Patients with lung cancer often experience reduced functional capacity and quality of life after surgery. The current study investigated the impact of a short-term, home-based, multimodal ...prehabilitation program on perioperative functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for nonsmall cell lung cancer (NSCLC).
A randomized controlled trial was conducted with 73 patients. Patients in the prehabilitation group (n = 37) received a 2-week multimodal intervention program before surgery, including aerobic and resistance exercises, respiratory training, nutrition counseling with whey protein supplementation, and psychological guidance. Patients in the control group (n = 36) received the usual clinical care. The assessors were blinded to the patient allocation. The primary outcome was perioperative functional capacity measured as the 6-minute walk distance (6MWD), which was assessed at 1 day before and 30 days after surgery. A linear mixed-effects model was built to analyze the perioperative 6MWD. Other outcomes included lung function, disability and psychometric evaluations, length of stay (LOS), short-term recovery quality, postoperative complications, and mortality.
The median duration of prehabilitation was 15 days. The average 6MWD was 60.9 m higher perioperatively in the prehabilitation group compared to the control group (95% confidence interval CI, 32.4-89.5; P < .001). There were no differences in lung function, disability and psychological assessment, LOS, short-term recovery quality, postoperative complications, and mortality, except for forced vital capacity (FVC; 0.35 L higher in the prehabilitation group, 95% CI, 0.05-0.66; P = .021).
A 2-week, home-based, multimodal prehabilitation program could produce clinically relevant improvements in perioperative functional capacity in patients undergoing VATS lobectomy for lung cancer.
Subretinal fibrosis resulting from neovascular age-related macular degeneration (nAMD) is one of the major causes of serious and irreversible vision loss worldwide, and no definite and effective ...treatment exists currently. Retinal pigmented epithelium (RPE) cells are crucial in maintaining the visual function of normal eyes and its epithelial-mesenchymal transition (EMT) is associated with the pathogenesis of subretinal fibrosis. Stem cell-derived exosomes have been reported to play a crucial role in tissue fibrosis by transferring their molecular contents. This study aimed to explore the effects of human umbilical cord-derived mesenchymal stem cell exosomes (hucMSC-Exo) on subretinal fibrosis in vivo and in vitro and to investigate the anti-fibrotic mechanism of action of hucMSC-Exo.
In this study, human umbilical cord-derived mesenchymal stem cells (hucMSCs) were successfully cultured and identified, and exosomes were isolated from the supernatant by ultracentrifugation. A laser-induced choroidal neovascularization (CNV) and subretinal fibrosis model indicated that the intravitreal administration of hucMSC-Exo effectively alleviated subretinal fibrosis in vivo. Furthermore, hucMSC-Exo could efficaciously suppress the migration of retinal pigmented epithelial (RPE) cells and promote the mesenchymal-epithelial transition by delivering miR-27b-3p. The latent binding of miR-27b-3p to homeobox protein Hox-C6 (HOXC6) was analyzed by bioinformatics prediction and luciferase reporter assays.
This study showed that the intravitreal injection of hucMSC-Exo effectively ameliorated laser-induced CNV and subretinal fibrosis via the suppression of epithelial-mesenchymal transition (EMT) process. In addition, hucMSC-Exo containing miR-27b repressed the EMT process in RPE cells induced by transforming growth factor-beta2 (TGF-β2) via inhibiting HOXC6 expression.
The present study showed that HucMSC-derived exosomal miR-27b could reverse the process of EMT induced by TGF-β2 via inhibiting HOXC6, indicating that the exosomal miR-27b/HOXC6 axis might play a vital role in ameliorating subretinal fibrosis. The present study proposed a promising therapeutic agent for treating ocular fibrotic diseases and provided insights into the mechanism of action of hucMSC-Exo on subretinal fibrosis.
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•Thirteen varieties of Z. bungeanum leaves were collected from a common garden.•Thirteen varieties were divided into four groups and two discriminant functions were ...constructed.•Quality was evaluated based on flavonoids profiles, bioactivity and HPLC fingerprint.•You Huajiao from Group 4 exhibited the best quality followed by Group 1, Group 2 and Group 3 in turn.
Zanthoxylum bungeanum leaves (ZBL) have rich flavonoids with a variety of bioactivities, which has great values of development and utilization. In this paper, the quality of thirteen varieties of ZBL collected from a common garden was evaluated based on flavonoids compositions, bioactivity and reversed-phase high performance liquid chromatography (RP-HPLC) fingerprint coupled with chemometrics analysis. The values revealed that You Huajiao (S13) exhibited the highest contents of flavonoids compounds and strongest bioactivity, followed by Hancheng Dangcun stingless (S1). Among different varieties HPLC-fingerprint, eight common characteristic peaks were selected and the similarity lay within the range of 0.502-0.999. Meanwhile, thirteen varieties were divided into four groups (G1-G4) and two discriminant functions with the discriminant rate of 100% were constructed. Additionally, quercitrin and afzelin were found to be key compounds of quality evaluation. In conclusion, G4 (You Huajiao, S13) was selected as the best variety, followed by G1 (S1, S3, S5, S6, S7, S10, S12) and G2 (S4, S8, S9, S11), respectively, and G3 (Fugu late-maturing, S2) was at the last level. Consequently, this study screened for fine varieties of ZBL and provided a basis for the development and utilization of high-quality resources of Z. bungeanum.
This paper addresses the problem of parameter estimation for the microbial continuous fermentation of glycerol to 1,3-propanediol. A nonlinear dynamical system is first presented to describe the ...microbial continuous fermentation. Some mathematical properties of the dynamical system in the microbial continuous fermentation are also presented. A parameter estimation model is proposed to estimate the parameters of the dynamical system. The proposed estimation model is a large-scale, nonlinear, and nonconvex optimization problem if the number of experimental groups is large. A sequential geometric programming (SGP) method is proposed to efficiently solve the parameter estimation problem. The results indicated that our proposed SGP method can yield smaller errors between the experimental and calculated steady-state concentrations than the existing seven methods. For the five error indices considered, that is, the concentration errors of biomass, glycerol, 1,3-propanediol, acetic acid, and ethanol, the results obtained using the proposed SGP method are better than those obtained using the methods in the literature (Xiu et al., Gao et al., Sun et al., Sun et al., Li and Qu, Wang et al., and Zhang and Xu), with improvements of approximately 71.86–95.03%, 52.08–94.87%, 99.70–99.98%, 5.39–90.29%, and 12.67–80.83%, respectively. This concludes that the established dynamical system can better describe the microbial continuous fermentation. We also present that our established dynamical system has multiple positive steady states in some fermentation conditions. We observe that there are two regions of multiple positive steady states at relatively high values of substrate glycerol concentration in feed medium.
Polaron is a composite quasiparticle derived from an excess carrier trapped by local lattice distortion, and it has been studied extensively for decades both theoretically and experimentally. ...However, atomic-scale creation and manipulation of single-polarons in real space have still not been achieved so far, which precludes the atomistic understanding of the properties of polarons as well as their applications. Herein, using scanning tunneling microscopy, we succeeded to create single polarons in a monolayer two-dimensional (2D) semiconductor, CoCl
. Combined with first-principles calculations, two stable polaron configurations, centered at atop and hollow sites, respectively, have been revealed. Remarkably, a series of manipulation progresses - from creation, erasure, to transition - can be accurately implemented on individual polarons. Our results pave the way to understand the physics of polaron at atomic level, and the easy control of single polarons in 2D semiconductor may open the door to 2D polaronics including the data storage.
Purpose
The differentiation of the ameloblastoma and odontogenic keratocyst directly affects the formulation of surgical plans, while the results of differential diagnosis by imaging alone are not ...satisfactory. This paper aimed to propose an algorithm based on convolutional neural networks (CNN) structure to significantly improve the classification accuracy of these two tumors.
Methods
A total of 420 digital panoramic radiographs provided by 401 patients were acquired from the Shanghai Ninth People’s Hospital. Each of them was cropped to a patch as a region of interest by radiologists. Furthermore, inverse logarithm transformation and histogram equalization were employed to increase the contrast of the region of interest (ROI). To alleviate overfitting, random rotation and flip transform as data augmentation algorithms were adopted to the training dataset. We provided a CNN structure based on a transfer learning algorithm, which consists of two branches in parallel. The output of the network is a two-dimensional vector representing the predicted scores of ameloblastoma and odontogenic keratocyst, respectively.
Results
The proposed network achieved an accuracy of 90.36% (AUC = 0.946), while sensitivity and specificity were 92.88% and 87.80%, respectively. Two other networks named VGG-19 and ResNet-50 and a network trained from scratch were also used in the experiment, which achieved accuracy of 80.72%, 78.31%, and 69.88%, respectively.
Conclusions
We proposed an algorithm that significantly improves the differential diagnosis accuracy of ameloblastoma and odontogenic keratocyst and has the utility to provide a reliable recommendation to the oral maxillofacial specialists before surgery.
Purpose
Thyroid-associated ophthalmopathy (TAO) might lead to blindness and orbital deformity. The early diagnosis and treatment are conducive to control disease progression, but currently, there is ...no effective screening method. The present study aimed to introduce an artificial intelligence (AI) model for screening and testing the model with TAO patients under clinical conditions.
Methods
A total of 1435 computed tomography (CT) scans were obtained from the hospital. These CT scans were preprocessed by resampling and extracting the region of interest. CT from 193 TAO patients and 715 healthy individuals were adopted for three-dimensional (3D)-ResNet model training, and 49 TAO patients and 178 healthy people were adopted for external verification. Data from 150 TAO patients and 150 healthy people were utilized for application tests under clinical conditions, including non-inferiority experiments and diagnostic tests, respectively.
Results
In the external verification of the model, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.919, indicating a satisfactory classification effect. The accuracy, sensitivity, and specificity were 0.87, 088, and 0.85, respectively. In non-inferiority experiments: the accuracy was 85.67% in the AI group and 84.33% in the resident group. The model passed both non-inferiority experiments (
p
= 0.001) and diagnostic test (the AI group sensitivity = 0.87 and specificity = 0.84%).
Conclusions
A promising orbital CT-based TAO screening AI model was established and passed application tests under clinical conditions. This may provide a new TAO screening tool with further validation.
Numerous natural and human-made systems exhibit critical transitions whereby slow changes in environmental conditions spark abrupt shifts to a qualitatively distinct state. These shifts very often ...entail severe consequences; therefore, it is imperative to devise robust and informative approaches for anticipating the onset of critical transitions. Real-world complex systems can comprise hundreds or thousands of interacting entities, and implementing prevention or management strategies for critical transitions requires knowledge of the exact condition in which they will manifest. However, most research so far has focused on low-dimensional systems and small networks containing fewer than ten nodes or has not provided an estimate of the location where the transition will occur. We address these weaknesses by developing a deep-learning framework which can predict the specific location where critical transitions happen in networked systems with size up to hundreds of nodes. These predictions do not rely on the network topology, the edge weights, or the knowledge of system dynamics. We validate the effectiveness of our machine-learning-based framework by considering a diverse selection of systems representing both smooth (second-order) and explosive (first-order) transitions: the synchronization transition in coupled Kuramoto oscillators; the sharp decline in the resource biomass present in an ecosystem; and the abrupt collapse of a Wilson-Cowan neuronal system. We show that our method provides accurate predictions for the onset of critical transitions well in advance of their occurrences, is robust to noise and transient data, and relies only on observations of a small fraction of nodes. Finally, we demonstrate the applicability of our approach to real-world systems by considering empirical vegetated ecosystems in Africa. Published by the American Physical Society 2024
Multiferroic materials offer a promising avenue for manipulating digital information by leveraging the cross-coupling between ferroelectric and ferromagnetic orders. Despite the ferroelectricity has ...been uncovered by ion displacement or interlayer-sliding, one-unit-cell of multiferroic materials design and wafer-scale synthesis have yet to be realized. Here we develope an interface modulated strategy to grow 1-inch one-unit-cell of non-layered chromium sulfide with unidirectional orientation on industry-compatible c-plane sapphire. The interfacial interaction between chromium sulfide and substrate induces the intralayer-sliding of self-intercalated chromium atoms and breaks the space reversal symmetry. As a result, robust room-temperature ferroelectricity (retaining more than one month) emerges in one-unit-cell of chromium sulfide with ultrahigh remanent polarization. Besides, long-range ferromagnetic order is discovered with the Curie temperature approaching 200 K, almost two times higher than that of bulk counterpart. In parallel, the magnetoelectric coupling is certified and which makes 1-inch one-unit-cell of chromium sulfide the largest and thinnest multiferroics.
Prehabilitation has been shown to have a positive effect on the postoperative recovery of functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. The optimal ...way to implement prehabilitation programs, such as the optimal forms of prehabilitation, duration, intensity, and methods to improve compliance, remained to be studied. This Prehabilitation for Thoracic Surgery Study will compare the effectiveness of multimodal and aerobic training-only programs in patients undergoing thoracoscopic lobectomy.
This randomized pragmatic trial will be conducted in Peking Union Medical College Hospital (PUMCH) and include 100 patients who are eligible to undergo VATS lobectomy. Patients will be randomized to a multimodal or aerobic training group. Prehabilitation training guidance will be provided by a multidisciplinary care team. The patients in the multimodal group will perform aerobic exercises, resistance exercises, breathing exercises, psychological improvement strategies, and nutritional supplementation. Meanwhile, the patients in the aerobic group will conduct only aerobic exercises. The interventions will be home-based and supervised by medical providers. The patients will be followed up until 30 days after surgery to investigate whether the multimodal prehabilitation program differs from the aerobic training program in terms of the magnitude of improvement in functional capability pre- to postoperatively. The primary outcome will be the perioperative 6-min walk distance (6MWD). The secondary outcomes will include the postoperative pulmonary functional recovery status, health-related quality of life score, incidence of postoperative complications, and clinical outcomes.
Prehabilitation remains a relatively new approach that is not widely performed by thoracic surgery patients. The existing studies mainly focus on unimodal interventions. While multimodal prehabilitation strategies have been shown to be preferable to unimodal strategies in a few studies, the evidence remains scarce for thoracic surgery patients. The results of this study will contribute to the understanding of methods for thoracoscopic lobectomy patients.
ClinicalTrials.gov NCT04049942 . Registered on August 8, 2019.
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