From London buses to activity trackers:A reflection of 70 years of physical activity research

In 1953,Morris et al.^(1)published their ground-breaking findings among London bus drivers and conductors,linking physical activity to a major chronic disease for the first time.This seminal paper marked the birth of a new field—physical activity epidemiology.^(1)Since then,the field has flourished,evidenced by mounting scientific publications.^(2)Our knowledge about the role of physical activity in disease prevention has expanded from coronary heart disease in Morris et al.’s^(1)initial study to dozens of additional diseases and conditions,such as diabetes,cancers,and dementia.^(3)More than 7 decades and thousands of publications later,we critically reflect on several aspects of the progress in physical activity epidemiology.

Glymphatic function and its influencing factors in different glucose metabolism states

BACKGROUND Dysfunction of the glymphatic system in the brain in different stages of altered glucose metabolism and its influencing factors are not well characterized.AIM To investigate the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states,the present study employed diffusion tensor imaging along the perivascular space(DTI-ALPS)index.METHODS Sample size was calculated using the pwr package in R software.This crosssectional study enrolled 22 patients with normal glucose metabolism(NGM),20 patients with prediabetes,and 22 patients with type 2 diabetes mellitus(T2DM).A 3.0T magnetic resonance imaging was used to evaluate the function of the glymphatic system.The mini-mental state examination(MMSE)was used to assess general cognitive function.The DTI-ALPS index of bilateral basal ganglia and the mean DTI-ALPS index was calculated.Further,the correlation between DTI-ALPS and clinical features was assessed.RESULTS The left-side,right-side,and mean DTI-ALPS index in the T2DM group were significantly lower than that in the NGM group.The right-side DTI-ALPS and mean DTI-ALPS index in the T2DM group were significantly lower than those in the prediabetes group.DTI-ALPS index lateralization was not observed.The MMSE score in the T2DM group was significantly lower than that in the NGM and prediabetes group.After controlling for sex,the left-side DTI-ALPS and mean DTI-ALPS index in the prediabetes group were positively correlated with 2-hour postprandial blood glucose level;the left-side DTI-ALPS index was negatively correlated with total cholesterol and low-density lipoprotein level.The right-side DTI-ALPS and mean DTI-ALPS index were negatively correlated with the glycosylated hemoglobin level and waist-to-hip ratio in the prediabetes group.The left-side,right-side,and mean DTI-ALPS index in the T2DM group were positively correlated with height.The left-side and mean DTIALPS index in the T2DM group were negatively correlated with high-density lipoprotein levels.CONCLUSION Cerebral glymphatic system dysfunction may mainly occur in the T2DM stage.Various clinical variables were found to affect the DTI-ALPS index in different glucose metabolism states.This study enhances our understanding of the pathophysiology of diabetic brain damage and provides some potential biological evidence for its early diagnosis.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

糖尿病患者足溃疡减压指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

减轻组织的机械性压力在治愈糖尿病相关的足溃疡所需的多种干预措施中最为重要。本文是2023年国际糖尿病足工作组(IWGDF)发布的减压治疗促进糖尿病相关的足溃疡愈合的循证指南,也是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展和评价分级(GRADE)方法学,以患者-干预-比较-结局(patient-intervention-control-outcome,PICO)模式设计临床问题和重要结果,进行系统评价和Meta分析,制定评判表汇总,为每个问题编写推荐和理由。每项推荐都是基于系统综述中发现的证据,在无证据情况下则采用专家意见,以及对判断项目的GRADE等级总结进行仔细权衡,包括可预期和不可预期的影响、证据的确定性、患者价值、所需资源、成本效益、公平性、可行性和可接受性。为了治愈糖尿病患者神经性前足底或中足底溃疡,要使用不可拆卸的齐膝高减压装置作为首选减压干预措施。如果患者存在对不可拆卸减压装置的禁忌证或不能耐受,考虑使用可拆卸齐膝(或踝)高减压装置作为减压干预措施的第二选择。如果无可用的减压装置,考虑使用合适的鞋具结合毡制泡沫作为减压干预措施的第三选择。如果这种非手术减压治疗不能治愈前足底溃疡,可以考虑跟腱延长术、跖骨头切除术、关节置换术或跖骨截骨术。为了治疗继发于屈趾畸形的神经性足底或小趾远端溃疡,可行趾屈肌腱切开术。为了促进后足、非足底或并发感染或缺血的溃疡的愈合,提出了进一步的推荐。所有推荐都已在减压临床路径中进行了总结,以帮助促进本指南在临床实践中的实施。这些减压推荐将帮助医务人员为糖尿病相关的足溃疡患者提供最佳的治疗和预后,降低患者感染、住院和截肢的风险。

Influence of Formulation and Hot-Pressing Conditions on the Performance of Bio-Based Molasses Adhesive for Plywood

Molasses can serve as a natural adhesive for plywood and particleboard.However,several disadvantages remain,including lower dimensional stability and low bonding strength compared to other adhesives.Therefore,modifications are needed to use molasses as an adhesive for plywood.This research aims to improve bio-based molasses(MO)adhesive for plywood using citric acid(CA)adhesive.In addition,this research aims to analyze the effect of adding citric acid and to investigate the optimum hot-pressing temperature to produce the best quality plywood.In the first stage,the molasses and citric acid were combined in a ratio of 100:0,75:25,50:50,25:75,0:100 w/w%.Then,the second stage focuses on analyzing the influences of pressing temperature based on an optimum first stage.The research demonstrated that the addition of CA altered the gelation time,solid content,viscosity,and pH of the molasses adhesives.In addition,the thermal properties of molasses adhesives were changed after mixing with citric acid.These phenomena indicate changes in characteristics,such as the curing of adhesive.Overall,the characteristics of plywood showed a steady improvement as the CA ratio increased but revealed a significant decline for the 25:75 MO-CA ratio.By raising the pressing temperature from 180℃ to 200℃,the quality of plywood was effectively improved.The plywood that was bonded using adhesives with a 50:50 MO-CA ratio exhibited superior mechanical properties and improved dimensional stability compared to the plywood bonded solely with MO.Furthermore,the optimal mechanical and physical properties resulted in plywood bonded with a 50:50 MO-CA ratio when subjected to a pressing temperature of 200℃.The Thermal and FTIR measurements revealed that CA established ester bonds with both the MO and wood veneers.In conclusion,the mechanical characteristics of plywood were improved,while maintaining its excellent dimensional stability.

Deep learning-based automatic pipeline system for predicting lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma using computed tomography:A multi-center study

Objective:The assessment of lateral lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)holds great significance.This study aims to develop and evaluate a deep learning-based automatic pipeline system(DLAPS)for diagnosing LLNM in PTC using computed tomography(CT).Methods:A total of 1,266 lateral lymph nodes(LLNs)from 519 PTC patients who underwent CT examinations from January 2019 to November 2022 were included and divided into training and validation set,internal test set,pooled external test set,and prospective test set.The DLAPS consists of an auto-segmentation network based on RefineNet model and a classification network based on ensemble model(ResNet,Xception,and DenseNet).The performance of the DLAPS was compared with that of manually segmented DL models,the clinical model,and Node Reporting and Data System(Node-RADS).The improvement of radiologists’diagnostic performance under the DLAPS-assisted strategy was explored.In addition,bulk RNA-sequencing was conducted based on 12 LLNs to reveal the underlying biological basis of the DLAPS.Results:The DLAPS yielded good performance with area under the receiver operating characteristic curve(AUC)of 0.872,0.910,and 0.822 in the internal,pooled external,and prospective test sets,respectively.The DLAPS significantly outperformed clinical models(AUC 0.731,P<0.001)and Node-RADS(AUC 0.602,P<0.001)in the internal test set.Moreover,the performance of the DLAPS was comparable to that of the manually segmented deep learning(DL)model with AUCs ranging 0.814−0.901 in three test sets.Furthermore,the DLAPSassisted strategy improved the performance of radiologists and enhanced inter-observer consistency.In clinical situations,the rate of unnecessary LLN dissection decreased from 33.33%to 7.32%.Furthermore,the DLAPS was associated with the cell-cell conjunction in the microenvironment.Conclusions:Using CT images from PTC patients,the DLAPS could effectively segment and classify LLNs non-invasively,and this system had a good generalization ability and clinical applicability.

Overview of the Synthesis, Characterization, and Application of Tannin-Glyoxal Adhesive for Wood-Based Composites

More than a century after its initial synthesis,urea-formaldehyde(UF)resins still have dominant applications as adhesives,paints,and coatings.However,formaldehyde in this industry produces formaldehyde emissions that are dangerous to health.Scientists have spent the last decade replacing formaldehyde and phenol with environmentally friendly substances such as glyoxal and tannin to create bio-based adhesives.This review covers recent advances in synthesizing glyoxal tannin-based resins,especially those made from sustainable raw material substitutes and changes made to synthetic processes to improve mechanical properties.The efficacy of using tannin-glyoxal adhesives in producing wood-based composites has been proven.The glyoxylate reaction forms cross-linked bridges between the aromatic sites of the tannin and glyoxal molecular structures.Glyoxal tannin adhesive with a greater percentage of glyoxal than tannin will produce an adhesive with better characteristics.The gel time reduces as the hardener concentration rises from 7.5%to 15%when glyoxal is used in adhesives.However,excessive amounts of glyoxal will result in a decrease in viscosity values.Glyoxal exhibits faster delivery degradation when it reaches a maximum temperature of approximately 130°C,although it initiates the curing process slightly slower at 110°C.Adding glyoxal to tannin-based adhesives can improve the mechanical properties of composite boards.The wet shear strength of the resulting plywood is increased by 105.4%with the addition of 5-weight percent tannin-based resin with glyoxal as a cross-linker in Soy Protein Adhesive.With glyoxal as a hardener,the panels produced showed good internal bond strengths(>0.35 MPa)and met the international standard specifications for interior-grade panels.

Predominant types of regional cold waves in North China and their historical changes

寒潮事件对东亚地区的社会经济,生态系统和人体健康影响巨大.根据1980-2019年间10月至次年3月的每日寒潮记录和K-means聚类,本文识别出了中国两种不同类型的区域性寒潮(T1和T2). T1区域性寒潮主要影响东北地区,T2区域性寒潮则主要影响华北和东部地区.与T1区域性寒潮相比, T2区域性寒潮强度更强,持续时间更长,影响范围更广. 1980–2019年期间, T1区域性寒潮的频率显著增加,而T2区域性寒潮的频率则没有趋势变化. T1和T2区域性寒潮事件均与西伯利亚高压增强有关,然而与它们相关的对流层中层波列明显不同.在T1区域性寒潮事件发生期间,西伯利亚-蒙古上空出现负-正模态的500-hPa位势高度异常波列,削弱了东亚大槽,导致西伯利亚冷空气东移.T1区域寒潮频次增加趋势可能与全球变暖引起的500-hPa位势高度的线性趋势变化有关.与T2区域寒潮事件相关的波列则在乌拉尔山脉,蒙古和华北地区形成了脊-槽-脊环流异常,导致冷空气向东南方向入侵.本文得出结论,由于两类区域寒潮影响不同,西伯利亚高压增强和对流层中层波列模态在我国区域性寒潮事件的预报中应综合考虑.

糖尿病相关的足病的定义和标准(2023年更新版)

糖尿病相关的足病管理涉及多个学科,通用的专业词汇对于各学科间准确沟通交流至关重要。国际糖尿病足工作组(IWGDF)对相关文献进行了系统综述,构成了制定IWGDF指南的基础,并且明确了糖尿病相关的足病的一系列定义、标准及名词解释。本文介绍2023年IWGDF对这些定义和标准的更新,并建议在临床实践和研究中一致使用,以利于世界各地不同学科人员针对糖尿病相关的足病的专业性交流。

Step it up: Advancing physical activity research to promote healthy aging in China

1.Introduction China has been transforming.Since the late 1970s,China’s economy has increased many fold,the proportion of Chinese living in urban areas has more than doubled,life expectancy has increased by 10 years^1 and the country has transitioned from the'bicycle kingdom'to the world’s largest'auto market'.~2 As a result,China is now challenged by the'side effects'of eco-

The bold sedentary behavior recommendations in the new Canadian guidelines: are they evidence-based? Response to “Sedentary Behavior Research Network members support new Canadian 24-Hour Movement Guideline recommendations”

Dear editor,We read with interest the commentary by Mark Tremblay and colleagues,1 which outlines the new 24-Hour Canadian sedentary behavior guidelines.These guidelines take the perspective of a continuum across the 24-h day,providing a vehicle for discussing physically active time,sitting and other sedentary time,as well as healthy sleep duration.The commentary 1 focuses on the sedentary behavior(SB)recommendations in these guidelines:(1)limiting sedentary time to8 h per day,(2)limiting recreational screen time to3 h,and(3)breaking up long periods of sitting as often as possible throughout the day.Support for this perspective was evidenced by a survey of a sample(n=126,6% of total)of Sedentary Behavior Research Network(SBRN)members2 indicating broad acceptance of these SB recommendations.1 In this response,we put this survey in context and discuss the evidence base underpinning these 3 Canadian sedentary-behavior recommendations.

Characterization of Formacell Lignin Derived from Black Liquor as a Potential Green Additive for Advanced Biocomposites

Black liquor is obtained as a by-product of the pulping process,which is used to convert biomass into pulp by removing lignin,hemicelluloses and other extractives from wood to free cellulose fibers.Lignin represents a major constituent in black liquor,with quantities varying from 20%to 30%,of which a very low share is used for manufacturing value-added products,while the rest is mainly burned for energy purposes,thus underestimating its great potential as a raw material.Therefore,it is essential to establish new isolation and extraction methods to increase lignin valorization in the development of bio-based chemicals.The aim of this research work was to determine the effect of KOH or ethanol concentration as an isolation agent on lignin yields and the chemical characteristics of lignin isolated from formacell black liquor of oil palm empty fruit bunch(OPEFB).Isolation of lignin was carried out using KOH with various concentrations ranging from 5%to 15%(w/v).Ethanol was also used to precipitate lignin from black liquor at concentrations varying from 5%to 30%(v/v).The results obtained showed that the addition of KOH solution at 12.5%and 15%concentrations resulted in better lignin yield and chemical properties of lignin,i.e.,pH values of 3.86 and 4.27,lignin yield of 12.78%and 14.95%,methoxyl content of 11.33%and 10.13%,and lignin equivalent weights of 476.25 and 427.03,respectively.Due to its phenolic structure and rich functional groups that are favorable for modifications,lignin has the potential to be used as a green additive in the development of advanced biocomposite products in various applications to replace current fossil fuel-based material,ranging from fillers,fire retardants,formaldehyde scavengers,carbon fibers,aerogels,and wood adhesives.

膝关节疼痛与身体活动水平关系量性研究的范围综述

目的身体活动对于膝关节疼痛有缓解作用并且能够预防其他健康问题.然而,进行身体活动对于有膝关节疼痛的人极具有挑战性.理解膝关节疼痛是如何影响身体活动能够帮助降低这一类患病人群因为膝关节疼痛不敢参与身体活动而造成的负面影响.本文旨在对膝关节疼痛与身体活动水平之间的定量关系及其影响因素进行范围综述.方法依据PRISMA-ScR流程和Peter的方法学框架,在Medline、PsycINFO、CINAHL及Scopus数据库通过关键词进行检索.结果共纳入9篇文献.其中,1篇文献发现膝关节疼痛水平的增高会导致身体活动水平的增高;4篇文献研究发现膝关节疼痛与身体活动水平之间存在负相关;1篇文献发现膝关节疼痛水平的增高会带来中等强度的身体活动水平下降,但并不影响低强度的身体活动水平;3篇文献发现膝关节疼痛水平对身体活动水平并没有影响.同时,负面情绪的放大、疼痛相关的活动干扰和某些特定的日常活动会降低膝关节疼痛人群的身体活动水平.结论目前针对膝关节疼痛和身体活动的定量关系研究有限且结论不一致,需要后续进一步的探索.两者之间的关系同时会被心理因素及不同的身体活动强度和类型所影响.因此,在设计提高膝关节疼痛人群身体活动水平的干预措施时,应当综合考虑多种因素的共同作用,从而达到有效提高该人群的身体活动水平的目的.

Dose-dependent associations of joint aerobic and muscle-strengthening exercise with obesity:A cross-sectional study of 280,605 adults

Background:Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone,a combination of moderate-tovigorous physical activity(MVPA:brisk walking/jogging,cycling)and muscle-strengthening exercise(MSE:push-ups/sit-ups,using weight machines)has more favorable associations with optimal weight status.However,few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity.Methods:Based on cross-sectional analyses of the European Health Interview Survey Wave 2(2013-2014),we examined prevalence ratios(PRs)of joint and stratified associations between MVPA(4 categories:(ⅰ)0 min/week,(ⅱ)1-149 min/week,(ⅲ)150-299 min/week,and(ⅳ)≥300 min/week)and MSE(3 categories:(ⅰ)0 day/week,(ⅱ)1 day/week,and(ⅲ)>2 days/week)with body mass index-defined obesity(body mass index of>30.0 kg/m2)using Poisson regression with robust error variance.PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics(e.g.,sex,age,education,income,and smoking status).Results:Data were available for 280,456 adults(≥18 years),of which 46,166(15.5%)were obese.The interaction MVPA x MSE guideline adherence was statistically significant for obesity(p≤0.05).The joint MVPA-MSE analysis showed that compared to the reference group(i.e.,no MVPA and no MSE),the PRs followed a dose-dependent pattern,with the lowest observed among those reporting≥150 MVPA min/week and≥1 MSE days/week(PR:0.43;95%confidence interval:0.41-0.46).When stratified across each MVPA strata,the PRs were mostly lower among those engaging in MSE 1 day/week,as compared to those doing MSE≥2 days/week.Conclusion:"There was evidence for a dose-dependent association between joint MVPA-MSE with a reduced prevalence of obesity.Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.

Striatins and STRIPAK complex partners in clinical outcomes of patients with breast cancer and responses to drug treatment

Objective: Striatins(STRNs) family, which contains three multi-domain scaffolding proteins, are cornerstones of the striatins interacting phosphatase and kinase(STRIPAK) complex. Although the role of the STRIPAK complex in cancer has become recognized in recent years, its clinical significance in breast cancer has not been fully established.Methods: Using a freshly frozen breast cancer tissue cohort containing both cancerous and adjacent normal mammary tissues, we quantitatively evaluated the transcript-level expression of all members within the STRIPAK complex along with some key interacting and regulatory proteins of STRNs. The expression profile of each molecule and the integrated pattern of the complex members were assessed against the clinical-pathological factors of the patients. The Cancer Genome Atlas(TCGA) dataset was used to evaluate the breast cancer patients’ response to chemotherapies. Four human breast cancer cell lines, MDA-MB-231, MDA-MB-361, MCF-7, and SKBR-3, were subsequently adopted for in vitro work.Results: Here we found that high-level expressions of STRIP2, calmodulin, CCM3, MINK1 and SLMAP were respectively associated with shorter overall survival(OS) of patients. Although the similar pattern observed for STRN3, STRN4 and a contrary pattern observed for PPP2CA, PPP2CB and PPPR1A were not significant, the integrated expression profile of STRNs group and PPP2 group members constitutes a highly significant prognostic indicator for OS [P<0.001, hazard ratio(HR)=2.04, 95% confidence interval(95% CI), 1.36-3.07] and disease-free survival(DFS)(P=0.003, HR=1.40, 95% CI, 1.12-1.75). Reduced expression of STRN3 has an influence on the biological functions including adhesiveness and migration. In line with our clinical findings, the breast cancer cells responded to STRN3 knockdown with changes in their chemo-sensitivity, of which the response is also breast cancer subtype dependent.Conclusions: Our results suggest a possible role of the STRIPAK complex in breast cancer development and prognosis. Among the members, the expression profile of STRN3 presents a valuable factor for assessing patients’ responses to drug treatment.

Indonesian marine and its medicinal contribution

The archipelagic country of Indonesia is populated by the densest marine biodiversity in the world which has created strong global interest and is valued by both Indigenous and European settlements for different purposes.Nearly 1000 chemicals have been extracted and identified.In this review,a systematic data curation was employed to collate bioprospecting related manuscripts providing a comprehensive directory based on publications from 1988 to 2022.Findings with significant pharmacological activities are further discussed through a scoping data collection.This review discusses macroorganisms(Sponges,Ascidian,Gorgonians,Algae,Mangrove)and microorganism(Bacteria and Fungi)and highlights significant discoveries,including a potent microtubule stabilizer laulimalide from Hyattella sp.,a prospective doxorubicin complement papuamine alkaloid from Neopetrosia cf exigua,potent antiplasmodial manzamine A from Acanthostrongylophora ingens,the highly potent anti trypanosomal manadoperoxide B from Plakortis cfr.Simplex,mRNA translation disrupter hippuristanol from Briareum sp,and the anti-HIV-1(+)-8-hydroxymanzamine A isolated from Acanthostrongylophora sp.Further,some potent antibacterial extracts were also found from a limited biomass of bacteria cultures.Although there are currently no examples of commercial drugs from the Indonesian marine environment,this review shows the molecular diversity present and with the known understudied biodiversity,reveals great promise for future studies and outcomes.

Autoimmune hepatitis in human immunodeficiency virus-infected patients: A case series and review of the literature

BACKGROUND Abnormal liver chemistry is a common problem in human immunodeficiency virus (HIV)-infected patients. Common causes of abnormal liver enzymes in this population include viral hepatitis B/C or opportunistic infection, drug toxicity, and neoplasm. Autoimmune hepatitis is a rare cause of hepatitis in HIV-infected individuals;however, this condition has been increasingly reported over the past few years. CASE SUMMARY We present 13 HIV-infected patients (5 males and 8 females) who developed autoimmune hepatitis (AIH) after their immune status was restored, i.e. all patients had stable viral suppression with undetectable HIV viral loads, and median CD4+ counts of 557 cells/× 106 L. Eleven patients presented with chronic persistent elevation of aminotransferase enzyme levels. One patient presented with acute hepatitis and the other patient presented with jaundice. The median levels of aspartate aminotransferase and alanine aminotransferase enzymes were 178 and 177 U/mL, respectively. Elevation of immunoglobulin G levels was present in 11 (85%) patients. Antinuclear antibody and anti-smooth muscle antibody were positive in 11 (85%) and 5 (38%) patients. Liver biopsy was performed in all patients. They had histopathological findings compatible with AIH. The patients were started on prednisolone for remission induction, with good response. After improvement of the liver chemistry, the dose of prednisolone was tapered, and azathioprine was added as life-long maintenance therapy. At the last follow-up visit, all were doing well, without HIV viral rebound or infectious complications. CONCLUSION This report underscores the emergence of autoimmune hepatitis in the context of HIV infection.

Radiomics for predicting perineural invasion status in rectal cancer

BACKGROUND Perineural invasion(PNI),as a key pathological feature of tumor spread,has emerged as an independent prognostic factor in patients with rectal cancer(RC).The preoperative stratification of RC patients according to PNI status is beneficial for individualized treatment and improved prognosis.However,the preoperative evaluation of PNI status is still challenging.AIM To establish a radiomics model for evaluating PNI status preoperatively in RC patients.METHODS This retrospective study enrolled 303 RC patients in a single institution from March 2018 to October 2019.These patients were classified as the training cohort(n=242)and validation cohort(n=61)at a ratio of 8:2.A large number of intraand peritumoral radiomics features were extracted from portal venous phase images of computed tomography(CT).After deleting redundant features,we tested different feature selection(n=6)and machine-learning(n=14)methods to form 84 classifiers.The best performing classifier was then selected to establish Rad-score.Finally,the clinicoradiological model(combined model)was developed by combining Rad-score with clinical factors.These models for predicting PNI were compared using receiver operating characteristic curve(ROC)analysis and area under the ROC curve(AUC).RESULTS One hundred and forty-four of the 303 patients were eventually found to be PNIpositive.Clinical factors including CT-reported T stage(cT),N stage(cN),and carcinoembryonic antigen(CEA)level were independent risk factors for predicting PNI preoperatively.We established Rad-score by logistic regression analysis after selecting features with the L1-based method.The combined model was developed by combining Rad-score with cT,cN,and CEA.The combined model showed good performance to predict PNI status,with an AUC of 0.828[95%confidence interval(CI):0.774-0.873]in the training cohort and 0.801(95%CI:0.679-0.892)in the validation cohort.For comparison of the models,the combined model achieved a higher AUC than the clinical model(cT+cN+CEA)achieved(P<0.001 in the training cohort,and P=0.045 in the validation cohort).CONCLUSION The combined model incorporating Rad-score and clinical factors can provide an individualized evaluation of PNI status and help clinicians guide individualized treatment of RC patients.

国际糖尿病足工作组:糖尿病足溃疡减压指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

1999年,国际糖尿病足工作组(IWGDF)根据循证医学证据发表了采用减压治疗促进糖尿病足溃疡愈合的预防和管理指南,这一版指南是在此基础上的更新。我们遵循GRADE方法学,采用患者-干预-比较-结果(PICO)模式设计临床问题和关键的重要结局,对医学科学文献进行系统评价分析后撰写了建议并阐述其理由。这些建议是基于系统评价、专家意见(尚无有效证据时)的基础上建立,并在患者依从性、可行性、实用性以及干预的成本等方面进行了利弊权衡。针对糖尿病患者前足或中足底的溃疡愈合,我们建议不可拆卸齐膝高减压装置作为减压治疗的首选。若出现禁忌或患者不耐受不可拆卸减压装置,则可拆卸齐膝高和齐踝高减压装置可作为二线或三线减压治疗方法。合适的鞋袜结合泡沫毡垫可被视为四线减压治疗选择。如果非外科手术减压失败,我们建议通过外科减压干预以促进跖骨头和足趾溃疡愈合。我们还增加了采用减压治疗促进合并感染、缺血的复杂足溃疡和足跟溃疡愈合的新的推荐意见。减压是促进糖尿病神经性足底溃疡愈合诸多干预措施中最重要的手段。遵循这些建议将帮助医务人员和团队,为那些具有感染、住院和截肢风险的糖尿病足溃疡患者提供更好的治疗。

Screening of aptamers and their potential application in targeted diagnosis and therapy of liver cancer

Aptamers are a class of single oligonucleotide molecules(DNA or RNA)that are screened from random DNA or RNA oligonucleotide chain libraries by the systemic evolution of ligands by exponential enrichment technology.The selected aptamers are capable of specifically binding to different targeting molecules,which is achieved by the three-dimensional structure of aptamers.Aptamers are similar in function to monoclonal antibodies,and therefore,they are also referred to as"chemical antibodies".Due to their high affinity and specificity and low immunogenicity,aptamers are topics of intense interest in today's biological targeting research especially in tumor research.They not only have high potential for clinical advances in tumor targeting detection but also are highly promising as targeted tumor drug carriers for use in tumor therapy.Various experimental studies have shown that aptamer-based diagnostic and therapeutic methods for liver cancer have great potential for application.This paper summarizes the structure,characteristics,and screening methods of aptamers and reviews the recent research progress on nucleic acid aptamers in the targeted diagnosis and treatment of liver cancer.