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As a refractory industrial solid waste, high-alumina fly ash is discharged into nature in large quantities, causing serious environmental harm. The extraction of valuable components, such as aluminum, from high-alumina fly ash has become a research hotspot at home and abroad. The shortcomings of traditional alumina extraction from high-alumina fly ash include long technological processes, large amounts of waste acid and alkali, and serious equipment corrosion. A novel method for alumina preparation by electrotransformation AlCl3 solution(EAS) under NH4Cl catalysis with injected CO2 has been proposed by Northeastern University. The process has advantages, such as short flow and no waste acid discharge. In this study, the influence of initial NH4Cl concentration in the cathodic chamber on solution pH, phase and morphology of electrotransformation products, phase, D(50) and D(90) of roasting products, and Al recovery rate were examined. Simultaneously, EAS was examined and compared with and without injected CO2, as well as EAS under NH4Cl catalysis with and without injected CO2. The results showed that, when the solution in the cathodic chamber was NH4Cl with CO2 injection, with electrotransformation time extension, pH increased slowly and the morphology of electrotransformation products were all rough and fluffy block structures. Increasing initial NH4Cl concentration effectively improved the product crystallization states, roasting products D(50) and D(90), and Al recovery rate.

OBJECTIVE: To explore the characteristics and clinical phenotypes of rheumatoid arthritis (RA) and provide the basis for further understanding, interventions and outcomes of this disease. METHODS: RA patients attended at Peking University People's Hospital from 2018 to 2021 were enrolled in the study. Data collection included demographic data, the sites and numbers of joints involved, extra-articular manifestations (EAM), comorbidities and laboratory variables. Statistical and bioinformatical analysis was performed to establish clinical subtypes by clustering analysis based on the type of joint involved, EAM involvement and other autoimmune diseases overlapped. The characteristics of each subtype were analyzed. RESULTS: A total of 411 patients with RA were enrolled. The mean age was (48.84±15.17) years, and 346 (84.2%) were females. The patients were classified into 4 subtypes: small joint subtype (74, 18.0%), total joint subtype (154, 37.5%), systemic subtype (100, 24.3%), and overlapping subtype (83, 20.2%). The small joint subtype had no medium or large joint involvement, and 35.1% had systemic involvement. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and platelet count (PLT) were lower than those in other subtypes, and the rates of positive rheumatoid factors (RF-IgA and RF-IgG) were significantly higher in the small joint subtype. The total joint subtype had both large and small joint involvement but no systemic involvement. The rate of morning stiffness and positive antinuclear antibodies (ANA) in this subtype were lower than those in other subtypes. In the systemic subtype, interstitial lung disease and secondary Sjögren syndrome were the most common systemic involvements, with prominent levels of disease activity score 28-joint count (DAS28-ESR and DAS28-CRP). The overlapping subtype was commonly combined with Hashimoto's thyroiditis or primary Sjögren syndrome. Female in the overlapping subtype was more common than in other subtypes. This subtype was characterized by hyperglobulinemia, hypocomplementemia and high rate of positive ANA, especially spotting type. CONCLUSION: Based on the clinical features, RA patients could be classified into 4 subtypes: small joint subtype, total joint subtype, systemic subtype, and overlapping subtype. Each subtype had its own clinical characteristics. They help for further understanding and a more individualized treatment strategy of RA.

The influence of the bilayer number on the microstructure, mechanical properties, adhesion strength and tribological behaviors of the WB2/Cr multilayer films was systematically investigated in the present study. Five groups of WB2/Cr films with the same modulation ratio were synthesized by magnetron sputtering technique. The crystalline structure of the films was determined by X-ray diffraction. The morphologies and the microstructure of the films were observed by scanning electron microscopy, atomic force microscopy and transmission electron microscopy. Furthermore, Nano indenter, scratch tester and ball-on-disc tribometer were used to evaluate the mechanical and tribological properties. As bilayer numbers varied from 5 to 40, the hardness increased first and then decreased with the maximum hardness of 33.9 GPa when the bilayer number is 30. The H/E* and H3/E*2 values calculated to evaluate the fracture toughness showed the similar changing trend with hardness. The adhesion strength reached the maximum of 67 N when the bilayer number is 30. The surface roughness and friction coefficient decreased with increasing bilayer number. The wear mechanism was also investigated, and the results suggested that the multilayer film with bilayer number of 30 exhibited the best wear resistance (1.78 × 10–7 mm3/Nm), benefiting from the contribution of high hardness, fracture toughness and adhesion strength.

WB2/Cr multilayer films with different modulation ratios (λ = 1, 3, 5, 7, 12, and 20) were deposited by a combination of direct-current and pulse direct-current magnetron sputtering, and the number of bilayers was fixed at ten. The effect of the modulation ratio on the microstructure, mechanical and tribological properties of the multilayer films was investigated in detail. X-ray diffraction demonstrates that a preferred orientation of WB2 (101) and Cr (110) exists, and WB2 (101) dominates the film's growth with increasing of modulation ratio. The TEM results show that the multilayer films consist of nanograins dispersed in an amorphous matrix in WB2 layers and polycrystalline grains in Cr layers. The hardness increases with the increasing modulation ratio, and the maximum hardness (31.1 GPa) is obtained at λ = 20. The indentation toughness presents an opposite changing trend, and the maximum indentation toughness (1.264 MPa m1/2) is obtained in S1 at λ = 1 which conforms to the rule of mixture due to the relatively thick bilayer thickness (Λ = 160–192 nm). The wear mechanism is investigated, and the results suggest that the multilayer film with λ = 7 possesses the best wear resistance (2.06 × 10−7 mm3/Nm), benefiting from the balance of hardness and indentation toughness.

Multi-agent regimens such as Folfirinox and gemcitabine plus nab-paclitaxel have shown significant improvements compared with single-agent gemcitabine as neoadjuvant chemotherapy for patients with borderline resectable or locally advanced pancreatic cancer. However, the efficacy and safety of Folfirinox and GNP as NAC for BRPC and LAPC is still controversial.The eligible studies including prospective, retrospective, and randomized controlled trial related to Folfirinox and GNP as NAC for patients with BRPC or LAPC up to March 2022 were searched and assessed. Pooled analysis for chemotherapy response rate, resection rate, R0 resection rate, progress free survival, overall survival, and grade 3/4 events of toxicity were performed in the study.Eight studies were included in this meta-analysis. Compared with GNP, Folfirinox had higher resection rate (HR=0.82; 95% CI 0.59-1.14) and R0 resection rate (HR=0.77; 95% CI 0.60-0.97), better PFS (HR=0.78; 95% CI 0.55-1.12) and OS (HR=0.68; 95% CI 0.46-0.99), and without increasing severe toxicity rate (HR=0.95; 95% CI 0.71-1.28). There are no differences in rate of stable disease (HR=1.06; 95% CI 0.92-1.22) and partial/complete regression (HR=0.85; 95% CI 0.59-1.23) between two groups.Higher resection and R0 resection rate and better PFS and OS results were obtained in Folfirinox group compared with GNP group for patients with BRPC and LAPC. There was no increased severe toxicity rate for Folfirinox compared with GNP.

Biliary liver disease refers to a group of diseases in which lesions of the biliary system cause liver damage. Early detection and standardized treatment can improve patient outcomes and prolong survival.Treatment includes pharmacological, non-pharmacological, and combination therapy. However, due to the involvement of a variety of diseases and different treatment characteristics, multidisciplinary cooperation is required when necessary, and there are still certain problems to be solved in the treatment.胆源性肝脏疾病指胆道系统病变引起肝损伤的一组疾病。早发现，早治疗，规范治疗可改善患者预后，延长患者生存期。治疗包括药物、非药物及综合治疗。因涉及病种多，治疗上存在不同特点，必要时需多学科协作。治疗上还存在一些待解决的问题。.

Asian Citrus Psyllid (ACP), Diaphorina citri, is a key vector transmitting the causative agent of Huanglongbing (HLB) disease. Population growth of ACP is evident after feeding on plant flush shoots, as they only oviposit here. However, the underlying mechanism as to why flush shoots govern oviposition is unclear. This study compares the fecundity and ovarian morphology of ACP between young flush and mature leaves. Furthermore, the transcriptome of mated females infesting Murraya paniculata was analysed. Finally, the gene of the key Target of Rapamycin (TOR) signalling pathway was silenced by RNAi. Results indicated that flush shoot feeding activated the development of the psyllids ovary and therefore induced oviposition. A total of 126 and 2794 differentially expressed genes were detected at 1 and 5 days, respectively, after pest infestation of flush shoots compared to mature leaves. Many genes are involved in protein metabolism, Mitogen-Activated Protein Kinase (MAPK) signalling pathway, hormone synthesis, and TOR signalling pathway: all thought to activate reproduction. Silencing of the positive regulator gene DcRheb in the TOR pathway resulted in lower levels of ecdysone and juvenile hormone and decreased vitellogenin synthesis, further disrupting reproductive ability. This study enhances understanding of the molecular mechanism underlying ACP's reproductive strategy.

Real-world data study evidence, as an important part of evaluating the safety and effectiveness of drugs and devices, has attracted increasing attention from regulatory agencies and scholars both at home and abroad, and has become an essential source of evidence to support the development and review of drugs and devices. This paper systematically discusses the process and mode of real-world data system construction based on the preliminary practical study of real-world data according to the guidelines/technical specifications issued by regulatory agencies and academic research results. This study result provides not only reference for the generation of clinical evaluation evidence to meet the regulatory requirements for innovative drugs and devices, but also reference for researchers, sponsors and regulators to carry out real-world data studies successfully.真实世界数据研究证据作为评价药物和医疗器械（药械）安全性和有效性的重要组成部分，日益受到国内外监管机构和学者的关注，已成为支持药械研发与审评的关键证据来源。本文在真实世界数据的前期实际研究基础上，结合国内外监管机构所发布的指导原则/技术规范和学术研究成果，系统探讨了真实世界数据体系的构建流程和模式探索。以期为特许药械产生满足监管要求的临床评价证据提供参考，而且为研究者、申办方及监管部门顺利开展真实世界数据研究提供借鉴。.

A retrospective analysis of a case of death from sudden convulsions caused by oral high-dose diquat was conducted, and the mechanism and treatment of central damage caused by diquat were investigated to lay the foundation for increasing the success rate of treatment of high-dose diquat poisoning. At the same time, at the same time, our clinical treatment experience has also been accumulated.回顾性分析1例口服大剂量敌草快致突发性抽搐死亡的案例，探讨敌草快所致中枢损害的机制及治疗方法，为提高大剂量敌草快中毒的救治成功率，同时积累临床救治经验。.

Boao Lecheng International Medical Tourism Pilot Area is the only administrative area in China where the pilot application of real-world data is performed. Based on the special healthcare policy in Boao Lecheng, conducting real-world data study to provide real-world evidence for the clinical evaluations and approvals of innovated medical products has become an important field that supports the reform of China's evaluation and approval system of medical products. Trustworthy real-world evidence needs to rely on both high-quality real-world data and reasonable and rigorous study designs. Based on the real-world data research guidelines and specifications issued by relevant academic research and regulatory authorities both at home and abroad, combined with the special policy environment of Boao Lecheng and previous practice experience, this paper summarizes the study designs of real world data in Boao Lecheng and discusses the key considerations of different study design in the context of special healthcare policies in Boao Lecheng in order to provide reference for the further study of real-world data.博鳌乐城国际医疗旅游先行区是全国唯一的真实世界数据应用试点地区，基于博鳌乐城特许医疗政策，开展真实世界数据研究，形成支持创新药械临床评价和审评审批的真实世界证据，已成为我国药品审评审批制度改革的重要领域，真实世界证据的产生不仅依靠高质量的真实世界数据，还需要合理可靠的研究设计。本文在国内外相关学术研究和监管部门所发布的真实世界数据研究指导原则或规范的基础上，结合博鳌乐城特殊政策环境和前期实践经验，总结了博鳌乐城真实世界数据研究的设计类型，并探讨了各设计类型在博鳌乐城特殊医疗政策环境中的关键考虑，旨在为进一步实施和开展真实世界数据研究提供借鉴。.

Parotid gland tumor is the most common salivary gland tumor and surgery is the main treatment method. The conventional surgery for the treatment of parotid tumor is mostly performed by using large incision which often causes complications and aesthetic problems to patients. With the advancement of medical technology, deeper understanding of histopathology and anatomy by the surgeons, as well as patients' higher demands on aesthetics and functions, the surgical methods and incisions have been constantly improved. This review focuses on the evolution of surgical approaches and incisions for the treatment of parotid tumors and provides an outlook based on the preliminary application of endoscopically assisted parotid tumor resection.腮腺肿瘤是最常见的一种唾液腺组织肿瘤，手术是其最主要的治疗手段。传统的腮腺肿瘤手术多采用大切口翻瓣，带来的并发症以及美观问题常会给患者造成诸多困扰。随着医学技术的进步、外科医师对组织病理学和解剖学认识的不断深入，以及患者对美学及功能要求的增高，手术切除方式和切口设计均在不断改进。本综述将重点围绕腮腺肿瘤手术切除方式及入路设计的演变等内容展开，并基于内镜辅助下腮腺肿瘤切除术的初步应用提出展望。.

BACKGROUND: This research aimed at investigating the safety and efficacy of autologous esophageal mucosa (AEM) with polyglycolic acid (PGA) transplantation and temporary stent implantation (TSI) in preventing esophageal stenosis (ES) after early esophageal cancer (EC) surgery. METHODS: Between April 2019 and October 2020, patients scheduled for circumferential endoscopic submucosal dissection (ESD) were prospectively recruited. After ESD, autologous esophageal mucosal patches (MPs) were constructed on the absorbable PGA felt. Then, the felt was structured onto a covered metal mesh stent (CMMS) and attached to the ulcer surface. The stents were removed 6–8 weeks after the operation. The occurrence of ES and adverse events was observed and analyzed. RESULTS: Data from 25 patients were analyzed. In total, 14 patients (56%) had no stenosis during an average follow-up of 10.2 months, and 11 patients (44%) suffered strictures at a mean interval of 63.73 days after the ESD procedure. Stent migration occurred in 2 patients. No other complications, including perforations, bleeding, or wound infections, occurred. The median of endoscopic balloon dilatation (EBD) sessions was 2.16 (range, 0–14). There showed a higher post-ESD stricture rate in patients with lesions located in the middle-lower esophagus (P

The aim of this study was to explore the dynamic changes in characteristic serum metabolic markers and pathways during early sepsis in rats. By using cecal ligation and puncture (CLP), we made rat models of sepsis, which were randomly divided into 5 groups with 10 rats in each group: group A, group B, group C, group D, and group E. We collected 2 mL of arterial blood at 0, 6, 12, 24, and 48 hours from rats in group A-E respectively and isolated serum via centrifugation. Next, adopting metabolomics analysis methods, we screened for metabolites from the animal serum with statistically and biologically significant abundance changes, and used the KEGG database to analyze the respective metabolic pathways. In all, our findings reveal that D-glucosamine 6-phosphate, D-glucosamine phosphate, α-D-glucosamine 1-phosphate, D-glucosamine 1-phosphate, and 5-hydroxy isocyanate decline continuously from 12 hours, while L-phenylalanine, (S) -α-amino-β-phenylpropionic acid, 5-methoxy indole acetic acid salt, 5-methoxy indole acetic acid, goose deoxyglycolic acid salt, goose deoxyglycolic acid, and Chen's deoxygenated sugar alcohol started to decrease from 6 hours. Additionally, 3.2,3-Bis-O-(geranyl geranyl)-sn-glycerol- 1-phosphoric acid-L-serine levels rose continuously from 12 hours. We found 13 differentially regulated ions, primarily ones involved in pathways responsible for the metabolism of sugar, amino acids, and lipids, which are related to the disorder of energy metabolism. Our findings mark serum-derived D-glucosamine and its phosphorous derivatives as characteristic metabolic markers of sepsis in rats.

Traditional anti-cancer treatments are far from satisfactory. There is an urgent to combine new therapeutics with traditional treatments to improve anti-cancer effectiveness. Ferroptosis is a new type of iron dependent non-apoptotic cell death could still offer benefits to patients who failed in apoptosis and necroptosis induction treatment. Iron plays a vital role during ferroptosis induction. While iron is a double-edged sword in cancer treatment, tumor specific distribution of iron is especially important. Nanotechnology is an efficient way to help drugs targeting distribution. We intended to review the latest progress in ferroptosis and iron based nanotherapeutics. First, the relationship between ferroptosis and iron metabolism was reviewed briefly to demonstrate the central role of iron in ferroptosis induction. Second, the latest progress of iron-based nanotechnology was presented and discussed according to the different designs. Finally, the future expectations of iron based nanotherapeutics for ferroptosis were spotlighted.

To investigate the prevalence ofDuring the period from April 2018 to December 2019, the population distribution, inhabiting activity and natural reproduction ofA total of 51The

目的 探讨初诊急性髓系白血病（AML）合并骨髓纤维化（MF）患者的基因突变、临床及预后特征。 方法 2016年1月1日至2020年2月1日河南省人民医院收治的初诊并同时行骨髓活组织检查的103例AML患者纳入研究，根据WHO（2016）骨髓纤维化分级标准将患者分为AML伴MF组（MF-1～3）与AML不伴MF组（MF-0），并对两组患者的临床特征、基因突变、疗效和预后进行回顾性比较。 结果 ①103例患者中AML伴MF组46例（44.7％），其中MF-1 39例（84.8％），MF-2/3 7例（15.2％）；AML不伴MF组57例（55.3％）。和AML不伴MF组相比，AML伴MF组中位WBC显著增高［11.205（0.69～191.82）×109/L对4.64（0.18～95.10）×109/L，P＝0.024］；外周血出现有核红细胞的比例明显增高（43.5％对24.6％，χ2＝4.119，P＝0.042）；FAB分型：4例AML-M0患者均在AML伴MF组，而AML不伴MF组AML-M2所占比例更高（P＝0.014）。②AML伴MF组患者FLT3-ITD及NPM1基因突变率更高（15.2％对1.8％，P＝0.021；26.1％对10.5％，P＝0.039），而CEBPA基因突变率明显低于AML不伴MF组（2.2％对17.5％，P＝0.029）。③AML伴MF组完全缓解（CR）率显著低于AML不伴MF组（69.7％对93.2％，χ2＝7.412，P＝0.006）。多因素分析显示MF，尤其是纤维化程度是影响初诊AML患者CR的独立危险因素。④AML伴MF组3年总生存（OS）率明显低于AML不伴MF组（20.5％对72.2％，χ2＝4.032，P＝0.045）；亚组分析显示MF-1和MF-2/3两组患者的OS率、无进展生存（PFS）率显著低于AML不伴MF组（P＝0.001）。Cox多因素分析显示MF，尤其是MF-2/3是影响初诊AML患者OS和PFS的独立危险因素（P值分别为0.021和0.044）。 结论 AML合并MF患者具有较为独特的实验室及临床特征；MF是影响AML患者CR、OS和PFS的独立预后不良指标，MF的评估对初诊AML的疗效和预后判断具有重要意义。