Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

BACKGROUND: The effect of air pollution on annual change rates in grip strength and body composition in the elderly is unknown. OBJECTIVES: This study evaluated the effects of long-term exposure to ambient air pollution on change rates of grip strength and body composition in the elderly. METHODS: In the period 2016-2020, grip strength and body composition were assessed and measured 1-2 times per year in 395 elderly participants living in the Taipei basin. Exposure to ambient fine particulate matters (PM_2.5), nitric dioxide (NO₂), and ozone (O₃) from 2015 to 2019 was estimated using a hybrid Kriging/Land-use regression model. In addition, long-term exposure to carbon monoxide (CO) was estimated using an ordinary Kriging approach. Associations between air pollution exposures and annual changes in health outcomes were analyzed using linear mixed-effects models. RESULTS: An inter-quartile range (4.1 µg/m³) increase in long-term exposure to PM_2.5 was associated with a faster decline rate in grip strength (-0.16 kg per year) and skeletal muscle mass (-0.14 kg per year), but an increase in body fat mass (0.21 kg per year). The effect of PM_2.5 remained robust after adjustment for NO₂, O₃ and CO exposure. In subgroup analysis, the PM_2.5-related decline rate in grip strength was greater in participants with older age (>70 years) or higher protein intake, whereas in skeletal muscle mass, the decline rate was more pronounced in participants having a lower frequency of moderate or strenuous exercise. The PM_2.5-related increase rate in body fat mass was higher in participants having a lower frequency of strenuous exercise or soybean intake. CONCLUSIONS Among the elderly, long-term exposure to ambient PM_2.5 is associated with a faster decline in grip strength and skeletal muscle mass, and an increase in body fat mass. Susceptibility to PM_2.5 may be influenced by age, physical activity, and dietary protein intake; however, these modifying effects vary across different health outcomes, and further research is needed to clarify their mechanisms and consistency.
Humans ; Hand Strength ; Aged ; Male ; Female ; Environmental Exposure/adverse effects* ; Follow-Up Studies ; Taiwan ; Air Pollution/adverse effects* ; Particulate Matter/adverse effects* ; Muscle, Skeletal/drug effects* ; Air Pollutants/adverse effects* ; Ozone/adverse effects* ; Aged, 80 and over ; Adipose Tissue/drug effects* ; Body Composition/drug effects* ; Nitrogen Dioxide/adverse effects*

Fusarium head blight (FHB), caused by Fusarium graminearum, not only leads to severe yield losses but also poses a threat to food safety due to the mycotoxins produced by the pathogen. Since this disease is preventable but not curable, the current control mainly relies on chemical fungicides, the long-term use of which may lead to pathogen resistance and environmental pollution. To develop green control methods, we screened 13 biocontrol strains from the rhizosphere soil of wheat, among which strain No. 12 (identified as Pythium aphanidermatum) showed significant antifungal effects. In the plate confrontation test, this strain reduced the colony diameter of the pathogen by 69.2% (1.47 mm vs. 4.78 mm in the control group), with an inhibition rate of 77% (P < 0.01). Microscopic observation revealed obvious deformations in the pathogen hyphae, suggesting a lysing effect. The coleoptile experiment further confirmed that the pre-treatment with this strain reduced the incidence rate to 0. These findings provide new candidate strains for the biocontrol of FHB and offer a scientific basis for reducing the use of chemical fungicides and promoting sustainable agricultural development.
Triticum/growth & development* ; Fusarium/growth & development* ; Plant Diseases/prevention & control* ; Soil Microbiology ; Pest Control, Biological/methods* ; Pythium/physiology* ; Biological Control Agents ; Rhizosphere ; Fungicides, Industrial

BACKGROUND:Recent studies have shown that the Notch signaling pathway plays a varying role in osteoporosis,and in-depth research in this field is of great significance to the prevention and treatment of osteoporosis.Traditional Chinese medicine has become the focus of research in today's society due to its obvious multi-faceted,multi-level benefits in alleviating osteoporosis with less adverse effects. OBJECTIVE:To analyze and summarize domestic and international literature to further understand the connection between the Notch signaling pathway and osteoporosis and to elucidate the mechanism by which traditional Chinese medicine prevents and treats osteoporosis via the Notch signaling pathway. METHODS:CNKI,WanFang,and VIP were searched with the keywords of"Notch,osteoporosis,osteoblasts,osteoclasts,bone marrow mesenchymal stem cells,signaling pathway,traditional Chinese medicine,pill,experiment"in Chinese.PubMed,Nature,and Embase were retrieved using the keywords of"Notch,osteoporosis,osteoblasts,osteoclasts,mesenchymal stem cells,signal pathway,traditional Chinese medicine,pill,experiment"in English.The search time was from database inception to October 2022. RESULTS AND CONCLUSION:The Notch signaling pathway plays a role in the development and progression of osteoporosis to varying degrees by regulating the differentiation and proliferation of mesenchymal stem cells,osteoblasts and osteoclasts.The Notch signaling pathway regulates the proliferation and differentiation of mesenchymal stem cells,osteoblasts and osteoclasts by directly or indirectly regulating key cytokines such as Notch1,Jagged1,Hes,Hey,macrophage colony-stimulating factor and nuclear factor-κB receptor-activating factor ligand,which in turn promotes or inhibits bone formation and ultimately has a certain effect on the prevention and treatment of osteoporosis.The active ingredients of Chinese herbs are mostly extracted from herbs for kidney tonifying,such as Epimedium,Cortex Eucommiae,Malaytea Scurfpea Fruit,Eleutherococcus Senticosus,Ligustrum Lucidum.Moreover,herbal compounds and preparations have the effect of tonifying kidney and strengthening bone,which provides more herbal options and directions for the subsequent study of Notch signaling pathway toward the prevention and treatment of osteoporosis.Current studies on traditional Chinese medicine mainly focus on active ingredients and single herbal extracts,with relatively few clinical trials on Chinese herbal compounds and preparations.Fewer studies have been conducted on the regulation of Notch signaling pathways by acupuncture,manipulation,and integrated Chinese and Western medicine to prevent and treat osteoporosis.Therefore,there is a need to explore the mechanisms by which traditional Chinese medicine technology-based therapies and integrated Chinese and Western medicine regulate the Notch signaling pathway to treat osteoporosis.

Para-aortic lymph node metastasis from colorectal cancer is relatively rare. Recent studies have shown that curative para-aortic lymph node dissection can lead to similar prognoses as stage III colorectal cancer for selected patients. However, there are still many unresolved debates regarding the appropriate surgical indications, extent of lymph node dissection, and treatment principles for colorectal cancer patients with para-aortic lymph node metastasis. With the continuous improvement of laparoscopic colorectal surgery techniques, the previously complex and high-risk procedure of para-aortic lymph node dissection has now become a safe and feasible approach. However, there are still several challenges that need to be addressed in this field. It is imperative to conduct multicenter clinical studies to demonstrate the survival benefits of this surgical procedure into greater survival benefits. This will help generate more robust evidence in the field of evidence-based medicine.

Objective:To investigate the pattern of distribution of the circumferential fascia of the rectum and elucidate its clinical implications.Methods:In this descriptive study, we examined the gross anatomy of four male hemipelvic cadaveric specimens from the Department of Anatomy at Fujian Medical University and the histological features of 16 fresh postoperative specimens from patients who had undergone total mesorectal excision for rectal cancer at the Department of Colorectal Surgery, Union Hospital, Fujian Medical University, between January and December 2022. The resultant combination of gross anatomical and histological features was employed to assess the following areas: (1)the morphology of the anterior mesorectum and fascia at the peritoneal reflection; (2)the caudal attachment point of Denonvilliers' fascia; (3) the fusion area of the pelvic plexus and the pre-hypogastric fascia; (4)the lateral and posterior attachment edges of the rectosacral fascia; and (5) selected histological features.Results:Our findings were as follows. (1) At the peritoneal reflection, the anterior mesorectum forms a triangular fat pad with a dense fascial structure. The base of this pad extends anteriorly across the most caudal point of the peritoneal reflection, with Denonvilliers' fascia originating from the anterior side of the triangle, near the bladder side of the peritoneum craniad to the peritoneal reflection. (2) The caudal attachment of Denonvilliers' fascia is at the angle between the seminal vesicles, the ampulla of the vas deferens, and the prostate. It adheres tightly to the prostatic capsule and vascular bundles pass through its cephalic side. (3) The pre-hypogastric fascia transitions laterally to merge with Denonvilliers' fascia; its middle part being inseparable from the main body of the pelvic plexus, which gives rise to the nerves that innervate the rectum. (4) The rectosacral fascia is formed by fusion of the fascia propria with the pre-hypogastric fascia. The resultant fused fascia bifurcates into two leaves on the right side; the outer leaf being the pre-hypogastric fascia and the inner leaf the fascia propria. (5) Histologically, the peritoneal reflection zone shows cuboidal epithelium of the peritoneum at its lowest point with no detectable origin of Denonvilliers' fascia. The anterior side of the peritoneal reflection, from which Denonvilliers' fascia originates, has a dense double-layered fascial structure comprising thick collagen fiber (16/16). The fascia propria exhibits a thinner and looser collagen fiber structure and its origin varies between individuals, 13/16 originating together with Denonvilliers' fascia from the craniad side of the peritoneal reflection, and 3/16 originating separately from the most caudal point of the peritoneal reflection. The caudal edge of Denonvilliers' fascia has a double-layered fascial structure with multiple S100-stained areas. The posterior edge of the rectosacral fascia has a fused fascial structure, thick nerve fibers being clearly observable between collagen fibers originating from the pre-hypogastric fascia under high magnification. The lateral edge of the rectosacral fascia extends interiorly, maintains the integrity of the fascia propria.Conclusions:In this study, we investigated the pattern of distribution of the circumferential fascia of the rectum by cadaveric dissection and histological examination of postoperative specimens. We found that the anterior mesorectum forms a triangular fat pad that can serve as a reference for dissection anterior to Denonvilliers' fascia, by making incisions 1 cm above the peritoneal reflection. The region of fusion of Denonvilliers' fascia with the prostatic capsule on the caudal side is rich in neurovascular bundles, contradicting the traditional view of a retroprostatic plane. This finding supports the practice of cutting Denonvilliers' fascia 0.5 cm above the base of the seminal vesicles. The fusion of the fascia propria with the pre-hypogastric fascia posteriorly forms the rectosacral fascia, which bifurcates into two leaves on both sides of the rectum, the inner leaf being the fascia propria and the outer leaf the pre-hypogastric fascia. These transition anteriorly to become Denonvilliers' fascia and fuse densely with the main body of the pelvic plexus on both sides. These findings provide a theoretical foundation for protecting the pelvic plexus and hypogastric nerve by transecting Denonvilliers' fascia and then dissecting in a top-to-bottom direction (i.e., from anterior to caudal), ultimately leading to the transection of the pre-hypogastric fascia.

Para-aortic lymph node metastasis from colorectal cancer is relatively rare. Recent studies have shown that curative para-aortic lymph node dissection can lead to similar prognoses as stage III colorectal cancer for selected patients. However, there are still many unresolved debates regarding the appropriate surgical indications, extent of lymph node dissection, and treatment principles for colorectal cancer patients with para-aortic lymph node metastasis. With the continuous improvement of laparoscopic colorectal surgery techniques, the previously complex and high-risk procedure of para-aortic lymph node dissection has now become a safe and feasible approach. However, there are still several challenges that need to be addressed in this field. It is imperative to conduct multicenter clinical studies to demonstrate the survival benefits of this surgical procedure into greater survival benefits. This will help generate more robust evidence in the field of evidence-based medicine.

Objective:To investigate the pattern of distribution of the circumferential fascia of the rectum and elucidate its clinical implications.Methods:In this descriptive study, we examined the gross anatomy of four male hemipelvic cadaveric specimens from the Department of Anatomy at Fujian Medical University and the histological features of 16 fresh postoperative specimens from patients who had undergone total mesorectal excision for rectal cancer at the Department of Colorectal Surgery, Union Hospital, Fujian Medical University, between January and December 2022. The resultant combination of gross anatomical and histological features was employed to assess the following areas: (1)the morphology of the anterior mesorectum and fascia at the peritoneal reflection; (2)the caudal attachment point of Denonvilliers' fascia; (3) the fusion area of the pelvic plexus and the pre-hypogastric fascia; (4)the lateral and posterior attachment edges of the rectosacral fascia; and (5) selected histological features.Results:Our findings were as follows. (1) At the peritoneal reflection, the anterior mesorectum forms a triangular fat pad with a dense fascial structure. The base of this pad extends anteriorly across the most caudal point of the peritoneal reflection, with Denonvilliers' fascia originating from the anterior side of the triangle, near the bladder side of the peritoneum craniad to the peritoneal reflection. (2) The caudal attachment of Denonvilliers' fascia is at the angle between the seminal vesicles, the ampulla of the vas deferens, and the prostate. It adheres tightly to the prostatic capsule and vascular bundles pass through its cephalic side. (3) The pre-hypogastric fascia transitions laterally to merge with Denonvilliers' fascia; its middle part being inseparable from the main body of the pelvic plexus, which gives rise to the nerves that innervate the rectum. (4) The rectosacral fascia is formed by fusion of the fascia propria with the pre-hypogastric fascia. The resultant fused fascia bifurcates into two leaves on the right side; the outer leaf being the pre-hypogastric fascia and the inner leaf the fascia propria. (5) Histologically, the peritoneal reflection zone shows cuboidal epithelium of the peritoneum at its lowest point with no detectable origin of Denonvilliers' fascia. The anterior side of the peritoneal reflection, from which Denonvilliers' fascia originates, has a dense double-layered fascial structure comprising thick collagen fiber (16/16). The fascia propria exhibits a thinner and looser collagen fiber structure and its origin varies between individuals, 13/16 originating together with Denonvilliers' fascia from the craniad side of the peritoneal reflection, and 3/16 originating separately from the most caudal point of the peritoneal reflection. The caudal edge of Denonvilliers' fascia has a double-layered fascial structure with multiple S100-stained areas. The posterior edge of the rectosacral fascia has a fused fascial structure, thick nerve fibers being clearly observable between collagen fibers originating from the pre-hypogastric fascia under high magnification. The lateral edge of the rectosacral fascia extends interiorly, maintains the integrity of the fascia propria.Conclusions:In this study, we investigated the pattern of distribution of the circumferential fascia of the rectum by cadaveric dissection and histological examination of postoperative specimens. We found that the anterior mesorectum forms a triangular fat pad that can serve as a reference for dissection anterior to Denonvilliers' fascia, by making incisions 1 cm above the peritoneal reflection. The region of fusion of Denonvilliers' fascia with the prostatic capsule on the caudal side is rich in neurovascular bundles, contradicting the traditional view of a retroprostatic plane. This finding supports the practice of cutting Denonvilliers' fascia 0.5 cm above the base of the seminal vesicles. The fusion of the fascia propria with the pre-hypogastric fascia posteriorly forms the rectosacral fascia, which bifurcates into two leaves on both sides of the rectum, the inner leaf being the fascia propria and the outer leaf the pre-hypogastric fascia. These transition anteriorly to become Denonvilliers' fascia and fuse densely with the main body of the pelvic plexus on both sides. These findings provide a theoretical foundation for protecting the pelvic plexus and hypogastric nerve by transecting Denonvilliers' fascia and then dissecting in a top-to-bottom direction (i.e., from anterior to caudal), ultimately leading to the transection of the pre-hypogastric fascia.

Objective To investigate the effect of serum soluble tumor necrosis factor receptor P55(sTNFR-P55)and metallothionein 1E(MT1E)on the clinical outcome of estrogen receptor(ER)positive breast cancer patients undergoing radical mastectomy.Methods The clinical data of 146 patients with ER positive breast cancer who were treated in our hospital from February 2017 to March 2018 were retrospectively analyzed.According to the clinical outcome of patients after surgery,they were divided into recurrent metastatic group and non-recurrent metastatic group.The clinical data,serum sTNFR-P55 and MT1E levels were compared between patients with recurrent metastatic group and non-recurrent metastatic group.Multivariate Logistic regression analysis was used to analyze the related factors influencing the clinical outcome of ER positive breast cancer patients undergoing radical mastectomy.The receiver operating characteristic curve(ROC)was made,and the area under the curve(AUC)was used to analyze the predictive value of serum sTNFR-P55,MT1E and their combination on the clinical outcome of ER positive breast cancer patients undergoing radical surgery.Results By the end of follow-up,32 of 146 patients with ER positive breast cancer had recurrence and metastasis.Tumor size and levels of tumor necrosis factor-α,carbohydrate antigen 125(CA125),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),carcinoembryonic antigen(CEA),tumor stage Ⅲ,serum sTNFR-P55 and MT1E in the recurrent metastatic group were higher than those in the non-recurrent metastatic group(P＜0.05).Multivariate Logistic analysis showed that CYFRA21-1(OR=2.768,95％CI 1.107-6.920),CEA(OR=2.751,95％CI 1.101-6.879),tumor stage Ⅲ(OR=3.611,95％CI 1.444-9.029),sTNFR-P55(OR=3.343,95％CI 1.337-8.361)and MT1 E(OR=3.267,95％CI 1.307-8.169)were all related factors affecting the clinical outcome of ER positive breast cancer patients undergoing radical surgery(P＜0.05).ROC curve analysis results showed that the sensitivity of serum sTNFR-P55,MT1E and their combination in predicting the clinical outcome of ER positive breast cancer patients undergoing radical surgery was 78.12％(95％CI 59.56-90.06),75.00％(95％CI 56.25-87.87)and 71.88％(95％CI 53.02-85.60),respectively.The specificity was 63.16％(95％CI 53.56-71.85),75.44％(95％CI 66.32-82.80)and 96.49％(95％CI 90.73-98.87),respectively.AUC was 0.723(95％CI0.642-0.793),0.760(95％CI0.682-0.827)and 0.880(95％CI0.816-0.928)respectively.Conclusion Serum sTNFR-P55 and MT1E are related to the clinical outcome of ER positive breast cancer patients undergoing radical mastectomy,and the combination of serum sTNFR-P55 and MT1E is more effective in predicting the clinical outcome of ER positive breast cancer patients undergoing radical mastectomy.

Objective To investigate the association between auditory processing and problem behaviors in preschool children,as well as the mediating role of executive function.Methods A total of 2 342 preschool children were selected from 7 kindergartens in Nanjing,China from June to August 2021.They were evaluated using Preschool Auditory Processing Assessment Scale,Conners Parent Symptom Questionnaire,and Behavior Rating Inventory of Executive Functioning-Preschool version.Children with different demographic features were compared in the scores and the abnormality rates of auditory processing,problem behaviors,and executive function.The influencing factors of the total scores of auditory processing,problem behaviors,and executive function were evaluated using multiple linear regression analysis.Whether executive function was a mediating factor between auditory processing and executive function was examined.Results Sex and grade were the main influencing factors for the total score of auditory processing(P<0.05),and sex,grade,parental education level,and family economic status were the main influencing factors for the total scores of problem behaviors and executive function(P<0.05).The auditory processing score(rs= 0.458,P<0.05)and problem behavior score(rs=0.185,P<0.05)were significantly positively correlated with the executive function score,and the auditory processing score was significantly positively correlated with the problem behavior score(rs=0.423,P<0.05).Executive function played a partial mediating role between auditory processing and problem behaviors,and the mediating effect accounted for 33.44% of the total effect.Conclusions Auditory processing can directly affect the problem behaviors of preschool children and indirectly affect problem behaviors through executive function.[Chinese Journal of Contemporary Pediatrics,2024,26(2):174-180]