Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress ...to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.
From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.
Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.
LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
To report the efficacy and safety of postoperative adjuvant hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and oxaliplatin (FOLFOX) in hepatocellular carcinoma (HCC) patients with ...microvascular invasion (MVI).
In this randomized, open-label, multicenter trial, histologically confirmed HCC patients with MVI were randomly assigned (1:1) to receive adjuvant FOLFOX-HAIC (treatment group) or routine follow-up (control group). The primary end point was disease-free survival (DFS) by intention-to-treat (ITT) analysis while secondary end points were overall survival, recurrence rate, and safety.
Between June 2016 and August 2021, a total of 315 patients (ITT population) at five centers were randomly assigned to the treatment group (n = 157) or the control group (n = 158). In the ITT population, the median DFS was 20.3 months (95% CI, 10.4 to 30.3) in the treatment group versus 10.0 months (95% CI, 6.8 to 13.2) in the control group (hazard ratio, 0.59; 95% CI, 0.43 to 0.81;
= .001). The overall survival rates at 1 year, 2 years, and 3 years were 93.8% (95% CI, 89.8 to 98.1), 86.4% (95% CI, 80.0 to 93.2), and 80.4% (95% CI, 71.9 to 89.9) for the treatment group and 92.0% (95% CI, 87.6 to 96.7), 86.0% (95% CI, 79.9 to 92.6), and 74.9% (95% CI, 65.5 to 85.7) for the control group (hazard ratio, 0.64; 95% CI, 0.36 to 1.14;
= .130), respectively. The recurrence rates were 40.1% (63/157) in the treatment group and 55.7% (88/158) in the control group. Majority of the adverse events were grade 0-1 (83.8%), with no treatment-related death in both groups.
Postoperative adjuvant HAIC with FOLFOX significantly improved the DFS benefits with acceptable toxicities in HCC patients with MVI.
Patients with severe chronic graft-versus-host disease (cGVHD) always experience debilitating tissue injury and have poorer quality of life and shorter survival time. The early stage of cGVHD is ...characterized by inflammation, which eventually leads to extensive tissue fibrosis in various organs, such as skin and lung, eventually inducing scleroderma-like changes and bronchiolitis obliterans syndrome. Here we review the functions of serum/glucocorticoid regulated kinase 1 (SGK1), a hub molecule in multiple signal transduction pathways and cell phosphorylation cascades, which has important roles in cell proliferation and ion channel regulation, and its relevance in cGVHD. SGK1 phosphorylates the ubiquitin ligase, NEDD4, and induces Th cells to differentiate into Th17 and Th2 phenotypes, hinders Treg development, and promotes inflammatory fibrosis. Phosphorylation of NEDD4 by SGK1 also leads to up-regulation of the transcription factor SMAD2/3, thereby amplifying the fibrosis-promoting effect of TGF-β. SGK1 also up-regulates the inflammatory transcription factor, nuclear factor-κB (NF-κB), which in turn stimulates the expression of multiple inflammatory mediators, including connective tissue growth factor. Overexpression of SGK1 has been observed in various fibrotic diseases, including pulmonary fibrosis, diabetic renal fibrosis, liver cirrhosis, hypertensive cardiac fibrosis, peritoneal fibrosis, and Crohn's disease. In addition, SGK1 inhibitors can attenuate, or even reverse, the effect of fibrosis, and may be used to treat inflammatory conditions and/or fibrotic diseases, such as cGVHD, in the future.
Background & Aims
The lymphocyte‐C‐reactive protein ratio (LCR) is a novel inflammatory‐based score, based solely on the lymphocyte and C‐reactive protein. We aimed to clarify the prognostic value of ...the LCR score in intrahepatic cholangiocarcinoma (ICC) patients after resection.
Methods
We compared the prognostic accuracy of the LCR score with other inflammatory‐based scores in this large, multicentre cohort study. The independent variables associated with overall survival (OS) were explored in both the primary (n = 228) and validation cohorts (n = 135). Harrell's concordance index (C‐index) was used to compare the predictive ability of all the assessed inflammatory‐based scores.
Results
The LCR score was differentiated two groups of ICC patients with distinct prognoses (1‐, 3‐, and 5‐year OS rates: 94.4%, 66.3%, and 59.3%; and 66.6%, 45.6%, and 32.7%, respectively) (P < .001). Multivariate analysis showed that the LCR score, as well as the TNM stage and preoperative CA19‐9 level, were independently associated with OS. The predictive accuracy of the LCR score (c score: 0.634) was superior to that of the other inflammatory‐based scores (c scores: 0.508‐0.615). These findings were supported by the external validation cohort.
Conclusion
The LCR score is stable and consistently the best prognostic score and may offer as a simple, objective and discriminatory method in facilitating the risk stratification of ICC patients.
A high-speed optical phase modulator based on graphene-silicon waveguide (GSW) is presented. Two graphene flakes, sandwiched by insulating dielectric spacers, are embedded in a silicon waveguide to ...enhance the interaction between the graphene and light. By applying a bias on the graphene flakes, the refractive index variation of TE mode in the waveguide shows a large quasi-linear dynamic range, which is ideal for achieving optical phase modulation. Based on this structure, a π phase shift can be achieved by a 75.6 μm-long GSW. Calculations show that the 3 dB modulation bandwidth of the optical phase modulator can be as high as 119.5 GHz with a low consumption of 0.452 pJ/bit.
Pressure-driven membranes-based desalination provides an effective and promising strategy to deal with the worldwide fresh water crisis. However, some drawbacks are still restricting their wider ...applications. Therefore, it still remains a great challenge to explore the novel technologies to develop new types of pressure-driven desalination membranes and to improve the properties of the present ones. Layer-by-layer (LBL) assembly technology, which can produce charged thin films on molecular levels by adsorbing oppositely charged polyelectrolytes and/or other nano-species via different interactions, provides a tunable and facile method to tailor separation membranes with desired properties. Moreover, LBL assembly has shown great potential for exploring multifunctional pressure-driven desalination membranes including reverse osmosis (RO) and forward osmosis (FO) membranes. This review aims to give a comprehensive discussion and comment on the state-of-the-art developments of LBL assembled technology applied on the pressure-driven desalination membranes, mainly focusing on RO and FO membranes. It is sincerely expected that this review can provide a scientific view and give some fundamental clues for acquiring new methodologies for the exploration of pressure-driven desalination membranes with preferable performances based on LBL assembly technology.
•Discussion of reverse osmosis (RO) and forward osmosis (FO) desalination membranes.•Layer-by-Layer assembly technology applied on RO and FO desalination membranes.•Perspective of LBL assembly technology on RO and FO desalination membranes.
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•Oil shale semi-coke was firstly utilized as the bulking agent during composting.•Utilization of semi-coke could reduce the nitrogen loss during composting.•Addition of the semi-coke ...was beneficial for the growing of AOA and AOB.•The PAHs in oil shale semi-coke could be removed effectively after composting.
Oil shale semi-coke is the solid waste produced from the retorting process of oil shale, which may cause pollution to the environment without reasonable disposing. In this study, semi-coke was used as the bulking agent during composting to accelerate biodegradation of the organics as well as decrease the nitrogen loss. Results showed that the addition of semi-coke could accelerate biodegradation of the organics, with a raise in the organic matter loss from 44.99 % to 47.05 % compared with the control. Furthermore, the nitrogen loss significantly decreased from 40.00%–14.70 % in the treatment added with semi-coke due to less emission of NH3 and much more transformation of NH4+-N to NO3−-N by nitrification, which could be explained by the increasing abundance of ammonia-oxidizing bacteria and archaea at the late composting stage and drastic shift of the microbial community like Chloroflexi, Firmicutes and Actinobacteria. After the composting cycle, the maturity of the produced compost was elevated greatly in the treatments amended with semi-coke. The result of PAHs detection suggested that there were low PAHs content in the raw oil shale semi-coke and they could be removed effectively to within the range for land application by composting especially when the surfactant was added.
Background and aims
The optimal treatment strategy for recurrent hepatocellular carcinoma (HCC) remains unclear. Therefore, we aimed to compare the outcomes of repeat hepatic resection (RHR) and ...radiofrequency ablation (RFA) for recurrent HCC.
Method
From December 2004 to December 2015, 138 patients who underwent RHR and 194 patients who underwent RFA were enrolled. Propensity score matching (PSM) was performed to establish 1:1 RHR‐RFA group matching. Clinical outcomes were compared before and after matching.
Results
Before matching, the 1‐, 3‐, and 5‐year postrecurrence survival (PRS) rates were 91.8%, 82.0%, and 72.9% for the RHR group (n = 138) and 94.4%, 75.4%, and 61.7% for the RFA group (n = 194), respectively (P = .380). After matching, the PRS rates at 1, 3, and 5 years were 90.5%, 81.5%, and 71.8% for the RHR group (n = 120) and 91.0%, 61.0%, and 41.7% for the RFA group (n = 120), respectively (P = .002). In the subgroup analysis, the PRS rates for the RHR group were better than those for the RFA group for patients who relapsed within 2 years (P = .004) or patients with primary tumor burden beyond the Milan criteria (P = .004). Multivariate analysis showed that treatment allocation was identified as an independent prognostic factor for PRS.
Conclusion
Compared with RFA, RHR provided a survival advantage for recurrent HCC, especially for patients who relapsed within 2 years and those with primary tumor burden beyond the Milan criteria.
Compared with RFA, repeat hepatic resection provided a survival advantage for recurrent HCC, especially for patients relapsed within 2 years and patients with primary tumor burden beyond Milan criteria.
With the growing population and rapid change in the social environment, nurses in China are suffering from high rates of stress; however, the neural mechanism underlying this occupation related ...stress is largely unknown. In this study, mental status was determined for 81 nurses and 61 controls using the Symptom Checklist 90 (SCL‐90) scale. A subgroup (n = 57) was further scanned by resting‐state functional MRI with two sessions. Based on the SCL‐90 scale, “somatic complaints” and “diet/sleeping” exhibited the most prominent difference between nurses and controls. This mental health change in nurses was further supported by the spatial independent component analysis on functional MRI data. First, dynamic functional connectome analysis identified two discrete connectivity configurations (States I and II). Controls had more time in the State I than II, while the nurses had more time in the State II than I. Second, nurses showed a similar static network topology as controls, but altered dynamic properties. Third, the symptom‐imaging correlation analysis suggested the functional alterations in nurses as potential imaging biomarkers indicating a high risk for “diet/sleeping” problems. In summary, this study emphasized the high risk of mental deficits in nurses and explored the underlying neural mechanism using dynamic brain connectome, which provided valuable information for future psychological intervention.
Nurses showed a high risk of mental problems in “somatic complaints” and “diet/sleeping.”
The proportion of different mental states was distinct between nurses and controls.
The dynamic brain features were correlated with “diet/sleeping” symptoms.
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•Functional characteristics and bacterial community went through drastic shifts.•Actinobacteria increased significantly when recycled ceramsite was added.•Metabolism of amino acid and ...carbohydrate were enhanced by recycled ceramsite.•Succession of bacteria was tightly related with the physicochemical properties.
This study aimed to investigate variations of bacterial community and functional characteristics during the continuous thermophilic composting (CTC). Also their differences were discussed when amended with ceramsite and recycled ceramsite as the porous bulking agent. Results showed that the bacterial community shifted greatly and bacterial diversity increased as the CTC proceeded. Firmicutes and Chloroflexi was one of the major phyla at the active and late phase respectively. While Actinobacteria was the dominant phyla during the whole CTC. With the addition of ceramsite and recycled ceramsite, no significant difference was found of the overall bacterial variation trends. But the major phyla of Chloroflexi and Actinobacteria and major genes related to amino acid metabolism and carbohydrate metabolism increased significantly, especially when the recycled ceramsite was added. Redundancy analysis indicated that the succession of bacterial community was tightly related with the pH, water soluble organic carbon, NH4+-N, organic matter and germination index.
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