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Aim: A nomogram was constructed to forecast the overall survival (OS) of patients with mycosis fungoides/Sezary syndrome. Patients & methods: The clinicopathological information of patients was obtained from the Surveillance, Epidemiology and End Results (SEER) database. A model was established based on the independent prognostic factors. Predictive ability of the model was evaluated with the concordance index and calibration curves. Risk stratification was conducted for patients with similar tumor node metastasis (TNM) stages. Results: The model included 1997 eligible patients and seven prognostic factors for OS. The concordance index of the nomogram was 0.84 in the training and external validation cohorts, which indicated good predictive ability of the model and reliability of the results. The high agreement between the model predictions and actual observations was identified by calibration curves, which demonstrated the prediction accuracy of the model. Risk stratification displayed significant differences for patients with similar TNM stages, which suggested that the OS of patients with similar TNM stages could be further distinguished. Conclusion: We established a reliable nomogram to predict the OS of patients with mycosis fungoides/Sezary syndrome, which highlighted the advantages of nomograms over the conventional TNM staging system and promoted the application of individualized therapeutic strategies.

Background: The purpose of this study was to evaluate the trends in adult spinal cases performed by E-Da hospital graduating neurological surgery residents, then comparing the case volumes against the national means in the US. Materials and Methods: The E-Da surgical case volumes were extracted using the hospital billing system for the years 2008–2017. These logs were coded according to the Accreditation Council for Graduate Medical Education guideline, providing a fair comparison against US national means. Linear regression analyses were conducted to identify changes in spinal categories. Finally, an unpaired student t-test was performed to compare E-Da case volumes to America's national means. Results: An average of 781.5 total spinal procedures were performed in the past 4 years of residency training for each of the four graduated E-Da neurosurgical residents, with the individual total caseload increasing by 38.07 cases each year (r2 = 0.40). The US national average was 427.72 spinal procedures for each of the 877 graduating residents, increasing by 19.96 cases every year (r2 = 0.95). E-Da has significantly more thoracic/lumbar instrumentation fusion procedures (mean 486.00 ± 90.27) and anterior cervical approach for decompression/stabilization and fusion procedures (mean 182.75 ± 42.91) than the US (means 145.95 ± 3.07 and 72.66 ± 4.62, respectively). The US has significantly more lumbar discectomy procedures (mean 125.70 ± 2.89), posterior cervical approach for decompression/stabilization and fusion procedures (mean 56.98 ± 3.73) and peripheral nerve procedures (mean 26.2 ± 0.79) than E-Da (means 64.5 ± 8.54, 39.75 ± 4.99, and 8.50 ± 5.07, respectively). Conclusion: Neurosurgical residents' surgical case exposures to different spinal categories were very different in E-Da and the US. Case entry logs provide valuable information nationally and internationally.

BACKGROUND Currently, various retractor systems are widely used for access to the lumbar spine in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Nevertheless, studies concerning the comparison of extensible retractor and inextensible tube systems are quite rare. OBJECTIVES This article was to compare perioperative characteristics, clinical outcomes, and multifidus muscle injury of obconic inextensible tube versus extensible retractor system for single-level MIS-TLIF. STUDY DESIGN A prospective observational study on 91 patients with a mean follow-up of 20.0 ± 4.1 months. SETTING This study was conducted by a university-affiliated hospital in a major Chinese city. METHODS From April 2015 to May 2016, 91 consecutive patients who underwent MIS-TLIF procedure using an obconic inextensible endoscopic tube or extensible retractor system were enrolled in this study. Operation parameters such as incision length, blood loss, postoperative drainage volume, surgical time, analgesic use rate, time to ambulation, and postoperative hospitalization days were evaluated. The concentration of white blood cells, interleukin-6, interleukin-8, tumor necrosis factor alpha, and creatine phosphokinase (CPK)-MM of the enrolled patients were measured for postoperative traumatic stress and muscle injury. Multifidus muscle edema and atrophy were evaluated by T2-weighted magnetic resonance imaging (MRI) at 3 different time points (preoperative, postoperative, and 1-year follow-up). Clinical outcomes such as Visual Analog Scale (VAS) score, Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI) score, fusion rates, and MacNab criteria were assessed for patients' symptoms. RESULTS In terms of baseline characteristics, the 2 groups were similar regarding sample size, gender, age, symptoms duration, operation level, body mass index, physical examination, and all the clinical outcomes measures (P > 0.05). Perioperative analysis showed that the inextensible group had comparative incision length, blood loss, operation time, time to ambulation, and postoperative hospitalization (P > 0.05). The inextensible tubular group had less postoperative drainage volume and analgesic use rate (P < 0.05). The concentration level of CPK-MM and c-reactive protein (CRP) was lower in the inextensible tubular group compared with the extensible retractor group.No significant difference was found between the 2 groups regarding MRI T2 signal intensity ratio of multifidus muscle at the immediate postoperative period. The MRI T2 signal intensity ratio of multifidus muscle was lower in the inextensible tubular group than the extensible retractor group at the 1-year follow-up period. The VAS scores for low back pain and leg pain improved significantly in both groups after surgery, as did the JOA and ODI scores. However, there were no significant differences between the 2 groups regarding the preoperative and final follow-up VAS, JOA, and ODI scores, fusion rates, and the distribution of the MacNab criteria. LIMITATIONS This was not a randomized controlled trail, which could provide more evidence-based medicine conclusions. CONCLUSIONS The obconic inextensible endoscopic tube system via the transforaminal approach for lumbar interbody fusion is a safe and sufficient technique. When compared with the extensible retractor system, it has comparable clinical outcomes, with additional significant benefits of less postoperative drainage volume and analgesic use rate, less multifidus muscle injury in terms of lower CPK-MM levels at immediate postoperative period, less change in CRP, and less change in MRI T2 signal intensity ratio of multifidus muscles at 1-year follow-up. KEY WORDS Minimally invasive, endoscopic, lumbar interbody fusion, tubular, multifidus muscle.

Introduction Tendon diseases and injuries are a serious problem for the aged population, often leading to pain, disability and a significant decline in quality of life. The purpose of this study was to determine the influence of aging on biochemistry and histology during tendon healing and to provide a new strategy for improving tendon healing. Method A total of 24 Sprague-Dawley rats were equally divided into a young and an aged group. A rat patellar tendon defect model was used in this study. Tendon samples were collected at weeks 2 and 4, and hematoxylin-eosin, alcian blue and immunofluorescence staining were performed for histological analysis. Meanwhile, reverse transcription-polymerase chain reaction (RT-PCR) and western blot were performed to evaluate the biochemical changes. Results The histological scores in aged rats were significantly lower than those in young rats. At the protein level, collagen synthesis-related markers Col-3, Matrix metalloproteinase-1 and Metallopeptidase Inhibitor 1(TIMP-1) were decreased at week 4 in aged rats compared with those of young rats. Though there was a decrease in the expression of the chondrogenic marker aggrecan at the protein level in aged tendon, the Micro-CT results from weeks 4 samples showed no significant difference(p>0.05) on the ectopic ossification between groups. Moreover, we found more adipocytes accumulated in the aged tendon defect with the Oil Red O staining and at the gene and protein levels the markers related to adipogenic differentiation. Conclusions Our findings indicate that tendon healing is impaired in aged rats and is characterized by a significantly lower histological score, decreased collagen synthesis and more adipocyte accumulation in patellar tendon after repair.

Background: Triple-negative breast cancer (TNBC) is an aggressive disease. Nomograms can predict prognosis of patients with TNBC. Methods: A total of 745 eligible TNBC patients were recruited and randomly divided into training and validation groups. Endpoints were disease-free survival and overall survival. Concordance index, area under the curve and calibration curves were used to analyze the predictive accuracy and discriminative ability of nomograms. Results: Based on the training cohort, neutrophil-to-lymphocyte ratio, positive lymph nodes, tumor size and tumor-infiltrating lymphocytes were used to construct a nomogram for disease-free survival. In addition, age was added to the overall survival nomogram. Conclusion: The current study developed and validated well-calibrated nomograms for predicting disease-free survival and overall survival in patients with TNBC.

Background Tendon stem/progenitor cells (TSPCs) play a vital role in tendon repair and regeneration. Previously we found more adipocytes accumulated in the patellar tendon injury sites in aging rats compared with the young ones, of which the mechanism is still unknown. Here, we want to identify whether erroneous differentiation of TSPCs by aging accounts for the adipocyte accumulation. Methods TSPCs from young and aging rats were isolated and propagated. Both young and aging TSPCs were induced to differentiate into adipocytes, and Oil red O staining, quantitative real-time polymerase chain reaction (qRT-PCR), western-blot and immunofluorescent staining were used to evaluate the capability of TSPCs. RNA sequencing was utilized to screen out different genes and signaling pathways related to adipogenesis between young and aging TSPCs. Results The Oil red O staining showed there were more adipocytes formed in young TSPCs. Besides, adipogenic markers perilipin, peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding proteins alpha (C/EBPα) and Fatty acid-binding protein 4 (FABP4) were elevated both at gene and protein level. PPARγ signaling pathway was selected as our target via RNA sequencing. After adding the signaling activators, Rosiglitazone maleate (RM), inhibited adipogenesis of aging TSCs was reversed. Conclusions In conclusion, aging inhibited adipogenesis of TSPCs by down‐regulating PPARγ signaling. It is not likely that the adipocyte accumulation in aging tendon during repair was due to the aging of TSPCs. This may provide new targets for curing aging tendon injuries or tendinopathies.

Multi-Camera multi-target tracking is essential in the research field of urban intelligence traffic. It shows that the task becomes challenging due to differences of illumination, angle, and occlusion under different cameras. In this paper, we propose an efficient multi-camera vehicle tracking system, which contains a model trained with multi-loss to extract appearance features, and a filter with spatial-temporal information between cameras. The proposed system includes three parts. Firstly, we generate tracklets in a single-camera with different views by vehicle detection and multi-target tracking. Secondly, we extract the appearance feature of each tracklet through the trained vehicle ReID model. Thirdly, we innovatively propose a matching strategy that calculates several factors, the similarity of appearance features, the time information, and the space information of target ID between adjacent cameras. The proposed system ranks the sixth place in the City-Scale Multi-Camera Vehicle Tracking of AI City 2021 Challenge (Track 3) with a score of 0.5763.

Extensive urbanization around the world has caused a great loss of farmland, which significantly impacts the ecosystem services provided by farmland. This study investigated the farmland loss due to urbanization in the Guangdong–Hong Kong–Macao Greater Bay Area (GBA) of China from 1980 to 2018 based on multiperiod datasets from the Land Use and Land Cover of China databases. Then, we calculated ecosystem service values (ESVs) of farmland using valuation methods to estimate the ecosystem service variations caused by urbanization in the study area. The results showed that 3711.3 km2 of farmland disappeared because of urbanization, and paddy fields suffered much higher losses than dry farmland. Most of the farmland was converted to urban residential land from 1980 to 2018. In the past 38 years, the ESV of farmland decreased by 5036.7 million yuan due to urbanization, with the highest loss of 2177.5 million yuan from 2000–2010. The hydrological regulation, food production and gas regulation of farmland decreased the most due to urbanization. The top five cities that had the largest total ESV loss of farmland caused by urbanization were Guangzhou, Dongguan, Foshan, Shenzhen and Huizhou. This study revealed that urbanization has increasingly become the dominant reason for farmland loss in the GBA. Our study suggests that governments should increase the construction of ecological cities and attractive countryside to protect farmland and improve the regional ESV.

Background: Phyllodes tumor is rare accounting for Case presentation: This case report presents a 34-year-old woman suffered from metastases to the femur the lung and bilateral axillas from a malignant phyllodes tumor in 9 years. The most recent recurrence was discovered on bilateral axillas. The patient accepted adjuvant chemotherapy. However, because no obvious benefit of chemotherapy was found, the patient received bilateral axillary lymph node dissection finally. Genetic testing after surgery showed tumor-specific mutations and mutations about thepolymorphism of drug metabolism-related enzymes. Conclusions: The primary treatment modality for phyllodes tumor is surgery. For metastases, adjuvant chemotherapy may be efficient. However, when the effect of chemotherapy is not obvious, aggressive surgical therapies should be performed. Besides, genetic testing can provide advices on effective treatments.

Tendon injuries are common musculoskeletal system disorders in clinical, but the regeneration ability of tendon is limited. Tendon stem cells (TSCs) have shown promising effect on tissue engineering and been used for the treatment of tendon injury. Exosomes that serve as genetic information carriers have been implicated in many diseases and physiological processes, but effect of exosomes from TSCs on tendon injury repair is unclear. The aim of this study is to make clear that the effect of exosomes from TSCs on tendon injury healing. Exosomes were harvested from conditioned culture media of TSCs by a sequential centrifugation process. Rat Achilles tendon tendinopathy model was established by collagenase‐I injection. This was followed by intra‐Achilles‐tendon injection with TSCs or exosomes. Tendon healing and matrix degradation were evaluated by histology analysis and biomechanical test at the post‐injury 5 weeks. In vitro, TSCs treated with interleukin 1 beta were added by conditioned medium including exosomes or not, or by exosomes or not. Tendon matrix related markers and tenogenesis related markers were measured by immunostaining and western blot. We found that TSCs injection and exosomes injection significantly decreased matrix metalloproteinases (MMP)‐3 expression, increased expression of tissue inhibitor of metalloproteinase‐3 (TIMP‐3) and Col‐1a1, and increased biomechanical properties of the ultimate stress and maximum loading. In vitro, conditioned medium with exosomes and exosomes also significantly decreased MMP‐3, and increased expression of tenomodulin, Col‐1a1 and TIMP‐3. Exosomes from TSCs could be an ideal therapeutic strategy in tendon injury healing for its balancing tendon extracellular matrix and promoting the tenogenesis of TSCs.

As backup energy storage devices, flexible microsupercapacitors (MSC) are expected to play an important role in future self-powered microelectronics. Graphene-based MSCs have attracted substantial attention due to their power performance, excellent mechanical flexibility, and superb cycling stability. The enhancement of the electrochemical performance of graphene-based MSCs is crucial for their practical application but remains a challenge. Herein, we report an electrochemically exfoliated O, P-functionalized holey graphene (FHG) with a hierarchical porous structure for high-performance flexible MSC electrodes. The areal capacitance increases linearly with the thickness of the electrode owing to the high ion-accessible surface area as well as efficient electron and ion transport pathways. The as-fabricated FHG-MSC delivers an areal capacitance of 6.41 mF cm−2, a volumetric capacitance of 30.51 F cm−3, and a high energy density of 4.24 mW h cm−3. Additionally, the MSC possesses exceptional mechanical flexibility with ∼99.7% capacitance retention over 500 bending cycles. Such outstanding results make it possible to use FHG in future high-performance self-powered microelectronics and provide a novel strategy for preparing few-layer functionalized holey graphene (FHG).

Background: Post-stroke dementia may affect up to one-third of stroke survivors. Acupuncture as a complementary treatment for stroke has been shown to be beneficial for subsequent post-stroke rehabilitation. The purpose of this retrospective cohort study was to investigate the potential effect of acupuncture to protect stroke patients from dementia.Methods: We included 9,547 patients receiving ambulatory or hospital care for stroke and 9.547 non-stroke patients; patients were matched for sex, age, and Charlson Comorbidity Index. Each individual was traced for the subsequent development of dementia. Two thousand four hundred and forty-nine stroke patients received acupuncture treatment and 7,098 residue stroke patients without acupuncture treatment served as control groups. This is a 3-year follow-up cohorts study: the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of post- stroke dementia in the Cox proportional hazard regression.Results: During the 3-year follow-up, 1,403 patients with stroke (14.70%) and 427 patients without stroke (4.47%) developed dementia. The adjusted HRs of development of dementia among stroke patients were 3.64-times (range, 3.27–4.06), and the incidence of dementia was higher in male. Stroke patients receiving acupuncture treatment had a lower probability of dementia than those without acupuncture during the follow-up period, the adjusted HRs was 0.49 (95% CI, 0.42–0.58; p < 0.001).Conclusions: The association between stroke and dementia existed in both sexes, more prominent in male. Patients with stroke receiving acupuncture treatments showed decreased risk of dementia. Care must be taken evaluating these results because this study was limited to lack of information regarding lifestyles, stroke severities, and acupuncture methods that were used in treatments.

Purpose To explore the effects of the intervening measure targeting myeloid differentiation 2 (MD2) on breast cancer progression in vitro and in vivo. Methods The expression of MD2 in normal breast cells (Hs 578Bst) and three kinds of breast carcinoma cell lines (MCF-7, MDA-MB-231 s and 4T1) were detected by western blot. MTT assay was used to detect the proliferation of 4T1 cells treated by L6H21, cell migration and invasion was measured by wound healing assay and trans-well matrigel invasion assay, respectively. In addition, to further study the role of MD2 in tumor progression, we assessed the effects of inhibition of MD2 on the progression of xenograft tumors in vivo. Results The expression of MD2 is much higher in MDA-MB-231 s and 4T1cells than that in normal breast cells (Hs 578Bst) or MCF-7 cells (p p −1 L6H21 in 60 days. Conclusion Overall, this work indicates that suppression of MD2 shows progression inhibition in vitro and significantly prolong survival in vivo. These findings provide the potential experimental evidence for using MD2 as a therapeutic target of breast carcinoma.

Trimethylamine N-oxide (TMAO) is reported to accelerate atherosclerosis and the development of adverse cardiac outcomes. Relationship between coronary atherosclerotic burden and TMAO has been examined in stable coronary artery disease and ST-segment elevation myocardial infarction, but not in non-ST-segment elevation myocardial infarction (NSTEMI). We examined the association between TMAO and coronary atherosclerotic burden in NSTEMI. In this prospective cohort study, two groups including NSTEMI (n = 73) and age-sex matched Healthy (n = 35) individuals were enrolled between 2019 and 2020. Coronary atherosclerotic burden was stratified based on the number of diseased coronary vessels and clinical risk scores including SYNTAX and GENSINI. Fasting plasma TMAO was measured by isotope dilution high-performance liquid chromatography. The median plasma TMAO levels were significantly higher in the NSTEMI group than in the Healthy group, respectively (0.59 μM; interquartile range [IQR]: 0.43-0.78 versus 0.42 μM; IQR: 0.33-0.64; P = 0.006). Within the NSTEMI group, higher TMAO levels were observed in the multivessel disease (MVD) versus single vessel disease (P = 0.002), and intermediate-high risk (score ≥ 23) versus low risk (score < 23) of SYNTAX (P = 0.003) and GENSINI (P = 0.005). TMAO level remained an independent predictor of MVD (odds ratio [OR]: 5.94, P = 0.005), intermediate-high risk SYNTAX (OR: 3.61, P = 0.013) and GENSINI scores (OR: 4.60, P = 0.008) following adjustment for traditional risk factors. Receiver operating characteristic curve (AUC) analysis for TMAO predicted MVD (AUC: 0.73, 95% confidence interval [Cl]: 0.60-0.86, P = 0.002), intermediate-high SYNTAX score (AUC: 0.70, 95% Cl: 0.58-0.82, P = 0.003) and GENSINI score (AUC: 0.70, 95% Cl: 0.57-0.83, P = 0.005). In all, TMAO levels are independently associated with high coronary atherosclerotic burden in NSTEMI.

Diffuse large B-cell lymphoma (DLBCL) has been correlated with virus infection and immunity status. We retrospectively analyzed the association between HBV antibody and DLBCL development in HBsAg- ...

Fosaprepitant dimeglumine (FD) is a precursor of aprepitant. FD can be metabolized into aprepitant. This randomized, single-center, open, 2-cycle, single-dose, crossover bioequivalence study compared the pharmacokinetics (PK) and safety of intravenously FD of test and reference products in healthy volunteers (HVs). HVs were assigned to the test group or reference group randomly and given FD intravenously. The plasma concentration of FD and aprepitant was measured using liquid chromatography-tandem mass spectrometry. PK parameters were ascertained based on a noncompartmental model. Data for 29 HVs were obtained. The geometric mean and 90% confidence intervals of maximum plasma concentration (Cmax ), area under the concentration-time curve from time 0 to time of last measurable plasma concentration (AUC0-t ), and area from the last datum point to time infinity (AUC0-∞ ) of test and reference groups were 101.69% (95.06%, 108.77%), 103.52% (99.15%, 108.09%), and 105.58% (99.51%, 112.01%), respectively. These 3 parameters were within the acceptance range of 80.0% to 125.00%, and the test product was bioequivalent to the reference product. The coefficient of variation (CV) of Cmax , AUC0-t , and AUC0-∞ was 15.14%, 9.67%, and 11.89%, respectively. Intravenously administered FD provided by 2 sponsors achieved bioequivalence. FD values from test and reference products were bioequivalent. All adverse events were mild and serious adverse events absent in HVs. This study indicated that FD may provide a safer alternative to aprepitant for chemotherapy-induced nausea and vomiting.

Background: Diffuse large B-cell lymphoma (DLBCL) has been correlated with virus infection and immunity status. Hepatitis B virus (HBV) infection is a significant public health problem around the world, especially in China. Previous research regarding the association of non-Hodgkin lymphoma (NHL) and HBV mostly focused on HBV antigen and HBV DNA. This study aimed to evaluate the relationship between HBV antibody and clinical prognosis in DLBCL. Methods: We retrospectively investigated the clinical characteristics of 190 newly diagnosed and untreated DLBCL patients and did a follow-up study. Results: Compared with HBeAb- patients, HBeAb+ patients displayed unique clinical features, such as more advanced disease stage (p=0.031) and higher International Prognostic Index (IPI) score (p=0.015). HBV antibody-negative patients had better therapeutic efficiency than positive patients (pConclusions: Taken together, our investigations identified for the first time the close association between HBV antibody and clinical prognosis and Rituximab responses in DLBCL patients. These findings indicate the novel association between HBV infection and DLBCL prognosis, provide potential biomarker to predict the effect of Rituximab, and offer novel insights into the role of immune response to HBV infection in DLBCL progression.

Background: Recently, trimethylamine N-oxide (TMAO) unexplained gut microbe has been proposed as a promising risk factor for atherosclerotic cardiovascular disease (CVD) pathogenesis and adverse events. The relationship of TMAO with coronary atherosclerotic burden has been evaluated in patients with stable coronary artery disease and ST-segment elevation myocardial infarction, but still needs to be explored in newly diagnosed non-ST-segment elevation myocardial infarction (NSTEMI) patients. Material and methods: A prospective, single-center, SZ-NSTEMI trial (ChiCTR1900022366) is underway to investigate the relationship of TMAO with the severity and prognosis of coronary atherosclerosis in newly diagnosed NSTEMI patients who will undergo coronary angiography with primary percutaneous coronary intervention (pPCI). The primary endpoint of the study will be assessed the association of TMAO with coronary atherosclerotic severity quantify by the number of diseased coronary arteries and SYNTAX score after the coronary angiography. The secondary endpoints will be identified the TMAO as a prognostic biomarker for the short (1 month) and long-term (12 months) major cardiovascular and cerebrovascular events (MACCEs) rate including myocardial infarction, target vessel revascularization, stroke, heart failure, all-cause rehospitalization, and all-cause mortality after the pPCI. The blood samples will be collected from each patient before the procedure to measure the TMAO by isotope dilution high-performance liquid chromatography. In conclusion, SZ-NSTEMI will be the first cohort that will be investigated the association of TMAO with the severity and prognosis of coronary atherosclerotic burden in NSTEMI patients, aiming to identify TMAO as a predictor and a prognostic biomarker.

Pulse-coupled neural network (PCNN) and its modified models are suitable for dealing with multi-focus and medical image fusion tasks. Unfortunately, PCNNs are difficult to directly apply to multispectral image fusion, especially when the spectral fidelity is considered. A key problem is that most fusion methods using PCNNs usually focus on the selection mechanism either in the space domain or in the transform domain, rather than a details injection mechanism, which is of utmost importance in multispectral image fusion. Thus, a novel pansharpening PCNN model for multispectral image fusion is proposed. The new model is designed to acquire the spectral fidelity in terms of human visual perception for the fusion tasks. The experimental results, examined by different kinds of datasets, show the suitability of the proposed model for pansharpening.

Using a database that enabled longitudinal follow-up, we assessed the cost, outcome, complications, and readmission rate of ruptured cerebral aneurysms repaired by surgical clipping and endovascular coiling.This study was a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of ruptured cerebral aneurysms between 1996 and 2013. The medical records and hospital cost data were all examined.A total of 7690 and 1380 cases were treated with clipping and coiling, respectively. Patients treated with clipping had more comorbidities and were older. The average total cost for endovascular coiling was $13,974.3, whereas the average total cost for surgical clipping was $16,581.7. Perioperative (30-day) mortality was 10.7% in patients with coiled aneurysms, compared with 12.6% in those with clipped aneurysms (P = 0.045). After 1 year of follow-up, clipping was associated with a significantly longer length of hospital stay (P0.001) and significantly higher total hospital costs (P0.001).In Taiwan, the total hospital costs for the surgical clipping of cerebral aneurysms were higher than for endovascular coiling, and the surgical results were associated with significant complications. We suggest that the indications for coiling might need to be expanded from the current standards dictated by the guidelines in Taiwan.

Recurrent symptoms of sciatica after previous surgical intervention is a relatively common and troublesome clinical problem. Percutaneous endoscopic lumbar decompression has been proved to be an effective method for recurrent lumbar disc herniation. However, the prognostic factors and outcomes of percutaneous endoscopic lumbar reoperation (PELR) for recurrent sciatica symptoms were still unknown. The purpose of this study was to evaluate the outcomes and prognostic factors of patients who underwent PELR for recurrent sciatica symptoms.From 2009 to 2015, 94 patients who underwent PELR for recurrent sciatica symptoms were enrolled. The primary surgeries include transforaminal lumbar interbody fusion (n = 16), microendoscopic discectomy (n = 31), percutaneous endoscopic lumbar decompression (PELD, n = 17), and open discectomy (n = 30). The mean follow-up period was 36 months, and 86 (91.5%) patients had obtained at least 24 months' follow-up.Of the 94 patients with adequate follow-up, 51 (54.3%) exhibited excellent improvement, 23 (24.5%) had good improvement, and 7 (7.4%) had fair improvement according to modified Macnab criteria. The average re-recurrence rate was 9.6%, with no difference among the different primary surgery groups (PELD, 3/17; microendoscopic discectomy, 2/31; open discectomy, 3/30; transforaminal lumbar interbody fusion, 1/16). There was a trend toward greater rates of symptom recurrence in the primary group of PELD who underwent percutaneous endoscopic lumbar reoperation compared with other groups, but this did not reach statistical significance (P 0.05). Multivariate analysis suggested that age, body mass index, and surgeon level was independent prognostic factors. Obesity (hazard ratio 13.98, 95% confidence interval 3.394-57.57; P0.001) was the risk factor affecting re-recurrence according to logistic regression analysis.PELR is a safe and effective treatment for recurrent sciatica symptoms regardless of different primary operation type. Obesity, inferior surgeon level, and patient age older than 40 years were associated with a worse prognosis. Obesity was also a strong and independent predictor of re-recurrence sciatica symptoms after percutaneous endoscopic lumbar decompression.

Background: Duroplasty has been widely used in cranial surgery when primary closure is not possible. The goal is to protect the cerebrum and thereby ensure that complications were as few as possible. We reviewed a single-institution experience with a variety of dural substitutes in craniotomy and analyzed the risk factors for duroplasty-associated hemorrhagic complications. Patients and Methods: Patients who received dural replacement after craniotomy or craniectomy between July 2004 and June 2009 were enrolled into this study. Medical records were reviewed for diagnosis, procedure, and type of dural replacement. Clinical courses were reviewed for hemorrhagic complications, including subdural hematoma, extradural hematoma, and subarachnoid hemorrhage. Logistic regression models were used to analyzed the risk factors of duroplasty-associated hemorrhagic complications. Results: Two hundred and twelve patients were included in the study. Overall, the hemorrhagic complication rate was 4.7% (10 patients). Complications were seen for microporous polyester urethane, expanded polytetrafluoroethylene monolayer, polyester silicone, and Biomesh in 4.1%, 0%, and 38.5% of patients, respectively. Patients who received duroplasty with Biomesh had a higher hemorrhagic complication rate with the odds ratio of 24.75 (95% confidence interval, 4.33–141.41) in comparison of those with microporous polyester urethane group after adjusting for individual confounders. Conclusion: The increased risk of hemorrhagic complications associated with craniotomy is modified by choice of dural replacement. Our results could assist clinicians in their decision-making with respect to the optimal timing for synthetic dural substitutes in patients with tumor infiltration of the patient's dura, severe brain swelling in traumatic brain injury, or a result of shrinkage from exposure and electrocautery.

This population-based study was designed to estimate and compare the risk of Alzheimer’s disease (AD) between patients with primary Sjögren’s syndrome (SS) and non-SS patients during a 10-year follow-up period. This is a retrospective cohort study. Data were obtained from the Taiwan’s National Health Insurance Research Database. We identified 4463 primary SS patients and 22,315 non-SS patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied to identify the subsequent manifestation of AD. Cox proportional hazard regression was used to study the subsequent manifestation of AD, and Kaplan-Meier survival curves were used to compare survival probability. During the 10-year follow-up period, 7 primary SS and 13 non-SS patients developed AD. During the 10-year follow-up period, the risk of AD was 2.68-fold higher in the primary SS cohort with an overall adjusted hazard ratio (HR) of 2.69 (95% CI 1.07–6.76), after adjusting for demographics and comorbidities. Within the 10-year period, patients with primary SS showed a 2.69-fold increased risk of developing AD. This risk increases with time, and the relative risk of AD is higher in older patients with primary SS.

The aggregation and deposition of transactivation response DNA-binding protein 43 (TDP-43) in neurons and astrocytes is characteristic in a number of neurodegenerative diseases including Alzheimer's disease, frontotemporal lobar degeneration, and amyotrophic lateral sclerosis. Nevertheless, the exact role of TDP-43 in astrocytes is unknown. Recently, TDP-43 was identified in neurons but not astrocytes after traumatic brain injury (TBI) in humans. In the present study, we evaluated TDP-43 expression and proteolysis in astrocytes in a rat model of TBI. We assessed TDP-43 fragment expression, astrocyte morphology, neuronal population numbers, and motor function after TBI with or without intracerebroventricular administration of a caspase-3 inhibitor. Motor dysfunction was observed after TBI in potential association astrocytic TDP-43 short fragment mislocalization and accumulation, astrogliosis, and neuronal loss. Notably, caspase-3 inhibition prevented these changes after TBI. Our findings suggest that TDP-43 proteolysis in astrocytes is related to astrogliosis and subsequent neuronal loss in TBI, and that TDP-43 may be an important therapeutic target for preventing motor dysfunction after TBI.

Introduction CTP synthase 2 (CTPS2) is a critical regulator in lymphocytes proliferation and nucleotides synthesis. Yet, the role of CTPS2 has not been explored in chronic lymphocytic leukemia (CLL). Hence, the aim of this study was to investigate the clinical significance and functional mechanism of CTPS2 regulation in CLL pathogenesis and progression. Methods In the present study, 1030 clinically annotated CLL patients from multiple cohorts were enrolled with informed consents. Peripheral blood samples from 66 de novo CLL patients were collected at the Department of Hematology in Shandong Provincial Hospital. Expression levels of CTPS2 in CLL cells were determined by quantitative RT-PCR and western blotting. Lentiviral vectors were utilized to stably silence CTPS2. RNA-sequencing and functional enrichment analysis were performed. Besides, cell viability, apoptosis and cell cycle were assessed by cell counting kit-8, annexin V-PE/7AAD and PI/RNase staining, respectively. All investigators comply with the guiding principles for experimental procedures found in the Declaration of Helsinki of the World Medical Association. Results Aberrantly increased expression of CTPS2 was detected in CLL primary cells and cell lines (MEC1 and EHEB) at mRNA and protein level compared with normal B cells (p Kaplan-Meier curves showed stratified CTPS2high patients were observed with significantly shorter overall survival versus the CTPS2low group in 2 independent cohorts (cohort 1, HR=4.488, p=0.001, Figure 2A; cohort 2, HR=1.614, p=0.049, Figure 2B). Besides, enhanced expression of CTPS2 were revealed to predict inferior treatment-free survival (cohort 1, HR=2.715, p=0.003, Figure 2C; cohort 2, HR=1.909, p=0.008, Figure 2D). Univariate cox regression analysis suggested that CTPS2 high expression predicted adverse survival (HR=1.785, p=0.003). Moreover, multivariate cox regression analysis confirmed the prognostic value of CTPS2 overexpression in CLL patients independent of age and Binet stage (HR=1.724, p=0.007; Figure 2E). To investigate the biological processes of CTPS2 involving in CLL progression, functional assays were performed. CLL cells with CTPS2 silencing exhibited attenuated cell proliferation, increased fast-onset apoptosis and induced G2/M phase arrest (Figure 3A-E). Additionally, down-regulated Bcl-2 expression as well as promoted cleaved-PARP, Bax and p21 expression were observed in CTPS2 knock-down transfected CLL cells (Figure 3F). To further explore the mechanism of CTPS2 regulation in the tumorigenesis of CLL, RNA-sequencing was conducted in CLL transfected cells. Annotations of differentiated genes implicated that CTPS2 was functionally enriched in cell cycle, DNA replication activation and oncogenic pathways (Figure 4A). Accordantly, activation of p-ATM, p-BRAC1, p-H2AX were visibly elevated, illuminating the potential mechanism of CTPS2 regulating DNA damage in CLL pathogenesis (Figure 4B). Collectively, the interactive network of CTPS2 and its down-stream targets was established, illuminating the potential mechanism of CTPS2 regulation in CLL progression (Figure 4C). Conclusion Taken together, the present study was the first investigation on the role of CTPS2 in CLL tumorigenesis by in silico analysis and ex vivo evaluation. CTPS2 was up-regulated and conferred independent inferior prognostic significance, highlighting the effectiveness and potential of CTPS2 in risk stratification and targeted strategy in CLL patients. Disclosures No relevant conflicts of interest to declare.

As an attractive tumor-associated antigen (TAA), Wilms tumor gene 1 (WT1) is usually overexpressed in malignant hematological diseases. In recent years, WT1-specific adoptive immunotherapy has been the "hot spot" for tumor treatment. The main immunotherapeutic techniques associated with WT1 include WT1-specific cytotoxic T lymphocytes (CTLs), vaccine, and T cell receptor (TCR) gene therapy. WT1-based adoptive immunotherapy exhibited promising anti-tumorous effect with tolerable safety. There are still many limitations needed to be improved including the weak immunogenetics of WT1, immune tolerance, and short persistence of the immune response. In this review, we summarized the progress of productive technologies and the clinical or preclinical investigations of WT1-specific immunotherapy in hematological diseases.

Po-Chou Liliang,1 Kang Lu,1 Cheng-Loong Liang,1 Ya-Wen Chen,2,3 Yu-Duan Tsai,1 Yuan-Kun Tu4 1Department of Neurosurgery, E-Da Hospital, 2Department of Nursing, I-Shou University, 3School of Nursing, Kaohsiung Medical University, 4Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan Purpose: Nucleoplasty is a minimally invasive technique that is considered efficacious in alleviating lumbar disk degenerative low back pain (LBP). The efficacy of nucleoplasty and identified variables that can predict pain relief for nucleoplasty was reported. Patients and methods: Between December 2013 and November 2015, 47 nucleoplasty procedures on 47 lumbar disks in 31 consecutive patients were performed. The outcome was evaluated using a visual analog scale (VAS) score. Improvements of ≥50% in VAS scores were considered substantial pain relief. The variables associated with pain relief after nucleoplasty included: 1) age; 2) sex; 3) body mass index; 4) hyperintensity zone at the rear of the disk; 5) hypointensity of the disk; 6) Modic changes of the end plates; 7) spinal instability pain; and 8) discography results. Results: Twenty-one patients (67.7%) experienced substantial pain relief. The most common side effects following nucleoplasty were soreness at the needle puncture site (64.5%), numbness in the lower leg (12.9%), and increased intensity of back pain (9.7%). All side effects were transient. Multivariate analysis revealed that the discography results were the most critical predictor for substantial pain relief of nucleoplasty (P=0.03). The sensitivity and specificity of discography were 92.8% and 62.5%, respectively. Conclusion: Discography results could improve the success rate of nucleoplasty in the treatment of disk degenerative LBP. Keywords: low back pain, lumbar disk degenerative, nucleoplasty, discography&nbsp

Kang Lu,1 Po-Chou Liliang,1 Hao-Kuang Wang,1 Jui-Sheng Chen,1 Te-Yuan Chen,1 Ruyi Huang,2 Han-Jung Chen1,3 1Department of Neurosurgery, E-Da Hospital, 2Department of Family Medicine, E-Da Hospital, 3Department of Neurosurgery, E-Da Cancer Hospital, College of Medicine, I-Shou University, Kaohsiung, Taiwan Background/objective: Internal disk disruption (IDD), an early event of lumbar disk degeneration, is the most common cause of low back pain. Since increased intradiskal pressure (IDP) is associated with symptoms and progression of disk degeneration, unloading a painful disk with an interspinous process device (IPD) is a rational treatment option. The goal of this study was to evaluate the effectiveness of dynamic stabilization with an IPD in the treatment of symptomatic IDD of the lumbar spine. Patients and methods: Patients with symptomatic IDD were treated with implantation of an IPD, the device for intervertebral assisted motion (DIAM). Diagnosis of IDD was based on typical MRI finding of posterior annular high-intensity zone and positive provocative test on discography. IDP was analyzed intraoperatively. Axial back and leg pain was evaluated with visual analog scale, functional status with Oswestry Disability Index, and final clinical outcomes with Odom criteria. Data from 34 patients followed up for at least 3years were collected. Results: DIAM implantation significantly reduced IDP (n=11, P

With the rapid development of Internet of Things (IoT) and wide acceptance of 4G/5G network, more and more devices are connected to the internet. In this environment, the cloud computing meets the critical challenges such as high latency and huge computing load. Therefore, researchers introduce the edge computing to make up the shortage of cloud computing and apply this idea to many scenarios. This paper applies the edge computing to emergency rescue which has a high requirement of latency. Firstly, we present an edge-based architecture for emergency rescue, the architecture includes three layers: Cloud Layer, Edge Layer and Device Access Layer. And the completion of rescue task needs the cooperation between layers. Moreover, we list some necessary parts in every layer. And aiming at mobile emergency of device access layer, the performer of rescue task which includes rescuer, wireless devices and rescue vehicles, we research the QoS-oriented multi-devices selection problem for composite services. We introduce an algorithm (MDSA) and compare it with a traditional allocation algorithm. The simulation result shows MDSA has a good performance in the aspect such as packet loss and energy consumption.

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapeutic strategy to cure a large number of hematologic diseases. Acute graft-versus-host disease (aGVHD) remains a major obstacle against long-term survival for patient underwent allo-HSCT. Oxidative stress can generate large amounts of oxygen free radicals affecting the metabolism, proliferation, and differentiation of normal cells. It may also further induce the autoimmune response to form a waterfall effect, causing reversible to extracellular insults. It has been confirmed that oxidative stress plays an important role in the pathogenesis of aGVHD and the following organ injury. Multiple immunosuppressant agents including calmodulin inhibitor, corticosteroids, anti-CD25 antibody, and JAK1/JAK2 inhibitors have been used to treat GVHD in clinical scenarios. However, quite an amount of patients will develop to glucocorticoid-refractory aGVHD and too intensive immunosuppressive therapy will increase the incidence of infection and malignancy relapse. Nrf2/HO-1 (Nuclear factor E2-related factor 2/ Haemoxygenase-1) signaling pathway has been recognized as a major regulator against oxidative stress injury. Recent studies have demonstrated that hyperbaric oxygen therapy (HBOT) significantly improved non-healing ulcers secondary to GVHD and hemorrhagic cystitis after HLA-mismatched allo-HSCT whether induced by infection or aGVHD. Based on the important role of oxidative stress in the process of aGVHD, we hypothesis that HBOT can improve aGVHD via up-regulating Nrf2/HO-1 pathway. Methods: By using an allo-HSCT murine model of C57BL/6 (H-2KB)→BALB/C (H-2KD), we evaluated the therapeutic effects of HBO on aGVHD. The murine model of aGVHD was established in BALB/C mice by lethally body irradiation, followed by 1×107 bone marrow cells and 2×107 spleen cell transplantation. Mice were randomly divided into three groups: BMT+HBO group, GVHD group, and GVHD+HBO group. BMT+HBO group and GVHD+HBO group mice were simultaneously treated with HBO per day for 2 weeks from day -7 to +7 before- to post stem cell transfusion. The HBO therapy was performed for mice in a sealed chamber at a pressure of 2.4 atmosphere absolute (ATA) for 90 min per day. The induction of the murine GVHD process and GVHD scores were calculated according to the method of Cooke et al (1996) every 6 days. Results: The flow cytometry showed that the level of H-2KB positive cells in the bone marrow cavity of the recipient mice was more than 95%, indicating successful implantation (Figure A). The BALB/C recipient mice in the control group (non-HBOT) showed typical aGVHD symptoms within 20 days, mainly including wasting, ruffled fur, hunched back, skin defect, ocular signs, diarrhea, and anal swelling (Figure B). The aGVHD+HBO group only showed slightly ruffled fur on 40 days post-transplantation (Figure C) and the aGVHD score of aGVHD+HBO group was much lower than that of GVHD group (Figure D) Weight loss was mild in the aGVHD+HBO group than that in the aGVHD group (Figure E). All aGVHD group mice eventually succumbed within 1 month after transplantation, the survival was shorter than that of aGVHD+HBO group. The survival time was analyzed by Kaplan-Meier method (Figure F). The BMT+HBO group served as a control for HBO toxicity. Immunofluorescence microscopy evaluation of mouse liver, skin, and small intestine revealed an attenuation of fluorescence signal in the aGVHD+HBO group, indicating HBO can significantly reduce ROS levels (Figure G). Immunohistochemical staining showed that the expression of NRF2 protein in the liver collected in day 16 post-transplantation was higher than the BMT+HBO group and aGVHD group (Figure H). Conclusions: By using this murine model of aGVHD following allo-HSCT, our results indicated that ROS inhibition by HBOT markedly reduced the infiltration of inflammatory cells and tissue damage to targeted organs, resulting in significantly improved symptoms and prolonged survival. In conclusion, our study provided laboratory evidence that HBO can prevent and treat aGVHD by upregulating the expression of NRF2 and HO-1. HBOT might be a promising prophylactic and pre-emptive treatment choice for aGVHD. In the future, we will further investigate the accurate mechanism of HOBT in the process of aGVHD via Nrf2/HO-1 pathway, verify our preliminary animal experimental results in clinical application. Figure Disclosures No relevant conflicts of interest to declare.

// Lingyun Geng 1 , Kang Lu 1 , Peipei Li 1 , Xinyu Li 1 , Xiangxiang Zhou 1 , Ying Li 1 and Xin Wang 1 1 Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, P.R. China Correspondence to: Xin Wang, email: xinw@sdu.edu.cn , xinw007@126.com Keywords: T-cell lymphoma, GLI1, STAT3, signaling pathway, targeted therapy Received: December 20, 2015 Accepted: May 04, 2016 Published: June 02, 2016 ABSTRACT T-cell lymphomas are lymphoid malignancies with aggressive clinical course and poor prognosis. Increasing evidences suggest that deregulation of signal transducer and activator of transcription-3 (STAT3) and suppressor of cytokine signaling 3 (SOCS3) is associated with the pathogenesis of T-cell lymphomas. The hedgehog (Hh)/glioma-associated oncogene-1 (GLI1) pathway, aberrantly activated in a number of tumors, has also been extensively studied. We found that protein expressions of GL11, p-STAT3, STAT3, and SOCS3 were up-regulated in T-cell lymphoma tissues and cell lines. Moreover, the protein expressions of p-STAT3 and SOCS3 were positively correlated with GLI1 in T-cell lymphomas. GLI1 inhibitor GANT61 and lentivirus-mediated siGLI1 exhibited inhibitory effects in the three T-cell lines (Jurkat, Karpass299 and Myla3676 cells). The protein expressions of p-STAT3 and SOCS3 were decreased accompanied with the inhibition of GLI1. These findings indicated that GANT61 is a promising agent against T-cell lymphoma and the antitumor activity might be partly mediated by down-regulating p-STAT3 and SOCS3.

Capital reduction through returning cash to shareholders is one mechanism by which firms distribute their surpluses. While distribution of excess funds can lower agency costs, it may also signal a decline in the firm's future investment opportunities. In this paper, we examine the information content and information transfer effects of the announcement of capital reduction and cash distribution in Taiwan during the period 2002–2010. We find that there is a significantly positive market reaction when Taiwanese firms announce a reduction in their capital and return cash to shareowners. We also document contagion intra-industry effects by showing that portfolios of rival firms in the same industry experience a significant and contemporaneous positive stock price performance. Consistently, our results support the free cash flow hypothesis of contagion intra-industry effects in the long-run stock return and operating performance of firms following cash refund capital reduction announcements. Moreover, multivariate analysis indicates that these contagion effects are influenced by competitors' features, which are negatively correlated with competitors' size and growth opportunity, and positively influenced by their dividend policy and ownership structure.

Background: According to the 2016 revised World Health Organization (WHO) Classification of Lymphoid Tumors, high grade B-cell lymphoma (HGBL) has been delimited as a new category with two subgroups: HGBL with rearrangements of MYC and BCL2 and/or BCL6 (so-called "double/triple hit lymphoma), and HGBL-NOS (HGBLs with features intermediate between DLBCL and Burkitt lymphoma). Retrospective data indicated many patients with HGBL diagnosed at an advanced stage and often have extremely poor outcome even if they received intensive chemotherapy. The accurate genetic and pathological mechanism of this high-risk lymphoma remains uncertain. For HGBL, traditional scoring may not be systematic enough and has limited reference value, more accurate prognostic grouping indicators are needed. The aim of this study was to evaluate the clinicopathological significances in newly diagnosed HGBL and DLBCL. Several clinical and hematological indexes in concert with Fluorescence in situ hybridization (FISH) rearrangement and Immunohistochemistry (IHC) expression profiles of biomarkers between HGBL and DLBCL will also be analyzed. Methods: We reviewed 52 patients diagnosed as HGBL or DLBCL in our hospital from 2017 to 2018 retrospectively. The clinical and hematological characteristics of the patients including age, gender, Ann-Arbor stage, B symptoms, serum LDH levels, β2-microglobulin (β2-MG), peripheral EBV-DNA copies, white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and IPI score were collected. FISH detection was done in each patient to identify whether the patient had MYC, BCL2, and BCL6 rearrangement. The expressions of the above three indexes were done by IHC as well. NLR (neutrophil to lymphocyte ratio) was definited as ANC/ALC ratio. Results: A total of 52 newly diagnosed patients were included in this study, including 34 (65.4%) males and 18 (34.6%) females. The median age at diagnosis was 54.1 years old (range, 15-88 years), and 22 (42.3%) of them were more than 60 years old. Six patients were classified into the HGBL category and 2 of them were HGBL-NOS subgroup. Twenty-five patients were MYC, BCL2, or BCL6 rearrangement single-positive. Among them, MYC, BCL2, and BCL6 rearrangement were detected in 13.5%, 7.7%, and 30.8% of 52 patients respectively.MYC (cut-off value >40%), BCL2 (cut-off value >50%), and BCL6 expression was found in 48.1%, 50%, and 65.4% of 52 patients, respectively. Among all of the patients, 32.7% (17/52) CD5 positive and 73.1% (38/52) MUM1 positive. 30.8% (16/52) of them were at stage Ⅰ/Ⅱ and 69.2% (36/52) of them were at stage Ⅲ/Ⅳ. 53.8% (28/52) of the patients had a high blood LDH level, 26.9% (14/52) showed an elevation of β2-MG level (>3mg/L) and 38.5% (20/52) presented high IPI score (IPI>2). The baseline clinical, hematological, and pathological characteristics are described in Table 1, 2. 3. With Pearson's Chi-square Tests analysis, the IPI score was significantly higher in patients older than 60 years old (P By the combination of either a positive gene rearrangement or a positive IHC marker (CD5 or MUM 1), there was a close association between any of the above with high β2-MG (P=0.024) and pheripheral EBV DNA copoies (P=0.012). Besides, the triple positive rearrangements combined with CD5 positive is associated with a higher NLR (P=0.027). Conclusions: In this study, we validated the prognostic value of several clinical, hematological, genetic, and pathological indexes in newly diagnosed HGBL and DLBCL. We found that if there's only one rearrangement gene or IHC marker (CD5 or MUM 1) positive, there was no significant difference between these alterations and some classic evaluation indexes such as serum LDH and Ann-Arbor stage. Patients with BCL2 + BCL6, or MYC + BCL6, or triple positive arrangement might have a more aggressive disease progression if positive CD5 expression could be detected at the same time. In the future, we plan to further evaluate if NLR has any correlation with the clinical outcome of patients with double-/triple-hit lymphomas or double-/triple expression lymphomas. More data from larger patient subset are needed to corroborate these findings. Disclosures No relevant conflicts of interest to declare.

Introduction: B-cell non-Hodgkin lymphoma is the most frequent type of non-Hodgkin's lymphoma. RCHOP regimen is established as the standard therapy for aggressive and indolent B-cell NHL, which has a 10%-20% rate of febrile neutropenia (FN). Recently, pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) is frequently used in clinical practice. This randomized controlled clinical study was conducted to investigate the efficacy and safety of prophylactic PEG-rhG-CSF in patients with B-cell non-Hodgkin lymphoma on RCHOP chemotherapy. Methods:We included 162 patients with pathological diagnosis of B-cell non-Hodgkin lymphoma including diffuse large B-cell lymphoma, follicular lymphoma and mantle cell lymphoma (MCL),from October 2016 to May 2019 at Shandong Provincial Hospital Affiliated to Shandong University. All patients gave written informed consent in accordance with the Declaration of Helsinki. The patients were randomized into PEG-rhG-CSF and rhG-CSF groups. Each patient received three cycles of chemotherapy with identical RCHOP regimens. In the study group, the patients received PEG-rhG-CSF 6mg(weight≥45Kg)or 3mg(weight≤45Kg)once 24 hours after the end of chemotherapy drugs of every chemotherapy cycle. In the control group, they weren't preventively administered rhG-CSF. If their neutrophil count (ANC)≤1.0×109/L, they were administered rhG-CSF:5ug/kg/day until their neutrophil count (ANC)≥2.0×109/L. The primary endpoint was the incidence of III/IV grade neutropenia and febrile neutropenia(FN) after each chemotherapy cycle. Meanwhile the rate of antibiotics application and safety were observed. Analyses were performed with SPSS Statistics 20.0 (IBM-SPSS, Chicago, Illinois). The numerical data was presented as mean ± SD. Statistical analysis was performed using one-way analysis of variance and chi-square test. A p-value Results: Clinical characteristics for PEG-rhG-CSF and rhG-CSF groups were shown in Table1. There were no significant differences in age, gender,height, body weight, body mass index, Ann Arbor and IPI staging. The incidence of IV grade neutropenia during cycle 1 in 81 evaluable study cycles and 81 evaluable control cycles were 7.41% and 35.80%( P0.05). The differences in I/II/III grade neutropenia between study and control groups weren't statistically significant (Table2,Fig.1). After secondary prophylactic use of PEG-rhG-CSF In the study group, the incidences of III/IV grade neutropenia decreased from 77.78% to 14.81% (P0.05 ), which were mostly mild or moderate. Patients receiving PEG-rhG-CSF who developed III/IV grade neutropenia were significantly older than those without neutropenia (53.41±14.96 vs. 63.64±4.65;years; p=0.01) (Fig.3).The incidence of III/IV grade neutropenia in patients older than 60 years was significantly higher than that in patients younger than 60 years(24.44% vs. 6.38%; P =0.038). Conclusions: Prophylactic use of PEG-rhG-CSF could effectively reduce the incidences of grade III/IV neutropenia and FN, which ensures that patients with lymphoma receive standard-dose chemotherapy to improve prognosis. III/IV grade neutropenia after prophylactic use of PEG-rhG-CSF were more likely to occur in patients older than 60 years. After the use of PEG-rhG-CSF, the elderly patients should be pay more attention to them. Disclosures No relevant conflicts of interest to declare.

Introduction: Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma (NHL), is strongly correlated with virus infection and host immunity status. To date, several kinds of virus infection have been involved in the tumorigenesis and progression of NHL, such as Epstein-Barr virus, hepatitis C virus, human immunodeficiency virus and so on. Hepatitis B virus (HBV) infection is a significant public health problem around the world, especially in China. HBV infection has been found to have an epidemiologic association with NHL and HBsAg status has been shown to be associated with the clinical feature and prognosis of DLBCL patients. However, no literature has been reported regarding the effect of HBV antibody in DLBCL. This study was to evaluate the impact of HBV antibody status on clinical outcome and prognosis in DLBCL patients. Methods: In this retrospective study, we investigated the clinical data of 190 patients with newly diagnosed and untreated DLBCL, who had received histological diagnosis and standard treatment at Shandong Provincial Hospital from May 2013 to May 2018. 127 DLBCL patients were effectively followed up to September 2018. Various statistical analyses were used to determine the significance of HBV antibody status in DLBCL patients. Results: The prevalence of HBsAg, HBsAb and HBcAb were increased in DLBCL patients compared with that in general Chinese population (Table 1).Compared with HBeAb-negative patients, HBeAb-positive patients displayed unique clinical features, such as more advanced disease stage (p=0.031) and higher International Prognostic Index (IPI) score (p=0.015, Table 2). Besides, patients in HBsAb-positive group displayed younger onset age (Figure 1). Patients in HBV antibody-negative group had better therapeutic efficiency than the positive group (Table 3), including HBsAb (p=0.013), HBeAb (p=0.013), combined HBsAb and HBcAb (p=0.019). The media progression-free survival (PFS) of HBeAb-positive group (p=0.004), HBcAb-positive group (p=0.038), HBsAb-positive and HBcAb-positive group (p=0.008) and the media overall survival (OS) of HBeAb-positive group (p=0.007), HBcAb-positive group (p=0.103), HBsAb-positive and HBcAb-positive group (p=0.035) were shorter than the negative group, respectively (Figure 2). We found the positive association between the expression of CD21 and HBsAb status (p=0.06, Table 4), both of which had no statistical significance in prognostic prediction. However, the media PFS (p=0.035) and OS (p=0.079) of patients with positive HBsAb and positive CD21 expression were worse than the negative group (Figure 3). Patients in Rituximab-containing group had better therapeutic efficiency (p=0.05), better PFS (p=0.015) and OS (p=0.008) than patients in Rituximab-free group (Figure 4). Interestingly, there were significant differences of Rituximab effect on clinical prognosis depending on the status of HBV antibody (Figure 5 and 6). For example, the positive effect of Rituximab on PFS (p=0.019) and OS (p=0.001) in HBsAb-positive patients was statistically significant while no difference was observed in PFS (p=0.251) and OS (p=0.987) in HBsAb-negative patients. In HBcAb-positive group, patients with Rituximab had better PFS (p=0.019) and OS (p=0.004) than patients without Rituximab. However, for HBcAb-negative patients, the PFS (p=0.596) and OS (p=0.80) were similar in Rituximab-containing group and Rituximab-free group. Similarly, the PFS (p=0.004 vs p=0.479) and OS (p Conclusions: The prevalence of HBV was increased in DLBCL patients and patients with positive HBV antibody displayed unique clinical features. Our investigations identified for the first time that HBV antibody had a negative effect on clinical outcome and prognosis in DLBCL patients. Interestingly, the effect of Rituximab in prognostic prediction was more significant in HBV antibody-positive group than the negative group. Therefore, our findings lead to a novel understanding of the association between HBV antibody and DLBCL development and provide promising factors for the prognostic prediction in DLBCL patients. Disclosures No relevant conflicts of interest to declare.

Background: A superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5. Objective: We report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle. Study Design: A technical note describing interventional procedures. Setting: The neurosurgery department of a cancer hospital. Methods: The patient was placed in the prone position with a pillow beneath the iliac crest to facilitate opening of the intervertebral disc. The entry point for the needle was 7–8 cm to the left of the midline of the L45 level. The spinal needle was slightly advanced caudally toward the L5- S1 disc and at a 40° angle from the vertical plane. Using lateral fluoroscopic control, the needle was advanced beneath the inferior aspect of the facet joint. After entering the disc, the needle was then advanced until it passed the anterior annulus fibrosus of the L5S1 disc. After verifying adequate position using contrast, 3 mL of 75% ethanol was injected for neurolysis. Results: During the follow-up, the patient reported reduction of pain in the lower abdomen and quality of life was significantly improved. Limitations: Sample size; no placebo control. Conclusion: Although different approaches exist, we prefer the posterolateral transdiscal approach for superior hypogastric plexus block and neurolysis using a single needle. This technique is a valuable alternative. Key words: Superior hypogastric plexus neurolysis, transdiscal approach, cancer pain

With the increased number of traffic accidents, the research and development of smart cars have been promoted. The detection of street objects has become one of the important research topics. Generic Model detection algorithm based on Convolution Neural Network(CNN) need to design the training model, while the training and testing of the model will take a lot of time. Transfer Learning is used to fine-tune the pre-trained models, using the Image task datasets of COCO, transferring a generic deep learning model to specific one with different weights and outputs. Furthermore, the CNN structure is adjusted to improve overall performance, and the street environment is trained to the special scene. We compare the results of experiments, and the results showed that the network which is fine-tuned is effective.

Background To investigate the association between primary insomnia and dementia using a Taiwanese population-based database. Methods This case-control study involved a subset of Taiwan’s National Health Insurance Research Database of reimbursement claims. We included 51,734 patients who were diagnosed with primary insomnia from 2002 to 2004 as the test group and 258,715 nonprimary insomnia participants aged 20 years or older as the reference group. We excluded patients under 20 and those with depression, post-traumatic stress disorder, and/or sleep disorders caused by organic lesion(s), drugs, or alcohol. We used a Cox proportional hazards model to assess the primary insomnia on the risk of developing dementia after adjusting for sociodemographic characteristics and comorbidities. Results The primary insomnia cohort had a higher prevalence of diabetes, dyslipidemia, hypertension, coronary heart disease, chronic liver disease, and chronic kidney disease at baseline. After adjusting for select comorbidities, primary insomnia remained a significant predisposing factor for developing dementia, and was associated with a 2.14-fold (95% confidence interval, 2.01–2.29) increase in dementia risk. We also found a higher risk of dementia in younger patients. Conclusions Taiwanese patients with primary insomnia, especially those under 40, had a higher risk of developing dementia than those without primary insomnia.

Interleukin‑9 (IL‑9) can function as both a positive and negative regulator of immune response, however the role of IL‑9 in tumor immunity is poorly understood. Chronic lymphocytic leukemia (CLL) is the most common chronic lympho‑proliferative disorder. Twenty CLL patients from 2010 to 2011 were recruited in the study. Expression and phosphorylation of transcription factor STAT3 and differential microRNAs (miRs) in peripheral blood mononuclear cells (PBMCs) from CLL patient samples were analyzed. In a previous study, we found a high level of IL‑9 in CLL patients. Concomitantly, overexpression of pSTAT3, miR‑155, and miR‑21 were observed in PBMCs from CLL patients in the present study. To elucidate whether there was interaction among IL‑9, STAT3, miR‑155, and miR‑21, MEC‑1 cells were used for further study. Our results revealed that there was no detectable IL‑9 in the culture medium of MEC‑1 cells. However, the IL‑9 protein could be detected using western blotting in MEC‑1 cells. Notably, when recombinant human IL‑9 (rIL‑9) was added to the medium of culturing MEC‑1 cells, the expression levels of pSTAT3 and IL‑9 in MEC‑1 cells were increased in a time‑dependent manner, which could be blocked by STAT3 inhibitor. Both miR‑155 and miR‑21 could increase IL‑9 expression, which could also be suppressed by the inhibitor of STAT3. Our data indicated that the existence of the novel 'extracellular IL‑9/pSTAT3/miR‑155/miR‑21/intracellular IL‑9' positive feedback system in CLL cells, provides a novel insight in the pathogenesis and possible therapeutic strategy of CLL.

OBJECTMultilevel long-segment lumbar fusion poses a high risk for future development of adjacent-segment degeneration (ASD). Creating a dynamic transition zone with an interspinous process device (IPD) proximal to the fusion has recently been applied as a method to reduce the occurrence of ASD. The authors report their experience with the Device for Intervertebral Assisted Motion (DIAM) implanted proximal to multilevel posterior lumbar interbody fusion (PLIF) in reducing the development of proximal ASD.METHODSThis retrospective study reviewed 91 cases involving patients who underwent 2-level (L4–S1), 3-level (L3–S1), or 4-level (L2–S1) PLIF. In Group A (42 cases), the patients received PLIF only, while in Group B (49 cases), an interspinous process device, a DIAM implant, was put at the adjacent level proximal to the PLIF construct. Bone resection at the uppermost segment of the PLIF was equally limited in the 2 groups, with preservation of the upper portion of the spinous process/lamina and the attached supraspinous ligament. Outcome measures included a visual analog scale (VAS) for low-back pain and leg pain and the Oswestry Disability Index (ODI) for functional impairment. Anteroposterior and lateral flexion/extension radiographs were used to evaluate the fusion status, presence and patterns of ASD, and mobility of the DIAM-implanted segment.RESULTSSolid interbody fusion without implant failure was observed in all cases. Radiographic ASD occurred in 20 (48%) of Group A cases and 3 (6%) of Group B cases (p < 0.001). Among the patients in whom ASD was identified, 9 in Group A and 3 in Group B were symptomatic; of these patients, 3 in Group A and 1 in Group B underwent a second surgery for severe symptomatic ASD. At 24 months after surgery, Group A patients fared worse than Group B, showing higher mean VAS and ODI scores due to symptoms related to ASD. At the final follow-up evaluations, as reoperations had been performed to treat symptomatic ASD in some patients, significant differences no longer existed between the 2 groups. In Group B, flexion/extension mobility at the DIAM-implanted segment was maintained in 35 patients and restricted or lost in 14 patients, 5 of whom had already lost segmental flexion/extension mobility before surgery. No patient in Group B developed ASD at the segment proximal to the DIAM implant.CONCLUSIONSProviding a dynamic transition zone with a DIAM implant placed immediately proximal to a multilevel PLIF construct was associated with a significant reduction in the occurrence of radiographic ASD, compared with PLIF alone. Given the relatively old age and more advanced degeneration in patients undergoing multilevel PLIF, this strategy appears to be effective in lowering the risk of clinical ASD and a second surgery subsequent to PLIF.

Background and purpose Physical activity is associated with a reduced incidence of first-time stroke. However, few studies have examined the effect of pre-stroke physical activity on post-stroke complications and clinical outcomes. Methods A total of 39 835 cases of stroke registered in the nationwide stroke registry system of Taiwan between 2006 and 2009 were analyzed according to five levels of severity as determined by National Institutes of Health Stroke Scale score upon hospital admission. Pre-stroke physical activity was defined in the Taiwan Stroke Registry as dedicated leisure-time physical activity for at least 30 min/day for 3 days/week for more than 6 months. A Cox model was used to compare complications and outcomes between active and inactive groups. Results The active and inactive groups were similar in age distribution and stroke type distribution, but the active group had better National Institutes of Health Stroke Scale scores upon admission. The active group also had significantly fewer post-stroke complications. Active patients had lower hospital mortality and better functional outcomes upon discharge as per the modified Rankin Scale. Improved functional status in the active group was significant at 1, 3 and 6 months post-stroke. Conclusion Dedicated leisure-time physical activity for at least 30 min/day, at least three times per week for more than 6 months was associated with decreased stroke severity, fewer post-stroke complications, lower mortality and better outcomes.

Objective When a cervical or thoracic benign intradural spinal tumor (BIST) coexists with lumbar degenerative diseases (LDD), diagnosis can be difficult. Symptoms of BIST-myelopathy can be mistaken as being related to LDD. Worse, an unnecessary lumbar surgery could be performed. This study was conducted to analyze cases in which an erroneous lumbar surgery was undertaken in the wake of failure to identify BIST-associated myelopathy. Methods Cases were found in a hospital database. Patients who underwent surgery for LDD first and then another surgery for BIST removal within a short interval were studied. Issues investigated included why the BISTs were missed, how they were found later, and how the patients reacted to the unnecessary lumbar procedures. Results Over 10 years, 167 patients received both surgeries for LDD and a cervical or thoracic BIST. In 7 patients, lumbar surgery preceded tumor removal by a short interval. Mistakes shared by the physicians included failure to detect myelopathy and a BIST, and a hasty decision for lumbar surgery, which soon turned out to be futile. Although the BISTs were subsequently found and removed, 5 patients believed that the lumbar surgery was unnecessary, with 4 patients expressing regrets and 1 patient threatening to take legal action against the initial surgeon. Conclusions Concomitant symptomatic LDD and BIST-associated myelopathy pose a diagnostic challenge. Spine specialists should refrain from reflexively linking leg symptoms and impaired ability to walk to LDD. Comprehensive patient evaluation is fundamental to avoid misdiagnosis and wrong lumbar surgery.

The body changes markedly during pregnancy; each system behaves differently from a nonpregnant state. As the eyes are the only windows to see directly what is going on in the internal environment, more and more researches have been done to explain the association between ocular changes and the physiological and pathological changes during pregnancy. The choroid is one of the critical parts of the eye, providing nutrition. And abnormal choroid may result in ocular dysfunction and visual problems. As the optical coherence tomography develops, a rapid, direct, noninvasive, and nontoxic way is available to obtain the choroid situation of pregnant women, which may explain the mechanism of pregnancy-related eye diseases. This review would summarize relevant original articles published from January 1, 2008 to December 1, 2016 to assess the changes of choroidal thickness (CT) with enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy. And the relationship between choroidal thickness changes and pregnancy remains uncertain. To our knowledge, this is the first review of EDI-OCT in assessing the choroidal thickness of the pregnant women.

Background: This retrospective cohort study was designed to assess whether there is an association between newly diagnosed dementia and the risk of stroke. Methods: From Taiwan’s National Health Insurance Research Database of reimbursement claims, we identified 2811 patients with newly diagnosed dementia and 14,055 randomly selected, agematched patients without dementia. A Cox proportional hazards model was constructed to calculate the development of stroke, including ischemic stroke, and intracerebral, or subarachnoid hemorrhage. Results: During the 3-year follow-up period, 339 patients with dementia (12.06%) and 691 patients without dementia (4.92%) developed stroke. The adjusted HRs of developing stroke among newly diagnosed dementia patients were 2.33-times (range, 2.05–2.66), and the incidence of hemorrhagic stroke was higher than that of other stroke types. Patients who had Alzheimer’s disease were at the highest risk of hemorrhagic stroke. Conclusion: Individuals with dementia, especially Alzheimer’s disease, are at greater risk of developing stroke, especially in intracerebral and subarachnoid hemorrhage than patients without dementia. Early mental screening programs and health education should be initiated for dementia patients.

Aim. Autoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period.Methods. Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression.Results. During the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79–1.76) in the ARD group after adjusting for demographics and comorbidities.Conclusions. Within the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.

We conducted a meta-analysis of analytic and observational studies to evaluate the association between smoking and epiretinal membrane (ERM). The pertinent studies were identified via a literature search using three databases (MEDLINE, Cochrane Library, Embase) and the reference lists of retrieved studies. Cohort, case-control and cross-sectional studies meeting the predefined criteria were included. We extracted the odds ratios (OR) and 95% confidence intervals (CI) from each study. Overall risk estimates were pooled using random-effects models. Subgroup analyses based on several stratified factors were also performed. Two cohort studies and six cross-sectional studies involving 46,837 subjects were included. The pooled effect of all eight studies showed an unexpected significant decreased association between smoking and the occurrence of ERM (OR, 0.72; 95% CI 0.61–0.84; p = 0.29, I2 = 17.9%). Subgroup analyses supported this finding, except for the age-unadjusted group (OR, 0.87; 95% CI 0.63–1.22), the ERM classification group (cellophane macular reflex (CMR) OR, 0.93; 95% CI 0.68–1.28; preretinal macular fibrosis (PMF) OR, 0.74; 95% CI 0.41–1.32), the Asian group (OR, 0.75; 95% CI 0.52–1.09) and the past smoker group (OR, 1.02; 95% CI 0.85–1.22). The pooled effects from the current literature suggested a declining association between smoking and ERM, which requires further studies to confirm.

Purpose: To investigate the association of interleukin (IL)-6 with proliferative diabetic retinopathy (PDR) of type 2 diabetes (T2D) in a Chinese population. Methods: Two subtypes of the IL-6 promoter (-174 and -572 G/C) were genotyped in 215 T2D patients with PDR and 207 T2D patients with a normal retinal function (controls) using the PCR-RFLP method. The mRNA and protein expression of IL-6 was examined by real-time PCR. Results: T2D patients with PDR had a significantly higher frequency of IL-6 -174 GC (OR 0.58; 95% CI 0.34-0.99; p = 0.011) and IL-6 -572 GG (OR 0.53; 95% CI 0.24-1.14; p = 0.016) than T2D controls. The mRNA expressions of the rs1800795 GC and rs1800796 GG genotype were significantly increased compared to other cases (Fsig = 0.002, p = 0.001, respectively), followed by a relative increase in IL-6 in protein. Conclusions: IL-6 genotypes of rs1800795 GC and rs1800796 GG might point to a relatively high risk for T2D patients suffering from PDR in a Chinese population and they were associated with elevation of IL-6 expression in both mRNA and protein.

Introduction: Extranodal natural killer/T-cell lymphoma (ENKTL) is an aggressive type of non-Hodgkin lymphoma (NHL), which is relatively more common in Asia. Accumulating evidence suggested that tumor microenvironment and inflammatory response played important roles in determining the clinical course and outcome of human malignancies. Recently, the derived neutrophil to lymphocyte ratio (dNLR) was demonstrated to act as prognostic factor in several malignancies. Nevertheless, the significance of dNLR in ENKTL has not been elucidated to date. The aim of this study is to investigate the prognostic value of dNLR in ENKTL. Methods: We included patients with pathological diagnosis of ENKTL from February 2002 to June 2018 at Shandong Provincial Hospital Affiliated to Shandong University. All the diagnoses were based on the criteria of the WHO 2016 Classifications of the Tumors and Hematopoietic and Lymphoid Tissues. The pretreatment clinical-pathological data, such as age, gender, stage, performance status, serum lactate dehydrogenase (LDH) levels, bone marrow involvement, and neutrophil count and leukocyte count were collected. The dNLR was calculated by absolute neutrophil count divided by (leukocyte count - neutrophil count).The primary end point was overall survival (OS). The secondary end point was progression-free survival (PFS). Survival analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate analyses were performed using Cox proportional-hazards regression model. This study was approved by the Medical Ethical Committee of Shandong Provincial Hospital Affiliated to Shandong University. P Results: A total of 33 patients with pathological diagnosis of ENKTL were included in this study, including 26 (78.8%) male patients and 7 (21.1%) female patients. The median age at diagnosis was 50 years (range 13-75 years), and 6 (18.2%) of them were more than 60 years old. Among them, 13 (39.4%) patients were diagnosed at stage I/II with mean dNLR of 1.801 ± 0.832, versus 20 (60.6%) at stage III/IV with mean dNLR of 2.834 ± 1.962 (P=0.047). In addition, elevated serum LDH (P=0.026), distant lympho-node involvement (P=0.013), high β2-microglobulin (β2-MG, P=0.035) and high International Prognostic Index (IPI) score (P=0.044) were also significantly associated with high dNLR at diagnosis of ENKTL (Table 1). To determine the clinical significance of dNLR, cutoff value of 3.6 for dNLR, which was determined by receiver operating characteristic (ROC) analysis, was selected as the best discriminate between patients' survival and death (AUC 0.714, 95%CI 0.524-0.904, P=0.043, Figure 1). Patients were divided into dNLR We next explored the correlation between clinical characteristics and survival of ENKTL patients by univariate and multivariate analysis. Univariate Cox proportional analysis revealed that high ECOG PS score (≥2, P=0.004), elevated β2-MG (P=0.014), high IPI score (≥2, P=0.007) and elevated dNLR (>3.6, P=0.001) as prognostic factors of poor outcome of patients. To further assess whether dNLR could act as an independent prognostic value for OS, multivariate analysis with Cox proportional hazard model was performed. In the multivariate analysis, which included all independent parameters significantly associated with clinical outcome in univariate analysis, we identified that high dNLR (≥3.6) as an independent prognostic factor for OS in patients with ENKTL (P=0.004). Conclusions: In this study, we validated for the first time the prognostic value of dNLR in ENKTL patients. High dNLR was associated with poor survival of ENKTL. The dNLR may serve as a novel and convenient prognostic factor for untreated ENKTL patients. Further validation of these results in larger cohorts of patients with ENKTL is warranted. Disclosures No relevant conflicts of interest to declare.

Object The reported incidence of hospital-acquired bacterial pneumonia in critically ill trauma patients varies from as low as 4% to as high as 87%, with fatality rates varying from 6% to 59%. Clinical studies have identified the risk factors for pneumonia. The authors undertook this retrospective study to evaluate the incidence, risk factors, and outcomes of hospital-acquired bacterial pneumonia in a group of patients with severe head injuries. Methods This was a retrospective review of consecutive adult patients admitted to the neurosurgical ICU in the authors' hospital because of severe head injury (Glasgow Coma Scale scores ≤ 8) between January 2008 and December 2010. Results During the study period, 290 patients were admitted to the neurosurgical ICU. Multivariate Cox regression analysis showed that age (HR 1.01, 95% CI 1.001–1.02), nasogastric tube insertion (HR 4.56, 95% CI 1.11–18.64), and hemiplegia or hemiparesis (HR 3.79, 95% CI 2.01–7.17) were significantly associated with the development of pneumonia. Conclusions The authors identified 3 risk factors (age, nasogastric tube insertion, and hemiplegia or hemiparesis) associated with the development of pneumonia in patients with severe head injury. This finding constituted the basis for developing a simple screening tool that can be used to assess the risk of occurrence of pneumonia in such patients.

This paper presents a vacuum system design for extreme ultraviolet lithography (EUV) and studies the prediction of pump-down curves for vacuum chambers. Related basic theories include gas laws, conductance for several kinds of flow regimes, equivalent length for pipes, outgassing, diffusion, and permeation etc. The simulation program consists of a MFC module and a MATLAB module. The MFC module is used to input necessary parameters, including start and target pressure for pumping, volume and inner surface area of vacuum chambers, configuration of pumping lines, performance of vacuum pumps, and gas loads. The MATLAB module deals with the pump-down curve calculation based on related theories. The governing equation of the conservation of mass in a pumped vacuum chamber is derived from extended Temkin isotherm. The pump-down curve of vacuum chamber is predicted by four steps, including calculation of equivalent length for pipes, conductance of pipes, and effective pumping speed of pumps, and pump-down time. An empty vacuum chamber is used to test the developed program. The pump-down curve reaches 6.5E-8 torr with 42 hours pump-down time in experiment measurement, and the simulated curve reaches 5.79E-8 torr at the same time point. The developed program can predict pump-down curve with a good accuracy in the range from low vacuum pressure to high vacuum pressure.