Gastric Extremely Well-Diferentiated Intestinal-Type Adenocarcinoma: A Challenging Lesion to Achieve Complete Endoscopic Resection

Extremely well-differentiated tubular adenocarcinomas (EWDAs) of the stomach are characterized by surface maturation and their mimicking of intestinal metaplasia. Endoscopically, intramucosal EWDAs are frequently ill defined with indistinct borders due to the pallor of the neoplastic mucosa and the lack of contrast against the background atrophic and metaplastic mucosa. We evaluated the effectiveness of endoscopic resection for EWDAs after endoscopic submucosal dissection (ESD). Among 872 patients with early gastric cancer, 17 EWDAs were identified (1.9 %). Endoscopically, the flat or depressed type was significantly more common among EWDAs (88.2 %) than among early gastric cancers of other histologies (37.8 %; P < 0.01). The discrepancy between endoscopically estimated tumor size and tumor size as confirmed in pathology reports was significantly greater among EWDAs (18.4 ± 22.0 mm) than among others (5.8 ± 7.5 mm). Involvement of the lateral resection margin was more common (29.4 % vs. 2.5 %; P < 0.05), and complete resection was achieved less often in EWDAs (47.1 % vs. 80.4 %; P = 0.01) compared to the others. EWDAs are associated with higher rates of incomplete resection after ESD, especially along the lateral margins. Pathologists should alert endoscopists when this diagnosis is made, with its associated risks; and endoscopists should pay particular attention to the extent of these tumors during resection

Efficacy and Safety of Oral Anticoagulants for Atrial Fibrillation Patients With Chronic Kidney Disease:A Systematic Review and Meta-Analysis

BACKGROUND: Data on different direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with renal impairment are insufficient. We aimed to perform pairwise and network meta-analysis comparing oral anticoagulants (OACs) in AF patients with renal impairment, including advanced chronic kidney disease (CKD) with creatinine clearance <30 mL/min. METHODS: PubMed, Embase, Cochrane Database, and references of related articles were searched up to April 2021. We included randomized trials and non-randomized studies using propensity-score or multivariable-model adjustments that compared clinical outcomes among OACs. Hazard ratios (HRs) for stroke or thromboembolism, major bleeding, and all-cause death were pooled using random-effects model. RESULTS: From 19 studies, 124,628 patients were included. In patients with AF and CKD, DOACs presented significantly lower risks of stroke or thromboembolism [HR(pooled) = 0.78, 95% confidence interval (CI) = 0.73–0.85, I(2) = 16.6%] and major bleeding [HR(pooled) = 0.76 (0.64–0.89), I(2) = 85.7%] when compared with warfarin, regardless of the severity of renal impairment. Results were consistent in advanced CKD patients for stroke or thromboembolism [HR(pooled) = 0.60 (0.43–0.85), I(2) = 0.0%] and major bleeding [HR(pooled) = 0.74 (0.59–0.93), I(2) = 30.4%]. In the network meta-analysis, edoxaban and apixaban presented the highest rank probability to reduce the risk of stroke or thromboembolism (edoxaban, P-score = 94.5%) and major bleeding (apixaban, P-score = 95.8%), respectively. Apixaban remained the safest OAC with the highest rank probability for major bleeding (P-score = 96.9%) in patients with advanced CKD. CONCLUSION: DOACs, particularly apixaban and edoxaban, presented superior efficacy and safety than warfarin in AF patients with CKD. Apixaban was associated with the lowest risk of major bleeding among OACs for patients with advanced CKD. SYSTEMATIC REVIEW REGISTRATION: [PROSPERO], identifier [CRD42021241718]

Convergence and Perturbation Resilience of Dynamic String-Averaging Projection Methods

We consider the convex feasibility problem (CFP) in Hilbert space and concentrate on the study of string-averaging projection (SAP) methods for the CFP, analyzing their convergence and their perturbation resilience. In the past, SAP methods were formulated with a single predetermined set of strings and a single predetermined set of weights. Here we extend the scope of the family of SAP methods to allow iteration-index-dependent variable strings and weights and term such methods dynamic string-averaging projection (DSAP) methods. The bounded perturbation resilience of DSAP methods is relevant and important for their possible use in the framework of the recently developed superiorization heuristic methodology for constrained minimization problems.Comment: Computational Optimization and Applications, accepted for publicatio

Spatial and kinematic alignments between central and satellite halos

Based on a cosmological N-body simulation we analyze spatial and kinematic alignments of satellite halos within six times the virial radius of group size host halos (Rvir). We measure three different types of spatial alignment: halo alignment between the orientation of the group central substructure (GCS) and the distribution of its satellites, radial alignment between the orientation of a satellite and the direction towards its GCS, and direct alignment between the orientation of the GCS and that of its satellites. In analogy we use the directions of satellite velocities and probe three further types of alignment: the radial velocity alignment between the satellite velocity and connecting line between satellite and GCS, the halo velocity alignment between the orientation of the GCS and satellite velocities and the auto velocity alignment between the satellites orientations and their velocities. We find that satellites are preferentially located along the major axis of the GCS within at least 6 Rvir (the range probed here). Furthermore, satellites preferentially point towards the GCS. The most pronounced signal is detected on small scales but a detectable signal extends out to 6 Rvir. The direct alignment signal is weaker, however a systematic trend is visible at distances < 2 Rvir. All velocity alignments are highly significant on small scales. Our results suggest that the halo alignment reflects the filamentary large scale structure which extends far beyond the virial radii of the groups. In contrast, the main contribution to the radial alignment arises from the adjustment of the satellite orientations in the group tidal field. The projected data reveal good agreement with recent results derived from large galaxy surveys. (abridged)Comment: accepted for publication in Ap

Synthesis and NOx removal performance of anatase S-TiO2/g-CN heterojunction formed from dye wastewater sludge.

In this study, sludges generated from Ti-based flocculation of dye wastewater were used to retrieve photoactive titania (S-TiO2). It was heterojunctioned with graphitic carbon nitride (g-CN) to augment photoactivity under UV/visible light irradiance. Later the as-prepared samples were utilized to remove nitrogen oxides (NOx) in the atmospheric condition through photocatalysis. Heterojunction between S-TiO2 and g-CN was prepared through facile calcination (@550 °C) of S-TiO2 and melamine mix. Advanced sample characterization was carried out and documented extensively. Successful heterojunction was confirmed from the assessment of morphological and optical attributes of the samples. Finally, the prepared samples' level of photoactivity was assessed through photooxidation of NOx under both UV and visible light irradiance. Enhanced photoactivity was observed in the prepared samples irrespective of the light types. After 1 h of UV/visible light-based photooxidation, the best sample STC4 was found to remove 15.18% and 9.16% of atmospheric NO, respectively. In STC4, the mixing ratio of S-TiO2, to melamine was maintained as 1:3. Moreover, the optical bandgap of STC4 was found as 2.65 eV, where for S-TiO2, it was 2.83 eV. Hence, the restrained rate of photogenerated charge recombination and tailored energy bandgap of the as-prepared samples were the primary factors for enhancing photoactivity

A Novel Liver-targeted Testosterone Therapy for Sarcopenia in Androgen Deprived Men With Prostate Cancer.

Objective: Androgen deprivation therapy (ADT) reduces muscle and bone mass, increasing frailty in men with prostate cancer. The liver mediates the whole body anabolic effects of testosterone. Based on first-pass metabolism, liver-targeted testosterone treatment (LTTT) entails oral delivery of a small dose of testosterone that does not raise peripheral blood testosterone levels. LTTT reduces blood urea and stimulates protein anabolism in hypogonadal men and postmenopausal women. We investigated whether LTTT prevents loss of lean and bone mass during ADT. Method: A 6-month, double-blind, placebo-controlled study of testosterone 40 mg/day in 50 men. Primary outcome measures were lean mass and bone mineral content (BMC). Testosterone, urea and prostate-specific antigen (PSA) were monitored. Patients were withdrawn if PSA exceeded 4 ng/mL. Results: 42 patients completed the study. Mean (95% CI) testosterone rose during LTTT but not placebo treatment [∆ 2.2 (1.3-3.0) vs -0.7 (-1.5 to 0.2) nmol/L; P < 0.01]. Mean PSA level did not change significantly during either treatment. Blood urea fell [∆ -0.4 (-0.9 to -0.1) mmol/L] during LTTT but not placebo [∆ 0.05 (-0.8 to 0.9) mmol/L]. BMC [∆ 49 (5 to 93) g; P < 0.02] and lean mass [∆ 0.8 (-0.1 to 1.7) kg; P = 0.04) increased compared to placebo. Five patients on LTTT withdrew from increased PSA levels, all returning to baseline levels. Conclusion: LTTT shows promise as a simple therapy for preventing sarcopenia and bone loss during ADT. LTTT may induce reversible PSA rise in some patients. Further studies are required to optimize LTTT dose in ADT. LTTT has potential application in other catabolic states in men and women

Biodegradable Nitrogen-Doped Carbon Nanodots for Non-Invasive Photoacoustic Imaging and Photothermal Therapy

Multifunctional nanoparticles have been widely investigated for biomedical applications, such as imaging, therapy, and drug delivery. Especially, photoactive nanoparticles have received great attention as theranostic agents because of their heat-generating abilities after exposure to laser irradiation. However, photostability and safety issues have been the technical hurdles for further clinical applications. Here, we designed nitrogen (N)-doped carbon nanodots (N-CNDs) that have strong absorption in the near-infrared region, high photostability, and excellent biodegradability. Optimized N-CNDs can be utilized not only as a new photoacoustic (PA) imaging agent but also as a superior photothermal therapy (PTT) agent in vivo because of their strong optical absorption at a specific wavelength. We used N-CNDs to perform in vivo/ex vivo noninvasive PA imaging of sentinel lymph nodes via local delivery and performed PTT for cancer ablation therapy. Finally, biodegradation and renal clearance were confirmed by performing whole-body PA monitoring and a degradation test

Biodegradable Nitrogen-Doped Carbon Nanodots for Non-Invasive Photoacoustic Imaging and Photothermal Therapy

Multifunctional nanoparticles have been widely investigated for biomedical applications, such as imaging, therapy, and drug delivery. Especially, photoactive nanoparticles have received great attention as theranostic agents because of their heat-generating abilities after exposure to laser irradiation. However, photostability and safety issues have been the technical hurdles for further clinical applications. Here, we designed nitrogen (N)-doped carbon nanodots (N-CNDs) that have strong absorption in the near-infrared region, high photostability, and excellent biodegradability. Optimized N-CNDs can be utilized not only as a new photoacoustic (PA) imaging agent but also as a superior photothermal therapy (PTT) agent in vivo because of their strong optical absorption at a specific wavelength. We used N-CNDs to perform in vivo/ex vivo noninvasive PA imaging of sentinel lymph nodes via local delivery and performed PTT for cancer ablation therapy. Finally, biodegradation and renal clearance were confirmed by performing whole-body PA monitoring and a degradation test.11269Ysciescopu