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Giant esophageal leiomyoma usually requires a thoracotomy or thoracoscopic surgery, which is more invasive than an endoscopic treatment. The purpose of this study is to evaluate the efficacy and safety of piecemeal submucosal tunneling endoscopic resection (P-STER) for giant leiomyoma originating from the muscularis propria (MP) layer of the esophagus. This is a retrospective study. Patients with giant esophageal leiomyoma (transverse diameter ≥ 3 cm) who underwent P-STER were enrolled from November 2012 to May 2023. Clinical data and results were investigated. A total of 16 patients were enrolled for analysis. The lesion mean transverse diameter and longitudinal diameter were 4.22 ± 1.20 cm and 6.20 ± 1.57 cm, respectively. Our mean operation time was 195.38 ± 84.99 min. The mean number of piecemeal resected was 4.31 ± 2.36. An adverse event noted was an esophageal fistula that occurred in one case (6.25%) and was treated conservatively. The mean length of hospital stay was around 11.81 ± 7.30 days. The mean total hospitalization cost was U.S. dollars (USD) $5976.50 ± 2866.39. No recurrence or metastasis was found during the follow-up period. P-STER can be an effective and safe treatment for giant leiomyoma originating from the MP layer of the esophagus. [ABSTRACT FROM AUTHOR]

To address gaps in health services for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), a treatment cascade model was used to evaluate patient retention and attrition at each successive step required to achieve a successful treatment outcome. From 2015–2018, a four-step treatment cascade model was established in patients with confirmed MDR/RR-TB in southeast China. Step 1: diagnosis of MDR/RR-TB, step 2: Initiation of treatment, step 3: still under treatment at 6 month and step 4: cure or completion of MDR/RR-TB treatment, with each successive step including a gap that shows attrition of patients between steps. The retention and attrition of each step were graphed. Multi-variate logistic regression was carried out to further identify potential factors associated with the attrition. In the treatment cascade consisting of 1752 MDR/RR-TB patients, the overall patient attrition rate was 55.8% (978/1752), with 28.0% (491/1752), 19.9% (251/1261), and 23.4% (236/1010) of patients attrition in the first, second, and third gap. Factors associated with MDR/RR-TB patients not initiating treatment included age ≥60 years (OR:2.875), and time for diagnosis ≥30 days (OR: 2.653). Patients who were diagnosed with MDR/RR-TB through rapid molecular test (OR: 0.517) and non-migrant residents of Zhejiang Province (OR: 0.273) both exhibited a lower likelihood of attrition during the treatment initiation phase. Meanwhile, old age (OR: 2.190) and non-resident migrants to the province were factors associated with not completing ≥ 6 months of treatment. Old age (OR: 3.883), retreatment (OR: 1.440), and time to diagnosis ≥30 days (OR: 1.626) were factors contributing to poor treatment outcomes. Several programmatic gaps were identified in the MDR/RR-TB treatment cascade. Future policies should provide more comprehensive support for vulnerable populations to improve the care quality at each step. [ABSTRACT FROM AUTHOR]

Solid fuel combustion is widely recognized as a major cause of air pollution and consequently premature deaths, while the changes in health risks associated with switching from fossil fuel to clean energy for heating remains unclear. This study filled in this research gap by identifying whether clean residential heating helps to mitigate public health risks, which aspects of health risks could be mitigated, and who would benefit from such transition. The nonlinear DID estimates showed that individuals using gas/electricity for heating had a significantly better self-reported health status. Also a relatively lower average risk of chronic lung diseases (−1.4 %) and asthma (−1.3 %), but the lower risk of chronic lung diseases was observed only for the elderly (−2.8 %) and men (−3.0 %), while the reduction in the risk of asthma was observed only for middle-aged adults (−1.1 %) and women (−2.2 %). The changes in the risks of heart diseases and stroke were not significant as expected. The findings added two new insights into our previous knowledge about the health effects of HAP exposure from fuel combustion. First, the mitigation effect of clean heating on the risk of respiratory disease is more obvious than that of cardiovascular diseases. Second, the elderly and women do not seem to experience more health benefits from clean heating. [Display omitted] • Multi-health effects of China's clean heating project were assessed. • A reduced risk of chronic lung diseases and asthma was observed. • Also an increased probability of self-reported health status as good. • Changes in the risks of heart diseases and stroke were not significant as expected. • The elderly and women did not experience more health benefits from clean heating. [ABSTRACT FROM AUTHOR]

Current guidelines provide recommendation for transcatheter aortic-valve replacement (TAVR) in severe aortic stenosis without emphasis on valve systems. The comparative performances of balloon-expandable valves (BEV) and self-expanding valves (SEV) remain unclear. We aim to compare the early (30-day) and midterm (1-year) mortality and cardiovascular outcomes of BEV with SEV. PubMed, CENTRAL, and EMBASE were searched from inception to February 13, 2020 for randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Odds ratios (ORs) for binary outcomes and mean differences for continuous outcomes were pooled using random-effect models (DerSimonian–Laird method) with Hartung-Knapp-Sidik-Jonkman variance correction. Primary outcomes were early and midterm all-cause mortality. We included 3 RCTs (1418 patients) and 12 PSM studies (36,540 patients). Compared with SEV, BEV was associated with significantly lower mortality at 30 days (OR 0.76, 95% CI 0.67–0.85, p < 0.001, I2 = 0) and 1 year (OR 0.87, 95% CI 0.77–0.99, p = 0.04, I2 = 20.4%) in PSM studies, but not RCTs with insufficient power. Similar findings were found in subgroups analysis based on valve generations and SEV types. The 30-day and 1-year cardiovascular mortality, 30-day incidences of moderate to severe paravalvular leak, procedural contrast agent volume, and procedure time were lower, but transvalvular pressure gradient was higher in BEV than SEV in PSM studies. The 30-day incidences of permanent pacemaker implantation (PPI), acute kidney injury, stroke, major bleeding, major vascular complications, and rehospitalization were not statistically different between BEV and SEV. Early-generation SEV was associated with a higher 30-day PPI risk than corresponding BEV comparators. PPI risk was lower in ACURATE neo (Boston Scientific, Natick, MA) but higher in Evolut R SEV (Medtronic Inc., Minneapolis, MN), both compared with SAPIEN 3 BEV (Edwards Lifesciences, Irvine, CA). PSM studies suggest lower early and midterm mortality in BEV than SEV, but the contribution of unmeasured confounders cannot be excluded. Results from adequately powered RCTs with long-term follow-up are critically needed to confirm these findings. [Display omitted] • Balloon-expandable valve (BEV) transcatheter aortic-valve replacement might be associated with lower early and midterm total mortality than self-expanding valve (SEV) replacement. • Early moderate to severe paravalvular leak was lower with BEV than SEV. • Early incidence of stroke, permanent pacemaker implantation, acute kidney injury, and major bleeding were not different. [ABSTRACT FROM AUTHOR]

Modulating electrical and thermal transport through zero-dimensional point defects and one-dimensional dislocations are extensively investigated. However, the systematic study of exploring single-atom-layer vacancies for improving thermoelectric (TE) performance remains rare. In this study, we modulate the number density of single-atom-layer two-dimensional (2D) Te vacancies in lead telluride (PbTe) for the first time through bismuth and indium doping. DFT calculations reveal (Bi, In) co-doping lowers the formation energy of such defects, confirming the feasibility of this method. 2D Te vacancies simultaneously enhance phonon scattering and evoke bond softening, significantly lowering the lattice thermal conductivity. Meanwhile, indium doping generates resonant level in the energy band, which increases the carrier concentration without deteriorating the Seebeck coefficient drastically. As a result, a peak TE figure of merit (zT) of ∼1.6 and an average zT (zT avg) of 1.17 are achieved in the (Bi, In) co-doped PbTe. Furthermore, a high conversion efficiency of 6.5 % is obtained for the fabricated 2-pair module at a temperature difference of 500 K. [Display omitted] • Single-atom-layer 2D Te vacancies lead a significant reduction in κ l. • Bi and In doping in PbTe decreases the 2D vacancy formation energy. • The peak zT of the Pb 0.988 Bi 0.007 In 0.005 Te sample reaches about 1.6 at 723 K. • The conversion efficiency of the 2-pair thermoelectric module is 6.5% at a ΔT of 500 K. [ABSTRACT FROM AUTHOR]

[Display omitted] • Ultra-dry C/W foam reduced reservoir permeability and decreased its heterogeneity. • The ability of residual foam to plug cores was stable. • Parallel-core experiment and COMSOL simulation verified good plugging of the foam. For oil recovery in low-permeability oil fields, ultra-dry CO 2 foam flooding possesses the dual advantages of pure CO 2 flooding and surfactant flooding, and is also effective for CO 2 storage. Herein, ultra-dry CO 2 -in-water (C/W) foam with 10 v/v% water content was used for core plugging and to decrease the heterogeneity of oil reservoirs. The resistance coefficient (R f) and residual resistance coefficient (R ff) characterizing the foam-plugged cores were measured at different foam existence times (different times after forming the foam) and for cores with different permeabilities. As the foam existence time increased, the non-uniformity of the foam intensified, resulting in a decrease in its ability to plug cores. Specifically, the resistance coefficient (R f) decreased from 12.179 to 6.802, while the residual resistance coefficient (R ff) decreased from 7.149 to 3.809. With a decrease in the core permeability, R f decreased from 26.525 to 10.398, R ff decreased from 17.313 to 4.230, and the ability of the foam to plug cores decreased, indicating that the ultra-dry C/W foam could effectively plug the high-permeability layer and decreasing the reservoir heterogeneity. Based on the distribution of foam and pore size, three plugging mechanisms were proposed: single-bubble bridge, multi-bubble accumulation and foam compression, deformation and rupture. Additionally, a scale factor I (I = R ff / R f) was introduced to evaluate the stability of the residual foam in the plugged core. After different existence times, the value of I for the foam injected into the core was stable at 0.55–0.6, indicating good stability of the foam. Finally, oil recovery in parallel cores was evaluated and two-phase flow was simulated based on the phase-field method, which further proved that the ultra-dry C/W foam can effectively decrease the reservoir heterogeneity and enhance oil recovery in the low-permeability zone. [ABSTRACT FROM AUTHOR]