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Background: Patients with recurrent cervical cancer have a poor prognosis. Cemiplimab, the fully human programmed cell death 1 (PD-1)-blocking antibody approved to treat lung and skin cancers, has been shown to have preliminary clinical activity in this population. Methods: In this phase 3 trial, we enrolled patients who had disease progression after first-line platinum-containing chemotherapy, regardless of their programmed cell death ligand 1 (PD-L1) status. Women were randomly assigned (1:1) to receive cemiplimab (350 mg every 3 weeks) or the investigator's choice of single-agent chemotherapy. The primary end point was overall survival. Progression-free survival and safety were also assessed. Results: A total of 608 women were enrolled (304 in each group). In the overall trial population, median overall survival was longer in the cemiplimab group than in the chemotherapy group (12.0 months vs. 8.5 months; hazard ratio for death, 0.69; 95% confidence interval [CI], 0.56 to 0.84; two-sided P

The Triassic Baikouquan Formation reservoir in the Mahu Sag, Junggar Basin is characterized by tight sandy conglomerate oil reservoir with long drilling cycle and great fracturing difficulty. The factory drilling and fracturing techniques of horizontal wells for the Ma131 Well Block of Mahu Oilfield have been determined by regional geological characteristics research and optimization scheme design. The key technologies for horizontal well drilling speed improvement were explored by designing small three-stage wellbore structure, customizing the PDC bit properly, optimizing drilling tool combination, and selecting the drilling fluid with inhibition and plugging ability. The factory reservoir stimulation technique carried out horizontal well hydraulic fracturing with small well spacing for two sets of beds, and adopted bridge plug + clustering perforation staged fracturing and slick water + gel composite fracturing technology. 12 wells in a drilling pad were arranged in the demonstration area with the depth of 5000m, the distance between adjacent sections was 150m or 100m, with the horizontal section length of 1800m. Batching drilling operation pattern was adopted, with 3⁃well drilling for each of rig. Rapid inclining prevention drilling through vertical sections adopted PDC bit + screw + MWD, with high rotary speed and high flow rate. In the build-up section, radical drilling parameters was used to improve the top drive rotary speed and release the torque. In the horizontal sections, rotary steering tool + low speed high torque screw was adopted. The application of this technology achieved good results, with average drilling cycle of 48.3 d and average ROP of horizontal section increased by 77%. The fracturing construction adopted high pad fluid ratio, high sand ratio and high pump rate. More than 10,000 m3 fluid was injected in a single well with high-intensity proppant injection. The factory operation was carried out in the order of construction from the two sides to the middle well with microseismic monitoring. Factory fracturing with small well spacing generated stress interference and improved the fracture reconstruction effect. Higher shut-in pressure, more microseismic events and large-scale stimulated reservoir volume had been carried out in horizontal wells fractured later. The factory drilling and fracturing techniques of horizontal wells for the Ma131 Well Block have achieved the goals of improving drilling speed and volume fracturing, which provided technical support for the efficient development of the tight sandy conglomerate oil reservoir of the Mahu Oilfield.

To evaluate the efficacy and safety of ruxolitinib in patients with polycythemia vera (PV).The clinical data of patients with PV treated with ruxolitinib in Peking Union Medical College Hospital from January 1, 2013 to December 31, 2019 were retrospectively analyzed. The starting dose of oral ruxolitinib was 10 mg twice daily and could be increased after 3 months of treatment if hematocrit (HCT) control was not achieved. HCT control was defined as HCT45% in the absence of phlebotomy.Thirty-three patients (17 males and 16 females) were treated with ruxolitinib at a median age of 50 (21-72) years. JAK2V617F and JAK2exon12 alleles were detected in 31 and 2 patients, respectively. Before treatment, median hemoglobin level was 187 (166-208) g/L, median white blood cell and platelet level was 10.4 (5.0-15.8)×10The remission rate of HCT in PV patients treated with ruxolitinib is high, and adverse reactions are rare. Ruxolitinib is effective in HCT control and generally well tolerated in patients with PV.芦可替尼治疗真性红细胞增多症的疗效及安全性评价.评价芦可替尼治疗真性红细胞增多症（PV）的疗效及安全性。.回顾性分析2013年1月至2019年12月北京协和医院接受芦可替尼治疗的PV患者的临床资料。芦可替尼起始剂量均为10 mg bid，治疗满3个月后，如果红细胞压积（HCT）控制不良，可以增加芦可替尼剂量。无需额外放血且HCT45%被视为HCT缓解。.共33例接受了芦可替尼治疗的PV患者纳入研究，男性17例，女性16例，中位年龄50（21-72）岁。JAK2V617F突变31 例，JAK2 exon12突变2例。接受治疗前中位血红蛋白187（166-208）g/L，白细胞10.4（5.0-15.8）×10芦可替尼治疗PV患者HCT缓解率高，不良反应少见，患者可以长期坚持用药。.

In order to investigate the effects of furrow and ridge rainwater harvesting, straw mulching, and reduced and slow-release fertilizer on soil microbial community structure of rapeseed, a two-year field study was conducted in rainy (2016-2017) and drought (2017-2018) seasons, which included three cultivation patterns:1 conventional flat planting, 2 straw mulching, and 3 ridge-furrow rainfall harvesting system and four fertilization patterns:1 conventional fertilization (100% of the amount), 2 reduced slow-release fertilizer Ⅰ (80% of the amount), 3 reduced slow-release fertilizer Ⅱ (60% of the amount), and 4 no fertilizer. The results indicated that it was rainy in 2016-2017, with seasonal drought during the nutritional growth stage in 2017-2018. The two technologies (straw mulching+80% slow-release fertilizer, J80 and ridge-furrow rainfall harvesting system+80% slow-release fertilizer, M80) were beneficial to boost the soil microbial activity. J80 and M80 increased the microbial biomass carbon by 9.94% and 10.32% and microbial biomass nitrogen by 2.38% and 1.19%, respectively, compared with that of the local cultivation pattern under two different climate conditions. The total amount of microbial phospholipid fatty acid (PLFA) decreased by 30.75% in the rainy year compared with that in the drought year, and mulching technology could effectively increase the total amount of soil PLFA. The PLFA contents of soil bacteria and fungi in the rainy year were 33.67% and 53.21%, respectively, lower than those in the drought year. However, the PLFA content of actinomycetes increased by 13.04%. Microbial communities were sensitive to abnormal precipitation. The bacteria/fungi ratio increased in rainy weather. The drought climate heighted the ratio of straight chain saturated fatty acid/straight chain monounsaturated fatty acid and straight chain monounsaturated fatty acid/cyclopropane acid. In conclusion, adopting the optimal cultivation technologies can stabilize the soil microenvironment under abnormal precipitation, relieve water and nutrient stress, and provide an effective means for rapeseed sustainable development.

Rice is one of staple food crops in the world. Improving the drought tolerance of rice has become an important issue for maintaining or increasing its grain production under water stress caused by the greenhouse effect. For achieving this goal, quantitative trait loci (QTL) mapping is considered to be useful in plant breeding. In this study, a doubled-haploid (DH) population was used as elite materials. Based on results of polymorphism detection, 108 polymorphic markers were identified. The mapping analysis results indicated that 40 QTLs putatively associated with seven traits were found in nine linkage groups.

Objective Breast cancer metastasis to the female genital tract is rare, and the ovaries are the most frequent site of extragenital cancer metastasis. The uterus and cervix have been rarely reported as the site of metastasis. Case report A 57-year-old woman diagnosed with invasive lobular carcinoma of the left breast 2 years prior was undergoing tamoxifen treatment. She presented with a right breast mass and postmenopausal bleeding. Synchronous right breast invasive lobular carcinoma with endometrium metastasis was diagnosed. The metastasis tumor involved the endometrium, myometrium, cervix, ovaries, and fallopian tubes. Conclusion We noted the rarity of massive metastasis of the female genital tract from breast cancer. Gynecological surveillance and prompt evaluation of the endometrium led to timely diagnosis and treatment.

Carbon monoxide (CO) poisoning is a public health issue in numerous countries. Oxygen supplementation is the standard and initial management for acute CO poisoning. Normobaric oxygen (NBO) and hyperbaric oxygen (HBO) therapies for CO poisoning have been discussed for several decades. NBO, one-session HBO, two-session HBO, and three-session HBO have not been clearly compared, although there are some syntheses. Therefore, this study aimed to provide an overview of various HBO therapies for CO poisoning. We searched online databases for randomized controlled trials (RCTs) on this topic, and two authors individually extracted data on characteristics, mortality, headache recovery, general fatigue, memory impairment, and difficulty concentrating. Outcomes were pooled using network meta-analysis. We included eight RCTs (n = 1785) that met our eligibility criteria. Pooled estimates showed that HBO had no better outcomes than NBO. Moreover, two-session HBO seemed to have a higher general fatigue rate than NBO, and compared with one-session HBO therapy, it had a higher fatigue rate (risk ratio (RR): 1.29, 95% confidence interval (CI): 1.03–1.62), memory impairment rate (RR = 1.80, 95% CI: 1.01–3.19), and concentration impairment rate (RR = 1.85, 95% CI: 1.19–2.89). HBO may be ineffective for patients with CO poisoning. Therefore, clinicians should consider the available treatment options carefully before recommending HBO to patients.

The peripheral blood gene expression profile of patients with coronary artery disease (CAD) has not been fully resolved. The aim of this study was to further analyze the peripheral blood transcriptome information of CAD patients and to uncover key genes and regulatory mechanisms in the pathogenesis and disease progression of CAD.The Gene Expression Omnibus (GEO) database was applied to screen out differentially expressed genes (DEGs) in the peripheral blood of CAD patients, and the DEGs were subjected to Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA). The core genes were screened by GO, KEGG, and GSEA, and the gene-gene interaction (GGI) and protein-protein interaction (PPI) networks of DEGs were constructed. The GeneCards database was used to obtain CAD-related genes, and the GEO dataset was used to obtain intersecting genes. The intersecting genes were analyzed for bioenrichment and prediction of potential therapeutic agents, and predictive models were constructed for the intersecting genes. Finally, immune infiltrating cells from the GEO dataset were analyzed.A total of 79 DEGs were screened in the peripheral blood of CAD patients, of which three were autophagy-related genes. Biological enrichment analysis showed that the DEGs were associated with metabolic pathways, and vascular smooth muscle contraction and were mainly involved the MAPK signaling pathway, metabolic pathways, and the PI3K-Akt signaling pathway. TheThe peripheral blood of CAD patients screened by the GEO dataset was significantly different from that of the healthy population, and the DEGs and intersecting genes were involved in numerous key biological processes that may be involved in the development and progression of CAD and could serve as its regulatory sites and therapeutic drug targets.

Monoelemental two-dimensional (2D) materials have attracted significant attention due to their exciting electro-mechanical properties and extreme thinness. However, most of these materials have stable centro-symmetric structures due to same electronegativities of all atoms and lack interesting properties such as piezoelectricity and ferroelectricity. Here we report the existence of piezoelectricity in atomically thin monoelemental α-Tellurium films. DFT calculations reveal that monoelemental few layer α-Tellurene is electrostrictive. However, group theory analysis shows that α-Tellurene belongs to piezoelectric C2 group due to negligible asymmetry and has high anomalous Born effective charges, similar to the traditional perovskite piezoelectric structures. Experimental exploration demonstrates the existence of through thickness piezoelectricity. With single and dual AC resonance tracking piezoelectric force microscopy, piezoelectric coefficient (d33) up to 1 pm/V is observed for the Te ultrathin films. Moderate layer dependent piezoelectricity observed in α-Te films makes it a promising candidate for the realization of atomically thin piezoelectric devices.

Radiation-induced bowel damage may compromise nutrient absorption and digestion and affect body composition during pelvic radiotherapy in patients with locally advanced cervical cancer (LACC). This study aimed to evaluate the relationship between bowel radiation dose-volume and body composition changes during pelvic radiotherapy. Data of 301 LACC patients treated with chemoradiotherapy were analyzed. Changes in skeletal muscle index (SMI) and density (SMD), and total adipose tissue index (TATI) were measured from computed tomography images at the L3 vertebral level. A reduction in SMI, SMD, or TATI of ≥10% was classified as “loss.” Bowel V45 indicates the bowel volume (mL) receiving a radiation dose of ≥45 Gy. The relationship between body composition and bowel V45 was analyzed using logistic regression models. After treatment, 61 (20.3%), 81 (26.9%), and 97 (32.2%) patients experienced SMI, SMD, and TATI loss, respectively. Increased bowel V45 was independently associated with increased odds of SMI loss (odds ratio [OR]: 1.012; 95% confidence interval [CI]: 1.007–1.018; p

Highlights • Myocardial injury is common in critically ill COVID-19 patients. • COVID-19 patients with myocardial injury are more likely to develop adverse events and fatal outcomes during the hospitalization. • Myocardial injury and advanced age (≥75 yrs old) are independent risk factors for 28-day in-ICU mortality., Objective The aim of this study was to investigate the incidence, clinical presentation, cardiovascular (CV) complications and mortality risk of myocardial injury on admission in critically ill ICU inpatients with COVID-19. Design A single-center, retrospective, observational study. Setting A new-built ICU in Tongji hospital (Sino-French new city campus), Huazhong University of Science and Technology, Wuhan, China. Participants Seventy-seven critical COVID-19 patients. Interventions Patients were divided into myocardial injury group and non-myocardial injury group according to the on-admission levels of high-sensitivity cardiac troponin I. Measurements and Main Results Demographic data, clinical characteristics, laboratory tests, treatment and clinical outcome were evaluated stratified by the presence of myocardial injury on admission. Compared with non-myocardial injury patients, patients with myocardial injury were older (68.4 ± 10.1 vs. 62.1 ± 13.5 years; P=0.02), had higher prevalence of underlying CV disease (34.1% vs. 11.1%; P=0.02) and in-ICU CV complications (41.5% vs13.9%; P=0.008), higher Acute Physiology and Chronic Health Evaluation II scores (20.3 ± 7.3 vs 14.4 ± 7.4; P=0.001) and Sequential Organ Failure Assessment scores [7, interquartile range (IQR) 5-10 vs. 5,IQR 3-6; P

This study was performed to explore the emission problems of livestock manure and nutrient caused by continuous development of livestock and poultry production. Based on the 2009-2018 statistics of livestock breeding in Anhui Province, an excretion coefficient was used to estimate the quantity of livestock manure and content of the main pollutants. In addition, time and spatial pattern and evolution characteristics of different types of manure were explored in the province. The results showed that the quantity of livestock manure increased from 55.97 million tons in 2009 to 63.38 million tons in 2015 and then decreased to 45.11 million tons in 2018. The contents of TN, TP, CODCr, and NH3-N in poultry and pig manure accounted for a high proportion in the whole province, while the content of pollutants in cattle urine accounted for the lowest. After 2018, the contents of CODCr and NH3-N in pig manure increased compared with those in 2011. Spatial distribution of livestock and poultry pollutant emissions in different cities showed a decreasing trend from north to south. The manure and urine discharge in Fuyang City accounted for the highest proportion in the whole area, reaching 9.235 million tons in 2011. The contents of TP, CODCr, and NH3-N in pig manure in northern Anhui Province were higher than those in other areas, and the content of various pollutants in poultry manure accounted for the largest proportion in southern Anhui Province. In addition, the pollutants content in cattle urine was significantly lower than those in other manure. Owing to the increasing efforts to prevent and control livestock and poultry pollution in the province, the discharge of fecal pollution in the whole province decreased significantly in 2018. Therefore, the control of pig and poultry manure should be paid additional emphasis, especially when promoting the adjustment of industrial structure.