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OBJECTIVE: Patients who underwent previous frozen elephant trunk (FET) implantation for Stanford type A aortic dissection (AAAD) remain at risk for secondary intervention due to unsuccessful distal aortic remodeling (DAR). We aimed to investigate the impact of DAR on early outcomes in patients who underwent two-stage thoracoabdominal aortic (TA) repair. METHODS: One hundred and six patients who previously underwent FET implantation and TA repair between October 2014 and December 2022 were enrolled in this study. The extent of DAR was evaluated, including aortic diameter, area ratio of the false lumen (FL)/aortic lumen (AoL) and patency of the FL at three levels of the aorta. Logistic regression analyses were performed to investigate the risk factors for early outcomes. RESULTS: The Ao diameter at the distal FET was significantly larger in patients who died early than in surviving patients (79.19±22.89 mm vs. 46.84±19.17 mm, adjusted P = 0.001). The optimal cutoff value for the Ao diameter at the distal FET was 60 mm. Patients with an Ao diameter ≥ 60 mm at the distal FET had worse early outcomes (P <0.05), including prolonged intubation, early death and postoperative complications. The Ao diameter at the distal FET was identified as a significant risk factor for early death in patients undergoing TA repair. CONCLUSIONS: Patients undergoing TA repair with an Ao diameter ≥ 60 mm at the distal FET have worse early outcomes. Moreover, an Ao diameter at the distal FET is a significant risk factor for early death in patients undergoing TA repair.
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OBJECTIVES: A consensus on the management of thoracoabdominal aortic aneurysms (TAAA) in patients with Marfan syndrome (MFS) has not yet been established. This study aimed to compare the long-term outcomes after open TAAA repair in patients with and without MFS. METHODS: This retrospective study encompassed 230 consecutive patients who underwent TAAA repair between 2012 and 2022, including a comparison of 69 MFS patients and 161 non-MFS patients. The primary endpoint was long-term mortality. The secondary endpoint was early composite adverse events, including early mortality, permanent stroke, permanent paraplegia, permanent renal failure, and reoperation. Univariable and multivariable logistic regression analyses were employed to assess the impact of MFS on early composite adverse events, while univariable and multivariable Cox proportional hazards models were constructed to evaluate the association between MFS and overall mortality. RESULTS: Compared with non-MFS patients, MFS patients were younger (31.9±8.5 vs 44.8±12.3 years; P<0.001), with less comorbid coronary artery disease (0 vs 8.1%; P=0.034), more frequently underwent Crawford extent III repair (56.5% vs 34.8%; P=0.002) and applied normothermic iliac perfusion (91.3% vs 81.4%; P=0.057). There was no significant difference in the rate of early composite adverse events between MFS and non-MFS groups (23.2% vs 14.3%; P=0.099), which was verified by multivariable logistic regression analyses with multiple models. Overall mortality was significantly lower in MFS group compared to non-MFS group (log-rank P=0.026), with 1-, 5- and 10-year cumulative mortality of 4.4% vs 8.7%, 8.1% vs 17.2% and 20.9% vs 36.4%, respectively. Multivariable Cox regression analyses across different models further confirmed MFS as a significant protective factor for overall mortality (Model1: HR 0.31, 95%CI 0.13-0.73, P=0.007; Model2: HR 0.32, 95%CI 0.13-0.75, P=0.009; Model3: HR 0.38, 95%CI 0.15-0.95, P=0.039). CONCLUSIONS: Despite varying risk profiles, MFS patients undergoing open TAAA repair can achieve comparable or even superior outcomes to non-MFS patients under tailored surgical strategies, meticulous perioperative care, and close follow-up surveillance, especially in the long term.
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The presence of heavy metals in mine tailings poses a serious threat to the surrounding environment. In this study, we aimed to stabilize Pb/Zn-containing mine tailings using modified fly ash (FA) with various alkali solutions. Notably, the modification of FA with Na2SiO3 (NaSi-FA) resulted in the most significant structure changes. To understand the adsorption mechanism of Pb and Zn by modified FA, batch adsorption experiments were conducted. Doubling the adsorption capacity for both Pb and Zn was observed in the modified FA samples compared to unmodified samples. These results could be attributed to the enhanced surface area and porous structure, providing more anchor sites for the heavy metal ions. Additionally, the adsorption of Pb and Zn was found to follow the Langmuir isotherm and pseudo-second order kinetic. Molecular dynamics simulations further supported the notion that Pb and Zn ions could effectively exchange with Na ions within the N-A-S-H gel network, ultimately solidifying them in its structure. Stabilizing Pb/Zn tailings with NaSi-FA resulted in a significant decrease in the leaching of Pb and Zn. Specifically, the leading amount decreased by 55.2% for Pb and 35.3% for Zn, showcasing the superior performance of this stabilization method. This reduction in leaching indicates effective compliance with environmental regulations regarding the containment of Pb and Zn.
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BACKGROUND: Normothermic iliac perfusion has been increasingly utilized for TAAA repair; however, the long-term outcomes in large samples are lacking. This study was designed to assesses the perioperative and long-term results of thoracoabdominal aortic repair using normothermic iliac perfusion. METHODS: We retrospectively analyzed 156 patients having Crawford extent II or III thoracoabdominal aortic aneurysm replacement with normothermic iliac perfusion from 2012 to 2022. Primary endpoints were composite adverse events and long-term survival, which encompassed 30-day mortality, persistent stroke, persistent paraplegia, and acute renal failure needing continuous dialysis. The cohort was divided into two subgroups based on the use of selective visceral and cold renal perfusion techniques. RESULTS: The combined adverse event rate was 14.1%. Specific rates were: 30-day mortality (4.5%), persistent stroke (1.9%), persistent paraplegia (4.5%), and renal failure requiring persistent dialysis (3.2%). The median follow-up time was 67 months. Overall survival rates at 1, 3, 5, 7, and 10 years were 91.6%, 90.0%, 85.4%, 77.6%, and 69.7%, respectively. Subgroup analysis showed the visceral and renal perfusion group had a significantly reduced adverse event incidence compared to the nonperfusion group (6.5% vs. 19.1%, P=0.026). Multivariable logistic regression analysis confirmed selective visceral and cold renal perfusion techniques as protective factors against postoperative adverse events (OR 0.30, 95%CI 0.09-0.94; P=0.038). Multivariable Cox regression analysis identified age ≥50 years (HR 2.63, 95%CI 1.10-6.27; P=0.029) and NYHA grade ≥III (HR: 3.20, 95% CI: 1.04-9.87; P=0.043) as independent risk factors predicting overall survival. CONCLUSIONS: Normothermic iliac perfusion is a feasible option for thoracoabdominal aortic repair with cost benefits and simpler management, and selective visceral and cold renal perfusion techniques may further improve its safety and effectiveness. However, enhanced vigilance and meticulous care are essential, particularly for elderly patients and those with cardiac insufficiency.
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BACKGROUND: For acute type A aortic dissection involving the aortic root with root diameter no more than 45 mm, there are various aortic root repair techniques. In this study, a novel surgical technique using a pericardial autograft for aortic root repair was introduced. We described its surgical steps in detail and compare its clinical outcomes with direct suture technique. METHODS: Between July 2017 and August 2022, 95 patients with acute type A aortic dissection who underwent aortic root repair were enrolled, including aortic root repair using pericardial autograft (group A, n = 49) or direct suture (group B, n = 46). The patient's clinical data were retrospectively analyzed, and a 5-year follow-up was conducted. RESULTS: The 30-day mortality, re-exploration for bleeding, postoperative new-onset renal failure requiring continuous renal replacement therapy, stroke, and paraplegia occurred in 3%, 4%, 11%, 5%, and 2% of the overall patients, respectively. There was no significant difference in the 30-day mortality and complication rate between the two groups. The 30-day mortality and re-exploration for bleeding marked the primary endpoint events. Logistic regression analysis indicated that there was a significant correlation between the primary endpoint events and surgical technique (odds ratio, 0.002; 95% confidence interval, 0-0.159; P = 0.026). The aortic valve insufficiency of the two groups were significantly improved after operation (group A, P < 0.001; group B, P < 0.001). During follow-up, there was no significant difference in short-term survival between the two groups after surgery (log-rank P = 0.75), and all patients were free from reoperation for aortic disease. CONCLUSIONS: Patients who underwent aortic root repair using pericardial autograft tended to have reduced 30-day mortality and a lower risk of re-exploration for bleeding. Using pericardial autograft for aortic root repair is a safe and useful approach for patients with acute type A aortic dissection involving the aortic root.
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Disección Aórtica , Pericardio , Humanos , Disección Aórtica/cirugía , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Pericardio/trasplante , Resultado del Tratamiento , Autoinjertos , Aneurisma de la Aorta Torácica/cirugía , Anciano , Enfermedad Aguda , Complicaciones Posoperatorias , Implantación de Prótesis Vascular/métodos , Trasplante Autólogo , Estudios de SeguimientoRESUMEN
BACKGROUND: Tumor microenvironment (TME) characteristics including tumor stroma ratio (TSR), tumor budding (TB), and tumor-infiltrating lymphocytes (TILs) were examined in resected gastric cancer. These TME features have been shown to indicate metastatic potential in colon cancer, and intestinal-type gastric cancer (IGC) has pathological similarities with that malignancy. METHODS: TSR, TB, and TILs were quantified in routine histological sections from 493 patients with IGC who underwent radical resection at 2 university hospitals in China from 2010 to 2016. TME variables were dichotomized as follows: TSR (50%), TILs (median), TB per international guidelines (4 buds/0.785mm2), and platelet-lymphocyte ratio (PLR) per survival ROC. Association of TME features with patient clinicopathological characteristics, time-to-recurrence (TTR), and cancer-specific-survival (CSS) were examined using univariate and multivariate analysis, including a relative contribution analysis by Cox regression. RESULTS: Patients whose tumors showed high TSR or high TB or low TILs were each significantly associated with increased T and N stage, higher histological grade, and poorer TTR and CSS at 5 years. Only TSR and N stage were independently associated with TTR and CSS after adjustment for covariates. PLR was only independently associated with TTR after adjustment for covariates. Among the variables examined, only TSR was significantly associated with both TTR (HR 1.72, 95% CI, 1.14-2.60, Pâ =â .01) and CSS (HR 1.62, 95% CI, 1.05-2.51, Pâ =â .03) multivariately. Relative contribution to TTR revealed that the top 3 contributors were N stage (45.1%), TSR (22.5%), and PLR (12.9%), while the top 3 contributors to CSS were N stage (59.9%), TSR (14.7%), and PLR (10.9%). CONCLUSIONS: Among the examined TME features, TSR was the most robust for prognostication and was significantly associated with both TTR and CSS. Furthermore, the relative contribution of TSR to patient TTR and CSS was second only to nodal status.
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BACKGROUND: The objective of this investigation was to identify the risk factors linked to major adverse outcomes (MAO) subsequent to total arch replacement with frozen elephant trunk procedure (TAR+FET) surgery among patients diagnosed with acute type A aortic dissection (ATAAD). Additionally, the study aimed to elucidate the influence of these adverse outcomes on the long-term prognosis of the patients. METHOD: 670 ATAAD patients received the TAR+FET procedure. Multivariable logistic regression was used to investigate the risk factors associated with in-hospital MAO. Additionally, long-term survival outcomes were assessed through follow-up observations of all patients. RESULTS: The overall in-hospital mortality was 4.33%. Among 670 patients, 169 patients (25.22%) developed postoperative MAO. Multivariate analysis showed that in-hospital MAO was positively associated with age (OR = 1.025, 95%CI: 1.005-1.045, P = 0.014), lower limb symptoms (OR = 2.562, 95%CI: 1.407-4.666, P = 0.002), involvement of coronary artery (OR = 2.027, 95%CI: 1.312-3.130, P = 0.001), involvement of left renal artery (OR = 1.998, 95%CI: 1.359-2.938, P < 0.001), CPB time (OR = 1.011, 95%CI: 1.007-1.015, P < 0.001) and WBC counts (OR = 1.045, 95%CI: 1.007-1.083, P = 0.019). MAO group showed a worse long-term prognosis than those non-MAO group (P = 0.002). CONCLUSIONS: While TAR+FET can be an effective treatment option for ATAAD patients, careful patient selection and management are essential in minimizing the risk of MAO and ensuring long-term success.
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The forest experience is good for people's physical and mental health. However, few studies on the effects of pure forest based on the duration and way of experience on people's physical and mental recovery. In this study, we took 180 first-year college students as research objects and conducted experiments in Pinus sylvestris and Betula platyphylla and the control group of grass plot. The changes of physiological and psychological indexes of the subjects were compared by two perception methods (onsite perception, video perception) and three perception duration (10 min, 20 min, 30 min). The results indicated that: (1) Differences between the two pure forests were mainly reflected in short-term recovery of diastolic blood pressure (DBP) and long-term recovery of total mood disorder (TMD). (2) Video perception was more conducive to short-term recovery of systolic blood pressure (SBP) and diastolic blood pressure (DBP). (3) Viewing the Pinus sylvestris for 20 min in different ways was the best way to relieve stress. It is suggested that, Pinus sylvestris can be used as the rehabilitation perception material, and reasonable path length or perception time can be selected for landscape construction in future. These results can provide scientific reference for landscape design based on forest health and environmental perception.
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Presión Sanguínea , Bosques , Humanos , Masculino , Femenino , Adulto Joven , Presión Sanguínea/fisiología , Betula , Percepción , Pinus sylvestris , Adulto , Factores de TiempoRESUMEN
This paper introduces an innovative differential sampling technique for calibrating AC waveforms, leveraging a commercially available 16-bit digital-to-analog converter (DAC) as the reference standard. The novelty of this approach lies in its enhanced stability over traditional direct sampling methods, especially as the frequency of the AC waveform increases. Notably, this technique provides a cost-effective sampler alternative to the differential sampling methods that rely on a programmable Josephson voltage standard (PJVS). A critical aspect of this methodology is the precise measurement of the DAC's output voltage, for which a static measurement strategy is adopted to utilize the exceptional linearity and transfer accuracy of the Keysight 3458A (Santa Rosa, CA, USA) in its standard DCV mode. The differential sampling method has demonstrated good accuracy, achieving a near 1 µV/V agreement with a pulse-driven AC Josephson voltage standard (ACJVS) across a 40 Hz to 200 Hz frequency range. The method attained an expanded uncertainty (k = 2) of 1 part in 106 while measuring a 0.707107 VRMS sine wave at 50 Hz, showcasing its efficacy in precise AC waveform calibration.
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Beyond conventional electrocatalyst engineering, recent studies have unveiled the effectiveness of manipulating the local reaction environment in enhancing the performance of electrocatalytic reactions. The general principles and strategies of local environmental engineering for different electrocatalytic processes have been extensively investigated. This review provides a critical appraisal of the recent advancements in local reaction environment engineering, aiming to comprehensively assess this emerging field. It presents the interactions among surface structure, ions distribution and local electric field in relation to the local reaction environment. Useful protocols such as the interfacial reactant concentration, mass transport rate, adsorption/desorption behaviors, and binding energy are in-depth discussed toward modifying the local reaction environment. Meanwhile, electrode physical structures and reaction cell configurations are viable optimization methods in engineering local reaction environments. In combination with operando investigation techniques, we conclude that rational modifications of the local reaction environment can significantly enhance various electrocatalytic processes by optimizing the thermodynamic and kinetic properties of the reaction interface. We also outline future research directions to attain a comprehensive understanding and effective modulation of the local reaction environment.
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Neonatal necrotizing enterocolitis (NNEC) is a disease characterized by intestinal inflammation and ischemic necrosis. Despite progress having been made during decades of research, details regarding its pathophysiology remain to be elucidated. It is known that abnormal expressions of TNF-α-induced protein 8-like 2 (TIPE2) can be observed in several diseases. However, the expression of TIPE2 in necrotizing enterocolitis (NEC) rats has not been examined before. The present study aimed to describe the expression pattern of TIPE2 and its role in NNEC pathogenesis. An NEC rat model was generated and used in the present study. All rats were sacrificed when the phenotype developed and the intestine between the lower end of the duodenum and the ileocecal were collected for further study. Hematoxylin and eosin, and immunohistochemical staining, reverse transcription-quantitative PCR and western blotting analysis were used to examine the expression of TIPE2. The results showed that the average body weight was significantly decreased in the NEC group compared with the control group along with a significant decrease of TIPE2 expression. However, the expressions of phosphatidylinositol-3-kinase (PI3K) and serine/threonine kinase AKT were significantly increased in NEC rats. The correlation analysis showed that the expressions of TIPE2 and PI3K were negatively correlated with a correlation coefficient of -0.797. To further determine the association between TIPE2 and PI3K/AKT pathway, two groups of wild type Sprague Dawley rats were infected with recombinant adenovirus Ad-V and Ad-TIPE2 respectively. The results showed that the expression of TIPE2 was significantly increased among rats in the Ad-TIPE2-infected group (OE group) compared to the ones from the Ad-V-infected group (NC group). However, the mRNA and protein expressions of PI3K and AKT were significantly decreased in Ad-TIPE2-infected rates. The difference of each index between OE and NC groups was statistically significant. The present study showed that the expression of TIPE2 was downregulated in NEC rats. TIPE2 might be involved in the pathogenesis of NEC by activating the PI3K/Akt signaling pathway.
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Obtaining partial methane oxidation reaction (MOR) with various oxygenates via a mild electrochemical method is practically difficult because of activation of stable CâH bond and consequent reaction pathway regulation. Here, a real-time tandem MOR with cascaded plasma and electrocatalysis to activate and convert the methane (CH4 ) synergistically is reported for the first time. Boosted CH4 conversion is demonstrated toward value-added products including, alcohols, carboxylates, and ketone via use of commercial Pd-based electrocatalysts. Compared with hash industrial processes, a mild condition, that is, anode potential < 1.0 V versus RHE (reversible hydrogen electrode) is used that mitigates overoxidation of oxygenates and obviates competing reaction(s). One evidence that Pd(II) sites and surface adsorbed hydroxyls are important in facilitating activated-CH4 species conversion, and establish a reaction mechanism for conversion(s) that involves coupling reactions between adsorbed hydroxyls, carbon monoxide and C1 /C2 alkyls. One conclude that pre-activation is important in boosting electrochemical partial MOR under mild conditions and will be of benefit in the development of sustainable CH4 conversion technology.
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OBJECTIVES: Edema is a complication of gamma knife radiosurgery (GKS) in meningioma patients that leads to a variety of consequences. The aim of this study is to construct radiomics-based machine learning models to predict post-GKS edema development. METHODS: In total, 445 meningioma patients who underwent GKS in our institution were enrolled and partitioned into training and internal validation datasets (8:2). A total of 150 cases from multicenter data were included as the external validation dataset. In each case, 1132 radiomics features were extracted from each pre-treatment MRI sequence (contrast-enhanced T1WI, T2WI, and ADC maps). Nine clinical features and eight semantic features were also generated. Nineteen random survival forest (RSF) and nineteen neural network (DeepSurv) models with different combinations of radiomics, clinical, and semantic features were developed with the training dataset, and evaluated with internal and external validation. A nomogram was derived from the model achieving the highest C-index in external validation. RESULTS: All the models were successfully validated on both validation datasets. The RSF model incorporating clinical, semantic, and ADC radiomics features achieved the best performance with a C-index of 0.861 (95% CI: 0.748-0.975) in internal validation, and 0.780 (95% CI: 0.673-0.887) in external validation. It stratifies high-risk and low-risk cases effectively. The nomogram based on the predicted risks provided personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration. CONCLUSION: This RSF model with a nomogram could represent a non-invasive and cost-effective tool to predict post-GKS edema risk, thus facilitating personalized decision-making in meningioma treatment. CLINICAL RELEVANCE STATEMENT: The RSF model with a nomogram built in this study represents a handy, non-invasive, and cost-effective tool for meningioma patients to assist in better counselling on the risks, appropriate individual treatment decisions, and customized follow-up plans. KEY POINTS: ⢠Machine learning models were built to predict post-GKS edema in meningioma. The random survival forest model with clinical, semantic, and ADC radiomics features achieved excellent performance. ⢠The nomogram based on the predicted risks provides personalized prediction with a C-index of 0.962 (95%CI: 0.951-0.973) and satisfactory calibration and shows the potential to assist in better counselling, appropriate treatment decisions, and customized follow-up plans. ⢠Given the excellent performance and convenient acquisition of the conventional sequence, we envision that this non-invasive and cost-effective tool will facilitate personalized medicine in meningioma treatment.
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Neoplasias Meníngeas , Meningioma , Radiocirugia , Humanos , Meningioma/radioterapia , Meningioma/cirugía , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirugía , Radiocirugia/efectos adversos , Aprendizaje Automático , Edema/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: To introduce a new and simple classification and management of coronary artery involvement in aortic dissection and report results. METHODS: Coronary artery involvement was classified into two types according to the integrity of coronary intima: simple lesion (type S) and complex lesion (type C). Complex lesions were treated by CABG and simple lesions were treated by ostial repair or reimplantation. Data were collected and analyzed retrospectively. RESULTS: From January 2010 to December 2019, 267 consecutive patients were enrolled in the study, and among them complex lesions occurred in 27 patients (11.1%) and simple lesions was found in 240 patients(89.9%). Eleven untreated vessels with simple lesion were found to be involved again in the same operation and treated by CABG. The two type groups had comparable operative mortality (type S vs. type C, 9.6% vs. 18.5%, P = 0.28). 221 patients received follow-up with a median duration of 52 months. The overall survival rates at 1, 5, and 10 years postoperatively were 88.9%, 85.7%, and 79.8% in type S group and 79.2%, 79.2%, and 79.2% in type C group, respectively (P = 0.47). For the patients who received CABG and survived at discharge, radiographic follow-up with a median duration of 28 (IQR 7-55.5) months showed the freedom from occlusion of vein graft at 1, 5, and 10 years postoperatively were 87.5%, 70.0%, 28.0%. CONCLUSIONS: According to the new classification, two types of lesions could be treated by corresponding methods with satisfactory early and long-term results. Unrepaired coronary artery was at a risk of re-involvement. Vein graft onto arteries without atherosclerosis still had a high occlusion rate.
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Disección Aórtica , Vasos Coronarios , Humanos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Puente de Arteria Coronaria , Estudios Retrospectivos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Resultado del TratamientoRESUMEN
The aim of this study was to improve the immobilization capacity of a binder prepared from As-containing biohydrometallurgy waste (BAW) on arsenic (As) by modifying it with halloysite nanotubes (HNTs) and biochar (BC). The study investigated the influence of HNTs and BC on the chemical fractions and leaching characteristics of As, as well as the influence on the compressive strength of BAW. The results indicated that the addition of HNTs and BC effectively decreased As leaching. The presence of 1.0 wt% HNTs decreased the As leaching concentration from 1.08 mg/L to 0.15 mg/L, with the corresponding immobilization rate reaching about 90.9 %. A high amount of BC seemed to show better performance in improving the As immobilization capacity of BAW. However, a strongly reduced early compressive strength of BAW was observed, making it unsuitable to be used as an additive in this situation. The effects of HNTs on the increase of As immobilization capacity of BAW were attributed to two aspects. Firstly, As species were adsorbed onto the surface of HNTs via H-bonds, which was verified via density functional theory calculation. Secondly, the addition of HNTs decreased the pore volume of BAW, leading to a more compact structure, and hence increasing the physical encapsulation capacity for As. ENVIRONMENTAL IMPLICATION: The rational disposal of arsenic-containing biohydrometallurgy waste has always been a top priority for the green and low-carbon development of the metallurgical industry. In this article, we have taken the perspective of large-scale resource utilization of solid waste and pollution control, and developed arsenic-containing biohydrometallurgy waste into a cementitious material, and enhancing arsenic immobilization capacity with the addition of HNTs and BC. This study provides an effective method for the rational disposal of arsenic-containing biohydrometallurgy waste.
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Experiences in natural environments can enhance human wellbeing and promote the recovery of physiological and psychological health. During the COVID-19 pandemic, university students' activity off-campus was limited, thus, the campus environment was particularly important for the recovery of students' physiological and psychological health. Although the benefits of sustained natural exposure are obvious for people's physiological and psychological health, the effects of brief exposure on physiological and psychological are unclear. In the present study, four types of campus environments, including square space, dense forest space, sparse forest space, and waterfront space, were selected to explore the transient recovery effects of different types of campus environments. Sixty university students were recruited, measuring their systolic blood pressure, diastolic blood pressure, and heart rate as physical parameters to assess stress recovery. Respondents also reported scores about their personal feelings in questionnaires to evaluate their psychological states. Both physiological and psychological indicators responded to the brief natural exposure (5 min), and physiological and psychological health was restored. However, only the recovery amounts of psychological indicators were significantly different in waterfront space, dense forest space, and sparse forest space. These results indicate that being compare with other spaces, the brief exposure in the waterfront space was the most beneficial to students' psychological health recovery. This recovery was attributed to the great role played by the sense of escape, but after the brief exposure, the attraction and compatibility of the environment would hinder the psychological health recovery. In conclusion, according to tests on both physiological and psychological aspects, the waterfront environment on campus is the best choice for students' transient health recovery.
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COVID-19 , Pandemias , Humanos , COVID-19/epidemiología , Estudiantes/psicología , Emociones , Salud MentalRESUMEN
RATIONALE: Rhabdomyosarcoma (RMS) is a rare sarcoma that rarely occurs in adults and accounts for only 1% of all adult tumors. The standard treatment for RMS is surgical resection, radiotherapy, and chemotherapy. PATIENT CONCERNS: Adult patients often present with an aggressive course and poor prognosis. DIAGNOSES: The patient was diagnosed with RMS in September 2019 and was confirmed by hematoxylin-eosin staining and immunohistochemistry after surgical resection. INTERVENTIONS: The patient received surgical resection in September 2019. He was admitted to another hospital after the first recurrence in November 2019. After the second routine surgical resection, the patient underwent chemotherapy, radiotherapy, and anlotinib maintenance treatment. He relapsed again in October 2020 and was admitted to our hospital. Next-generation sequencing was performed on the punctured tissue of the patient's lung metastatic lesion, and high tumor mutational burden (TMB-H), high microsatellite instability (MSI-H), and positive programmed death-ligand 1 (PD-L1) were observed. The patient then received toripalimab and anlotinib combined therapy and was evaluated for a partial response after 2 months. OUTCOMES: This benefit has persisted for more than 17 months. LESSONS: This is the longest progression-free survival for PD-1 inhibitors in RMS, and there is a trend of continued extension of progression-free survival in this patient. This case supports the hypothesis that positive PD-L1, TMB-H, and MSI-H could be beneficial biomarkers for immunotherapy in adult RMS.
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Antígeno B7-H1 , Rabdomiosarcoma , Masculino , Humanos , Adulto , Secuenciación de Nucleótidos de Alto Rendimiento , Mutación , Rabdomiosarcoma/genética , Rabdomiosarcoma/terapia , Inestabilidad de Microsatélites , Inmunoterapia , Biomarcadores de Tumor/genéticaRESUMEN
OBJECTIVES: To evaluate the impact of antiplatelet therapy on the long-term descending thoracic aorta (DTA) fate and prognosis of extensive repaired type A aortic dissection (TAAD). METHODS: 1147 eligible TAAD patients from January 2010 to December 2019 were stratified into non-antiplatelet (n = 754) and antiplatelet groups (n = 393). The primary end points were overall survival, and DTA remodelling, including false lumen (FL) thrombosis and aortic redilation. The secondary end points were DTA reintervention or rupture and major bleeding events (MBEs). RESULTS: The 5-year overall survival rates were 95.6% and 94.3% in the non-antiplatelet and antiplatelet groups (P = 0.53), respectively. In the stent covering segment, the 1-year FL complete thrombosis rates were 92.1% and 92.4% in the non-antiplatelet and antiplatelet groups (P = 0.27), respectively, while in the stent uncovering segment, the 5-year FL complete thrombosis rates were 47.1% and 56.5% in the non-antiplatelet and antiplatelet groups (P = 0.12), respectively. Antiplatelet therapy was not an independent predictor of aortic redilation at the pulmonary artery bifurcation (ß±SE = -0.128 ± 0.203, P = 0.53), diaphragm (ß±SE = 0.143 ± 0.152, P = 0.35) or coeliac artery (ß±SE = 0.049 ± 0.136, P = 0.72) levels. With death as a competing risk, the cumulative incidences of DTA reintervention or rupture at 5 years were 4.6% and 4.0% in the non-antiplatelet and antiplatelet groups (sHR = 0.85, 95% CI, 0.49â¼1.19; P = 0.58), respectively, and the 5-year cumulative incidences of MBEs were 2.1% and 2.3% in the non-antiplatelet and antiplatelet groups (sHR = 0.82, 95% CI, 0.56â¼2.67; P = 0.62), respectively. CONCLUSIONS: Antiplatelet therapy did not impact long-term DTA FL thrombosis, redilation, reintervention or rupture, MBEs or overall survival on extensive repaired TAAD. Thus, antiplatelet therapy can be administered as indicated on extensive repaired TAAD.