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Ying Zhou,1 Zhixian Luo,1 Mengying Yu,1 Chenyi Zhan,1 Haoli Xu,1 Ru Lin,1 Shuying Bian,1 Yunjun Yang,2,3 Zhenghao Jiang,4 Xinyi Tao,4 Zusen Ye,5 Meihao Wang,1 Dongqin Zhu2 1Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Nuclear, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3Key Laboratory of Novel Nuclide Technologies on Precision Diagnosis and Treatment & Clinical Transformation of Wenzhou, Wenzhou, People’s Republic of China; 4The First School of Medicine, Wenzhou Medical University, Wenzhou, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of ChinaCorrespondence: Dongqin Zhu, Department of Nuclear, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China, Tel +86 0577 55579667, Email zhudongqin96@163.comObjective: Post-stroke hyperglycemia as a common phenomenon is associated with unfavorable outcomes. Focusing on admission hyperglycemia, other markers of dysglycemia were overlooked. This study aimed to explore the contribution of acute phase blood glucose levels in combination with other radiological signs to the prognostication of functional outcomes in patients with spontaneous intracerebral hemorrhage (sICH).Methods: Consecutive patients with sICH with at least five random plasma glucose measurements and complete radiological data during hospitalization were included. We calculated the average, maximum, minimum, standard deviation, and coefficient of variation of blood glucose levels for each patient. Radiological data, including island, black hole, blend, and satellite signs were collected. Functional outcomes were evaluated using the Barthel index. Unfavorable outcomes were defined as a Barthel index score ≤ 60. Univariate and multivariate analyses were performed to identify independent predictors of unfavorable outcomes.Results: Two hundred and thirty-eight patients (mean age 58.5, 163 men and 75 women) were included, and 71 had a history of diabetes. Unfavorable outcomes occurred in 107 patients (45.0%) at 3 months. Multivariate logistic regression analysis demonstrated that maximum blood glucose levels (odds ratio, 1.256; 95% confidence interval, 1.124‒1.404; p < 0.001) and island sign (odds ratio, 2.701; 95% confidence interval, 1.322‒5.521; p = 0.006) were independent predictors of unfavorable outcomes in the nondiabetic group. Meanwhile, patients without diabetes who experienced hematoma expansion had higher average (p = 0.036) and maximum blood glucose levels (p = 0.014).Interpretation: Maximum blood glucose levels and island sign were independently associated with unfavorable outcomes in patients without diabetes, whereas no glycemic variability indices were associated with unfavorable outcomes. Glucose levels influenced hematoma expansion and functional outcomes, particularly in patients without diabetes with sICH. Thus, clinical management of blood glucose levels should be strengthened for patients with sICH with or without a history of diabetes.Keywords: spontaneous intracerebral hemorrhage, glycemic variability, functional outcomes, island sign, diabetes

Zhuzhu Qin,1,&ast; Xinxin Ye,2,&ast; Huanju Liu,3 Yining Tao,4 Xutong Zheng,1 Yanxia Zhong,5 Danfeng Chen,1 Wan Ye,6 Chenju Zhan7 1School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China; 2Department of Sports and Exercise Science, College of Education, Zhejiang University, Hangzhou, Zhejiang, China; 3Women’s Hospital and Institute of Genetics, Zhejiang University School of Medicine, Hangzhou, China; 4Department of Global Public Health, Karolinska Institute, Stockholm, Sweden; 5Department of Nursing, Shijiazhuang Medical College, Shijiazhuang, China; 6Department of Nursing, Xiamen Medical College, Xiamen, Fujian, China; 7Department of Nursing, Mindong Hospital Affiliated to Fujian Medical University, Ningde, China&ast;These authors contributed equally to this workCorrespondence: Wan Ye, Department of Nursing, Xiamen Medical College, Xiamen, Fujian, China, Tel +86 13806086169, Email 200600010142@xmmc.edu.cn Chenju Zhan, Department of Nursing, Mindong Hospital Affiliated to Fujian Medical University, No. 89 HeShan Road, Fuan City, Fujian Province, 355000, China, Tel +86 13809562183, Email zhanchenju@yeah.netObjective: This study investigated factors influencing the knowledge, attitudes, practice profiles, and vaccination intentions among Chinese nursing students and nursing interns toward the coronavirus disease (COVID-19) vaccination.Materials and Methods: The multicenter cross-sectional study was based on a self-reported questionnaire collecting information among nursing students and nursing interns from three major geographic regions of China, and the sample was selected by consecutive sampling. The questionnaire was developed by knowledge, attitudes, and practice (KAP) theory. Univariate and multivariate logistic regression were used for statistical analysis.Results: A total of 3180 nursing students and interns (effective rate: 99.8%) from six Chinese provinces were polled. The vaccine hesitation rate was 9.65% (307/3180), 2230 participants (70.1%) had gotten at least one dose of the vaccine, and 643 participants (67.7%) had indicated a readiness to be vaccinated. The results showed that older age, higher academic background, perfect vaccine management, others’ recommendations, influenza vaccination history, epidemic under control, knowledge of vaccines or intervals, and vaccine knowledge training were associated with higher vaccination rates. Conversely, vaccine hesitancy was caused by a perceived lack of physical need, uncertainty about vaccination requirements, and fear of vaccination.Conclusion: This study provided population-based estimates of COVID-19 vaccine uptake intention among mainland Chinese nursing students and interns. Factors such as age, education, vaccine knowledge, and attitudes influence COVID-19 vaccine behaviour. Relevant authorities should understand the barriers to COVID-19 vaccination from knowledge, attitude and practice, which is significant for formulating effective response strategies in future global public health crises.Graphical Abstract: Keywords: COVID-19, vaccine, knowledge, attitudes, practice, nursing students and interns

Wu Yang,1,&ast; Tingting Liu,1,&ast; Chun Zhan,2 Hui Jiang,1 Wang Zhang,3 Qing Yang,4 Xia Zheng1 1Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China; 2Department of Critical Care Medicine, Hang Zhou Integrative Medicine Hospital, Hangzhou, Zhejiang, 310000, People’s Republic of China; 3Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China; 4Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xia Zheng, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-13958174689, Fax +86-571-87236838, Email zxicu@zju.edu.cnAbstract: Burkholderia cepacia is an aerobic opportunistic Gram-negative pathogen that mainly infects immunodeficiency patients. However, soft tissue infections with fractures due to Burkholderia cepacia are rare with no cases reported. Here, we report a rare case of 3 years of brain death in a 43-year-old woman with Burkholderia cepacia resulting in an occipital subcutaneous abscess and fracture. Through the second-generation sequencing of the whole genome of this strain, it was found that there were no high virulence genes and virulence factors. The patient received targeted antibiotic therapy and showed improvement in clinical symptoms and radiological signs. Bone destruction because of Burkholderia cepacia is easily overlooked due to the lack of characteristic symptoms and limited clinical examination. This case reminds us that Burkholderia cepacia without major virulence factors could damage the bone in immune-compromised patients.Keywords: brain death, Burkholderia cepacia, subcutaneous abscess, generation sequencing, case report

Dandan Wang, Changchun Zhan School of Management, Jiangsu University, Zhenjiang, People’s Republic of ChinaCorrespondence: Changchun Zhan, Tel +86-15952808385, Email Zcc1973@126.comPurpose: To identify the factors that influence whistleblowing behavior as it relates to health care insurance fraud in Jiangsu Province, China.Methods: To construct a factor model and formulate research hypotheses using the Motivation–Opportunity–Ability framework. We designed a questionnaire containing 24 items and distributed it on-site to 2081 respondents in Jiangsu Province, China. Afterward, we applied structural equation modeling to validate the research hypotheses.Results: Policy awareness negatively contributes to whistleblowing behavior, risk perception does not reduce the incentive to blow the whistle, and an inability to recognize fraud is another critical barrier to converting whistleblowing intentions into behavior.Conclusion: Practices that are likely to promote citizen whistleblowing on insurance fraud may focus on the constraints identified by the comprehensive Motivation–Opportunity–Ability framework.Keywords: health care insurance fraud, whistleblowing behavior, Motivation–Opportunity–Ability framework, structural equation modeling

Changqing Zhan,1 Qiao Wang,2 Jie Liu,3– 5 Lei Wang,1 Zongsheng Chen,1 Hongbo Pang,1 Jun Tu,3– 5 Xianjia Ning,3– 5 Jinghua Wang,3– 5 Shizao Fei1 1Department of Neurology, The Second People’s Hospital of Wuhu, Wuhu, Anhui, People’s Republic of China; 2Department of Pathology, The Second People’s Hospital of Wuhu, Wuhu, Anhui, People’s Republic of China; 3Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 4Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 5Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of ChinaCorrespondence: Shizao FeiDepartment of Neurology, The Second People’s Hospital of Wuhu, 259 Jiuhuazhong Road, Wuhu, 241000, Anhui Province, People’s Republic of ChinaTel +86-553-3909017Fax +86-553-3832545Email feishizao@163.comJinghua WangLaboratory of Epidemiology, Tianjin Neurological Institute, Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of ChinaTel +86-22-60817504Fax +86-22-60817448Email jwang3@tmu.edu.cnIntroduction: To explore the relationship between metabolic syndrome (MetS) and cognitive impairment in a low-income and low-education population.Methods: All residents aged ≥ 45 years in a low-income population in Tianjin, China, were eligible to participate in this study. The Mini-Mental State Examination (MMSE) scale was used to conduct a preliminary screening and assessment of the participants’ cognitive statuses. The MMSE components are orientation, registration, attention and calculation, recall, and language.Results: In this population, the prevalences of MetS and cognitive impairment were 54.1% and 44.5%, respectively. In the overall population, the registration score was 0.105 points lower in the elevated triglycerides (TG) group than in the normal TG group (β, − 0.105; 95% confidence interval [CI]: − 0.201, − 0.010; P=0.030). In men, high TG was associated with registration scores that were 0.152 points lower than those in the normal TG group (95% CI: − 0.281, − 0.022; P=0.022), while larger WC and lower HDL-C had positive effects on cognitive scores (all P< 0.05). However, in women, there were no significant differences between cognitive scores and MetS or its components.Conclusion: In this population, first, TG had a great impact on cognition, even greater than the impact of MetS on cognition. Second, the impact of MetS components on cognition was more obvious in men, and not all of the effects were negative. Therefore, the effect of MetS on cognition may need to be analyzed separately for different populations, and it may be that the effect of a single component is greater than the overall effect. When formulating prevention strategies for cognitive impairments, population differences must also be taken into consideration.Keywords: cognitive impairment, MMSE, metabolic syndrome, aging, population-based study

Yuansheng Zheng,1,* Yiwei Huang,1,* Guoshu Bi,1,* Zhencong Chen,1 Tao Lu,1 Songtao Xu,1,2 Cheng Zhan,1 Qun Wang1 1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai City, People’s Republic of China; 2Department of Thoracic Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen City, Fujian Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cheng Zhan; Qun WangDepartment of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai 200032, People’s Republic of ChinaTel/Fax +86-21-64041990Email czhan10@fudan.edu.cn; wang.qun@zs-hospital.sh.cnBackground: Most non-small cell lung cancer patients with enlarged mediastinal lymph nodes (LN) in preoperative computer tomography (CT) images are diagnosed with N0 in the pathological examination after surgery. However, these patients seem to have worse survival than those without enlarged mediastinal LN in our clinical practice. This study aimed to investigate whether the size of mediastinal LN is correlated with the prognosis in pathological N0 patients, which could help us to predict the prognoses further.Methods: The retrospective cohort study involved 758 N0 patients with a thin layer CT scan. We have measured the size of mediastinal LN, including long diameter, short diameter, and volume on CT image, and classified patients by X-tile. Next, we explored the risk factors of enlarged LN by univariate and multivariate logistic analysis. Then, we have compared the 5-year cancer-specific survival by Kaplan–Meier and log-rank method. Multivariate Cox analysis was utilized to further survival analysis. Finally, we have constructed the prediction model by nomogram.Results: A total of 150 N0 patients (19.8%) had mediastinal LN enlargement in our study. After multivariate logistic analysis, we found the LN enlargement was significantly correlated with age (p=0.001), pathology (p < 0.001) and tumor recurrence (p < 0.001). The patients with LN enlargement had a worse 5-year cancer-specific survival (75.3% vs 92.8%, p < 0.001) after Kaplan–Meier analysis. Patients with a larger volume had increased risk of tumor-associated death when compared with the normal group (p < 0.001) by multivariate Cox analyses.Conclusion: N0 patients with larger mediastinal LN had a worse 5-year cancer-specific survival and a higher risk of recurrence. The volume of LN was the most valuable prognostic factor in N0 patients.Keywords: mediastinal lymph nodes, enlarged, prognosis, computed tomography

Mengkun Shi,1 Cheng Zhan,2 Jialun Shi,3 Qun Wang2 1Department of Oncology, The Affiliated Heping Hospital of Changzhi Medical College, Changzhi City, Shanxi Province, People’s Republic of China; 2Department of Thoracic Surgery, ZhongShan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Department of Thoracic Surgery, The Affiliated Heping Hospital of Changzhi Medical College, Changzhi City, Shanxi Province, People’s Republic of ChinaCorrespondence: Jialun ShiDepartment of Thoracic Surgery, The Affiliated Heping Hospital of Changzhi Medical College, 110 Yan’an South Road, Changzhi City, Shanxi Province 046000, People’s Republic of ChinaTel +86-13122625627Email hepingdoctor@126.comPurpose: Risk stratification of patients with non-small cell lung cancer (NSCLC) is crucial to select the appropriate treatments, but available models for patients with complete resection are unsatisfactory. The purpose of this study was to determine a prediction model based on clinical information, routine physical and blood tests, and molecular markers.Patients and Methods: This was a retrospective cohort study of patients who underwent surgical resection for lung cancer between 2009 to 2013. Potential prognostic factors were used to build a full prediction model based on a multivariable Cox regression analysis. A nomogram was constructed. The risk stratification cutoffs for clinical use were determined based on the model.Results: A total of 368 NSCLC patients with R0 resection were included. The final multivariable model indicated that low diffusing capacity of the lung for carbon monoxide (HR=1.66, 95% CI: 1.18–2.34), high platelet-to-lymphocyte ratio (HR=1.42, 95% CI: 1.04–1.95), histology type of squamous cell carcinoma and others (squamous cell carcinoma vs adenocarcinoma, HR=1.40, 95% CI: 1.01–1.96; others vs adenocarcinoma, HR=2.36, 95% CI: 1.15–4.84; P trend=0.001), N>0 status (HR=1.96, 95% CI: 1.42–2.70), high serum carcinoembryonic antigen levels (HR=1.61, 95% CI: 1.13–2.27), and postoperative chemotherapy (HR=0.53, 95% CI: 0.33–0.87) were independently associated with poor OS. The patients were classified into four risk groups according to the nomogram, and the OS was different among the four groups (P

Guoshu Bi,* Tao Lu,* Guangyu Yao, Yunyi Bian, Mengnan Zhao, Yiwei Huang, Yi Zhang, Liang Xue, Cheng Zhan, Hong Fan Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hong Fan; Cheng ZhanZhongshan Hospital, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, People’s Republic of ChinaTel +86 139 1689 7139Fax +86 21 6404 1990 Ext 2915Email fan.hong@zs-hospital.sh.cn; czhan10@fudan.edu.cnBackground: Lymph node ratio (LNR), defined as the ratio of the number of positive lymph nodes to the total of all resected nodes, has been reported to be a predictor of survival of patients with several types of cancer. However, the prognostic value of LNR and other factors in patients with resected N2 stage lung squamous cell carcinoma has never been considered.Methods: Data from 1778 patients with resected N2 stage lung squamous cell carcinoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The optimal cutoff value of LNR was identified by X-tile. A multivariable Cox model and corresponding nomogram were constructed to predict overall survival (OS) and cancer-specific survival (CSS). Both the cutoff value of LNR and the model were further validated in 146 similar patients treated in Zhongshan Hospital. Heat maps were created to visualize the distribution of LNR and the number of positive lymph nodes with the predicted survival probabilities.Results: The optimal cutoff value for LNR was identified as 0.42. Multivariable analysis showed that age, sex, tumor laterality, type of surgery, T stage, chemotherapy and LNR were independently correlated with OS. Harrell’s C-index of the nomogram (0.64) was significantly higher than the index of the T stage-based model (0.54). Calibration curves showed good agreement between predicted and observed survival probabilities. The robustness of the model was also demonstrated by external validation.Conclusion: LNR less than 0.42 was associated with improved OS and CSS for patients with resected N2 stage lung squamous cell carcinoma.Keywords: lymph node ratio, N2 stage lung squamous cell carcinoma, prognostic model, nomogram, heatmap

Tian Jiang, Ming Li, Miao Lin, Mengnan Zhao, Cheng Zhan, Mingxiang FengDepartment of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of ChinaObjective: The aim of the study was to compare the prognoses between part-solid and pure-solid tumors for clinical stage IA non-small-cell lung cancer (NSCLC) patients in the eighth edition TNM classification.Methods: We searched the literature in PubMed and Web of Science for all eligible articles published before November 31, 2018. The pooled data included overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The hazard ratio (HR) of OS (pure-solid/part-solid) was used as the measure of differential effects. Pure-solid or part-solid tumors in all studies included were matched according to the solid component size or according to the eighth edition TNM classification.Results: Seven studies including 2,037 patients with c-stage IA NSCLC were pooled in the meta-analysis. Patients with pure-solid tumors had significantly poorer OS (HR 1.69, 95% CI 1.21‒2.35, P=0.002), DFS (HR 1.27, 95% CI 1.07‒1.51, P=0.006) and RFS (HR 1.74, 95% CI 1.08‒2.80, P=0.020). In subgroup analyses, when the meta-analysis was limited to T1a-1b (≤2 cm) lung cancer, the prognosis for pure-solid tumors was inferior to that for part-solid tumors regarding both OS and RFS. In adenocarcinoma subgroup, there was no difference between the two groups in terms of OS and RFS, but we detected a meaningful difference in DFS.Conclusion: Part-solid tumors may have a better prognosis than pure-solid tumors in clinical stage IA patients according to the eighth edition TNM classification, and similar results were found for the T1a-1b (≤2 cm) subgroup. There were no substantial differences in OS and RFS between two groups in lung adenocarcinoma. However, we detected a meaningful difference in DFS, which might also suggest a superior prognosis for part-solid tumors. We propose that the part-solid and pure-solid tumors in the same T component category be considered separately.Keywords: part-solid, pure-solid, stage IA, adenocarcinoma, lung cancer, meta-analysis

Tao Lu,* Xiaodong Yang,* Yiwei Huang, Mengnan Zhao, Ming Li, Ke Ma, Jiacheng Yin, Cheng Zhan, Qun WangDepartment of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China*These authors contributed equally to this work Purpose: This study used the Surveillance, Epidemiology, and End Results (SEER) data to investigate the changes in incidence, treatment, and survival of lung cancer from 1973 to 2015.Patients and methods: The clinical and epidemiological data of patients with lung cancer were obtained from the SEER database. Joinpoint regression models were used to estimate the rate changes in lung cancer related to incidence, treatment, and survival.Results: From 1973 to 2015, the average incidence of lung cancer was 59.0/100,000 personyears. The incidence increased initially, reached a peak in 1992, and then gradually decreased. A higher incidence rate was observed in males than in females and in black patients than in other racial groups. Since 1985, adenocarcinoma became the most prevalent histopathological type.The surgical rate for lung cancer was about 25%, and treatment with chemotherapy showed an increasing trend, while the radiotherapy rate was in downward trend. The surgical rate for non-small-cell lung cancer (NSCLC) was higher than that for small cell lung cancer (SCLC), while chemotherapy for SCLC far exceeded that for NSCLC. Treatment with chemotherapy andradiotherapy for advanced stage had higher rate than early stage. The 5-year relative survival rate of lung cancer increased with time, but

Bo Zhou,1 Qiyi Zhang,1 Canyang Zhan,2 Yuan Ding,1 Sheng Yan1 1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 2Department of Neonatology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Introduction: An epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) is a rare non-neoplastic cyst, typically occurring in the pancreatic tail. It is difficult to preoperatively differentiate ECIPAS from other types of pancreatic neoplastic cysts.Case presentation: We herein report a case of a 32-year-old man with a cystic tumor in the tail of the pancreas. The patient underwent a laparoscopic spleen-preserving distal pancreatectomy, and histological examination revealed the presence of ECIPAS. In addition, we also performed a literature review of 42 case reports of ECIPAS.Conclusion: Although the preoperative diagnosis of ECIPAS is relatively difficult, familiarity with the imaging features, the clinical presentation and the location of the cyst could lead to a correct preoperative diagnosis of ECIPAS, which might thereby reduce the number of unnecessary resections. Keywords: epidermoid cyst, accessory spleen, pancreas

OBJECTIVE: The primary surgical techniques used to treat localized renal tumors are laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Obese patients have more intra-abdominal fat accumulation, which may make the localization and operation in minimally invasive surgery more complicated. Currently, limited research has been conducted on which method is more suitable for performing a partial nephrectomy on obese individuals. The aim of our investigation was to analyze and compare the perioperative results associated with both approaches to offer valuable information about the selection of LPN or RAPN as an optimal choice when performing a partial nephrectomy in obese patients. PATIENTS AND METHODS: We retrospectively collected clinical data from 78 cases of obese individuals [Body mass index (BMI) > 28] who underwent RAPN, as well as 50 cases of obese individuals (BMI > 28) who underwent LPN. The analysis covered various aspects, including initial patient characteristics, glomerular filtration rate (GFR), warm ischemia time (WIT), operation time, volume of blood loss during the surgical procedure, time taken to recover bowel function, positive surgical margin rate, incidence of postoperative complications, and postoperative hospital stay. RESULTS: We observed that RAPNs exhibited shorter warm ischemia time and reduced intraoperative blood loss in obese patients, along with decreased postoperative duration of abdominal drainage and hospitalization periods compared to LPNs. CONCLUSIONS: In obese patients, RAPN demonstrates advantages over LPN in minimizing intraoperative blood loss, WIT, and facilitating postoperative recovery. These findings may serve as valuable evidence when considering the choice between LPN or RAPN for partial nephrectomy in obese individuals. [ABSTRACT FROM AUTHOR]

Abstract Objective The CHOP combined chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) is commonly used to treat non-Hodgkin Lymphoma (NHL). While these drugs are effective for cancer treatment, they may have side effects on the reproductive system that are poorly studied. This study used a mouse model to investigate the mechanisms of reproductive function impairment induced by the CHOP regimen and developed a predictive model for assessing reproductive damage with a non-invasive procedure. Methods From 2022 to 2023, we statistically analyzed the changes of reproductive function of NHL patients before and after receiving CHOP regimen in the First Affiliated Hospital of Xiamen University. The NHL mouse model was established and divided into CHOP treatment group and control group. The weight of testis and epididymis, sperm quality and motility were compared between the two groups. Histopathological examination of testicular tissue was performed to determine pathological changes. ELISA was used to measure the expression of cytokines and cytokine pathways in serum, protein expression was analyzed by immunohistochemistry, and protein and mRNA levels of cytokines and pathways were evaluated by Western blotting and qPCR. Using stepwise regression method to select important factors, a prediction model of reproductive system damage was constructed. Results Fifty-two NHL patients included in the questionnaire showed significant reproductive system damage after CHOP regimen treatment. The weight of testis and epididymis, as well as the number and vitality of sperm in the mouse model treatment group were significantly lower than those in the control group. Serum LH, FSH, estradiol and progesterone levels decreased significantly, while inhibin B levels increased significantly. There was no significant change in testosterone or prolactin levels. Inflammatory markers such as CSF-1, IL-1, IL-6, TGF-β1 and GDNF increased significantly, while the level of SOD1 decreased significantly. Immunohistochemical staining analysis showed that CAMP, Caspase3, CSF-1, GDNF, IL-1, IL-6, PRKACB, TGF-β1 and TXNDC5 were all expressed in spermatocytes, and the expression of therapeutic histones was significantly higher than that of the control group. Western blot analysis further detected the protein expression, and QPCR detected the mRNA content. The results showed that the expression of histone and mRNA in the treatment group was significantly higher than that in the control group. Stepwise regression method determined that estradiol (E2) was the most important variable in the prediction model, and the AUC for predicting reproductive damage was 1. Conclusions The CHOP regimen induces male reproductive toxicity, potentially mediated through alterations in hormone levels and increased expression of inflammatory cytokines and oxidative stress. Using E2 as the sole predictor in the model accurately predicts the extent of reproductive damage, offering a non-invasive method for detecting reproductive system damage.

In the fields of wind power, and other industries, the Al2O3/TiO2 coating is prepared and ground on the bearing ring, in order to obtain the insulation resisting the electrical erosion for the motors at high voltage. A novel wet chemical mechanical grinding (WCMG) method is proposed to finish this hard-brittle composite material, utilizing the structured diamond abrasives pad and the NaOH solution. The softened workpiece's surface under the chemical reaction was demonstrated by means of Raman spectrum, indentation and scratching tests. The analytical model of surface roughness and fracture cracks is established based on the synthesis of geometry and kinematics, contact mechanics, material removal and indentation fracture mechanics. The surface roughness of coating was reduced from initial Sa 3.293 μm down to final Sa 0.049 μm in the WCMG process with grain size 3 μm and pH 12.01, mostly attributed to the ductile removal of chemically softened coating surface.

Abstract Frictional vibration often occurs during sliding, commonly referred to as the stick-slip phenomenon. It is more likely to occur in the range of the Stribeck curve, where friction and velocity have negative gradient characteristics. In this study, ultrasonic vibration is applied to the metal/metal sliding friction pair which reduce both static and kinetic friction forces. The inhibition mechanism of ultrasonic vibration on the stick-slip phenomenon is investigated for a sliding pair moving at low velocities (0.05–1.0 mm/s) under the condition of dry friction and oil lubrication. Under the condition of dry friction, ultrasonic vibration reduces the slider’s friction force by up to 89%, and the displacement fluctuation by up to 61%, effectively inhibiting the stick-slip phenomenon. Under the condition of oil lubrication, the friction force fluctuates when driving at a constant velocity, and the displacement fluctuation also fluctuates with the change of driving velocities. After ultrasonic vibration is applied, the friction reduction of the slider changes greatly with the driving velocity, so that the inhibition effect of ultrasonic vibration on stick-slip phenomenon under oil lubrication condition is unstable.

Abstract Purpose One of the most frequent side effects of radical prostatectomy (RP) is urinary incontinence. The primary cause of urine incontinence is usually thought to be impaired urethral sphincter function; nevertheless, the pathophysiology and recovery process of urine incontinence remains unclear. This study aimed to identify potential risk variables, build a risk prediction tool that considers preoperative urodynamic findings, and direct doctors to take necessary action to reduce the likelihood of developing early urinary incontinence. Methods We retrospectively screened patients who underwent radical prostatectomy between January 1, 2020 and December 31, 2023 at the First People ‘s Hospital of Nantong, China. According to nomogram results, patients who developed incontinence within three months were classified as having early incontinence. The training group’s general characteristics were first screened using univariate logistic analysis, and the LASSO method was applied for the best prediction. Multivariate logistic regression analysis was carried out to determine independent risk factors for early postoperative urine incontinence in the training group and to create nomograms that predict the likelihood of developing early urinary incontinence. The model was internally validated by computing the performance of the validation cohort. The nomogram discrimination, correction, and clinical usefulness were assessed using the c-index, receiver operating characteristic curve, correction plot, and clinical decision curve. Results The study involved 142 patients in all. Multivariate logistic regression analysis following RP found seven independent risk variables for early urinary incontinence. A nomogram was constructed based on these independent risk factors. The training and validation groups’ c-indices showed that the model had high accuracy and stability. The calibration curve demonstrates that the corrective effect of the training and verification groups is perfect, and the area under the receiver operating characteristic curve indicates great identification capacity. Using a nomogram, the clinical net benefit was maximised within a probability threshold of 0.01–1, according to decision curve analysis (DCA). Conclusion The nomogram model created in this study can offer a clear, personalised analysis of the risk of early urine incontinence following RP. It is highly discriminatory and accurate, and it can help create efficient preventative measures and identify high-risk populations.

Abstract Craniopharyngioma (CP) is an intracranial tumor with high mortality and morbidity. Though biologically benign, CP will damage the hypothalamus, inducing comorbidities such as obesity, metabolic syndrome, and cognitive impairments. The roles of gut microbiome and serum metabolome in CP‐associated hypothalamic comorbidities are aimed to be explored. Patients with CP are characterized by increased Shannon diversity, Eubacterium, Clostridium, and Roseburia, alongside decreased Alistipes and Bacteroides. CP‐enriched taxa are positively correlated with dyslipidemia and cognitive decline, while CP‐depleted taxa are negatively associated with fatty liver. Subsequent serum metabolomics identified notably up‐regulated purine metabolism, and integrative analysis indicated an association between altered microbiota and elevated hypoxanthine. Phenotypic study and multi‐omics analysis in the Rax‐CreERT2::BrafV600E/+::PtenFlox/+ mouse model validated potential involvement of increased Clostridium and dysregulated purine metabolism in hypothalamic comorbidities. To further consolidate this, intervention experiments are performed and it is found that hypoxanthine co‐variated with the severity of hypothalamic comorbidities and abundance of Clostridium, and induced dysregulated purine metabolism along with redox imbalance in target organs (liver and brain cortex). Overall, the study demonstrated the potential of increased Clostridium and up‐regulated purine metabolism as signatures of CP‐associated hypothalamic‐comorbidities, and unveiled that elevated Clostridium, dysregulated purine metabolism, and redox imbalance may mediate the development and progression of CP‐associated hypothalamic‐comorbidities.

ObjectivesThis study evaluated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) for survival outcomes in bladder cancer patients treated with radical cystectomy.MethodsStudies assessing NLR’s prognostic significance for bladder cancer after radical cystectomy were identified from PubMed, Embase, Web of Science, and Cochrane databases until April 2024. Survival outcomes analyzed included overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), cancer-specific survival (CSS), and progression-free survival (PFS).ResultsThe meta-analysis comprised 15 cohort studies with 8,448 patients. Multivariate analysis showed significantly shorter OS, CSS, DFS, and RFS in the high NLR group compared to the low NLR group. However, no significant difference in PFS was observed between the groups.ConclusionsNLR serves as an independent prognostic indicator for bladder cancer patients undergoing radical cystectomy, with elevated NLR associated with poorer survival. Further large-scale, prospective studies are warranted to validate the relationship between NLR and prognosis in bladder cancer.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024549573.

Abstract Cloud removal algorithm is a crucial step of remote sensing image preprocessing. The current mainstream remote sensing image cloud removal algorithms are implemented based on deep learning, and most of them are supervised. A large number of data pairs are required for training to achieve cloud removal. However, real with/without cloud image pairs datasets are difficult to obtain in the real world, and the models obtained by training on synthetic datasets often need to generalize better to natural scenes. And the existing unsupervised thin cloud removal methods based on Cycle‐GAN framework with considerable model complexity and unstable training are not an excellent solution to the problem of lack of paired datasets. Based on this, in this paper, the authors propose an unsupervised remote sensing image thin cloud removal method based on contrastive learning—GAN‐UD. It is a network consisting of a frequency‐spatial attention generator and a discriminator. In addition, the authors introduce local contrastive loss and global content loss to constrain the content of the generated images to ensure that the generated cloud‐free images are consistent with the input cloud images in terms of image content. Experimental results show that the proposed method in this paper can still effectively remove thin clouds from remote sensing images without paired training datasets, outperforms current unsupervised cloud removal methods, and achieves comparable performance to supervised methods.