The antitumor action of endocannabinoids in the tumor microenvironment of glioblastoma.

Approximately 80% of all malignant brain tumors are gliomas, which are primary brain tumors. The most prevalent subtype of glioma, glioblastoma multiforme (GBM), is also the most deadly. Chemotherapy, immunotherapy, surgery, and conventional pharmacotherapy are currently available therapeutic options for GBM; unfortunately, these approaches only prolong the patient's life by 5 years at most. Despite numerous intensive therapeutic options, GBM is considered incurable. Accumulating preclinical data indicate that overt antitumoral effects can be induced by pharmacologically activating endocannabinoid receptors on glioma cells by modifying important intracellular signaling cascades. The complex mechanism underlying the endocannabinoid receptor-evoked antitumoral activity in experimental models of glioma may inhibit the ability of cancer cells to invade, proliferate, and exhibit stem cell-like characteristics, along with altering other aspects of the complex tumor microenvironment. The exact biological function of the endocannabinoid system in the development and spread of gliomas, however, is remains unclear and appears to rely heavily on context. Previous studies have revealed that endocannabinoid receptors are present in the tumor microenvironment, suggesting that these receptors could be novel targets for the treatment of GBM. Additionally, endocannabinoids have demonstrated anticancer effects through signaling pathways linked to the classic features of cancer. Thus, the pharmacology of endocannabinoids in the glioblastoma microenvironment is the main topic of this review, which may promote the development of future GBM therapies.

Do domestic budgerigars perceive predation risk?

Predation risk may affect the foraging behavior of birds. However, there has been little research on the ability of domestic birds to perceive predation risk and thus adjust their feeding behavior. In this study, we tested whether domestic budgerigars (Melopsittacus undulatus) perceived predation risk after the presentation of specimens and sounds of sparrowhawks (Accipiter nisus), domestic cats (Felis catus), and humans, and whether this in turn influenced their feeding behavior. When exposed to visual or acoustic stimuli, budgerigars showed significantly longer latency to feed under sparrowhawk, domestic cat, and human treatments than with controls. Budgerigars responded more strongly to acoustic stimuli than visual stimuli, and they showed the longest latency to feed and the least number of feeding times in response to sparrowhawk calls. Moreover, budgerigars showed shorter latency to feed and greater numbers of feeding times in response to human voices than to sparrowhawk or domestic cat calls. Our results suggest that domestic budgerigars may identify predation risk through visual or acoustic signals and adjust their feeding behavior accordingly.

3D-printed antibiotic-loaded bone cement spacers as adjunctive therapy for hip periprosthetic infection after arthroplasty: A clinical assessment.

OBJECTIVE: To explore the effect of three-dimensional (3D) printing to create personalized antibiotic-loaded bone cement (ALBC) spacers to assist in treatment of periprosthetic infection after total hip arthroplasty (THA). METHODS: The data of 40 patients with postoperative infection after THA were analysed retrospectively. The patients were divided into two groups: the 3D-printing group (age 47-78 years, n = 20) and the conventional group (age 57-78 years, n = 20). In stage I surgery, 3D-printed silicone moulds were used to create ALBC spacers for the 3D-printing group, while traditional manual methods were used to create spacers for the conventional group. After the infection was controlled, both groups underwent conventional hip revision surgery (stage II surgery). All patients were evaluated using the Harris Hip Score (HHS) (primary outcome) for hip function. RESULTS: All 40 patients had follow-up data from 3 months after stage I surgery and 12 months after stage II surgery. The intergroup difference in HHS was 11.25 points [97.5% confidence interval (CI) 7.92-14.58; P < 0.01] at 3 months after stage I surgery, and 9.15 points (97.5% CI 4.82-13.48; P < 0.01) at 12 months after stage II surgery. The overall difference between the two groups was 9.55 points (97.5% CI 5.83-13.27; P < 0.01), which was significant (P < 0.05). CONCLUSION: During the follow-up period, the hip function of the 3D-printing group was superior to that of the conventional group following the treatment of infections after THA.

Monthly variations of groundwater arsenic risk under future climate scenarios in 2081-2100.

The seasonal variations of shallow groundwater arsenic have been widely documented. To gain insight into the monthly variations and mechanisms behind high groundwater arsenic and arsenic exposure risk in different climate scenarios, the monthly probability of high groundwater arsenic in Hetao Basin was simulated through random forest model. The model was based on arsenic concentrations obtained from 566 groundwater sample sites, and the variables considered included soil properties, climate, topography, and landform parameters. The results revealed that spatial patterns of high groundwater arsenic showed some fluctuations among months under different future climate scenarios. The probability of high total arsenic and trivalent arsenic was found to be elevated at the start of the rainy season, only to rapidly decrease with increasing precipitation and temperature. The probability then increased again after the rainy season. The areas with an increased probability of high total arsenic and trivalent arsenic and arsenic exposure risk under SSP126 were typically found in the high-arsenic areas of 2019, while those with decreased probabilities were observed in low-arsenic areas. Under SSP585, which involves a significant increase in precipitation and temperature, the probability of high total arsenic and trivalent arsenic and arsenic exposure risk was widely reduced. However, the probability of high total arsenic and trivalent arsenic and arsenic exposure risk was mainly observed in low-arsenic areas from SSP126 to SSP585. In conclusion, the consumption of groundwater for human and livestock drinking remains a threat to human health due to high arsenic exposure under future climate scenarios.

Spatial distribution of antibiotics and antibiotic resistance genes in tidal flat reclamation areas in China.

Tidal flat areas are important resources for land development and are becoming antibiotic resistance receivers that trigger major health concerns. The spatial distributions of forty-nine antibiotics, nine antibiotic resistance genes (ARGs), one mobile gene element (MGE) gene, and nine available metals in the soils and sediments along the coastlines of the Yellow Sea in China were quantified. Hierarchical linear model analysis was used to explore relationships between the antibiotics and ARGs across multiple effects resulting from human activities and environmental factors. Fish farm sediments and farmland soils showed high levels of quinolones (QNs) (maximum 637 ng·g-1), sulfonamides (SAs) (maximum 221 ng·g-1), and corresponding ARGs. Significant positive correlations (P from 5.47 × 10-14 to 0.0487) were observed between the antibiotics (QNs, SAs, and chlortetracycline) and their corresponding ARGs (qnrA, qnrD, aac(6')-Ib-cr, dfrA, sul2, and tetA), indicating the selective pressure from antibiotics in soils and sediments. Nine available metals had positive correlations with at least one ARG, indicating heavy metal pollution could enhance the ARGs. Sheep and poultry husbandry and marine aquaculture contribute the most to the antibiotic resistance in the coastlines. In conclusion, antibiotic pollutions have promoting effects at sub-inhibitory concentrations and more attention should be given to inhibit the enrichment of ARGs during tidal flat reclamation processes. The study also suggests the induction effects from metal pollutions, MGE spread, and the antibiotic pollutions from the usage in livestock and aquaculture.

The geochemical stability of typical arsenic-bearing sinter in the Tibetan plateau: Implications from quantitative mineralogy.

High­arsenic (As) sinter deposited from geothermal water is a potentially overlooked hazardous matrix and there remain substantial gaps in our comprehension of the stability of As sequestered within it. In this study, qualitative and quantitative analysis of the mineralogy of As-bearing sinter was conducted by Mineral Liberation Analyzer (MLA) in geothermal areas of the Tibetan Plateau to reveal the geochemical stability of As. Our results indicated that the contents of As in sinter were 3 orders of magnitude higher than the local soil. The dominant host minerals of As were calcite (40.9 %), thenardite (22.5 %), calcium silicate (13.0 %), and halite (8.1 %). Additionally, it was found that a relatively higher As bioavailability was extracted by ethylene diamine tetraacetic acid (EDTA), with a leaching rate of 41.2 %. Notably, the X-ray diffraction (XRD) showed that the thenardite and halite were decomposed after the leaching. The combination of mineralogy and geochemistry data suggested that calcite and calcium silicate were a crucial mechanism for As retention in sinter, while the dissolution of saline minerals (e.g., thenardite, halite, and calcium chloride) served as the primary sources for As release. This finding unveils the potential risks and mechanisms associated with high-As sinter, providing scientific guidance for risk management of sinter.

Genomic and Transcriptomic Remodeling by Neoadjuvant Chemoradiotherapy (nCRT) and the Indicative Role of Acquired INDEL Percentage for nCRT Efficacy in Esophageal Squamous Cell Carcinoma.

PURPOSE: The effect of genomic factors on the response of patients with esophageal squamous cell carcinoma (ESCC) to neoadjuvant chemoradiotherapy (nCRT), as well as how nCRT influences the genome and transcriptome of ESCC, remain largely unknown. METHODS AND MATERIALS: In total, 137 samples from 57 patients with ESCC undergoing nCRT were collected and subjected to whole-exome sequencing and RNA sequencing analysis. Genetic and clinicopathologic factors were compared between the patients achieving pathologic complete response and patients not achieving pathologic complete response. Genomic and transcriptomic profiles before and after nCRT were analyzed. RESULTS: Codeficiency of the DNA damage repair and HIPPO pathways synergistically sensitized ESCC to nCRT. nCRT induced small INDELs and focal chromosomal loss concurrently. Acquired INDEL% exhibited a decreasing trend with the increase of tumor regression grade (P = .06, Jonckheere's test). Multivariable Cox analysis indicated that higher acquired INDEL% was associated with better survival (adjusted hazard ratio [aHR], 0.93; 95% CI, 0.86-1.01; P = .067 for recurrence-free survival [RFS]; aHR, 0.86; 95% CI, 0.76-0.98; P = .028 for overall survival [OS], with 1% of acquired INDEL% as unit). The prognostic value of acquired INDEL% was confirmed by the Glioma Longitudinal AnalySiS data set (aHR, 0.95; 95% CI, 0.902-0.997; P = .037 for RFS; aHR, 0.96; 95% CI, 0.917-1.004; P = .076 for OS). Additionally, clonal expansion degree was negatively associated with patient survival (aHR, 5.87; 95% CI, 1.10-31.39; P = .038 for RFS; aHR, 9.09; 95% CI, 1.10-75.36; P = .041 for OS, with low clonal expression group as reference) and also negatively correlated with acquired INDEL% (Spearman ρ = -0.45; P = .02). The expression profile was changed after nCRT. The DNA replication gene set was downregulated, while the cell adhesion gene set was upregulated after nCRT. Acquired INDEL% was negatively correlated with the enrichment of the DNA replication gene set (Spearman ρ = -0.56; P = .003) but was positively correlated with the enrichment of the cell adhesion gene set (Spearman ρ = 0.40; P = .05) in posttreatment samples. CONCLUSIONS: nCRT remodels the genome and transcriptome of ESCC. Acquired INDEL% is a potential biomarker to indicate the effectiveness of nCRT and radiation sensitivity.

The Pink Zone Pattern (PP) sign: A novel simple marker for early gastric cancer.

BACKGROUND: We previously found a pink-colored change in early gastric cancer (EGC) lesions under magnifying endoscopy with narrow-band imaging (ME-NBI) and named it the "Pink Zoon Pattern" (PP) sign, which appeared independent of microvascular and microstructural changes. The aim of this study was to further investigate the characteristics of the PP sign in EGC. METHODS: The consecutive patients with suspicious gastric lesions detected by ME-NBI and confirmed by pathology at Zhejiang Cancer Hospital between November 2020 and December 2021 were enrolled in the study. The suspicious lesions were observed and assessed by the "VS" system and the PP sign respectively. RESULTS: We found that in the PP-positive group, 238 lesions (96.0%) were diagnosed as malignant. The overall accuracy, sensitivity, and specificity were 84.7%, 85.3%, and 81.8%. Among 164 EGC lesions diagnosed with low confidence (Grades 2, 3, and 4) using the VS system, the overall accuracy of PP to discriminate tumor from normal was 82.3%. The sensitivity and specificity were 82.7% and 81.5% respectively. CONCLUSIONS: The PP sign could be a new simple sign for the diagnosis of EGC and as an effective supplement to VS system when using ME-NBI.

Nest box entrance hole size can influence nest site selection and nest defence behaviour in Japanese tits.

Birds have the ability to assess the risk of predation in their environment and adjust their antipredation strategies based on this risk information. However, whether nest site selection has effect on subsequent nest defence behaviour has not been studied. In this study, we aimed to determine whether the Japanese tit (Parus minor) exhibits a nest-box hole size preference and whether the entrance hole sizes of nest boxes influence the nest defence behaviour of tits. We hung nest boxes with three different entrance hole sizes (diameters: 6.5 cm, 4.5 cm and 2.8 cm) in our study sites and investigated which nest boxes were occupied by tits. In addition, by using dummy-presentation experiments, we observed the nest defence behaviours of tits that nested in boxes with 2.8 cm and 4.5 cm entrance holes towards common chipmunks (Tamias sibiricus, a small nest predator able to enter these holes) and Eurasian red squirrels (Sciurus vulgaris, a large nest predator unable to enter the 2.8 cm entrance hole). The tits that bred in nest boxes with 2.8 cm entrance holes exhibited more intense nest defence responses to chipmunks than to squirrels. In contrast, the tits that bred in nest boxes with 4.5 cm entrance holes exhibited similar nest defence responses to chipmunks and squirrels. Additionally, Japanese tits that bred in nest boxes with 2.8 cm entrance holes exhibited more intense behavioural responses to chipmunks than those that bred in nest boxes with 4.5 cm entrance holes. Our results suggested that Japanese tits prefer to occupy nest boxes with small holes for breeding and that nest-box characteristics influenced their nest defence behaviour.

Leaching characteristics and potential risk of heavy metals from drip irrigation pipes and mulch substrate in agricultural ecosystems.

Drip irrigation is a valuable method for optimising water and fertiliser usage, motivating its increasing use. However, the ecological effects of drip irrigation fertilisation have not been sufficiently evaluated, limiting its effective and widespread use. Within this context, we aimed to determine the effects and potential ecological risks of using polyethylene irrigation pipes and mulch substrate under various drip irrigation conditions as well as burning of waste pipes and mulch substrate. Laboratory simulations of field conditions were used to determine the distribution, leaching, and migration pattern of heavy metals (Cd, Cr, Cu, Pb, and Zn) from plastic drip irrigation pipes and agricultural mulch substrate into various solutions. Maize samples obtained from drip-irrigated fields were analysed to determine the presence of heavy metal residues and assess the risk of heavy metal contamination. Heavy metal leaching from pipes and mulch substrate was high under acidic conditions, while the migration of heavy metals from plastic products was low in alkaline water-soluble fertiliser solutions. After combustion, heavy metal leaching from pipes and mulch residues increased considerably, with the migration capacity of Cd, Cr, and Cu increasing by >10-fold. Heavy metals in plastic pipes migrated primarily to the residue (bottom ash), whereas those from mulch substrate migrated to the fly ash component. Under experimental conditions, the migration of heavy metals from plastic pipes and mulch substrate had a negligible effect on the heavy metal content in aqueous environments. Although heavy metal leaching increased, the effect on water quality under actual irrigation conditions was relatively minor (in the order of 10-9). Thus, the use of plastic irrigation pipes and mulch substrate did not result in significant heavy metal contamination and potential risk to the agriculture ecosystem. Our study findings provide evidence for the effective application and widespread promotion of drip irrigation and fertiliser technology.

Assessment of Helicobacter pylori infection by deep learning based on endoscopic videos in real time.

BACKGROUND AND AIMS: Endoscopic assessment of Helicobacter pylori infection is a simple and effective method. Here, we aimed to develop a deep learning-based system named Intelligent Detection Endoscopic Assistant-Helicobacter pylori (IDEA-HP) to assess H. pylori infection by using endoscopic videos in real time. METHODS: Endoscopic data were retrospectively obtained from Zhejiang Cancer Hospital (ZJCH) for the development, validation, and testing of the system. Stored videos from ZJCH were used for assessing and comparing the performance of IDEA-HP with that of endoscopists. Prospective consecutive patients undergoing esophagogastroduodenoscopy were enrolled to assess the applicability of clinical practice. The urea breath test was used as the gold standard for diagnosing H. pylori infection. RESULTS: In 100 videos, IDEA-HP achieved a similar overall accuracy of assessing H. pylori infection to that of experts (84.0% vs. 83.6% [P = 0.729]). Nevertheless, the diagnostic accuracy (84.0% vs. 74.0% [P<0.001]) and sensitivity (82.0% vs. 67.2% [P<0.001]) of IDEA-HP were significantly higher than those of the beginners. In 191 prospective consecutive patients, IDEA-HP achieved accuracy, sensitivity, and specificity of 85.3% (95% CI: 79.0%-89.3%), 83.3% (95% CI: 72.8%-90.5%), and 85.8% (95% CI: 77.7%-91.4%), respectively. CONCLUSIONS: Our results show that IDEA-HP has great potential for assisting endoscopists in assessing H. pylori infection status during actual clinical work.

A case report of an Eurasian jay (Garrulus glandarius) attacking an incubating adult and depredating the eggs of the Japanese tit (Parus minor).

In May 2021, we opportunistically observed one Eurasian jay (Garrulus glandarius) attacking an adult incubating Japanese tit (Parus minor) and depredating nine tit eggs at a nest box where a woodpecker had greatly enlarged the entrance. After the predation event, the Japanese tits abandoned the nest. We recommend that when using artificial nest boxes to protect hole-nesting birds, the appropriate entrance size should be proportional to the body size of the target species. This observation gives us a better understanding of the potential predators of secondary hole-nesting birds.

Geographical variation in nest defense among cinereous tit populations in China.

Behavioral divergence among populations is common across taxonomic groups, still we know very little about anti-predator behaviors. Animal exposure to predation risk is variable in different ecological contexts. In addition, reproduction value of animals in different geographical regions usually varies. In this study, we tested whether cinereous tits Parus cinereus in different populations exhibited nest defense behaviors similar to those of nest or adult predators and whether their nest defense behaviors showed geographical variation. By using field dummy experiments, we observed tits' nest defense behavior in nest predator common chipmunk Tamias sibiricus and red squirrel Sciurus vulgaris, adult predator Eurasian sparrowhawk Accipiter nisus and nonthreatening species Oriental turtle dove Streptopelia orientalis in the ZJ (44° N), DZ (31° N), and DLS (18° N) populations, respectively. The response scores varied significantly across the 4 dummies in ZJ-tits and DLS-tits but did not in DZ-tits. When facing the chipmunk, ZJ-tits showed the highest response score and DZ-tits showed the lowest response score. When facing the squirrel, ZJ-tits showed a higher response score than tits in the other 2 populations. However, tits among the 3 populations responded similarly to a sparrowhawk or dove with slight response behaviors. In addition, response scores to nest predators were positively correlated with brood size across the 3 populations, but no trend was found for sparrowhawks or doves. Our results indicated that the nest defense behaviors of cinereous tits have evolved in response to large-scale geographical variation in ecological contexts and reproduction value.

Distribution Characteristics and Influencing Factors of Bio-elements in the Human Hair of Uyghur Communities in an Oasis Area of Xinjiang, China.

Located in central Asia, Xinjiang is characterized as a diverse environment in China, consisting of vast deserts, dotted oases, and high mountains. Due to the combined effect of climate conditions under such a diverse environment, there are large differences in human activities, living styles, and eating habits in farmland and grazing pastures between Xinjiang and other regions of China. This study aimed to investigate the variations and mechanisms of elemental distribution in the hair of Uyghur communities among different ages and genders and under different land use backgrounds in an oasis region in Xinjiang. Hair samples from 524 residents from four traditional farmland areas and two grazing pasture areas in Bai Cheng County in Xinjiang were collected, and the levels of thirteen elements were analyzed. The results indicated that the average levels of Cu, Mg, Mn, Zn, Ni, Co, Pb, Fe, Ca, Cd, Cr, As, and Se in the hair of Uyghur communities were within the background levels of Chinese and global residents' hair. Overall, the levels of elements in the hair of women residents were higher than those of men residents. The levels of elements in the human hair of the middle-aged group were higher than those of child and older-aged groups. Elements Cr and Se in the hair of grazing pastures were higher than those of farmland areas. The levels of Cd, Pb, As, and Zn in the hair of farmland areas were higher than those of grazing pasture areas. The levels of Ca, Mg, Cu, and Fe in the hair of Uyghur communities were higher than those of other ethnic groups, while the toxic elements in the hair of residents in Bai Cheng were lower than those in other regions of China. Middle-aged people were exposed to higher levels of toxic elements in their daily activities compared to elderly and child groups. Also, adult groups need much more nutrients for their growth and intellectual development compared to child and elderly groups. The change in land use from grazing pastures to farmland increased the toxic trace element concentration levels in human hair. The significant differences in the overall concentration levels of elements in human hair among the different ethnic groups and regions can be attributed to the differences in lifestyles, cultural customs, dietary habits, and internal and external exposure routes.

Factors associated with non-lifting of colorectal mucosal lesions.

BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective treatment for colorectal tumors. However, lesions that cannot be lifted after submucosal injection are not indication for ESD. This is because the procedure is difficult, and the lesions are often considered as tumor invasion or submucosal fibrosis. The aims of this study are to evaluate the efficacy and safety of ESD for non-lifting lesions and to analyze the causes of non-lifting phenomenon. METHODS: This retrospective study included 29 patients with non-lifting colon lesions resected by ESD from February 2018 to September 2021. Cases were observed for demographics, endoscopic findings, treatment outcomes, adverse events and endoscopic follow-up. We studied the pathological features of lesions to explore the reasons for non-lifting. RESULTS: Among 29 cases of non-lifting lesions, 20 lesions (69.0%) were 30 mm in diameter or larger. Most of lesions (96.6%) were non-lifting in center, and only one lesions (3.4%) had non-lifting of one side. The en bloc and curative resection rates of ESD were 100 and 86.2%, respectively. There was one (3.4%) delayed bleeding, no perforations and other complications. No tumor recurrence occurred during the follow-up period. For pathological features, 16 (55.2%) non-lifting lesions had submucosal fibrosis and only 4 cases (13.8%) had deep submucosal invasion. There were 9 cases (31.0%) of non-lifting lesions due to musculo-fibrous of muscularis propria anomaly (MMPA). CONCLUSION: MMPA is another reason for non-lifting signs besides invasive carcinomas and submucosal fibrosis. ESD should be considered in patients with large non-lifting adenoma instead of surgery.

Characteristics, sources, and risk assessment of thallium and associated with metal(loid)s in the Yarlung Tsangpo River Basin, southern Tibetan Plateau.

The Tibetan Plateau (TP) is known as the water tower of Asia, and the water quality has long been a focus of public concern, especially in the Yarlung Tsangpo River Basin (YTRB), a unique area that is climate-sensitive, geologically complex, eco-fragile, and densely populated. Thallium (Tl) is a typical metal that is more toxic than Pb, Cd, and As and often occurs in sulfide minerals. Although large-scale polymetallic sulfide mineralization developed in the YTRB, the geochemical dispersion and potential risk of Tl in aquatic environments of the YTRB remain poorly understood. In this study, the concentration, distribution, source, and health risk of Tl and associated metal(loid)s in the hot springs and surface water in the YTRB were systematically analyzed. The results showed that the trace elements (Cd, Cr, Zn, Cu, Al, Sr, Ni, Co, Mn, Pb) in water environments are within the recommended limits, except for Tl and As. Principal component analysis (PCA) and correlation analysis (CA) showed that the elements of Tl and As were positively related to each other in either both hot spring water and surface water, indicating their common origin. Spatial variations suggested that high levels of Tl and As observed in the north YTRB, which may be relevant to the reduction-dissolution of Tl (As)-bearing minerals and the magmatic hydrothermal system formed in the shallow part of the northern YTRB. Furthermore, source apportionment identified natural sources of Cu, Ni, Cr, Co, Mn, Zn, and Cd and anthropogenic inputs of Al and Pb. Exposure assessment studies have found that ingestion is the primary route of As and Tl exposure to local population, and balneological and bathing purposes do not constitute a human health concern. This study offers valuable insights into the risk of naturally occurring Tl enrichment being hidden in As-rich hydrosphere in the YTRB and other regions with similar geoenvironmental contexts.

Risk factors of lymph node metastasis or lymphovascular invasion for superficial esophageal squamous cell carcinoma: A practical and effective predictive nomogram based on a cancer hospital data.

Background: Lymphovascular invasion (LVI) is mostly used as a preoperative predictor to establish lymph node metastasis (LNM) prediction models for superficial esophageal squamous cell carcinoma (SESCC). However, LVI still needs to be confirmed by postoperative pathology. In this study, we combined LNM and LVI as a unified outcome and named it LNM/LVI, and aimed to develop an LNM/LVI prediction model in SESCC using preoperative factors. Methods: A total of 512 patients who underwent radical resection of SESCC were retrospectively collected. Logistic regression and least absolute shrinkage and selection operator (LASSO) regression were adopted to identify the predictive factors of LNM/LVI. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were calculated to select the potential predictive factors from the results of LASSO and logistic regression. A nomogram for predicting LNM/LVI was established by incorporating these factors. The efficacy, accuracy, and clinical utility of the nomogram were, respectively, assessed with the area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Finally, the random forest (RF) algorithm was used to further evaluate the impact of these factors included in the nomogram on LNM/LVI. Results: Tumor size, tumor location, tumor invasion depth, tumor differentiation, and macroscopic type were confirmed as independent risk factors for LNM/LVI according to the results of logistic regression, LASSO regression, IDI, and NRI analyses. A nomogram including these five variables showed a good performance in LNM/LVI prediction (AUC = 0.776). The calibration curve revealed that the predictive results of this nomogram were nearly consistent with actual observations. Significant clinical utility of our nomogram was demonstrated by DCA. The RF model with the same five variables also had similar predictive efficacy with the nomogram (AUC = 0.775). Conclusion: The nomogram was adopted as a final tool for predicting LNM/LVI because its risk score system made it more user-friendly and clinically useful than the random forest model, which can help clinicians make optimal treatment decisions for patients with SESCC.

Geographic Variation in Note Types of Alarm Calls in Japanese Tits (Parus minor).

Geographic variability in acoustic signals has been documented in many bird species. However, geographic variations in alarm calls have been so far neglected despite their crucial role on reducing risk to group members and relatives. We analyzed the note types and acoustic parameters of Japanese tit (Parus minor) alarm calls to three types of intruders (a nest predator, an adult predator, and a harmless species) from three populations in China. Our results revealed that tits in the same population produce similar note types to different intruders, but the three populations only shared six note types and each population had unique note types. The frequency and duration parameters of three shared common note types were significantly different among populations. The three populations belong to the same species, thus they have shared note types. We suspect that the unique note types occurring in each population may be related to three potential reasons: founder effect, predation pressure, and vocal learning. The differences in acoustic parameters of common notes among populations may be a consequence of adaptations to their environments. We suggest that population differences in the note levels of bird alarm calls do exist.

Clinical Application of Remifentanil Combined with Sevoflurane in Manual Reduction of Humeral Supracondylar Fracture in Children.

Objective: To explore the effect of the combination of remifentanil and sevoflurane on children with humeral supracondylar fractures undergoing manual reduction. Methods: A total of 60 children undergoing manual reduction external fixation due to humeral supracondylar fractures were enrolled between September 2020 and September 2021. According to the random number table method, they were divided into the control group (inhalation of 7% sevoflurane) and the observation group (inhalation of 7% sevoflurane and intravenous infusion of remifentanil). The heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) in both groups were investigated. The sedation and analgesic effects, fracture reduction, and complications were compared between the two groups. Results: There was no significant difference found in HR, MAP, or SpO2 between the two groups at 3 minutes prior to anesthesia, 2 minutes post anesthesia, and post manual reduction (P > 0.05). The difference in HR, MAP, and SpO2 between the two groups was not statistically significant at any time point (P > 0.05). The good rate of sedation and analgesia in the observation group was 93.33%, which is significantly higher than that in the control group (P < 0.05). The reduction time and success rate of one-time manual reduction in the observation group were higher than those in the control group (P < 0.05). There was no significant difference in fracture healing time between the two groups (P > 0.05). Both groups had airway complications (nausea and vomiting, neurovascular damage and asphyxia, and laryngospasm). Conclusion: The combination of remifentanil and sevoflurane showed good sedative and analgesic effects on children with humeral supracondylar fractures undergoing manual reduction with relatively higher safety.

A Novelly Developed Bipolar Needle Knife Can Be an Alternative Device Choice for Endoscopic Submucosal Dissection (With Video).

Background: Endoscopic submucosal dissection (ESD) is technically difficult with high rates of complications, such as perforation and bleeding. We aimed to explore the safety and cutting efficiency of a novelly devised bipolar knife for ESD procedure. Methods: Taking a traditional monopolar knife as a reference, the safety and feasibility of the novel bipolar knife were evaluated by an animal experiment and a human study. Furthermore, we assessed the usefulness and advantage of this novel bipolar knife by using the finite element method. Results: A porcine experiment confirmed that there was no significant difference in wound size and cutting speed between the monopolar and bipolar knives. The thermal damage and histopathological scores produced by the two knives were similar. In addition, the porcine experiment and patients' study identified that the incidence of postoperative complications, such as bleeding, perforation, and infection, had no statistical difference between the monopolar and bipolar groups. Finally, the finite element model showed that the length and depth of thermal damage caused by the bipolar knife were, respectively, 102.77-117.98% and 80.87-84.53% of those caused by the monopolar knife at the same power. Conclusion: The novel bipolar knife was theoretically safer than the monopolar knife and, at least, was confirmed not inferior to the monopolar knife in operability and cutting efficiency. Thus, the novel bipolar knife can be an alternative device choice for ESD.