The outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome: case series.

PURPOSE: To summarize the outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome (SJS). METHODS: This is a retrospective analysis of a consecutive case series. Twenty-four eyes of 18 SJS patients were included in this study. The ocular parameters, surgical procedures, postoperative complications, and additional treatments of the cases were reviewed. RESULTS: A total of 29 corneal sight rehabilitating surgeries, which consists of 9 keratoplasties, 8 Keratolimbal allograft (KLAL) and 12 combined surgeries (keratoplasty and KLAL simultaneously) were performed on the 24 eyes. All patients were treated with glucocorticoid eyedrops and tacrolimus eyedrops for anti-rejection treatment without combining systemic immunosuppression, except two patients who were prescribed prednisone tablets for the management of systemic conditions. The mean follow-up period was 50.6 ± 28.1 months. The optimal visual acuity (VA) (0.74 ± 0.60 logarithm of the minimum angle of resolution [logMAR]) and endpoint VA (1.06 ± 0.82 logMAR) were both significantly better than the preoperative VA (1.96 ± 0.43 logMAR) (95% CI, p = 0.000). 57.1% patients (8/14) were no longer in the low vision spectrum, and 88.9% patients (8/9) were no longer blind. The mean epithelialization time was 7.1 ± 7.6 weeks. The success rate was 86.7%. Additional treatments for improving epithelialization included administration of serum eyedrops (n = 10), contact lens (n = 15), amniotic membrane transplantation (n = 6), and tarsorrhaphy (n = 8). Complications included delayed epithelialization (n = 4, over 12 weeks), glaucoma (n = 11), and severe allograft opacity (n = 4). Only one graft rejection was observed. CONCLUSIONS: Keratoplasty and KLAL can remarkably enhance VA and improve low vision or even eliminate blindness for ocular complications of SJS. The outcome of the surgeries was correlated with the preoperative ocular situation and choice of operative methods.

Comparison of short-term outcomes of laparoscopic surgery, robot-assisted laparoscopic surgery, and open surgery for lateral lymph-node dissection for rectal cancer: a network meta-analysis.

This study attempted to compare short-term outcomes of laparoscopic surgery (LS), robot-assisted laparoscopic surgery (RS), and open surgery (OS) for lateral lymph-node dissection (LLND) in treatment of rectal cancer through network meta-analysis. Embase, Web of Science, PubMed, and The Cochrane Library databases were searched to collect cohort studies on outcomes of LS, RS, and OS for LLND for rectal cancer. Newcastle-Ottawa Scale (NOS) was utilized to evaluate the quality of cohort studies. Primary outcomes should at least include one of the following clinical outcome measures: operative time, blood loss, total lymph-node harvest, positive resection margin rate, postoperative complications, and postoperative hospital stay. A network meta-analysis was conducted using STATA software. Fourteen cohort studies including 8612 patients were eligible for inclusion. The network meta-analysis results showed that, in terms of intraoperative outcomes, the RS group had the longest operative time, while the OS group had the shortest; the LS and RS groups had significantly less blood loss than the OS group. In terms of histological outcomes, there were no significant differences in the total number of lymph nodes harvested and the positive margin rate among the LS, RS, and OS groups (P > 0.05). Regarding postoperative outcomes, the OS group had the highest probability of postoperative complications and the longest hospital stay, followed by the LS group, with the RS group being the lowest. RS was the best method in blood loss, postoperative complication rate, and postoperative hospital stay, followed by LS. OS had the shortest operative time and the highest blood loss.

Bimetal-Organic Frameworks Incorporating Both Hard and Soft Base Active Sites for Heavy Metal Ion Capture.

The design and synthesis of stable porous materials capable of removing both hard and soft metal ions pose a significant challenge. In this study, a novel metal-organic framework (MOF) adsorbent named CdK-m-COTTTB was developed. This MOF material was constructed using sulfur-rich m-cyclooctatetrathiophene-tetrabenzoate (m-H4COTTTB) as the organic ligand and oxygen-rich bimetallic clusters as the inorganic nodes. The incorporation of both soft and hard base units within the MOF structure enables effective removal of various heavy metal ions, including both soft and hard acid species. In single-component experiments, the adsorption capacity of CdK-m-COTTTB for Pb2+, Tb3+, and Zr4+ ions reached levels of 636.94, 432.90, and 357.14 mg·g-1, respectively, which is comparable to specific MOF absorbents. The rapid adsorption process was found to be chemisorption. Furthermore, CdK-m-COTTTB exhibited the capability to remove at least 12 different metal ions in both separate and multicomponent solutions. The material demonstrated excellent acid-base stability and renewability, which are advantageous for practical applications. CdK-m-COTTTB represents the first reported pristine MOF material for the removal of both hard and soft acid metal ions. This work serves as inspiration for the design and synthesis of porous crystalline materials that can efficiently remove diverse heavy metal pollutants.

Role of Bushen Huoxue Formula and transplanted endothelial progenitor cells play in promoting endplate microcirculation and attenuating intervertebral disc degeneration.

Objective: To explore whether Bushen Huoxue Formula (BSHXF) improves the angiogenesis ability of transplanted endothelial progenitor cells (EPCs) in endplate and its potential mechanism in delaying intervertebral disc degeneration (IDD). Methods: BSHXF was analyzed via Ultra-High Performance Liquid Chromatography (UPLC). Rabbit axial compression lumbar IDD models were constructed and the effects of BSHXF, EPCs, and their combination in IDD were determined by MRI, histological evaluation, TUNEL, and immunofluorescence assays. Additionally, CCK-8 assay, flow cytometry, and tube formation assay were used to evaluate EPCs viability, proliferation, cell cycle and the angiogenesis ability of EPCs between groups. Results: BSHXF and transplanted EPCs both attenuate the process of IDD in the rabbit model assessed by MRI, HE staining and Masson staining. TUNEL-positive NP cells were significantly reduced in the BSHXF group, EPCs group, and EPC + BSHXF group compared to the model group (P < 0.05), with the EPC + BSHXF group showing the most significant therapeutic effect. Immunofluorescence detection showed that VEGF, CD34 expression and quantity of microvessels in the endplate significantly increased in the EPC + BSHXF group compared to all the other groups (P < 0.05). Besides, the CCK-8 assay showed an upregulation of EPC viability and the tube formation assay demonstrated a significant increase in tube length and branching in EPCs cultured with BSHXF-containing serum (P < 0.05). Furthermore, BSHXF-containing serum increased VEGF expression in EPCs cultured in vitro (P < 0.05). Conclusions: Both BSHXF and EPCs transplantation play an important role in increasing endplate angiogenesis and attenuating IDD. BSHXF can enhance the viability and tube-forming ability of EPCs and endplate microcirculation.

Revealing the reason for enhanced CZTSSe device performance after Ag heavily doped into absorber surface.

Ag-doping treatment is a popular method for enhancing the performance of kesterite-structured Cu2ZnSn(S,Se)4 (CZTSSe) solar cells. Among the various methods, incorporating a high concentration of Ag+ into an absorber surface has proven to be particularly effective. However, the exact mechanisms behind this improvement are still unclear. This study aims to investigate the key factors that improve device performance through simulation. Specifically, the influence of the change in the carrier density, CuZn antisite defects, interface defect density, and formation of an n-type AZTSSe surface after heavy surface Ag doping have been examined. The simulation results indicate that the formation of an n-type AZTSSe layer on an absorber surface can significantly improve the open circuit voltage (VOC) and overcome the efficiency saturation problem induced by severe interface recombination for CZTSSe devices with a negative conduction band offset (CBO), compared to other affecting factors. This is because the modified conduction band alignment and the realization of interface-type inversion reduce interface recombination and retard the Fermi level pinning. However, the formation of interface-type inversion does not significantly improve CZTSSe devices with a positive CBO, as these devices already have weaker interface recombination. This work implies that the formation of an n-type AZTSSe layer is crucial for further improving the performance of CZTSSe devices with a negative CBO and can pave the way for improving the performance of thin film solar cells with severe interface recombination.

Integrated transmission electron microscopy and proteomic analyses reveal the cytoarchitectural response to cucumber mosaic virus infection in tobacco.

Cucumber mosaic virus (CMV) causes huge economic losses to agriculture every year; thus, understanding the mechanism of plant resistance to CMV is imperative. In this study, an integrated analysis of transmission electron microscopy (TEM) observations and proteomic results was used to identify cytoarchitectural differences in Nicotiana tabacum cv. NC82 (susceptible) and cv. Taiyan 8 (T.T.8; resistant) following infection with CMV. The TEM observations showed that the structure of the chloroplasts and mitochondria was severely damaged at the late stage of infection in NC82. Moreover, the chloroplast stroma and mitochondrial cristae were reduced and disaggregated. However, in T.T.8, organelle structure remained largely intact Selective autophagy predominated in T.T.8, whereas non-selective autophagy dominated in NC82, resembling cellular disorder. Proteomic analysis of T.T.8 revealed differentially expressed proteins (DEPs) mostly associated with photosynthesis, respiration, reactive oxygen species (ROS) scavenging, and cellular autophagy. Biochemical analyses revealed that ROS-related catalase, autophagy-related disulfide isomerase, and jasmonic acid and antioxidant secondary metabolite synthesis-related 4-coumarate:CoA ligase (Nt4CL) exhibited different trends and significant differences in expression in the two cultivars after CMV inoculation. Furthermore, mutant phenotyping verified that reduced Nt4CL expression impaired resistance in T.T.8. The identified DEPs are crucial for maintaining intracellular homeostatic balance and likely contribute to the mechanism of CMV resistance in tobacco. These findings increase our understanding of plant cytological mechanisms conferring resistance to CMV infection.

Application of the strip clear-cutting system in a running bamboo (Phyllostachys glauca McClure) forest: feasibility and sustainability assessments.

Introduction: As a renewable forest resource, bamboo plays a role in sustainable forest development. However, traditional cutting systems, selection cutting (SeC) and clear-cutting (ClC), result in an unsustainable production of bamboo forests due to labor-consuming or bamboo degradation. Recently, a strip clear-cutting (StC) was theoretically proposed to promote the sustainability of bamboo production, while little is known about its application consequence. Methods: Based on a 6-year experiment, we applied the strip clear-cutting system in a typical running bamboo (Phyllostachys glauca McClure) forest to assess its feasibility and sustainability. Using SeC and ClC as controls, we set three treatments with different strip widths (5 m, 10 m, and 20 m) for strip clear-cutting, simplified as StC-5, StC-10, and StC-20, respectively. Then, we investigated leaf physiological traits, bamboo size and productivity, population features, and economic benefits for all treatments. Results: The stands managed by StC had high eco-physiological activities, such as net photosynthetic rate (P n), photosynthetic nitrogen use efficiency (PNUE), and photosynthetic phosphorus use efficiency (PPUE), and thus grew well, achieved a large diameter at breast height (DBH), and were tall. The stand biomass of StC (8.78 t hm-2 year-1) was 1.19-fold and 1.49-fold greater than that of SeC and ClC, respectively, and StC-10 and StC-20 were significantly higher than SeC or ClC (p< 0.05). The income and profit increased with the increase in stand density and biomass, and StC-20 and StC-10 were significantly higher than SeC or ClC (p< 0.05). Using principal components analysis and subordinate function analysis, we constructed a composite index to indicate the sustainability of bamboo forests. For the sustainability assessment, StC-10 had the highest productive sustainability (0.59 ± 0.06) and the second highest economic sustainability (0.59 ± 0.11) in all cutting treatments. StC-10 had the maximum overall sustainability, with a value of 0.53 ± 0.02, which was significantly higher than that of ClC (p< 0.05). Conclusion: The results verified that StC for Phyllostachys glauca forests is feasible and sustainable as its sustainability index outweighs those of traditional cutting systems (SeC and ClC), and 10 m is the optimum distance for the strip width of StC. Our findings provide a new cutting system for managing other running bamboo forests sustainably.

Network Pharmacology with Metabolomics Study to Reveal the Mechanisms of Bushen Huoxue Formula in Intervertebral Disc Degeneration Treatment.

Background: Intervertebral disc degeneration (IVDD) is a pathophysiological process that leads to severe back pain or neurological deficits. The Bushen Huoxue Formula (BSHXF) is a traditional herbal remedy widely used to treat diseases related to IVDD. However, its pharmacological mechanism needs further exploration. Objective: This study aimed to elucidate the mechanisms through which BSHXF treats IVDD-related diseases by integrating metabolomics with network pharmacology. Methods: Network pharmacology was utilized to identify potential targets of BSHXF against IVDD. Additionally, an animal model of needle puncture-induced disc degeneration was established to assess the effect of BSHXF. Mice were randomly assigned to the sham group, model group, and BSHXF group. Various techniques, including PCR, CCK-8 assay, MRI, histological examinations, and immunohistochemical analyses, were employed to evaluate degenerative and oxidative stress conditions in mouse disc tissue and cultured nucleus pulposus (NP) cells. UHPLC-HRMS/MS was used to differential distinct metabolites in the disc tissue from different groups, and MetaboAnalyst 5.0 was employed to enrich the metabolic pathways. Results: Through network pharmacology, 15 core proteins were identified through protein-protein interaction (PPI) network construction. Functional enrichment analysis highlighted the critical role of BSHXF in addressing IVDD by influencing the response to oxidative stress. Furthermore, experimental evidence demonstrated that BSHXF significantly improved the pathological progression of IVDD and increased oxidative stress markers SOD-1 and GPX1, both in the disc degeneration model and cultured NP cells. Metabolomics identified differential metabolites among the three groups, revealing 15 metabolic pathways between the sham and model groups, and 13 metabolic pathways enriched between the model and BSHXF groups. Conclusion: This study, integrating network pharmacology and metabolomics, suggests that BSHXF can alleviate IVDD progression by modulating oxidative stress. Key metabolic pathways associated with BSHXF-mediated reduction of oxidative stress include the citrate cycle, cysteine and methionine metabolism, alanine, aspartate and glutamate metabolism, glycine, serine and threonine metabolism, D-glutamine and D-glutamate metabolism, glutathione metabolism, and tryptophan metabolism. While this research demonstrates the therapeutic potential of BSHXF in reducing oxidative stress levels in IVDD, further research is needed to thoroughly understand its underlying mechanisms.

Design and analysis of impedance matching for a radial standing wave piezoelectric ultrasonic motor.

Impedance matching circuits are capable of tuning and wave filtering, which is beneficial to performance improvement of piezoelectric ultrasonic motors. At present, impedance matching for piezoelectric ultrasonic motors is usually realized through a series inductance, which has the problem of poor wave filtering effect. Different from the previous series inductance matching method for ultrasonic motors, a series inductance and capacitance matching method is proposed for a radial standing wave piezoelectric ultrasonic motor. The series capacitance is added to adjust the quality factor of the resonance tank so that a desired wave filtering effect can be obtained. The values of the series inductance and capacitance are derived based on the Butterworth-Van Dyke model of the piezoelectric ultrasonic motor. Simulations are conducted to verify the feasibility of the proposed matching method. Finally, the waveforms of voltages and currents as well as torque-speed curves of the motor are measured. The results validate the proposed matching method. In addition, the previous series inductance matching method is compared. The results show that the proposed series inductance and capacitance matching method not only achieves tuning function but also obtains a significantly improved wave filtering effect. Moreover, the torque-speed characteristics of the motor are also improved with the proposed matching method.

Fine mapping and identification of two NtTOM2A homeologs responsible for tobacco mosaic virus replication in tobacco (Nicotiana tabacum L.).

BACKGROUND: Tobacco mosaic virus (TMV) is a widely distributed viral disease that threatens many vegetables and horticultural species. Using the resistance gene N which induces a hypersensitivity reaction, is a common strategy for controlling this disease in tobacco (Nicotiana tabacum L.). However, N gene-mediated resistance has its limitations, consequently, identifying resistance genes from resistant germplasms and developing resistant cultivars is an ideal strategy for controlling the damage caused by TMV. RESULTS: Here, we identified highly TMV-resistant tobacco germplasm, JT88, with markedly reduced viral accumulation following TMV infection. We mapped and cloned two tobamovirus multiplication protein 2A (TOM2A) homeologs responsible for TMV replication using an F2 population derived from a cross between the TMV-susceptible cultivar K326 and the TMV-resistant cultivar JT88. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (CRISPR/Cas9)-mediated loss-of-function mutations of two NtTOM2A homeologs almost completely suppressed TMV replication; however, the single gene mutants showed symptoms similar to those of the wild type. Moreover, NtTOM2A natural mutations were rarely detected in 577 tobacco germplasms, and CRISPR/Cas9-mediated variation of NtTOM2A led to shortened plant height, these results indicating that the natural variations in NtTOM2A were rarely applied in tobacco breeding and the NtTOM2A maybe has an impact on growth and development. CONCLUSIONS: The two NtTOM2A homeologs are functionally redundant and negatively regulate TMV resistance. These results deepen our understanding of the molecular mechanisms underlying TMV resistance in tobacco and provide important information for the potential application of NtTOM2A in TMV resistance breeding.

Continual Learning for Cuffless Blood Pressure Measurement using PPG and ECG Signals.

Although numerous studies have been conducted on cuffless blood pressure (BP) estimation using machine learning methods, most of the data-driven models are static, with model parameters fixed after training is complete. However, BP is dynamic and the performance would degrade for a static model when the to-be predicted BP distribution deviates from the training BP distribution. In this paper, we propose a continual learning (CL) framework in which deep learning models are developed to learn dynamically and continuously for arterial BP (ABP) estimation with photoplethysmography (PPG) and electrocardiogram (ECG) waveforms. The effectiveness of the CL model is validated on UCI Repository and MIMIC-III database with a total of 132 individual samples, and compared with conventional training method. It was found that the CL model improved the ABP estimation accuracy in terms of mean absolute error (MAE) by 17.47% on average compared with conventional training model. Furthermore, the improvement increased with the variability of ABP. These results demonstrate that CL model has potential to estimate dynamic ABP, which has been challenging with conventional training.

Development and validation of a diagnostic model for the identification of chronic ocular graft-versus-host disease (oGVHD).

Purpose: To verify the International Chronic Ocular Graft-Versus-Host Disease (ICCGVHD) Group diagnostic criteria and establish an easy-to-use and reliable diagnosis model for quick identification of chronic oGVHD. Methods: This study included 180 patients (355 eyes) who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and visited the Peking University Third Hospital Cornea and Ocular Surface Disease Specialist Clinic from July 2020 to February 2021. The proportion of chronic oGVHD was 76.06% (279/355). Results: Five complaints, including eye dryness, photophobia, foreign body sensation, eye redness, and burning sensation; six ophthalmic examinations, including Ocular Surface Disease Index (OSDI) score, corneal fluorescein staining (CFS), tear break-up time (TBUT), Schirmer's test score without anesthesia, conjunctival score, tear meniscus height, and non-ocular GVHD-involved organs were significantly different between patients with chronic oGVHD and control group (p < 0.05). Binary logistic regression (backward LR algorithm) selection demonstrated that three variables retained diagnostic significance for chronic oGVHD: CFS (OR = 2.71 (1.92-3.81), p < 0.001), Schirmer's test score without anesthesia (OR = 0.83 (0.76-0.91), p < 0.001), and conjunctival score (OR = 1.96 (1.13-3.42), p = 0.031). A nomogram for the identification of chronic oGVHD was developed, and its performance was examined using an internal validation cohort (118 eyes). The areas under the curve (AUCs) for the three-variable-based nomogram were 0.976 (95% CI (0.959-0.992), p < 0.01) and 0.945 (95% CI (0.904-0.986), p < 0.01) in the development and internal validation cohorts, respectively. Conclusion: This concise three-variable-based nomogram based on ICCGVHD criteria could serve as an easy-to-use and reliable tool for rapid screening of chronic oGVHD.

Sulfur-graded kesterite structured film drives improvement of VOC.

Realizing the graded bandgap in absorber layer is very essential for high efficient thin film solar cells. However, such bandgap modification in kesterite-structured Cu2ZnSnSe4 is normally realized via high temperature sulfurization process (above 500°C), which is not only difficult to control the sulfurization depth, but also introduces additional deep defects because of the decomposition of absorber layer at such high temperature. In this study, a low-temperature sulfurization process (150°C) is developed. Such process not only inhibits the decomposition of Cu2ZnSnSe4 films and controls the elemental distribution very well, but also increase the surface bandgap of the absorber layer and form a gradient energy bandgap. Also, the density of deep-level defects in the Cu2ZnSnSe4 layer is reduced. As a consequence, the open circuit voltage of the solar cell is improved by 60 mV. This study paves the way towards the high efficient kesterite solar cell and other solar cells.

Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study.

BACKGROUND: Venous thromboembolism (VTE) is a common and serious complication after colorectal cancer (CRC) surgery. Few large-sample studies have reported VTE incidence and management status after CRC surgery in China. This study aimed to investigate the incidence and prevention of VTE in Chinese patients after CRC surgery, identify risk factors for developing VTE, and construct a new scoring system for clinical decision-making and care planning. METHODS: Participants were recruited from 46 centers in 17 provinces in China. Patients were followed up for 1 month postoperatively. The study period was from May 2021 to May 2022. The Caprini score risk stratification and VTE prevention and incidence were recorded. The predictors of the occurrence of VTE after surgery were identified by multivariate logistic regression analysis, and a prediction model (CRC-VTE score) was developed. RESULTS: A total of 1836 patients were analyzed. The postoperative Caprini scores ranged from 1 to 16 points, with a median of 6 points. Of these, 10.1% were classified as low risk (0-2 points), 7.4% as moderate risk (3-4 points), and 82.5% as high risk (≥5 points). Among these patients, 1210 (65.9%) received pharmacological prophylaxis, and 1061 (57.8%) received mechanical prophylaxis. The incidence of short-term VTE events after CRC surgery was 11.2% (95% CI 9.8-12.7), including deep venous thrombosis (DVT) (11.0%, 95% CI 9.6-12.5) and pulmonary embolism (PE) (0.2%, 95% CI 0-0.5). Multifactorial analysis showed that age (≥70 years), history of varicose veins in the lower extremities, cardiac insufficiency, female sex, preoperative bowel obstruction, preoperative bloody/tarry stool, and anesthesia time at least 180 min were independent risk factors for postoperative VTE. The CRC-VTE model was developed from these seven factors and had good VTE predictive performance ( C -statistic 0.72, 95% CI 0.68-0.76). CONCLUSIONS: This study provided a national perspective on the incidence and prevention of VTE after CRC surgery in China. The study offers guidance for VTE prevention in patients after CRC surgery. A practical CRC-VTE risk predictive model was proposed.

Low-temperature drying of waste activated sludge enhanced by agricultural biomass towards self-supporting incineration.

A high moisture content of waste activated sludge (WAS) associated with a low calorific value needs to be deeply dried towards self-supporting incineration. On the other hand, thermal energy with low temperature exchanged from treated effluent has great potential for drying sludge. Unfortunately, low-temperature drying of sludge seems to be low in efficiency and long in drying time. For this reason, some agricultural biomass was added into WAS to improve the drying efficiency. The drying performance and sludge properties were analyzed and evaluated with this study. Experimental results demonstrated that wheat straw was the best in enhancing the drying performance. With only 20 % (DS/DS) of crushed wheat straw added, the average drying rate achieved up to 0.20 g water/g DS·min, much higher than 0.13 g water/g DS·min of the raw WAS. The drying time to the targeted moisture content (63 %) (for self-supporting incineration) was shortened to only 12 min, much lower than 21 min of the raw WAS. The analysis revealed that wheat straw could reduce the specific resistance of filtration (SRF) and increase the sludge filterability (X). Also, the sludge rheology, particle size distribution and SEM images could conclude that agricultural biomass played a positive role in skeleton builders, forming a mesh-like structure in sludge flocs. These special channels could obviously improve the transfer capacities of heat and water inside the sludge matrix and thus greatly increase the drying performance of WAS.

Association between red blood cell distribution width and ischemic stroke recurrence in patients with acute ischemic stroke: a 10-years retrospective cohort analysis.

Numerous studies have reported that a higher red blood cell distribution width (RDW) level was associated with adverse outcomes in patients with the first stroke. However, no studies have examined the association between RDW and recurrent ischemic stroke. We performed a population-based cohort data analysis from 2007 to 2017. Baseline RDW was measured in 6402 first ischemic stroke participants, who were followed for about five years on average. During 62 months of median follow-up, 205 participants (3.20%) reported a recurrence (self-reported). RDW showed a nonlinear relationship with the risk of ischemic stroke recurrence. When RDW was assessed as quartiles (quartile 1, RDW<12.4; quartile 2, 12.4 to 12.8; quartile 3,12.8 to 13.3, quartile4, RDW>13.3), compared with the reference group (quartile 1), the hazard ratios (HRs) of ischemic stroke recurrence were 1.372 (95% confidence interval [CI]=0.671-2.805, P=0.386) in quartile 2, 1.835 (95% CI=1.222-2.755, P=0.003) in quartile 3, and 1.732 (95% CI=1.114-2.561, P<0.001) in quartile 4. The trend test was significant (P<0.001). When quartiles 3 and 4 were combined, the adjusted HR of ischemic stroke recurrence was 1.439 (95% CI=1.330-1.556, P<0.001) compared with the combined quartiles 1 and 2 subgroups. This study demonstrated that elevated RDW levels were positively associated with an increased risk of recurrent ischemic stroke. RDW can provide a new perspective for initial risk assessment and identify high-risk patients early. Further research is required to confirm our results.

Assessment of Corneal Epithelial Changes and Related Factors in Ocular Chronic Graft-Versus-Host Disease (GVHD) by in Vivo Confocal Microscopy.

PURPOSE: To evaluate corneal epithelial changes and related factors in chronic ocular graft-versus-host disease (oGVHD) patients. METHODS: 21 patients (35 eyes) with chronic oGVHD and 8 patients (12 eyes) without oGVHD after bone marrow transplantation were recruited for assessment involving in vivo confocal microscopy (IVCM) analysis, ocular surface parameter determination and tear cytokine level analysis. The IVCM corneal epithelial scoring system was used to evaluate corneal epithelial changes. RESULTS: There was a significant difference in the corneal epithelial score (p = .001) between the two groups. The corneal epithelial scores were significantly correlated with the corneal fluorescein staining scores (CFS, r = 0.463, p < .001), Schirmer's test (r = -0.389, p = .009) and tear cytokine levels of EGF (r = -0.491, p < .001) and APRIL (r = -0.318, p = .030). CONCLUSIONS: The depth of corneal epithelial defects can be estimated by the CFS. Corneal epithelial changes of chronic oGVHD are considered to be associated with lacrimal deficiency and a lack of EGF.

Tear Cytokines Associated With Therapeutic Effects in Chronic Ocular Graft-Versus-Host Disease.

PURPOSE: The local application of antiinflammatory and immunosuppressive agents is an effective method for the treatment of ocular graft-versus-host disease (oGVHD); however, we noticed that some patients with oGVHD did not respond to topical therapy as well as many others. This study aimed to determine whether tear cytokines were associated with therapeutic effects in oGVHD. METHODS: Forty patients with chronic oGVHD were enrolled and grouped as responders (n = 24) and nonresponders (n = 16) based on the clinical response to 1 month of topical treatment. Tear samples were collected from each participant before and after treatment, and the tear concentrations of 7 cytokines (IL-2, IL-6, IL-8, IL-10, IL-17A, TNF-α, and ICAM-1) were measured using microsphere-based immunoassay analysis. Differences between pretreatment and posttreatment tear samples were analyzed using the Wilcoxon test. RESULTS: No significant differences in ophthalmic symptoms or cytokine levels were observed between responders and nonresponders at baseline. After 1 month of topical treatment, ocular surface parameters (including Ocular Surface Disease Index, National Institutes of Health eye score, best-corrected visual acuity, corneal fluorescein staining score, and fluorescein tear film break-up time) were significantly ameliorated in responders, but not in nonresponders. Moreover, none of the cytokines exhibited significant alteration in nonresponders, whereas the tear levels of IL-6 (P = 0.031) and IL-8 (P = 0.037) exhibited significant decreases in responding patients. CONCLUSIONS: Our results revealed that tear IL-6 and IL-8 levels were significantly altered in response to topical oGVHD treatment.

The effects of biochar derived from feedstock with different Si and Al concentration on soil N2O and CO2 emissions.

Desilicification and allitization is important characteristic of acidic soil. While decrease in soil silicon (Si) may generate Si limitation, the increase of aluminum (Al) will aggravate soil acidification. Biochar has been used in acid soil improvement, which could mitigate nitrous oxide (N2O) emissions and alter soil Si and Al concentration. However, the effect of biochar with different Si and Al concentration on greenhouse gas emissions remains unclear. We evaluated the effects of biochar derived from feedstock with different Si (moso bamboo leaves, BL; rice straw, RS) and Al (Camellia oleifera fruit shell, CFS; C. oleifera leaves, CL) concentration on greenhouse gas emissions and soil acidification. Microbial functional gene abundance associated with N2O emissions were measured to further explore the response of microbiological community. The results showed that BL, RS, CFS and CL significantly increased soil pH (by 19.2%, 16.7%, 18.7% and 24.9%, respectively), decreased soil exchangeable acid and exchangeable Al content, and reduced N2O emission rate of soil with nitrogen (N) (by 14.2%, 27.3%, 25.6% and 38.7%, respectively), which correlated with increase in soil nosZ abundance. BL, RS, CFS and CL increased soil nirK (by 325.6%, 66.7%, 155.8%, and 253.2%, respectively) and nosZ (by 198.6%, 174.1%, 72.2%, and 152.0%, respectively) abundance with N. Structural equation model showed that Si input via biochar application directly reduced N2O emissions, and soil acid-extractable Si is inversely proportional to N2O emission rate. In addition, Si input reduced carbon dioxide (CO2) emissions via indirect effects. Al input via biochar addition indirectly affected N2O and CO2 emissions through mainly indirect effects on other soil factors. In intensive management and production activities, Si-rich biochar can be considered instead of sole addition as fertilizer, which will be beneficial to the sustainable development of agricultural and forestry production in acid soil areas, and mitigation of global change.

Effect of improved partial graft excision in the treatment of infected arteriovenous grafts / 中华肾脏病杂志

Objective:To investigate the effect of improved partial graft excision (iPGE) in the treatment of infected arteriovenous grafts (AVG).Methods:It was a single-center retrospective study. A cohort database study of patients who underwent surgery for infected AVG from January 2019 to July 2022 was conducted. The cases were divided into total graft excision (TGE) group and iPGE group, and the postoperative reinfection rate and surgery-related complications, such as bleeding, nerve injury and limb ischemia, in the two groups were analyzed. The primary patency rate and the secondary patency rate at 3 months and 6 months after the surgery in the iPGE group were analyzed.Results:(1) General information: A total of 47 cases were included in the study. Among these 47 cases, 14 cases had undergone iPGE of infected AVG, and 33 cases had undergone TGE. The study population was of an average age of 59 years (21-81 years), including 18 males and 29 females. Dialysis age was 36 (14, 72) months. AVG age was 18 (4, 36) months. The shortest AVG age was half a month, and the longest AVG age was 72 months. (2)Comparative analysis of the two groups: The reinfection rate of the iPGE group was 21.4% (3/14), and the reinfection rate of the TGE group was 0 (0/33). The reinfection rate of the iPGE group was higher than that of the TGE group, and the difference was statistically significant (Fisher exact test, P=0.022). For 11 patients in the iPGE group (excluding 3 cases with reinfection), the shortest follow-up period was 5 months and the longest follow-up period was 18 months. In the iPGE group, the primary patency rate at 3 months was 72.7% (8/11), and the primary patency rate at 6 months was 72.7% (8/11); the secondary patency rate at 3 months was 100% (11/11) and the secondary patency rate at 6 months was 90.9% (10/11). There was no brachial artery rupture, nerve injury or limb ischemia in the iPGE group. In the TGE group, 1 case underwent secondary repair of brachial artery due to brachial artery rupture, and there was no nerve injury or limb ischemia in other cases. Conclusions:During the treatment of infected AVG, iPGE can preserve the original fistula, and avoid central venous catheterization. At the same time, the operation difficulty and risk are relatively low. Although the reinfection rate of iPGE is slightly higher than that of TGE in this study, the reinfection rate of iPGE is lower than that reported in the previous study. The key to prevent reinfection is to grasp the reasonable surgical adaptation signs in preoperative evaluation, perform intraoperative reevaluation and control surgical operation details. The iPGE represents an acceptable method for the treatment of some particular patients with infected AVG.