Validation and modification of the AJCC 8th TNM staging system for pancreatic ductal adenocarcinoma in a Chinese cohort:A nationwide pancreas data center analysis

Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for PDAC.Methods:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank test.Univariate and multivariate analyses based on Cox regression were performed to identify prognostic factors.The recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 level.Validation was performed for both staging systems in the validation cohort.Results:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and IIA.The analysis of T and N stages demonstrated a better prognostic value in the N category.Multivariate analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk factors.All patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage III.The modified staging system had a better performance for predicting CSS than the 8 th AJCC staging scheme.Conclusions:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T category.Our modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.

Upregulation of circ0000381 atienuates microglial/macrophage pyroptosis after spinal cord injury

Neuroinflammation exacerbates secondary damage after spinal cord injury,while microglia/macrophage pyroptosis is important to neuroinflammation.Circular RNAs(circRNAs)play a role in the central nervous system.However,the functional role and mechanism of circRNAs in regulating microglia/macrophage pyroptosis after spinal cord injury are still poorly studied.In the present study,we detected microglia/macrophage pyroptosis in a female rat model of spinal cord injury,along with upregulated levels of circ0000381 in the spinal cord.Our further experimental results suggest that circ0000381 may function as a sponge to sequester endogenous microRNA423-3p(miR-423-3p),which can increase the expression of NOD-like receptor 3(NLRP3),a pyroptosis marker.Therefore,upregulation of circ0000381 may be a compensatory change after spinal cord injury to attenuate microglia/macrophage pyroptosis.Indeed,knockdown of circ0000381 expression exacerbated microglia/macrophage pyroptosis.Collectively,our findings provide novel evidence for the upregulation of circ0000381,which may serve as a neuroprotective mechanism to attenuate microglia/macrophage pyroptosis after spinal cord injury.Accordingly,circ0000381 may be a novel therapeutic target for the treatment of spinal cord injury.

Hematuria after nocturnal exercise of a man: A case report

BACKGROUND A man experienced multiple episodes of macroscopic hematuria following nocturnal exercise.Urinary stones and tumors were considered the two most likely causes.The patient had two hobbies:Consuming health care products in large quantities and engaging in late-night running.CASE SUMMARY Health care products contain a large amount of calcium phosphate,and we hypothesize that this could induce the formation of small phosphate stones.After exercise,the urinary system is abraded,resulting in bleeding.The patient was advised to stop using the health care products.Consequently,the aforementioned symptoms disappeared immediately.However,the patient resumed the above two habits one year later;correspondingly,the macroscopic hematuria reap-peared.CONCLUSION This finding further confirmed the above inference and allowed for a new avenue to determine the cause of the patient’s hematuria.

Unveiling the secrets of gastrointestinal mucous adenocarcinoma survival after surgery with artificial intelligence:A population-based study

BACKGROUND Research on gastrointestinal mucosal adenocarcinoma(GMA)is limited and controversial,and there is no reference tool for predicting postoperative survival.AIM To investigate the prognosis of GMA and develop predictive model.METHODS From the Surveillance,Epidemiology,and End Results database,we collected clinical information on patients with GMA.After random sampling,the patients were divided into the discovery(70%of the total,for model training),validation(20%,for model evaluation),and completely blind test cohorts(10%,for further model evaluation).The main assessment metric was the area under the receiver operating characteristic curve(AUC).All collected clinical features were used for Cox proportional hazard regression analysis to determine factors influencing GMA’s prognosis.RESULTS This model had an AUC of 0.7433[95% confidence intervals(95%CI):0.7424-0.7442]in the discovery cohort,0.7244(GMA:0.7234-0.7254)in the validation cohort,and 0.7388(95%CI:0.7378-0.7398)in the test cohort.We packaged it into Windows software for doctors’use and uploaded it.Mucinous gastric adenocarcinoma had the worst prognosis,and these were protective factors of GMA:Regional nodes examined[hazard ratio(HR):0.98,95%CI:0.97-0.98,P<0.001]and chemotherapy(HR:0.62,95%CI:0.58-0.66,P<0.001).CONCLUSION The deep learning-based tool developed can accurately predict the overall survival of patients with GMA postoperatively.Combining surgery,chemotherapy,and adequate lymph node dissection during surgery can improve patient outcomes.

Association of obesity with Helicobacter pylori infection: A retrospective study

AIM To explore the association between Helicobacter pylori(H. pylori) infection and obesity/weight gain in a Chinese population.METHODS Our primary outcome was the change in body mass index(BMI). The generalized linear models were used to explore the association between H. pylori infection and the change of BMI, and the logistic regression models were used to explore the association between H. pylori infection and obesity.RESULTS A total of 3039 subjects were recruited and analyzed, of which 12.8% were obese. The prevalence of H. pylori infection was 53.9%(1639/3039) overall and 54.6%(212/388) in the obese subjects. The change of BMI in the H. pylori(+) group was not significantly higher than that in the H. pylori(-) group after adjustment for potential confounding factors [RR = 0.988, 95%CI:0.924-1.057, P = 0.729]. The prevalence of obesity decreased 1.1% in the H. pylori(+) group and 0.5% in the H. pylori(-) group. The RR of H. pylori infection for obesity was 0.831(95%CI: 0.577-1.197, P = 0.321) after the adjustment.CONCLUSION H. pylori infection was not associated with overweight/obesity observed from the retrospective study in this Chinese population.

Pseudomyxoma peritonei originating from intestinal duplication:A case report and review of the literature

BACKGROUND Pseudomyxoma peritonei(PMP)is a rare mucinous neoplasm with a relatively low incidence of 1 to 2 per million individuals.It is typically characterized by a type of gelatinous ascites named“jelly belly”.Most cases of PMP occur in association with ruptured primary mucinous tumors of the appendix(90%).Periodically,PMP can originate from mucinous carcinomas at other sites,including the colorectum,gallbladder,and pancreas.However,unusual origin can occur,as noted in this case report.CASE SUMMARY A 52-year-old woman had an unusual derivation of PMP from intestinal duplication.The patient complained of abdominal distension and increasing abdominal girth.Abdominal contrast-enhanced computed tomography showed a mass in the greater omentum located on the left side of the abdomen,likely to be a cystic mass of peritoneal origin.A PMP diagnosis was presumed based on the specific signs of the mass with flocculent and stripe-like echoes in ultrasound images.Ultrasound-guided percutaneous aspiration suggested a high likelihood of PMP.Once the PMP diagnosis was recognized,identification of the origin of the primary tumor was indicated.Thus,an exploratory laparoscopy was performed.In the absence of a primary tumor of appendix origin,the diagnosis of a low-grade mucinous neoplasm of intestinal duplication origin was finally confirmed by histopathology.CONCLUSION PMP is secondary to mucinous carcinomas of the appendix mostly.This case resulted from an unusual derivation from intestinal duplication.

Ischemic colitis after receiving the second dose of a COVID-19 inactivated vaccine: A case report

BACKGROUND The outbreak of the coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 has been the most important clinical challenge worldwide since January 2020.COVID-19 inactivated vaccines play a crucial role in reducing the rates of morbidity and mortality.CASE SUMMARY We presented a 48-year-old woman from Haidian District,Beijing,China who developed ischemic colitis after receiving the second dose of COVID-19 inactivated vaccine.Computed tomography of the abdomen showed edema and bowel wall thickening with hypodensity in the sigmoid colon and descending colon.Colonoscopy revealed hyperemia,edema and erosion of the mucosa with superficial ulceration and a yellow-white coating at the descending colon and sigmoid colon.The symptoms were relieved after 1 wk of receiving pinaverium bromide(50 mg,tid)and aspirin enteric-coated tablets(0.1 g,qd).CONCLUSION The possible occurrence of ischemic colitis should be considered after administration of the COVID-19 inactivated vaccines.

Brainstem abscesses caused by Listeria monocytogenes:A case report

BACKGROUNDIntracranial Listeria infections are common in newborns and immunocompromisedindividuals, but brainstem abscesses are rare.CASE SUMMARYWe report a rare case of brainstem abscesses caused by Listeria monocytogenes in apreviously healthy adult patient. The patient’s magnetic resonance imagingexamination showed multiple brain abscesses, and his second cerebrospinal fluidculture test indicated the presence of Listeria monocytogenes. Despite earlyempirical therapy, the patient’s condition progressively deteriorated. Because thepatient's abscesses were located in the brainstem and multiple lobes, surgery wasnot possible. The patient died 40 d after admission.CONCLUSIONThis case highlights the importance of rational clinical use of drugs to avoidpotentially serious infectious complications.

Coarse-Grained Molecular Dynamics Study based on TorchMD

The coarse grained(CG)model implements the molecular dynamics simulation by simplifying atom properties and interaction between them.Despite losing certain detailed information,the CG model is still the first-thought option to study the large molecule in long time scale with less computing resource.The deep learning model mainly mimics the human studying process to handle the network input as the image to achieve a good classification and regression result.In this work,the TorchMD,a MD framework combining the CG model and deep learning model,is applied to study the protein folding process.In 3D collective variable(CV)space,the modified find density peaks algorithm is applied to cluster the conformations from the TorchMD CG simulation.The center conformation in different states is searched.And the boundary conformations between clusters are assigned.The string algorithm is applied to study the path between two states,which are compared with the end conformations from all atoms simulations.The result shows that the main phenomenon of protein folding with TorchMD CG model is the same as the all-atom simulations,but with a less simulating time scale.The workflow in this work provides another option to study the protein folding and other relative processes with the deep learning CG model.

K-means Find Density Peaks in Molecular Conformation Clustering

Performing cluster analysis on molecular conformation is an important way to find the representative conformation in the molecular dynamics trajectories.Usually,it is a critical step for interpreting complex conformational changes or interaction mechanisms.As one of the density-based clustering algorithms,find density peaks(FDP)is an accurate and reasonable candidate for the molecular conformation clustering.However,facing the rapidly increasing simulation length due to the increase in computing power,the low computing efficiency of FDP limits its application potential.Here we propose a marginal extension to FDP named K-means find density peaks(KFDP)to solve the mass source consuming problem.In KFDP,the points are initially clustered by a high efficiency clustering algorithm,such as K-means.Cluster centers are defined as typical points with a weight which represents the cluster size.Then,the weighted typical points are clustered again by FDP,and then are refined as core,boundary,and redefined halo points.In this way,KFDP has comparable accuracy as FDP but its computational complexity is reduced from O(n^(2))to O(n).We apply and test our KFDP method to the trajectory data of multiple small proteins in terms of torsion angle,secondary structure or contact map.The comparing results with K-means and density-based spatial clustering of applications with noise show the validation of the proposed KFDP.

The Impact of a Multidisciplinary Nursing Model on the Quality of Life of COPD Patients in Remission in the Elderly

Objective:To study the effects of multidisciplinary nursing model on self-care ability,lung function,exercise endurance,negative emotion and quality of life of elderly patients with chronic obstructive pulmonary disease(COPD).Methods:80 patients with COPD hospitalized in the Aerospace Center Hospital from August 2019 to August 2020 were recruited.They were randomly divided into control group and experimental group,with 40 patients in each group.The patients in the control group received routine nursing,and the patients in the experimental group received multidisciplinary nursing intervention on the basis of routine nursing.The nursing observation time of the two groups was 8 weeks.Results:after 8 weeks of nursing intervention,it was found that FEV1/FVC and 6MWD in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in SAS score and SDS score between the two groups before nursing,but it was significantly lower in the observation group after nursing.The difference between the above data was statistically significant(P<0.05).The SGRQ score of the observation group was significantly lower than that of the control group(P<0.05).Conclusion:the application of multidisciplinary nursing model can effectively improve the exercise endurance of elderly patients with COPD,eliminate the negative emotions of patients,and improve the quality of life of patients.The comprehensive application value is significant.

Application and prospects of high-throughput screening for in vitro neurogenesis

Over the past few decades,high-throughput screening(HTS)has made great contributions to new drug discovery.HTS technology is equipped with higher throughput,minimized platforms,more automated and computerized operating systems,more efficient and sensitive detection devices,and rapid data processing systems.At the same time,in vitro neurogenesis is gradually becoming important in establishing models to investigate the mechanisms of neural disease or developmental processes.However,challenges remain in generating more mature and functional neurons with specific subtypes and in establishing robust and standardized three-dimensional(3D)in vitro models with neural cells cultured in 3D matrices or organoids representing specific brain regions.Here,we review the applications of HTS technologies on in vitro neurogenesis,especially aiming at identifying the essential genes,chemical small molecules and adaptive microenvironments that hold great prospects for generating functional neurons or more reproductive and homogeneous 3D organoids.We also discuss the developmental tendency of HTS technology,e.g.,so-called next-generation screening,which utilizes 3D organoid-based screening combined with microfluidic devices to narrow the gap between in vitro models and in vivo situations both physiologically and pathologically.

Influence of Built Environment in Hygienic City in China on Self-rated Health of Residents

Objective To assess the subjective perception of residents on the built environment in hygienic cities and its relation to the self-rated health(SRH)status of residents,providing a basis for a better promotion on construction of health-supportive environments.Methods The online survey was adopted with the respondents recruited from residents living in Chaoyang District of Beijing in January 2021.With SRH level as the dependent variable,two-category logistic regression analysis was conducted to analyze the impact of the built environment in hygienic cities on the SRH status of residents.Results A total of 1,357 respondents were enrolled in this study.After controlling confounding factors,four aspects in the built environment in hygienic cities were detected remarkable influences on the SRH level of residents,including enough green space in the living area[odds ratio(OR)=1.395,95%confidence interval(95%CI):1.055–1.845],clean and hygienic living environment(OR=1.472,95%CI:1.107–1.956),residents’confidence in drinking water safety in the living area(OR=1.856,95%CI:1.354–2.544)and residents’confidence in food safety in the living area(OR=1.405,95%CI:1.027–1.921).Conclusion Regarding city construction,the government should focus more on the subjective perception of residents on built environments to build a supportive environment benefiting the health of residents.

Lead helix winding tricuspid chordae tendineae: A case report

BACKGROUND As left bundle branch pacing(LBBP)is more like physiological pacing,LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable pacing parameters.LBBP has been revealed associated with a significantly reduced risk of new-onset atrial fibrillation and heart failure compared with conventional permanent pacemaker implantation.CASE SUMMARY A 64-year-old man was admitted with a 24-h history of chest distress and shortness of breath,which continued unabated.The patient had no symptoms of chest pain,dizziness,syncope,nausea nor vomiting.There were no abnormalities found in routine examinations after admission.Twelve-lead electrocardiogram presented a result of 2:1 atrioventricular block.Coronary angiography was performed the next day and no abnormality was found.Finally,the patient agreed to received LBBP and signed the informed consent.During the process of withdrawing the Medtronic Model 3830 lead into sheath,we found the lead helix was wrapped around the chordae tendineae of the septal valve of tricuspid.Attempts to rotate the 3830 lead failed to release the lead helix from the chordae tendineae,and ultimately we used radiofrequency ablation to ablate the wrapped chordae tendineae.CONCLUSION Radiofrequency ablation effectively solved this problem without complications.It is an effective and reliable method to resolve lead winding chordae.

SI of Interaction energy prediction of organic molecules using Deep Tensor Neural Network

The support informations of DTNN architecture and prediction results of six testing cases in K-fold are listed here.

Interaction Energy Prediction of Organic Molecules using Deep Tensor Neural Network

The interaction energy of two molecules system plays a critical role in analyzing the interacting effect in molecular dynamic simulation.Since the limitation of quantum mechanics calculating resources,the interaction energy based on quantum mechanics can not be merged into molecular dynamic simulation for a long time scale.A deep learning framework,deep tensor neural network,is applied to predict the interaction energy of three organic related systems within the quantum mechanics level of accuracy.The geometric structure and atomic types of molecular conformation,as the data descriptors,are applied as the network inputs to predict the interaction energy in the system.The neural network is trained with the hierarchically generated conformations data set.The complex tensor hidden layers are simplified and trained in the optimization process.The predicted results of different molecular sys tems indica te that deep t ensor neural net work is capable to predic t the interaction energy with 1 kcal/mol of the mean absolute error in a relatively short time.The prediction highly improves the efficiency of interaction energy calculation.The whole proposed framework provides new insights to introducing deep learning technology into the interaction energy calculation.

Changes of hs-CRP, S100B and NSE levels in serum and cerebrospinal fluid of children with epilepsy and their correlation with the nerve cell apoptosis

Objective:To study the changes of hs-CRP, S100B and NSE levels in serum and cerebrospinal fluid of children with epilepsy and their correlation with the nerve cell apoptosis.Methods:The children who were diagnosed with epilepsy in this hospital between March 2015 and February 2017 were selected as epilepsy group, and the children who underwent operation due to hernia during the same period were selected as control group. The cerebrospinal fluid was collected to determine the contents of hs-CRP, S100B and NSE, and the serum was collected to detect the contents of hs-CRP, S100B, NSE, apoptosis molecules and Sirtuins family molecules.Results: hs-CRP, S100B and NSE levels in serum and cerebrospinal fluid of epilepsy group were significantly higher than those of control group, Bim, Bax, Caspase-3, Caspase-4 and Caspase-9 levels in cerebrospinal fluid were significantly higher than those of control group, and XIAP, Bcl-2, SIRT1, SIRT2, SIRT3, SIRT4, SIRT5, SIRT6 and SIRT7 levels in cerebrospinal fluid were significantly lower than those of control group;hs-CRP, S100B and NSE levels in serum and cerebrospinal fluid of children with epilepsy were positively correlated with Bim, Bax, Caspase-3, Caspase-4 and Caspase-9 levels in cerebrospinal fluid, and negatively correlated with XIAP, Bcl-2, SIRT1, SIRT2, SIRT3, SIRT4, SIRT5, SIRT6 and SIRT7 levels in cerebrospinal fluid.Conclusion: The abnormally elevated hs-CRP, S100B and NSE in serum and cerebrospinal fluid of children with epilepsy are closely related to the excessive apoptosis of nerve cells.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin-801 Cases from a Single Institution in China

Aim:As more and more centers has published their treatment results of pseudomyxoma peritonei(PMP)with cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC),the data from China is missing.Myxoma Department of Aerospace Hospital is the biggest center treating PMP in China.The purpose of this study is to report the early and long-term outcomes for PMP from this single center.Methods:801 appendix-derived PMP out of 1008 consecutive patients treated in Myxoma Department of Aerospace Hospital between 2008 and 2019 were retrospectively analyzed.Results:Complete cytoreductive surgery(CCRS)was achieved in 240(30%)patients with median PCI of 14(1~39),and the rest had maximal tumor debulking(MTD),HIPEC was implemented in 96.3%of CCRS and 78.6%of MTD.The major morbidity(grade III/IV)was 11.4%and the 30-day operative mortality is 0.7%.The 5-and 10-year OS of CCRS was 76.9%and 64.1%,which is significantly higher than MTD(5-,10-year OS as 36.1%,27.1%;p<0.001).On the univariate analysis,all prognostic factors(gender,PSS,interval time,prior chemotherapy,prior HIPEC,Peritoneal Cancer Index(PCI),completeness of cytoreduction(CC),HIPEC,pathology,present of serous ascites)were found to be associated with overall survival except for age.On multivariate analysis,only PCI>20,MTD,high pathologic grade and without HIPEC were independent factors predicting poorer prognosis.Conclusions:CCRS+HIPEC can benefit PMP well with controllable risks.MTD+HIPEC may benefit PMP as well when CCRS cannot be achieved after fully asscessment by an experienced peritoneal maglignacy center,but the surgery should be performed as limited as possible.

Current situation and development of hematopoietic cell transplantation centers:A nationwide survey in China

To the Editor:Hematopoietic cell transplantation(HCT)is a vital modality to cure severe hematological disorders.[1]Global or regional summarized data of HCT are annually reported by the Chinese Blood and Marrow Transplantation Registry Group(CBMTRG),European Society for Blood and Marrow Transplantation(EBMT)and Center for International Blood and Marrow Transplant Research(CIBMTR).It is shown that the number of transplants is continuously increasing,particularly in China in recent years.[2]Since the donor accessibility is significantly addressed by the well-established protocol of haplo-identical HCT(haplo-HCT).

Impact of the zero-markup drug policy on volume of medical service:based on 57 county hospitals of China

In the present study,we aimed to assess the long-term impact of zero-markup drug policy on volume of medical service in county hospitals of China.This study used 57 county hospitals’records of medical service from 2011 to 2015,and a fixed effect model was applied to examine the impact of the zero-markup drug policy on volume of medical service.The outcome indicators included the number of patient visits,the number of prescriptions,the number of discharged patients,the length of stay,the number of patients who had surgeries and the number of patients who had CT or MRI,monthly.The number of hospitals which implemented the zero-markup drug policy was increased continuously.By the end of 2015,41 hospitals(71.9%)implemented this policy.The panel regression showed that most indicators were insignificantly decreased,including the number of patient visits(P<0.01),the length of stay(P<0.05),the number of patients who had surgeries(P<0.01)and the number of patients who had CT or MRI(P<0.01).However,the number of prescriptions and the number of discharged patients were not significantly changed.The implementation of the zero-markup drug policy might affect the reduction of the volume of medical service in county-level hospitals and the reason needs to be clarified in future studies.