类方法分析了等动量区在湍流边界层中的发展和演化, 对比研究了超疏水表面对等动量区特性的影响. 根据瞬时快照中包含的等动量区的数量对流场进行分类, 研究了湍流/非湍流界面的高度与流场中包含的等动量区数量之间的联系, 对比了不同类别流场的统计量, 讨论了等动量区在不同法向高度对于喷射/扫掠事件的贡献, 并讨论了结果在超疏水表面上的差异.

Red organic light-emitting diodes based photobiomodulation therapy enabling prominent hair growth

Hair loss can cause psychological distress.Here,red organic light-emitting diode(OLED)light source is first introduced as the photobiomodulation therapy(PBMT)for hair growth and demonstrated as a promising and non-invasive therapeutic modality for alopecia.OLED exhibits unique advantages of homogeneous irradiation,flexible in form factor,less heat generation.These features enable OLED to be an ideal candidate for wearable PBMT light sources.A systematic study of using red OLEDs to facilitate hair growth was conducted.The results show that OLEDs excellently promote hair regrowth.OLED irradiation can increase the length of the hair by a factor of 1.5 as compared to the control,the hair regrowth area is enlarged by over 3 times after 20 days of treatments.Moreover,the mechanism of OLED that stimulates hair follicle regeneration is investigated invivo by conducting a systematic controlled experiments on mice with or without OLED PBMT.Based on the comprehensive histological and immunofluorescence staining studies,two key factors are identified for red OLEDs to facilitate hair follicle regeneration:(i)increased autophagy during the anagen phase of the hair growth cycle;(ii)increased blood oxygen content promoted by the accelerated microvascular blood flow.

Cyclocarya cf. paliurus （Batal.） Iljinskaja （Juglandaceae） from the Hunchun Formation （Eocene）, Jilin Province, China

The leaflet architecture of Cyclocarya cf. paliurus （Batal.） Iljinskaja from the Hunchun Formation （Middle Eocene） shows similarity to that of modem C. paliurus （Batal.） Iljinskaja and the specimen is the oldest fossil record in Europe and Asia. The distributions of C. cf. paliurus and other fossil records, such as Glyptostrobus, Metasequoia, Nyssa, and Liquidambar, in Hunchun flora show that it would have been a warmer-temperature to subtropical climate in Hunchun District during the Eocene period.

Association between Polymorphism of Interleukin-23 Receptor and Hashimoto＇s Thyroiditis in Chinese Han Population of Shandong

Objective：The interleukin-23 receptor （IL-23R） has been shown to be associated with autoimmune diseases in many different populations.This study aimed to investigate the association between IL-23R gene polymorphism and susceptibility to Hashimoto＇s thyroiditis （HT） in Chinese Han population of Shandong.Methods：A case-control cohort study was performed in 145 HT patients from First People＇s Hospital of Jining between February 2010 to October 2013 and 150 healthy controls.Two single nucleotide polymorphisms located in the promoter region ofIL-23R gene （rs 17375018 and rs7517847） were examined by polymerase chain reaction-restriction fragment length polymorphism analysis.Hardy-Weinberg equilibrium was performed using the Chi-square test.Genotype frequencies were estimated by direct counting,and allele and genotype frequencies between patients and controls were analyzed by the Chi-square test.Results：The rs 17375018 GG genotype and the G allele were significantly increased in HT patients compared with healthy controls （P =0.034 and P =0.013,respectively）.No association was identified between HT patients and healthy controls in rs7517847.Conclusion：The study demonstrated that polymorphism of IL-23R gene rs17375018 is highly associated with HT in Chinese Han population of Shandong,suggesting that IL-23R gene polymorphism （rs 17375018 G） may play a critical role in susceptibility to HT.

A simultaneous improvement of both strength and ductility by Sn addition in as-extruded Mg-6Al-4Zn alloy

Commercial wrought Mg alloys normally contain low alloying contents to ensure good formability.In the present work,high-alloyed Mg-6 Al-4 Zn-x Sn(x=1,2 and 3 wt.%,respectively)alloys were fabricated by extrusion.Hereinto,Sn was proven to play an effective contribution to simultaneous improvement in strength and ductility that are traditional trade-off features of synthetic materials.It was found that the average grain size of those alloys decreases significantly from^11 to^4μm as a function of Sn contents increasing from 0 to 3 wt.%,while the amounts of Mg2 Sn and Mg17 Al12 particles continuously increase.More importantly,the addition of Sn leads to the transformation of dominated deformation modes from{1012}extension twinning(1 wt.%)to pyramidal slip(3 wt.%)during tensile tests along the extrusion direction at room temperature.The advantageous combination of ultimate tensile strength(~366 MPa)and elongation(~19%)in Mg-6Al-4Zn-3 Sn alloy is mainly attributed to the strong strain hardening ability induced by the enhanced activity of non-basal slip.This work could provide new opportunities for the development of high-alloyed wrought Mg alloys with promising mechanical properties.