Effect of waste cooking oil on the performance of EVA modified asphalt and its mechanism analysis.

The balance between the low and high temperature performance of asphalt materials is important to avoid either rutting deformation or low temperature cracking resistance of asphalt pavement. This is beneficial for improving the asphalt pavement comprehensive performance. Considering the excellent high temperature performance of Ethylene-vinyl acetate (EVA) modified asphalt, this study first modified it with Waste Biological Oil (WBO) to prepare WBO/EVA composite modified asphalt (WEMA) with different dosages. Then the samples were evaluated by the traditional physical properties, low and high temperature rheological properties. Finally, the micro mechanism of WBO on EVA modified asphalt were explored by gel permeation chromatography (GPC) test and atomic force microscope (AFM) experiments. The experimental results reveal that WBO has a softening effect on EVA modified asphalt, reducing its stiffness and improving its stretching performance and flowability. In addition, WBO can reduce the high-temperature deformation resistance of EMA modified asphalt, but it significantly enhances the low-temperature property of EVA modified asphalt. When the WBO content ranges from 1.5 to 2.5%, the high-temperature performance of WEMA is inferior to that of EVA-modified asphalt, however, its low-temperature performance is significantly better than that of EVA-modified asphalt. Importantly, within this WBO content range, the comprehensive performance of WEMA is superior to that of pure asphalt. Mechanism investigation showed that WBO reduces the content of macromolecular micelles and average molecular weight in EVA modified asphalt, and it also diluts the asphaltene components in the asphalt system, resulting in a slight weakening of the performance of WEMA at high temperatures and a significant performance enhancement at low temperatures. Ultimately, the utilization of WBO/EVA composite modified asphalt has a better comprehensive performance.

Effect of Humidified High-Flow Nasal Cannula Oxygen Therapy with a Pulmonary Infection Control Window as a Ventilation Switching Indication in Combination with Atomizing Inhalation of Terbutaline on the Lung Function of Patients with Acute Exacerbation of COPD.

We investigated how humidified high-flow nasal cannula oxygen therapy (HFNC) with a pulmonary infection control (PIC) window as a ventilation switching indication in combination with atomizing inhalation of terbutaline affects the lung function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We examined 140 hospitalized AECOPD patients randomized to control and observation groups. Conventional supportive therapy and invasive mechanical ventilation with tracheal intubation were conducted in both groups, with a PIC window as the indication for ventilation switching. Noninvasive positive pressure ventilation (NIPPV) plus atomizing inhalation of terbutaline was used in the control group. In the observation group, HFNC combined with atomizing inhalation of terbutaline was used. Compared to the control group, after 48-hr treatment and treatment completion, the observation group had significantly increased levels of lung function indicators (maximal voluntary ventilation [MVV] plus forced vital capacity [FVC], p<0.05) and oxygen metabolism indicators (arterial oxygen partial pressure [PaO2], arterial oxygen content [CaO2], and oxygenation index, p<0.05). The comparison of the groups revealed that the levels of airway remodeling indicators (matrix metalloproteinase-2 [MMP-2], tissue inhibitor of metalloproteinase 2 [TIMP-2] plus MMP-9) and inflammatory indicators (interferon gamma [IFN-γ] together with interleukin-17 [IL-17], IL-10 and IL-4) were significantly lower after 48 h of treatment as well as after treatment completion (both p<0.05). These results demonstrate that HFNC with a PIC window as the indication for ventilation switching combined with atomizing inhalation of terbutaline can relieve the disorder of oxygen metabolism and correct airway hyper-reactivity.

Bionic dual-scale structured films for efficient passive radiative cooling accompanied by robust durability.

Passive radiative cooling (PRC), as an energy-free cooling approach, is ingeniously harnessed for certain natural organisms to withstand extreme high-temperature climates, which has inspired numerous bionic designs. However, it is a great challenge to enhance the durability of the designed materials in practical scenarios while inheriting the natural biological principles. We demonstrate bionic dual-scale structured (BDSS) films for efficient passive radiative cooling accompanied by robust durability after discovering the excellent thermoregulatory properties of the inner surface of Hawaiian scallop shell. We found that the inner surface of the shell consists of large-scale triangular ridges scattered with small-scale terrace steps. This dual-scale structure can enhance the reflectivity of sunlight by efficient Mie scattering and increase the emissivity in the mid-infrared range by lengthening the propagation of photons, thereby decreasing the surface temperature. Underpinned by this finding, we developed a BDSS film that features a strong solar spectrum reflectivity of 0.95 and a high mid-infrared emissivity of 0.98, achieving a sub-ambient cooling of 10.8 °C under direct sunlight. Additionally, the designed films possess robust durability including excellent self-cleaning, flexibility, mechanical strength, chemical stability, and anti-ultraviolet radiation, which is promising for thermal thermoregulation in various harsh scenarios.

High-Branched Natural Polysaccharide Flaxseed Gum Binder for Silicon-Based Lithium-Ion Batteries with High Capacity.

Silicon-based anodes heavily depend on the binder to preserve the unbroken electrode structure. In the present work, natural flaxseed gum (FG) is used as a binder of silicon nanoparticles (SiNPs) anode for the first time. Owing to a large number of polar groups and a rich branched structure, this material not only anchors tightly to the surface of SiNPs through bonding interactions but also formed a hydrogen bonding network structure among molecules. As a result, the FG binder can endow the silicon electrode with stable interfacial adhesion and outstanding mechanical properties. In addition, FG with a high viscosity facilitates the homogeneous dispersion of the electrode components. When FG is used as a binder, the cycling performance of the Si anode is greatly improved. After one hundred cycles at an applied current density of 1 A g-1, the electrode continues to display remarkable electrochemical properties with a significant cyclic capacity (2213 mA h g-1) and initial Coulombic efficiency (ICE) of 89.7%.

Association between triglyceride-glucose index and intracranial/extracranial atherosclerotic stenosis: findings from a retrospective study.

OBJECTIVE: The association of the triglyceride-glucose (TyG) index with intracranial atherosclerotic stenosis (ICAS) and extracranial atherosclerotic stenosis (ECAS) is unclear. This study aimed to investigate the relationship of TyG index with the distribution and severity of ICAS and ECAS. METHOD: Patients who underwent digital subtraction angiography (DSA) for evaluating ICAS/ECAS in Zhongnan Hospital of Wuhan University from January 2017 to October 2021 were retrospectively enrolled in our study. Clinical characteristics, DSA data, blood routine, lipid profile and fasting glucose were recorded. The association of TyG index and ICAS/ECAS status were investigated in four aspects: location and distribution of stenosis, stenosis severity and whether stenosis is symptomatic. Logistic regression models were used to evaluate the association. Restricted cubic splines were constructed to model the non-linear relationship between the TyG index and different arterial stenosis status. RESULTS: Among 1129 included patients, the median age was 62 (IQR 55-68) years, and 71.3% were male. The median TyG index was 8.81 (8.40, 9.21). Elevated TyG index was significantly associated with ICAS, combined ICAS/ECAS, anterior circulation stenosis, posterior circulation stenosis, combined anterior/posterior circulation stenosis, severe stenosis, both asymptomatic and symptomatic stenosis. This association was maintained after adjusting for age, sex, smoking, drinking, medical history of hypertension and stroke, platelet, total cholesterol, high-density lipoprotein, and low-density lipoprotein. Multivariable-adjusted spline regression models showed that a progressively increasing risk of arterial stenosis was related to an elevated TyG index. CONCLUSION: Elevated TyG index was associated with ICAS/ECAS. TyG index might be a useful indicator of ICAS and severe stenosis.

Myopia control efficacy of peripheral defocus soft contact lenses in children and adolescents: A meta-analysis.

OBJECTIVES: To evaluate the effect of peripheral defocus soft contact lenses (PDSCLs) on controlling myopia progression in children and adolescents, and to compare it with orthokeratology (Ortho-K) and single vision lenses (SVLs). METHODS: We conducted a systematic search of PubMed, the Cochrane Library, Medline, CNKI, CBM, VIP, and WanFang Data databases for randomized controlled trials (RCTs) and cohort studies that investigated the effects of PDSCLs on myopia control in children and adolescents. The published languages were limited to English and Chinese. The risk bias tool provided by the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale were used to assess the risk bias of included studies of RCTs and CTs. The published biases of included studies were assessed by Egger`s test. RESULTS: We included 21 studies, comprising 13 RCTs and 8 cohort studies, with a total of 1337 participants in the PDSCLs group, 428 in the Ortho-K group, and 707 in the SVLs group. The meta-analysis indicated no significant difference between PDSCLs and Ortho-K in controlling the increase of diopter (MD = 0.01, 95% CI: -0.06, 0.09; P = 0.69) and axial length (MD = -0.01, 95% CI: -0.02, 0.00; P = 0.28). Compared with SVLs, PDSCLs had a better effect in controlling the increase of diopter (MD = 0.23, 95% CI: 0.17, 0.28; P < 0.00001) and axial length (MD = -0.11, 95% CI: -0.12, -0.09; P < 0.00001) in children and adolescents. CONCLUSIONS: Children and adolescents wearing PDSCLs can achieve better myopia control than those wearing SVLs, and their effect is comparable to that of Ortho-K.

Optimal starting dosing regimen of intravenous oxytocin for labor induction based on the population kinetic-pharmacodynamic model of uterine contraction frequency.

BACKGROUND: Intravenous oxytocin is commonly used for labor induction. However, a consensus on the initial dosing regimen is lac with conflicting research findings and varying guidelines. This study aimed to develop a population kinetic-pharmacodynamic (K-PD) model for oxytocin-induced uterine contractions considering real-world data and relevant influencing factors to establish an optimal starting dosing regimen for intravenous oxytocin. METHODS: This retrospective study included pregnant women who underwent labor induction with intravenous oxytocin at Peking University Third Hospital in 2020. A  population K-PD model was developed to depict the time course of uterine contraction frequency (UCF), and covariate screening identified significant factors affecting the pharmacokinetics and pharmacodynamics of oxytocin. Model-based simulations were used to optimize the current starting regimen based on specific guidelines. RESULTS: Data from 77 pregnant women with 1095 UCF observations were described well by the K-PD model. Parity, cervical dilation, and membrane integrity are significant factors influencing the effectiveness of oxytocin. Based on the model-based simulations, the current regimens showed prolonged onset times and high infusion rates. This study proposed a revised approach, beginning with a rapid infusion followed by a reduced infusion rate, enabling most women to achieve the target UCF within approximately 30 min with the lowest possible infusion rate. CONCLUSION: The K-PD model of oxytocin effectively described the changes in UCF during labor induction. Furthermore, it revealed that parity, cervical dilation, and membrane integrity are key factors that influence the effectiveness of oxytocin. The optimal starting dosing regimens obtained through model simulations provide valuable clinical references for oxytocin treatment.

Successful hybrid endovascular treatment for refractory cerebral venous sinus thrombosis in pregnancy: A case report.

Background: Cerebral venous sinus thrombosis (CVST) in pregnancy was common and endovascular treatment (EVT) could be an effective and safe treatment for patients with severe and refractory CVST. However, the efficacy and safety of hybrid EVT (craniotomy + endovascular treatment) for CVST were unknown. We represented a rare case of hybrid EVT through the incision of the superior sagittal sinus in a pregnant woman with CVST who failed to EVT through the femoral vein pathway. Case presentation: A 26-year-old woman, in her second month of pregnancy, complained of a headache for 5 days and aggravation with coma combined with convulsions for 2 days. She was diagnosed with CVST in the local hospital by digital subtraction angiography (DSA) and treated with anticoagulation. She had no history of illness and the biochemical tests were normal. Hybrid EVT (craniotomy + EVT) was attempted after failing to conduct EVT through the femoral vein pathway due to difficulty to reach the target cerebral venous sinus. Briefly, a small hole was made in the frontotemporal head to expose the superior sagittal sinus and a 6F sheath was inserted into 2cm of superior sagittal sinus incision and fixed on the scalp, after repeated aspiration by 5F intermediate catheter and balloon dilatation of stenosis in the right transverse sinus and right sigmoid sinus, the cerebral venous system got successful recanalization. No obvious complications were found and the patient recovered very well after the surgery. Conclusion: Anticoagulation was the standard treatment for CVST. EVT could rapidly restore venous flow and improve the prognosis for refractory and severe CVST. EVT by hybrid surgery through the superior sagittal sinus incision may be safe and effective for desperate patients with severe CVST.

Recurrent stroke shortly after mechanical thrombectomy secondary to carotid web: A case report.

RATIONALE: Carotid web, a known source of thrombus for embolic stroke, presents a considerable risk of stroke recurrence. While case reports have demonstrated the safety and effectiveness of mechanical thrombectomy in treating carotid web-related stroke, the need for concurrent carotid artery stenting to prevent recurrent stroke immediately after thrombectomy remains unclear. This study aims to underscore the importance of immediate carotid artery stenting in preventing recurrent stroke following mechanical thrombectomy in patients with carotid web-related stroke. PATIENT CONCERNS: A 43-year-old woman with acute onset of left limb weakness and slurred speech within 3 hours was admitted to the emergency department. DIAGNOSES: Computed tomographic angiography confirmed the M1 segment occlusion of the right middle cerebral artery. INTERVENTIONS: The patient received intravenous thrombolysis in the local hospital and mechanical thrombectomy in our stroke center. OUTCOMES: Three days post-mechanical thrombectomy, there was a sudden exacerbation of her neurological deficit symptoms. A reexamination via computed tomographic angiography revealed a re-occlusion in M1 segment of the right middle cerebral artery, despite the implementation of stringent anticoagulation therapy for carotid web-related stroke. LESSONS: Stroke patients with carotid web had a high risk of stroke recurrence and it was necessary to conduct carotid artery stenting to prevent stroke recurrence secondary to the carotid web immediately after mechanical thrombectomy.

Development and validation of a predictive model for white matter lesions in young- and middle-aged people.

Background: White matter lesion (WML) is an age-related disorder associated with stroke and cognitive impairment. This study aimed to investigate the risk factors and build a predictive model of WML in young- and middle-aged people. Methods: We performed a second analysis of the data from the Dryad Digital Repository. We selected those people who are <60 years old and randomly divided them into the training group and the validation group. We investigated the risk factors of WML in the training group with logistic regression analysis and built a prediction nomogram based on multivariate logistic regression analysis; finally, the performance of the prediction nomogram was evaluated for discrimination, accuracy, and clinical utility. Results: There were 308 people in the training group and 723 people in the validation group. Multivariate regression analysis showed that the age (OR = 1.49, 95% CI: 1.31-1.70), diastolic blood pressure (OR = 1.02, 95% CI: 1.00-1.03), carotid plaque score (OR = 1.31, 95% CI: 1.14-1.50), female gender (OR = 2.27, 95% CI: 1.56-3.30), and metabolic syndrome (OR = 2.12, 95% CI: 1.22-3.70) were significantly associated with white matter lesions. The area under the curve value (AUC) of the receiver operating curve (ROC) was 0.734 for the training group and 0.642 for the validation group. The calibration curve and clinical impact curve showed that the prediction nomogram has good accuracy and clinical application value. Conclusion: Age, diastolic blood pressure, carotid plaque score, female gender, and metabolic syndrome were risk factors in young- and middle-aged people <60 years old with WML, and the nomogram based on these risk factors showed good discrimination, accuracy, and clinical utility.

Predicting functional outcome in acute ischemic stroke patients after endovascular treatment by machine learning.

Background: Endovascular therapy (EVT) was the standard treatment for acute ischemic stroke with large vessel occlusion. Prognosis after EVT is always a major concern. Here, we aimed to explore a predictive model for patients after EVT. Method: A total of 156 patients were retrospectively enrolled. The primary outcome was functional dependence (defined as a 90-day modified Rankin Scale score ≤ 2). Least absolute shrinkage and selection operator and univariate logistic regression were used to select predictive factors. Various machine learning algorithms, including multivariate logistic regression, linear discriminant analysis, support vector machine, k-nearest neighbors, and decision tree algorithms, were applied to construct prognostic models. Result: Six predictive factors were selected, namely, age, baseline National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT (ASPECT) score, modified thrombolysis in cerebral infarction score, symptomatic intracerebral hemorrhage (sICH), and complications (pulmonary infection, gastrointestinal bleeding, and cardiovascular events). Based on these variables, various models were constructed and showed good discrimination. Finally, a nomogram was constructed by multivariate logistic regression and showed a good performance. Conclusion: Our nomogram, which was composed of age, baseline NIHSS score, ASPECT score, recanalization status, sICH, and complications, showed a very good performance in predicting outcome after EVT.

Mechanical thrombectomy for acute ischemic stroke with large vessel occlusion in pregnancy with mechanical heart valves： A case report.

Background: The management of anticoagulation for mechanical heart valves (MHVs) during pregnancy posed a special challenge. Mechanical thrombectomy (MT) was the standard treatment for acute ischemic stroke (AIS) in anterior circulation with large vessel occlusion. However, the efficacy and safety of MT in the treatment of acute ischemic stroke in pregnancy were unknown. Case presentation: A 29-year-old woman with MHVs in her first pregnancy at 7 weeks' gestation underwent MT because of a large occlusive thrombus in the end of the internal carotid artery despite therapeutic anticoagulation with low-molecular-weight heparin. This pregnant woman recovered well after MT with a modified rank score (mRS) of 0 at 90 days. Conclusion: At present, there was no standard protocol of anticoagulation therapy for pregnant women with MHVs. Acute ischemic stroke with large vessel occlusion in pregnancy was rare, but could bring devastating consequences for both mother and infant. Our case report demonstrated that MT could be safe and effective in pregnancy.

Study on the high-temperature and aging properties of agricultural waste-modified asphalt based on rheology.

The modifier of road materials from agricultural waste (AW) as raw material has been widely noticed. Considering the environmental impact of AW treatment and the National policy on the promotion of resource reuse, the feasibility of four AW (namely, bamboo powder, rape straw, corn cob, and wheat straw) for styrene butadiene styrene (SBS) asphalt modification is studied from the properties and mechanism perspectives. Through properties evaluation tests (such as the dynamic shear rheometer, multiple stress creep recovery, and rotating thin film oven test), the influence of four AW and different mixing amounts on the properties of SBS modified asphalt pavement is analyzed from the aspects of high-temperature deformation resistance and anti-aging properties. The results reveal that the four AW can improve the SBS asphalt's high-temperature deformation resistance and anti-aging properties, among which rape straw has the most significant improvement effect. In addition, through the fourier transform infrared spectroscopy test, the microscopic mechanism of the AW/SBS composite modified asphalt binder is revealed from the functional groups. The analysis shows that the AW is physically mixed with the SBS asphalt binder, which inhibits the growth of sulfoxide groups and the cracking of the SBS modifier during aging.

Efficient Passive Daytime Radiative Cooling by Hierarchically Designed Films Integrating Robust Durability.

Surfaces with efficient passive daytime radiative cooling (PDRC) are underpinned by maximizing both solar reflection and thermal radiation to the outer space at no additional energy cost. Despite notable progress, their practical applications are of great challenge due to their complicated fabrication processes, easy contamination and damage, and high costs. Herein, we fabricate a hierarchically designed passive daytime radiative cooling film (HPRF) comprising cost-effective Al2O3 particles and poly(dimethylsiloxane) (PDMS) via a simple phase separation method. The designed film possesses a high solar spectrum reflectance of ∼0.96 and a mid-infrared emittance of ∼0.95, achieving a ∼12.4 °C subambient cooling under direct solar irradiation. This excellent PDRC is due to the efficient Mie scattering of sunlight by hierarchical micro-/nanostructures and selected molecular vibrations of PDMS combined with the phonon polariton resonance of Al2O3 particles, respectively. Moreover, the designed HPRF is accompanied with robust durability endowed by superior self-cleaning, flexibility, and anti-ultraviolet radiation that can present substantial application promises of thermal management in various electronic devices and wearable products.

Recent advances and perspectives on production of value-added organic acids through metabolic engineering.

Organic acids are important consumable materials with a wide range of applications in the food, biopolymer and chemical industries. The global consumer organic acids market is estimated to increase to $36.86 billion by 2026. Conventionally, organic acids are produced from the chemical catalysis process with petrochemicals as raw materials, which posts severe environmental concerns and conflicts with our sustainable development goals. Most of the commonly used organic acids can be produced from various organisms. As a state-of-the-art technology, large-scale fermentative production of important organic acids with genetically-modified microbes has become an alternative to the chemical route to meet the market demand. Despite the fact that bio-based organic acid production from renewable cheap feedstock provides a viable solution, low productivity has impeded their industrial-scale application. With our deeper understanding of strain genetics, physiology and the availability of strain engineering tools, new technologies including synthetic biology, various metabolic engineering strategies, omics-based system biology tools, and high throughput screening methods are gradually established to bridge our knowledge gap. And they were further applied to modify the cellular reaction networks of potential microbial hosts and improve the strain performance, which facilitated the commercialization of consumable organic acids. Here we present the recent advances of metabolic engineering strategies to improve the production of important organic acids including fumaric acid, citric acid, itaconic acid, adipic acid, muconic acid, and we also discuss the current challenges and future perspectives on how we can develop a cost-efficient, green and sustainable process to produce these important chemicals from low-cost feedstocks.

An integrated PK/PD model investigating the impact of tumor size and systemic safety on animal survival in SW1990 pancreatic cancer xenograft.

Survival is one of the most important endpoints in cancer therapy, and parametric survival analysis could comprehensively reveal the overall result of disease progression, drug efficacy, toxicity as well as their interactions. In this study we investigated the efficacy and toxicity of dexamethasone (DEX) combined with gemcitabine (GEM) in pancreatic cancer xenograft. Nude mice bearing SW1990 pancreatic cancer cells derived tumor were treated with DEX (4 mg/kg, i.g.) and GEM (15 mg/kg, i.v.) alone or in combination repeatedly (QD, Q3D, Q7D) until the death of animal or the end of study. Tumor volumes and net body weight (NBW) were assessed every other day. Taking NBW as a systemic safety indicator, an integrated pharmacokinetic/pharmacodynamic (PK/PD) model was developed to quantitatively describe the impact of tumor size and systemic safety on animal survival. The PK/PD models with time course data for tumor size and NBW were established, respectively, in a sequential manner; a parametric time-to-event (TTE) model was also developed based on the longitudinal PK/PD models to describe the survival results of the SW1990 tumor-bearing mice. These models were evaluated and externally validated. Only the mice with good tumor growth inhibition and relatively stable NBW had an improved survival result after DEX and GEM combination therapy, and the simulations based on the parametric TTE model showed that NBW played more important role in animals' survival compared with tumor size. The established model in this study demonstrates that tumor size was not always the most important reason for cancer-related death, and parametric survival analysis together with safety issues was also important in the evaluation of oncology therapies in preclinical studies.

Associations of neutrophil-to-lymphocyte ratio with intracranial and extracranial atherosclerotic stenosis.

Background: Neutrophil-to-lymphocyte ratio (NLR) has been shown to be an important inflammatory maker. This study aims to investigate the association of NLR with intracranial and extracranial atherosclerotic stenosis. Methods: We retrospectively recruited patients who underwent digital subtraction angiography (DSA) for evaluating intracranial/extracranial stenosis in the Zhongnan Hospital of Wuhan University from January 2017 to October 2021. Clinical characteristics, DSA data, blood routine, and lipid profile were recorded. Logistic regression was used to evaluate the association of NLR and intercranial/extracranial atherosclerotic stenosis in three aspects: distribution of stenosis, whether the stenosis is symptomatic, and degree of stenosis. Results: A total of 1,129 patients were included in our analysis, with a median age of 62 y (interquartile range 55-68), and a median admission NLR of 2.39 (interquartile range 1.84-3.42). A total of 986 patients presented intracranial and/or extracranial atherosclerotic stenosis. Increased NLR were associated with intracranial stenosis [odds ratio (OR), 1.54; 95% CI, 1.27-1.85; p < 0.001], extracranial stenosis (OR, 1.56; 95% CI, 1.25-1.96; p < 0.001), and combined intracranial/extracranial stenosis (OR, 1.61; 95% CI, 1.28-2.03; p < 0.001). After adjustment of potential factors, higher NLR were independently associated with symptomatic stenosis (OR, 1.16; 95% CI, 1.05-1.27; p = 0.003) and degree of stenosis (OR, 1.32; 95% CI, 1.17-1.49; p < 0.001). Compared with the first quartile NLR, the second, third, and fourth quartiles NLR were independent risk factors for symptomatic stenosis and stenosis degree (both p for trend <0.001). Conclusion: Increased NLR is an important factor associated with both intracranial and extracranial atherosclerotic stenosis. Patients with symptomatic intracranial/extracranial atherosclerotic stenosis or a more severe degree of stenosis presented elevated NLR levels.

A model-based meta-analysis of immune-related adverse events during immune checkpoint inhibitors treatment for NSCLC.

Immune checkpoint inhibitors (ICIs) have become a vital part of the therapeutic landscape for non-small cell lung cancer (NSCLC) in recent years benefiting from their remarkable efficacy. However, ICIs are associated with potentially life-threatening immune-related adverse events (irAEs). This study aims to quantify dose dependence and additional influencing factors of both any grade and grade greater than or equal to 3 irAEs in patients with NSCLC treated by ICIs. The trial-level irAE data was collected and pooled from 129 cohorts in 81 clinical studies. A logit-transformed meta-regression model was applied to derive the quantitative relationship of irAE rate and ICI exposure. Programmed cell death-1 (PD-1) or programmed cell death ligand-1 (PD-L1) inhibitors showed no dose dependence in patients with NSCLC, whereas cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors exhibited a statistically significant dose dependence when used alone or combined with PD-1 or PD-L1 inhibitors. Besides, therapy line and combination of ICIs with chemotherapy or target therapy were significant covariates. Hopefully, the results of this study can improve clinicians' awareness of irAEs and be helpful for clinical decisions during ICI treatment for NSCLC.

Asymmetric Synthesis of Pyrrolidines via Oxetane Desymmetrization.

Asymmetric synthesis of chiral pyrrolidines bearing an all-carbon quaternary stereocenter in the 3-position remains challenging. Herein we report two efficient protocols by means of oxetane desymmetrization, featuring the use of a readily available tert-butylsulfinamide chiral auxiliary and a catalytic system with chiral phosphoric acid as the source of chirality, respectively.

Hypoperfusion cerebral infarction after carotid artery stenting: A case report.

Carotid artery stent implantation (CAS) plays an important role in preventing cerebral infarction associated with carotid stenosis. The postoperative complications of CAS include cerebral hyperperfusion syndrome (CHS), cerebral infarction, vascular injury, carotid sinus reaction, and stent restenosis. Hyperperfusion syndrome (CHS) is a serious complication that arises after the performance of carotid endarterectomy (CEA) or CAS and is characterized by high blood pressure, headache, epilepsy, and focal neurological deficit. Therefore, it is very important to evaluate and diagnose CHS. Cerebral infarction after CAS is often caused by distal embolism due to the shedding of microemboli. With the application of distal brain protection devices, the risk of distal embolism is significantly reduced. In this study, we report a rare case of hypoperfusion cerebral infarction after carotid artery stenting in a patient with severe carotid stenosis complicated with contralateral common carotid artery occlusion.