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Infrared small target detection occupies an important position in the infrared search and track system. The most common size of infrared images has developed to 640×512. The field-of-view (FOV) also increases significantly. As the result, there is more interference that hinders the detection of small targets in the image. However, the traditional model-driven methods do not have the capability of feature learning, resulting in poor adaptability to various scenes. Owing to the locality of convolution kernels, recent convolutional neural networks (CNN) cannot model the long-range dependency in the image to suppress false alarms. In this paper, we propose a hierarchical vision transformer-based method for infrared small target detection in larger size and FOV images of 640×512. Specifically, we design a hierarchical overlapped small patch transformer (HOSPT), instead of the CNN, to encode multi-scale features from the single-frame image. For the decoder, a top-down feature aggregation module (TFAM) is adopted to fuse features from adjacent scales. Furthermore, after analyzing existing loss functions, a simple yet effective combination is exploited to optimize the network convergence. Compared to other state-of-the-art methods, the normalized intersection-over-union (nIoU) on our IRST640 dataset and public SIRST dataset reaches 0.856 and 0.758. The detailed ablation experiments are conducted to validate the effectiveness and reasonability of each component in the method.

Inkjet-printed wearable electronic textiles (e-textiles) are considered to be very promising due to excellent processing and environmental benefits offered by digital fabrication technique. Inkjet-printing of conductive metallic inks such as silver (Ag) nanoparticles (NPs) are well-established and that of graphene-based inks is of great interest due to multi-functional properties of graphene. However, poor ink stability at higher graphene concentration and the cost associated with the higher Ag loading in metal inks have limited their wider use. Moreover, graphene-based e-textiles reported so far are mainly based on graphene derivatives such as graphene oxide (GO) or reduced graphene oxide (rGO), which suffers from poor electrical conductivity. Here we report inkjet printing of highly conductive and cost-effective graphene-Ag composite ink for wearable e-textiles applications. The composite inks were formulated, characterised and inkjet-printed onto PEL paper first and then sintered at 150 °C for 1 hr. The sheet resistance of the printed patterns is found to be in the range of ~0.08–4.74 Ω/sq depending on the number of print layers and the graphene-Ag ratio in the formulation. The optimised composite ink was then successfully printed onto surface pre-treated (by inkjet printing) cotton fabrics in order to produce all-inkjet-printed highly conductive and cost-effective electronic textiles.

Background Biliary tract cancer (BTC) is a relatively rare but highly aggressive malignancy. However, there is currently no satisfactory second-line regimen for patients without specific genetic mutations. Nanoparticle albumin–bound paclitaxel, also known as nab-paclitaxel (Abraxane, Bristol Myers Squibb), has shown activity in patients with BTC. Studies investigating the immunogenic features of BTC suggested that checkpoint inhibition may lead to antitumor immune responses. In recent years, improved survival has been observed in patients treated with chemotherapy combined with immunotherapy across multiple cancer types, including BTC. This clinical trial aims to evaluate the efficacy and safety of second-line sintilimab in combination with nab-paclitaxel in advanced BTC patients. Methods The NapaSinti trial is a prospective, nonrandomized, open-label, phase 2 study conducted at a tertiary hospital in Chengdu, China. Eligible patients are those with histologically or cytologically confirmed locally advanced non-resectable or metastatic adenocarcinoma in the biliary tract (including intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder cancer), aged between 18 and 75 years, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, who have experienced disease progression after prior gemcitabine- or fluorouracil-based chemotherapy and have not received taxane or immune checkpoint inhibitor treatment. Enrolled patients will receive intravenous administration of sintilimab 200 mg on day 1 and nab-paclitaxel 125 mg/m2 on days 1 and 8, every three weeks. The primary endpoint is the objective response rate (ORR), while the secondary endpoints include overall survival (OS), progression-free survival (PFS), and safety. Exploratory objectives aim to identify biomarkers and molecular signatures for predicting response or prognosis. Using Simon’s two-stage design, a total of 63 participants will be enrolled in the study. This trial was initiated in March 2022 in China. Discussion The NapaSinti trial evaluates the efficacy and safety of second-line sintilimab plus nab-paclitaxel for advanced biliary tract cancer. Additionally, the trial provides an opportunity for translational research. Trial registration Chinese Clinical Trial Registry ChiCTR2100052118. Registered October 19, 2021.

Graphene‐based wearable electronic textiles (e‐textiles) show promise for next‐generation personalized healthcare applications due to their non‐invasive nature. However, the poor performance, less comfort, and higher material cost limit their wide applications. Here a simple and scalable production method of producing graphene‐based electro‐conductive yarn that is further embroidered to realize piezoresistive sensors is reported. The multilayer structures improved the conductivity of the piezoresistive sensors, exhibiting good sensitivity with high response and recovery speed. Additionally, the potential applications of such wearable, ultraflexible and machine‐washable piezoresistive sensors as pressure and breathing sensors are demonstrated. This will be an important step toward realizing multifunctional applications of wearable e‐textiles for next‐generation personalized healthcare applications. A simple and scalable production method of producing graphene‐based electro‐conductive yarn that is further embroidered to realize piezoresistive sensors is reported. The multilayer structures improved the conductivity of the piezoresistive sensors, exhibiting good sensitivity with high response and recovery speed. Additionally, the potential applications of such wearable, ultraflexible and machine‐washable piezoresistive sensors as pressure and breathing sensors are demonstrated.

Background: Second-line options for biliary tract cancer (BTC) are limited. While nab-paclitaxel has demonstrated certain antitumor activity, evidence remains scarce. With gemcitabine–cisplatin plus anti-programmed death-ligand 1 (PD-(L)1) established as the first-line standard, the benefit of second-line immunotherapy—especially in patients without prior anti-PD-(L)1 exposure—remains unclear. Objectives: To evaluate the efficacy and safety of nab-paclitaxel-based second-line treatments for advanced BTC, and compare outcomes between regimens with and without anti-PD-(L)1. Design: This is a real-world retrospective study. Methods: This study reviewed BTC patients who received second-line nab-paclitaxel-based therapy at West China Hospital between August 2018 and August 2023. The primary endpoint was overall survival (OS) in the entire population. Secondary endpoints were progression-free survival (PFS), response rate, adverse events (AEs) in the entire population, and comparison of survival outcomes and response rate between the chemo-anti-PD-(L)1 and chemotherapy groups. Results: Among 84 patients (41 in the chemo-anti-PD-(L)1 group and 43 in the chemotherapy group), the median OS was 15.17 months (95% confidence interval (CI), 12.63–21.43), median PFS was 5.40 months (95% CI, 3.23–8.03), objective response rate (ORR) was 21.43% (95% CI, 13.22–31.74), and disease control rate (DCR) was 60.71% (95% CI, 49.45–71.20). Common grade 3–4 AEs were leukopenia (21.4%), neutropenia (17.9%), and anemia (13.1%). Hepatitis (14.6%) was the most frequent immune-related AE. Although a numerical trend favored the chemo-anti-PD-(L)1 group, no statistically significant differences were observed in OS (16.9 vs 14.6 months), PFS (7.3 vs 4.6 months), ORR (29.3% vs 13.9%), or DCR (68.3% vs 53.5%). In the entire cohort, radical surgery improved OS. In addition, patients with a baseline neutrophil-to-lymphocyte ratio ⩾3 and a ⩽30% reduction in carbohydrate antigen 19-9 from an initially elevated level during treatment had worse OS and PFS. Conclusion: Nab-paclitaxel-based regimens represent a promising second-line treatment option for BTC. Although the improvement was not statistically significant, adding anti-PD-(L)1 therapy showed a trend toward improved survival. Trial registration: ChiCTR2500096599. Plain language summary Effectiveness and safety of Nab-paclitaxel-based chemotherapy with or without immunotherapy as a second-line treatment for advanced biliary tract cancer: a real-world study Background: Biliary tract cancer (BTC) is a rare but aggressive cancer that affects the bile ducts and gallbladder. Treatment options after the first-line therapy are limited. Nab-paclitaxel has shown promising efficacy in patients with BTC, but there is still little research on how well it works. The current standard first-line treatment for BTC combines gemcitabine and cisplatin with immunotherapy. It is still not clear whether adding immunotherapy in the second-line treatment is helpful, especially for patients who did not receive it in the first-line therapy. What did we study? Our aim was to evaluate the efficacy of nab-paclitaxel-based therapy as a potential second-line treatment for advanced BTC. We analyzed the medical records of 84 BTC patients who received nab-paclitaxel-based therapy, with or without immunotherapy, at West China Hospital between 2018 and 2023. Key findings: 1. Patients who received nab-paclitaxel-based therapy survived for a median of 15.17 months. 2. Adding immunotherapy did not significantly improve survival, although a trend toward longer survival was observed. 3. Common side effects included bone marrow suppression. Overall, nab-paclitaxel-based treatment was generally safe and well tolerated. 4. Patients with an neutrophil-to-lymphocyte ratio (NLR) of 3 or higher at the start of treatment, and a CA19-9 decrease of 30 percent or less during treatment, had less benefit from nab-paclitaxel-based therapy. What does this mean? Our study suggests that nab-paclitaxel-based therapy is a potentially safe and effective second-line treatment option for BTC.

Background Fruquintinib has demonstrated significant improvement in overall survival (OS) among previously treated metastatic colorectal cancer (mCRC) patients. However, the utilization of fruquintinib has been constrained by various toxicities, such as hand‐foot skin reaction (HFSR) and hypertension, particularly in elderly patients with reduced tolerance to the standard dosage. This study aims to investigate the efficacy and safety of fruquintinib dose‐escalation strategy for elderly refractory mCRC patients. Patients and Methods This open‐label, single‐arm, phase II trial included patients aged 65 years or over with mCRC who had progressed after two or more lines of chemotherapy. Fruquintinib was administered for 21 consecutive days of a 28‐day treatment cycle. The starting dose of fruquintinib was 3 mg/day and escalated to 4 mg/day in Week 2 and 5 mg/day in Week 3 if no significant drug‐related toxicity was observed. The highest tolerated dose from Cycle 1 would be administered in Cycle 2 and all subsequent cycles. Before commencing treatment, all enrolled patients underwent a G8 questionnaire and comprehensive geriatric assessments. The primary endpoint of the study was progression‐free survival (PFS). Results A total of 29 patients were enrolled and all started fruquintinib at 3 mg/day. Fifteen patients (51.7%) were subsequently escalated to 4 mg/day and 4 (13.8%) to 5 mg/day. Only four (13.8%) patients discontinued treatment due to adverse events (AEs). The median PFS was 3.8 months (95% CI, 2.7–4.9), and the median OS was 7.6 months (95% CI, 6.5–8.7). Treatment‐related adverse events (TRAEs) were observed in all 29 patients (100%). The most frequently occurring (>10%) TRAEs greater than Grade 3 were HFSR (20.7%), hypertension (20.7%), and diarrhea (10.3%). Conclusion Our study indicated that a dose of 4 mg/day was well tolerated by most elderly patients, suggesting that fruquintinib dose‐escalation strategy during the first cycle could serve as a viable alternative to the standard 5 mg/day dosing.

IntroductionAccurate baseline clinical staging is critical to inform treatment decision-making for patients with gastric cancers. Peritoneal metastasis (PM) is the most common form of metastasis in gastric cancer and mainly diagnosed by diagnostic laparoscopy and peritoneal lavage evaluation. However, diagnostic laparoscopy is invasive and less cost-effective. It is urgent to develop a safe, fast and non-invasive functional imaging method to verify the peritoneal metastasis of gastric cancer. The aim of our study was to evaluate the proportion of patients in whom 68Ga-FAPI-04 positron emission tomography/CT (PET/CT) led to a change in treatment strategy and to assess the diagnostic accuracy of 68Ga-FAPI-04 PET/CT for the detection of occult peritoneal metastasis compared with laparoscopic exploration.Methods and analysisIn this single-centre, prospective diagnostic test accuracy study, a total of 48 patients with locally advanced gastric or gastro-oesophageal junction adenocarcinoma (cT4a-b, N0-3, M0, based on CT images) who are considering radical tumour surgery will be recruited. All participants will undergo 68Ga-FAPI-04 PET/CT before the initiation of laparoscopic exploration. The primary outcome is the proportion of patients with occult peritoneal metastatic lesions detected by 68Ga-FAPI-04 PET/CT, leading to a change in therapy strategy. The secondary outcomes include the diagnostic performance of 68Ga-FAPI-04 PET/CT for occult peritoneal metastasis, including sensitivity, specificity, accuracy, positive predictive value and negative predictive value.Ethics and disseminationThe study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University (2022-1484). Study results will be presented at public and scientific conferences and in peer-reviewed journals.Trial registration numberChiCTR2300067591.

The surge in modern civil technologies demands a transformation in cement composites to surpass traditional roles and integrate smart functionalities. In this regard, enhancing the electrical conductivity of cement composites is a critical challenge. This study introduces a novel strategy for the self‐propagating formation of expandable graphite‐based high‐conductivity cement composites through a simple thermal treatment with 3 wt.% expandable graphite and 1 wt.%carbon fiber as conductive fillers. Inspired by the popcorn effect, this method leverages the rapid expansion of graphite at high temperatures, promoting contact between conductive fillers and forming new conductive networks. The obtained composites demonstrate a remarkable reduction of 60% in electrical resistance after heat treatment compared to the electrical resistance of standard cement composites, and the enhancing mechanisms is explored. The conductive properties endow the material with excellent electrothermal (>100 °C at 10 V), electrothermochromic (response time of 2 s), and electromagnetic interference shielding (42 dB at 12.4 GHz) performance. This innovative approach provides vast opportunities for developing smart infrastructure with enhanced electrical properties, regarded as a promising candidate for promoting next‐generation buildings and infrastructures. This study introduces a novel popcorn‐inspired strategy for self‐propagating expandable graphite‐based conductive cement composites. Through thermal treatment, the graphite expands and forms new conductive networks, significantly reducing electrical resistance by 60%. This enhancement broadens its application scope in electrical applications, including joule heating, electrothermochromic applications, and EMI shielding.

Background: Cholangiocarcinoma (CCA) is a highly aggressive malignant tumor with poor overall survival. Although the first-line standard chemotherapy (gemcitabine plus cisplatin) combined with immunotherapy has yielded positive results with survival prolongation, the efficacy remains unsatisfactory, and new treatment modalities need to be explored. Case presentation: We report the case of a patient with metastatic extrahepatic CCA who achieved a durable response and good tolerance to the combination treatment of pembrolizumab and nab-paclitaxel following progression on gemcitabine plus capecitabine chemotherapy. The tumor samples of the patient revealed low TMB, MSS, negative PD-L1 expression, and negative CD8 + TIL expression. This patient was treated with 3 cycles of pembrolizumab plus nab-paclitaxel and cisplatin, followed by 5 cycles of pembrolizumab plus nab-paclitaxel. Finally, 10 cycles of pembrolizumab monotherapy were administered. The patient survived for over 27 months after the initiation of combined therapy and was still in continuous remission at the last follow-up. Conclusion: As far as we know, this is the first report that pembrolizumab plus nab-paclitaxel successfully treated a patient with advanced CCA. This combination therapy might be a potential treatment option for patients with cholangiocarcinoma, and further clinical trials are needed to explore the outcomes.

The patients with advanced mismatch repair deficiency (dMMR) cancers can benefit from programmed cell death 1 (PD-1) pathway blockade, regardless of the tumor type. Little is known about the prevalence of dMMR in intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (cHCC-CC). This study aimed to assess the mismatch repair (MMR)-related protein expression in patients with ICC and cHCC-CC. Formalin-fixed, paraffin-embedded tumor specimens were obtained from patients undergoing surgery at the West china Hospital between 2009 and 2017. The immunoreactions for MLH1, MSH2, MSH6, and PMS2 were investigated to determine the MMR status. A total of 97 patients were evaluated, including 73 ICC patients and 24 cHCC-CC patients. The prevalence of dMMR was only found in two cases of 97 patients (2.06%). Both patients are ICC. In 24 cHCC-CC patients, no dMMR was observed. They did not receive an adjuvant chemotherapy after surgery. At the end of the follow-up, one patient was in a tumor-free state, and the other patient had local recurrence and metastasis. After receiving sintilimumab (an immune checkpoint inhibitor [ICI] for PD- 1), the patient had a partial response. DMMR was detected in few patients with ICC and cHCC-CC. Thus, it is not recommended to routinely evaluate the MMR status of patients with ICC or cHCC-CC after surgery, but that of patients with advanced ICC or cHCC-CC should be assessed.