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Objective: In 2015, American Thyroid Association (ATA) issued the first version of Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. The purpose of this study is to evaluate whether the ATA pediatric guidelines recommended surgical approach for the patient can be applied to surgical treatment of pediatric PTC in China. Method: From April 2012 to December 2020, clinical data of children (≤18 years) with PTC consecutively admitted and treated with initial surgery in the study's department were retrospectively reviewed. Results: The authors found that the central lymph node metastasis (CLNM) rate was significantly higher than that in the lateral neck (83.33 % vs 62.96%, χ2 = 5.704, p = 0.017) .The lymph node metastasis rate was significantly lower in cN1b (-) patients than in cN1b (+) patient (55.00% vs 100.00%, χ2 = 15.263, p = 0.000); Meanwhile, the CLNM and LLNM rates of ipsilateral were significantly higher than those of contralateral central compartment (83.33༅vs 57.41༅%, χ2 = 8.704, p = 0.003). Lymph nodes of 51 lateral lymph node dissection (LND) were analyzed, which revealed the LNM rate of cN1b (-) patients was significantly lower than that of cN1b (+) patients (55.00% vs. 100.00%, χ2 = 15.263, p = 0.000). Conclusion: Children and adolescents have a higher rate of lymph node metastasis at the time of diagnosis. TT should be conducted in the majority of children with PTC. CND should be routinely performed; therapeutic LND is recommended for children with cN1b (+).

Human-scale greenery has been heavily featured in the development of planning-related theories and research. Daily exposure to street greenery is proportionately greater than exposure to parks. Several case studies have estimated the green view index (GVI), which quantifies daily exposure to street-side greenery, at the city-scale. However, the street-side greenery distribution is uneven. The relationship between the GVI and the surrounding environment has rarely been discussed. Here, we investigate the differentiation of street greenery from the physical features of a street and examine how the surrounding environment affects the physical appearance of eye-level greenery. In this work, we analyzed the GVI using the internet data crawling approach and obtained 12,232 panoramic street view images from Baidu Map for the urban zones of Hangzhou, China. A range of 17 surrounding environmental characteristics are integrated with multisource geographic data to analyze their relationship with the GVI at the microscale. Spatial econometric models are explored to provide insights into the underlying mechanisms associated with the GVI. The results showed that the surrounding environment exhibited a strong role in the physical appearance of eye-level greenness. There are two pathways through which surrounding environmental characteristics (the nature of land use and the enclosure of the street) affect the distribution of GVI. Four factors proved to be important: scenic protection policies and ecological renewal projects, vertical and horizontal green characteristics of different land uses, and facade designs dominated by enclosed exterior walls or railing walls. Interesting approaches are presented to rationally implement activities related to these factors. The urban green design process should be facilitated in terms of the trade-off between greenery and optimum land use. These findings can be useful in drafting appropriate policies and increasing eye-level greenery in cities.

Accurate quantification of grassland structural and functional traits is the foundation for grassland management and restoration. Light detection and ranging (lidar), especially the unmanned aerial vehicle (UAV) lidar, has been recognized as an accurate and effective technique for local to regional-scale vegetation structural and functional traits estimation. However, in grassland ecosystems, it is more likely to be influenced by UAV lidar information loss caused by dense vegetation canopies. In this study, we investigated how UAV lidar information loss may occur and how it may influence the estimation accuracy of grassland structural and functional traits by comparing it with terrestrial laser scanning (TLS) and field measurements in a meadow steppe of northern China. Five structural traits (i.e., mean vegetation height, maximum vegetation height, standard deviation of vegetation height, canopy cover, and canopy volume) and one functional trait (i.e., aboveground biomass) were estimated from the UAV lidar data and TLS data for evaluation. The results showed that TLS-derived structural and functional traits had a much higher accuracy than UAV lidar-derived traits. By comparing with TLS data, we found that UAV lidar data had a much more prevailing information loss at canopy tops than at canopy bottoms. The average height loss of UAV lidar at canopy tops reached over 0.30 m, and the average relative height loss reached over 49%, comparing to a value of 0.03 m and 6% at canopy bottoms. Maximum vegetation height, standard deviation, and the distance from the UAV lidar system to the ground were the three most influential factors on UAV lidar information loss at canopy tops, indicating the commonly seen sharp canopy tops of grasslands were prone to be missed by the UAV lidar system. UAV lidar information loss at canopy tops had a much stronger influence on the estimation accuracy of grassland structural and functional traits than that at canopy bottoms. With the decrease of information loss at canopy tops, UAV lidar can be used to extract grassland structural and functional traits with a comparable accuracy to TLS. Among the five grassland traits, aboveground biomass was the least influenced by UAV lidar information loss. This study is a very first evaluation on the UAV lidar information loss in grassland ecosystems and its influence on grassland structural and functional trait estimation, which can provide guidance for UAV lidar data collection and processing in future grassland applications.

Background: We compared the efficacy, safety, and immunogenicity of MIL60 with reference bevacizumab as first-line treatment in patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC) in this phase 3, randomized, double-blind study. Methods: Patients with untreated advanced or recurrent NSCLC were randomized (1:1 ratio) to receive either MIL60 or bevacizumab in combination with paclitaxel/carboplatin. Patients with non-progressive disease continued maintenance single-agent MIL60 until disease progression, or intolerable toxicity. The primary endpoint was the 12-week objective response rates (ORR12) by independent review committee (IRC) using RECIST 1.1. Bioequivalence was established if the ORR ratio located between 0.75 and 1/0.75. The trial was registered with clinicaltrials.gov (NCT03196986). Findings: Between Aug 23, 2017, and May 8, 2019, 517 patients were randomly assigned to MIL60 group (n=257) and bevacizumab group (n=260). In the full analysis set (FAS) population including all randomized and evaluable patients who received at least one dose of MIL60 or bevacizumab, the ORR12 in MIL60 group and bevacizumab group were 48.6% and 43.1%, respectively. The ORR ratio of these two groups were 1.14 (90% CI 0.97-1.33), which fell within the pre-specified equivalence boundaries (0.75-1/0.75). The median DOR was 5.7 months (95% CI 4.5-6.2) for MIL60 and 5.6 months (95% CI 4.3-6.4) for bevacizumab. No significant difference was noted in median PFS (7.2 vs. 8.1 months; HR 1.01, 95% CI 0.78-1.30, p=0.9606) and OS (19.3 vs. 16.3 months; HR 0.81, 95% CI 0.64-1.02, p=0.0755). Safety and tolerability profiles were similar between the two groups. No patient detected positive for Anti-drug antibody (ADA). Interpretation: The efficacy, safety and immunogenicity of MIL60 were similar with bevacizumab, providing an alternative treatment option for advanced or recurrent non-squamous NSCLC. Funding: This study was sponsored by Betta Pharmaceutical Co., Ltd.

The mangrove forests of northeast Hainan Island are the most species diverse forests in China and consist of the Dongzhai National Nature Reserve and the Qinglan Provincial Nature Reserve. The former reserve is the first Chinese national nature reserve for mangroves and the latter has the most abundant mangrove species in China. However, to date the aboveground ground biomass (AGB) of this mangrove region has not been quantified due to the high species diversity and the difficulty of extensive field sampling in mangrove habitat. Although three-dimensional point clouds can capture the forest vertical structure, their application to large areas is hindered by the logistics, costs and data volumes involved. To fill the gap and address this issue, this study proposed a novel upscaling method for mangrove AGB estimation using field plots, UAV-LiDAR strip data and Sentinel-2 imagery (named G∼LiDAR∼S2 model) based on a point-line-polygon framework. In this model, the partial-coverage UAV-LiDAR data were used as a linear bridge to link ground measurements to the wall-to-wall coverage Sentinel-2 data. The results showed that northeast Hainan Island has a total mangrove AGB of 312,806.29 Mg with a mean AGB of 119.26 Mg ha−1. The results also indicated that at the regional scale, the proposed UAV-LiDAR linear bridge method (i.e., G∼LiDAR∼S2 model) performed better than the traditional approach, which directly relates field plots to Sentinel-2 data (named the G∼S2 model) (R2 = 0.62 > 0.52, RMSE = 50.36 Mg ha−1

Objectives: The guidelines recommend fractional flow reserve-guided coronary artery bypass grafting (CABG) during primary valve surgery without evidence. Quantitative flow ratio (QFR) is a novel coronary angiography (CAG)-based fractional flow reserve measurement. We aimed to compare the early clinical outcomes between QFR-guided and CAG-guided CABG in these patients. Methods: This observational study screened all 2081 patients admitted to our institution for elective primary mitral and/or aortic valve surgery from January 2017 to September 2020. Of them, all 188 patients with comorbid coronary artery lesions (visual estimated stenosis ≥50%) were included. Sixty-nine patients with QFR analysis received bypasses only for lesions with QFR ≤0.80 (QFR-guided group). The remaining 119 patients without QFR analysis received bypasses for all stenosis ≥50% (CAG-guided group). Propensity overlap weighting was used to neutralize the intergroup imbalance. The primary end point was major adverse cardiovascular events. Results: After propensity score weighting, the baseline characteristics were comparable. Concomitant coronary artery bypass grafting was performed 58.1% versus 100% in the QFR-guided and CAG-guided groups, respectively. The mean number of grafts was significantly lower in QFR-guided group than in the CAG-guided group (0.9 ± 0.7 vs 1.6 ± 0.5 [P

The healthy benefits of milk fat globules and membrane (MFGs/MFGM) ingredients are increasingly recognized in the dairy industry. In this research, we examined the effects of ultrasonic treatment on the physicochemical and rheological properties, as well as the emulsions stability of MFGs/MFGM derived from bovine raw milk. Fresh milk was subjected to sonication at frequencies of 20 kHz and 40 kHz, either individually or simultaneously, for durations of 5 min or 15 min, using work/rest cycles of 5 s on and 3 s off. Bovine milk, without any treatment, served as the control. Regardless of the intensity difference, ultrasonic treatment for 5 min resulted in more pronounced changes in the regions of Amide Ⅱ (1600–1500 cm−1), Amide Ⅲ (1500–1200 cm−1), and fingerprint region (1200–1900 cm−1) compared to both the 15 min treatments and control MFGs/MFGM. Principal component analysis (PCA) conducted on the entire spectra, as well as in the regions of Amide Ⅰ, Amide Ⅱ, and the fingerprint spectra, clustered the 5 min treatment distinctly from the control and MFGs/MFGM ultrasonically treated for 15 min. MFGs/MFGM samples following 20 kHz and 40 kHz synchronous treatment for 15 min exhibited lower absorbance bands at 1727–1726 cm−1, whereas a higher content at 1740 cm−1 was observed compared to control MFGs/MFGM. Additionally, a more significant reduction in the intramolecular β-sheet content in 20 + 40 kHz/ 15 min treatment was observed. According to the sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) patterns, a diminished intensity of Periodic Acid Schiff 6/7 (PAS 6/7) bands was observed across all the MFGs/MFGM. Ultrasonic treatment retained more caseins while reducing the β –LG levels compared to the controls, enhancing the stability of MFGs/MFGM, except in MFGs/ MFGM subjected to 20 and 40 kHz simultaneously treated for 15 min. The irregular sphericity of fat globules was noted particularly in MFGs/MFGM treated at 20 kHz independently or in combination with 40 kHz for 15 min. According to the confocal laser scanning microscopy (CLSM), ultrasonic treatment facilitated the binding of caseins or whey proteins to the MFGs surface and induced flocculation of membrane proteins. Hierarchical cluster analysis (HCA) heat map further underscored the impact of ultrasonic treatments on the structural and compositional changes, as well as rheology and emulsions stability, of MFGs/MFGM.

Background: Prosocial behavior is essential for effective patient communication and building a positive doctor-patient relationship in medical students. Research on the factors influencing prosocial behavior in medical students is limited. This research aims to examine how perceived social support influences prosocial behavior among medical students, focusing on the mediating role of empathy and the moderating role of moral identity. Methods: This cross-sectional study included 2425 medical students from central and southern Jiangsu province. Participants were assessed using the Prosocial Behavior Scale, Interpersonal Response Index Scale, Moral Identity Scale, and Perceived Social Support Scale, with data collected through via an online questionnaire. SPSS PROCESS macro model 4.1 was used to examine the mediating effect and the moderating effect. Results: Perceived social support showed a significant positive correlation with prosocial behavior among medical students. The indirect effects of perceived social support on prosocial behavior through perspective taking (βindirect = 0.11, 95% Boot CI [0.09, 0.13]) and empathic concern (βindirect = 0.08, 95% Boot CI [0.06, 0.10]) confirmed the mediating roles of these variables, accounting for 32.05% and 23.82% of the total effect, respectively. However, personal distress did not mediate this relationship (βindirect = −0.004, 95% Boot CI [−0.01, 0.005]). Moral identity significantly moderated the effect of perceived social support on perspective taking (β = 0.05, p

Background: According to statistics, ovarian cancer (OV) is the most prevalent type of gynecologic malignancy and has the highest mortality rate of all gynecologic tumors. Although several studies have shown that oxidative stress (OS) contributes significantly to the onset and progression of cancer, the role of OS in OV needs to be investigated further. Thus, it is critical to comprehend the function of OS-related genes in OV. Methods: In this study, all data related to the transcriptome and clinical status of the patients were retrieved from “The Cancer Genome Atlas” (TCGA) and “Gene Expression Omnibus” (GEO) databases. Using the unsupervised cluster analysis technique, all patients with OV were classified into two different subtypes (categories) based on the OS gene. All hub genes were screened using the weighted gene co-expression network analysis (WGCNA). Since the hub genes and the differentially expressed genes (DEGs) in both categories were found to intersect, the univariate Cox regression analysis was implemented. A multivariate Cox analysis was also performed to construct a novel clinical prognosis model, which was validated using data from the GEO cohort. In addition, the relationship between risk score and immune cell infiltration level was evaluated using CIBERSORT. Finally, qRT-PCR was used to confirm the expression of the genes used to construct the model. Results: Two subtypes of OS were obtained. The findings indicated that OS-C1 had a better survival outcome than OS-C2. The results of WGCNA yielded 112 hub genes. For univariate COX regression analyses, 49 OS-related trait genes were obtained. Finally, a clinical prognostic model containing two genes was constructed. This model could differentiate between patients with OV having varying years of survival in the TCGA and GEO cohorts. The model risk score was verified as an independent prognostic indicator. According to the results of CIBERSORT, many tumor-infiltrating immune cells were found to be significantly related to the risk score. Furthermore, the results revealed that patients with low-risk OV in the CTLA4 treatment group had a high likelihood of benefiting from immunotherapy. qRT-PCR results also showed that the expression of MARVELD1 and VSIG4 was high in the OV samples. Conclusions: Analysis of the results suggested that the newly developed model, which contained two characteristic OS-related genes, could successfully predict the survival outcomes of all patients with OV. The findings of this study could offer valuable information and insights into the refinement of personalized therapy and immunotherapy for OV in the future.

Milk fat globules or milk fat globule membranes (MFGs/MFGM) have been added to the infant formula to fortify the phospholipids and narrow the nutritional gap from breast milk. The main aim of this study was to profile the interfacial and thermal properties of MFGs/MFGM prepared from ultrasonicated bovine milk. Bovine milk was sonicated at ultrasonic intensities of 20 kHz and 40 kHz independently or synchronously with the duration time of 0 min (control), 5 min, 10 min, and 15 min (work/rest cycles = 5 s: 3 s). Ultrasonic treatments at 20 kHz/ 5 min and 20 + 40 kHz/ 5 min improved the volume density (%) of smaller particles (1–10 µm) while significantly decreasing the surface hydrophobicity (H0) (p 0.05). X-ray diffraction (XRD) results showed that α-crystal peaks only existed in control and ultrasonicated 5 min samples but disappeared in all 15 min samples. According to the different scanning calorimetry (DSC), one or two new exothermic events (in the range of 17.29 – 18.81 ℃ and 22.14 – 25.21 ℃) appeared after ultrasonic treatments, which, however, were not found in control samples. Ultrasonic treatments resulted in the low-melting fractions (LMF) (TM1) peaks undetectable in MFGs/MFGM samples in which only peaks of medium-melting fractions (MMF) (TM2) and high-melting fractions (HMF) (TM3) were detected. Compared with the control, both enthalpies of crystallisation (ΔHC) and melting (ΔHM) decreased in ultrasonicated samples. In conclusion, ultrasonic treatment affects the interfacial and thermal properties of MFGs/MFGM.

We describe the clinical and therapeutic course of a 63-year-old patient with a sudden onset of acute herpes zoster on the left side of head, face and eye. The patient was hospitalized for 5 days after the onset of persistent needling pain and severe swelling of the left eye and was treated with cryogenic radiofrequency plasma ablation to alleviate clinical symptoms. After the CT-guided minimally invasive surgical treatment, the pain was relieved obviously and the local skin herpes subsided quickly. This is the first case report of CT-guided cryo-plasma technique for acute trigeminal zoster. This case illustrates that the method invented by our center can quickly relieve trigeminal herpes zoster, reduce the incidence of postherpetic trigeminal neuralgia and ocular sequelae.

The anterior portion of the bed nucleus of the stria terminalis (BNST) modulates fear and stress responses. The anterodorsal BNST (adBNST) can be anatomically subdivided further into the lateral and medial divisions. Although output projections of BNST subregions have been studied, the local and global input connections to these subregions remain poorly understood. To further understand BNST-centered circuit operations, we have applied new viral-genetic tracing and functional circuit mapping to determine detailed synaptic circuit inputs to lateral and medial subregions of adBNST in the mouse. Monosynaptic canine adenovirus type 2 (CAV2) and rabies virus-based retrograde tracers were injected in the adBNST subregions. The amygdalar complex, hypothalamus and hippocampal formation account for the majority of overall inputs to adBNST. However, lateral versus medial adBNST subregions have distinct patterns of long-range cortical and limbic brain inputs. The lateral adBNST has more input connections from prefrontal (prelimbic, infralimbic, cingulate) and insular cortices, anterior thalamus and ectorhinal/perirhinal cortices. In contrast, the medial adBNST received biased inputs from the medial amygdala, lateral septum, hypothalamus nuclei and ventral subiculum. We confirmed long-range functional inputs from the amydalohippocampal area and basolateral amygdala to the adBNST using ChR2-assisted circuit mapping. Selected novel BNST inputs are also validated with the AAV axonal tracing data from the Allen Institute Mouse Brain Connectivity Atlas. Together, these results provide a comprehensive map of the differential afferent inputs to lateral and medial adBNST subregions, and offer new insight into the functional operations of BNST circuitry for stress and anxiety-related behaviors.

An unreported polysaccharide, PLP90-1B, was isolated from Paeonia lactiflora. Structural analysis showed that PLP90-1B contained arabinose and glucose, which was a highly-linear gluco-arabinan having a molecular weight of about 9.5 kDa. The backbone of PLP90-1B consisted of → 5)-α-l-Araf-(1→, →3,5)-α-l-Araf-(1→, →2,3,5)-α-l-Araf-(1→, and → 4)-α-d-Glcp-(1→, terminating with α-l-Araf. PLP90-1B was found to have anti-tumor activity by suppressing the proliferation and migration of HepG2 cells microinjected into the zebrafish. The further mechanism investigation revealed that the anti-tumor activity of PLP90-1B was closely related to immune regulation, which can improve phagocytic ability and enhance the release of NO and cytokines (IL-6, IL-1β, and TNF-α) in RAW264.7 cells. The immunopotentiation activity was further corroborated by zebrafish experiments. All these results exhibited that PLP90-1B may have the potential to become a potentially immune-mediated anti-tumor drug in the future.

In this investigation, the friction stir processing (FSP) method was utilized to improve the properties of the surface of the as-cast nickel aluminum bronze (NAB) alloy in two different processing parameters. The microstructure, element distribution and mechanical properties of the alloys before and after FSP were observed and estimated. The cavitation erosion behaviors of the original NAB and FSP NAB in different test solutions were also discussed. The results indicated that the microstructure became finer and more homogeneous and the element distribution became more uniform after FSP. The FSP NAB alloys also possessed better mechanical properties. The lower cumulative cavitation erosion mass loss of FSP NAB in all test solutions indicated the fact that the cavitation erosion resistance of the as-cast NAB could also be improved by the FSP method. Compared to the as-cast NAB, the corrosion effect on the cavitation erosion was more significant for the FSP NAB alloys owing to their better pure cavitation erosion resistance.

We developed and applied a Cre-dependent, genetically modified rabies-based tracing system to map direct synaptic connections to specific CA1 neuron types in the mouse hippocampus. We found common inputs to excitatory and inhibitory CA1 neurons from CA3, CA2, the entorhinal cortex (EC), the medial septum (MS), and, unexpectedly, the subiculum. Excitatory CA1 neurons receive inputs from both cholinergic and GABAergic MS neurons, whereas inhibitory neurons receive a great majority of inputs from GABAergic MS neurons. Both cell types also receive weaker input from glutamatergic MS neurons. Comparisons of inputs to CA1 PV+ interneurons versus SOM+ interneurons showed similar strengths of input from the subiculum, but PV+ interneurons received much stronger input than SOM+ neurons from CA3, the EC, and the MS. Thus, rabies tracing identifies hippocampal circuit connections and maps how the different input sources to CA1 are distributed with different strengths on each of its constituent cell types.

A batch mode, pilot-scale process, involving ultrasound pretreatment (USP), enzymolysis, membrane filtration and drying was investigated for the production of angiotensin converting enzyme (ACE) inhibitory and antioxidative peptides from milk protein concentrate (MPC). The MPC solutions (2% or 5% protein) were hydrolyzed for 2 h with Neutrase at enzyme-to-substrate ratio of 1:50 (w/w) in 50 L batches after USP for 4 min at 800 W. Ultrafiltration (8 and 3.5 kDa membranes) and nanofiltration (0.2 kDa membrane) were done to produce 4 fractions (F1, >8 kDa; F2, 3.5–8 kDa; F3, 0.2–3.5 kDa; and F4,