Two hypogean species of genus Triplophysa are herein described from two subterranean tributaries of the River Yangtze drainage in Guiyang City, Guizhou Province, China. Triplophysa wudangensis, new species, can be distinguished from its congeners by the combination of the following characters: eye reduced, with diameter 5.1-6.5% HL; interorbital width 33.1-35.8% HL; body scaleless; lateral line complete; posterior chamber of air bladder degenerated; anterior nostril with elongated barbel-like tip; distal margin of dorsal fin truncate; dorsal fin with 7, anal fin with 5, and caudal fin with 14 branched fin rays; vertebrae 4 + 34. Triplophysa qingzhenensis, new species, can be distinguished from its congeners by the combination of the following characters: eye reduced, with diameter 2.1-4.4% HL; interorbital width 25.1-30.4% HL; body scaleless; lateral line complete; posterior chamber of air bladder degenerated; anterior nostril with elongated barbel-like tip; distal margin of dorsal fin truncate; dorsal fin with 7-8, anal fin with 5, and caudal fin with 14 branched fin rays; vertebrae 4 + 36. Molecular phylogenetic analysis supported the validity of these two new species and indicated their close relationship with Triplophysa rosa.

Sinocyclocheilus guiyang, a new troglobitic species from a subterranean tributary of the upper Yangtze Basin in Guiyang City, Guizhou Province, China is described in the present study. The new species is distinguishable from its congeneric species by a combination of the following characters: tip of maxillary barbel reaching to posterior edge of orbit; forehead horn absent; eye absent (or highly reduced) and tip of pectoral fins not significantly extending beyond the base of the pelvic fin. Molecular evidence, based on the mitochondrial cytochrome b (cytb) gene, further supports the validity of the species and also reveals its close relationship with S. cyphotergous, S. multipunctatus, S. punctatus and S. sanxiaensis. In addition, the new species faces a high risk of extinction, underscoring the urgency for habitat protection measures within its limited range.

Background: Clinical decision of extubation is a challenge in the treatment of patient with invasive mechanical ventilation (IMV), since existing extubation protocols are not capable of precisely predicting extubation failure (EF). This study aims to develop and validate interpretable recurrent neural network (RNN) models for dynamically predicting EF risk. Methods: A retrospective cohort study was conducted on IMV patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Time series with a 4-h resolution were built for all included patients. Two types of RNN models, the long short-term memory (LSTM) and the gated recurrent unit (GRU), were developed. A stepwise logistic regression model was used to select key features for developing light-version RNN models. The RNN models were compared to other five non-temporal machine learning models. The Shapley additive explanations (SHAP) value was applied to explain the influence of the features on model prediction. Results: Of 8,599 included patients, 2,609 had EF (30.3%). The area under receiver operating characteristic curve (AUROC) of LSTM and GRU showed no statistical difference on the test set (0.828 vs. 0.829). The light-version RNN models based on the 26 features selected out of a total of 89 features showed comparable performance as their corresponding full-version models. Among the non-temporal models, only the random forest (RF) (AUROC: 0.820) and the extreme gradient boosting (XGB) model (AUROC: 0.823) were comparable to the RNN models, but their calibration was deviated. Conclusions: The RNN models have excellent predictive performance for predicting EF risk and have potential to become real-time assistant decision-making systems for extubation.

Insulinoma is the commonest functioning pancreatic neuroendocrine tumor causing hyperinsulinemic hypoglycemia. This study is aimed to evaluate the clinical features, preoperative laboratory and imaging diagnosis, and pathologic findings of insulinoma. Data of the patients from 2001 to 2016 diagnosed as insulinoma in Tongji Hospital, China were retrospectively extracted and analyzed. A total of 40 patients were diagnosed as insulinoma with a male/female ratio of 0.68:1. The median onset age was 46.5 years. Nearly all the included patients presented neurological symptoms and 60% presented autonomic symptoms. More than 95% of the patients met the functional ENETS criteria including glucose, insulin and C-peptide levels. The preoperative detection rates of ultrasonography (US), enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and endoscopic ultrasonography (EUS) were 60.50%, 84.95%, 80%, and 83.3% respectively. The joint imaging examinations can markedly increase the detection rate. The mean tumor size was 1.89±0.72 cm. Ki-67 index by histopathological diagnosis were all less than 20%. The positive rates of insulin, synaptophysin (Syn), and chromogranin A (CgA) were close to 100%. Laboratory tests of glucose, insulin and C-peptide are reliable for preoperative diagnosis. Combination of the imaging examinations can improve the diagnosis.

The efficacy of rituximab (RTX) in treating steroid-resistant Graves' orbitopathy (GO) has been limitedly studied in Asians. Moreover, RTX has been considered even less for patients with steroid-resistant dysthyroid optic neuropathy (DON) who failed to undergo orbital decompression surgery for physical or financial reasons, or who responded poorly to the procedure. This study aimed to investigate the efficacy of RTX in treating steroid-resistant active moderate-to-severe and sight-threatening GO in a Chinese population. Data from 28 patients with steroid-resistant GO prescribed a single dose of 500 mg RTX were retrospectively retrieved. Treatment responses and contributing factors were analyzed. The median follow-up time was 22 (8-34) weeks. 23 (82.1 %) patients had a positive objective outcome recommended by the European Group on Graves' Orbitopathy (EUGOGO), while 25 (92.6 %) had a decrease in 7-item clinical activity score (CAS) by at least 2. Diplopia, visual dysfunction, and MRI-detected T2 relaxation time of the involved extraocular muscles improved significantly at the last follow-up compared to baseline (81.0 % vs. 47.6 %, 38.9 % vs. 16.7 %, and 87.8 (8.64) vs. 75.8 (10.9) ms, respectively; all p values < 0.05). No significant improvement was seen in terms of proptosis and eye muscle duction. Notably, a higher baseline IgG4 to IgG ratio was a predictor for RTX-induced positive EUGOGO outcomes. After RTX treatment, all 8 patients with DON demonstrated inactivation, and 4 improved in visual acuity by ≥ 1 line. No patient with DON experienced obvious deterioration. A single dose of 500 mg RTX seemed to be an effective and tolerable treatment for steroid-resistant GO. However, larger-scale studies with a control group are required for a more solid conclusion. The role of RTX in steroid-resistant DON management where surgery is unavailable or ineffective should be further explored.

Two new species of Homatula are herein described from the Wu-Jiang of the upper Chang-Jiang Basin in Guizhou Province, China. Homatula xiangzhi and H. shexiang are respectively assigned to the scaleless group and the partially scaled group of the genus. Homatula xiangzhi differs from all other species of the scaleless group in having a complete lateral line, an adipose crest along the dorsal mid-line of the caudal peduncle anteriorly terminating behind the middle of the anal-fin base, nine branched dorsal-fin rays, vertebrae 4+42-43 and no median notch on the lower jaw. Homatula shexiang is similar to H. longidorsalis in having nine branched dorsal-fin rays rather than seven or eight in all other species of the partially scaled group, but differs from it in having an adipose crest along the dorsal mid-line of the caudal peduncle anteriorly terminating behind the middle of the anal-fin base, a deeper head and a slender caudal peduncle. The validity of the two new species is further corroborated in a molecular phylogenetic analysis, based on the Cytb gene.