Exploration of decision aids to support advance care planning: A scoping review

BACKGROUND

Advance care planning is a process through which people communicate their goals and preferences for future medical care. Due to the complexity of the decision-making process, decision aids can assist individuals in balancing potential benefits and risks of treatment options.

OBJECTIVE

While decision aids have the potential to better promote advance care planning, their characteristics, content and application effectiveness are unclear and lack systematic review. Therefore, we aimed to explore these three aspects and establish a foundation for future research.

DESIGN

Scoping review.

METHODS

This scoping review adheres to the framework proposed by Arksey and O'Malley and the PRISMA-ScR list. Six English-language databases were systematically searched from the time of construction until 1 December 2023. Two researchers conducted the article screening and data extraction, and the extracted data was presented in written tables and narrative summaries.

RESULTS

Of the 1479 titles and abstracts, 20 studies fulfilled the inclusion criteria. Types of decision aids were employed, mainly websites and videos. Decision aid's primary components center around 11 areas, such as furnishing information, exploring treatment and care preferences. The main manifestations were a significant increase in knowledge and improved recognition of patients' target value preferences. Among the aids, websites and videos for advance care planning have relatively high content acceptability and decision-making process satisfaction, but their feasibility has yet to be tested.

CONCLUSIONS

Decision aids were varied, with content focused on describing key information and exploring treatment and care preferences. Regarding application effects, the aids successfully facilitated the advance care planning process and improved the quality of participants' decisions. Overall, decision aids are efficient in improving the decision-making process for implementing advance care planning in cancer and geriatric populations. In the future, personalised decision aids should be developed based on continuous optimization of tools' quality and promoted for clinical application.

REPORTING METHOD

The paper has adhered to the EQUATOR guidelines and referenced the PRISMAg-ScR checklist.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a review without patient and public contribution.

REGISTRATION

https://doi.org/10.17605/OSF.IO/YPHKF, Open Science DOI: 10.17605/OSF.IO/YPHKF.

Deep degradation of atrazine in water using co-immobilized laccase-1-hydroxybenzotriazole-Pd as composite biocatalyst

The efficient and green removal technology of refractory organics such as atrazine in water has been an important topic of research in water treatment. A novel membrane composite biocatalyst Lac-HBT-Pd/BC as prepared for the first time by co-immobilizing laccase, mediator 1-hydroxybenzotriazole (HBT) and metal Pd on functionalized bacterial cellulose (BC) to investigate the removal of atrazine and degradation of its intermediates under mild ambient conditions. It was found that atrazine could be completely degraded in 5 h by the catalysis of Lac-HBT-Pd/BC, and the removal rate of degradation intermediates from atrazine was about 85% after continuous catalysis, which achieved deep degradation of atrazine. The effect of electrochemical activity and radical stability of the membrane composite biocatalysts loaded with Pd was investigated. The possible degradation pathways were proposed by identifying and analyzing the deep degradation products of atrazine. The Lac-HBT-Pd/BC demonstrated deep degradation of atrazine and favorable reusability as well as considerable adaptability to various water qualities. This work provides an important reference for preparing new kinds of biocatalysts to degrade refractory organic pollutants in water.

Diagnostic performance of PIVKA-II in identifying recurrent hepatocellular carcinoma following curative resection: a retrospective cohort study

Protein induced by vitamin K absence or antagonist II (PIVKA-II) plays a critical role in the diagnosis of hepatocellular carcinoma (HCC), however, studies on its efficacy in diagnosing recurrent HCC were rarely found. A multicenter, retrospective, and observational study was conducted. During the overall follow-up of 5 years, HCC patients who had curative resection were monitored every 3 months in the first year post-surgery and every 6 months thereafter if no recurrence occurred. Tumor markers were collected at the diagnosis of recurrence for those with recurrence and at the last follow-up for those without recurrence. The median serum levels of PIVKA-II and AFP in the recurrence group were significantly higher than those in the non-recurrence group (PIVKA-II: 84.62 vs. 18.76 mAU/ml, p < 0.001; AFP: 4.90 vs. 3.00 ng/ml, p < 0.001) and there is a significant correlation between PIVKA-II and AFP (R = 0.901, p < 0.001). PIVKA-II showed better accuracy than AFP in the diagnosis of overall recurrent HCC (AUC: 0.883 vs. 0.672; p < 0.0001), but also in patients with negative PIVKA-II before curative resection (AUC: 0.878 vs. 0.680, p = 0.001). Clinician should pay more attention to serum PIVKA-II values when following patients after curative HCC resection to detect early recurrence.Clinical trial registration: ChiCTR2300070874.

Enhanced performance of acridine degradation and power generation by microbial fuel cell with g-C3N4/PANI-DA/CF anode

Microbial fuel cell (MFC) has attracted much attention in treating organic wastewater due to its double functions of degrading organics and generating electricity with microorganisms as biocatalysts. Unfortunately, some organics with biological toxicity such as acridine could inhibit the growth and activity of the microorganisms on the anode so that the double functions of MFC would recede. Enhancing microbial activity by using new biocompatible materials as anodes is prospective to solve problem. A novel anode was achieved by electrodepositing g-C3N4 sheets to the carbon felt (CF) modified with polyaniline-dopamine composite film, and used to treat wastewater containing acridine for the first time. After the operation of 13 d, MFC loading with the composite anode showed a degradation efficiency of 98.3% in 150 mg L-1 acridine, while that of CF-MFC was 55.8%. Moreover, MFC loading the modified anode obtained a maximum power density of 1976 ± 47 mW m-2, 140.1% higher than that of CF-MFC. Further analysis revealed that the functional microorganisms associated with acridine degradation such as Achromobacter and Alcaligenes were enriched on the g-C3N4/PANI-DA/CF anode. Moreover, the composite anode could improve the activity of microorganisms and elicit them to generate conductive nanowires, which was beneficial to transferring electrons from microbes to anode over long distances, suggesting a promising prospect application in MFC.

Esmolol increases the fecal abundance of Lactobacillus in a rat model of sepsis

BACKGROUND

Disorders of the gut microbiome could be responsible for the progression of multiple organ dysfunction syndrome. In this study, we examined the effect of esmolol on the gut microbiome in a rat model of sepsis induced by cecal ligation and puncture (CLP).

METHODS

The animals (n = 32) were randomly divided into 3 groups: Sham group (sham operation + normal saline treatment, n = 8), CLP group (cecal ligation and puncture + normal saline treatment, n = 12), and CLP + ESM group (cecal ligation and puncture + esmolol treatment, n = 12). After 24 h, feces in the colon were collected for 16S rRNA gene sequencing and nitric oxide analysis. In addition, colon was removed for immunohistochemical staining of inducible nitric oxide synthase (iNOS).

RESULTS

Four rats in the CLP group and two rats in the CLP + ESM group died. The abundance of Lactobacillus in the CLP + ESM group was higher than CLP group (P = 0.048). In the linear discriminant analysis effect size analysis, Norank f Muribaculaceae, Escherichia-Shigella and Lactobacillus were the predominant bacteria in the Sham group, CLP group and CLP + ESM group, respectively. The iNOS expression in colonocytes stained by brown in the CLP group were much more than Sham group (P = 0.001). Compared to CLP group, the iNOS expression in colonocytes reduced after esmolol treatment (P = 0.013). The concentration of nitric oxide in colon feces was different in Sham group, CLP group and CLP + ESM group (1.31 ± 0.15μmmol/l vs. 1.98 ± 0.27μmmol/l vs. 1.51 ± 0.14μmmol/l, P = 0.001). In addition, the concentration of nitric oxide in CLP group was higher than Sham group (P = 0.001) or CLP + ESM group (P = 0.001).

CONCLUSIONS

Esmolol increased the fecal abundance of Lactobacillus in a rat model of sepsis. Moreover, esmolol reduced the iNOS expression of colonocytes and the nitric oxide concentration of colon feces.

Visible-light-driven photo-peroxidase catalysis: high-efficiency degradation of indole in water

The demand for H2O2 restricts the wider application of horseradish peroxidase (HRP) in degradation. In this work, a novel photoenzyme synergistic catalytic system was developed for high-efficiency degrading of indole in water by HRP without extra H2O2. The HRP was immobilized on CN-ZIF prepared by the combination of g-C3N4 and ZIF-8 to achieve photo-peroxidase catalyst HRP/Zn-CN-ZIF. Under visible light, photogenerated electrons and H2O2 from HRP/Zn-CN-ZIF participated in the biocatalytic cycle of HRP directly. As a result, the indole at 20 mg L-1 in water was degraded completely in 2 h by the HRP/Zn-CN-ZIF photoenzyme synergistic catalytic system without the addition of H2O2. Furthermore, HRP/Zn-CN-ZIF exhibited superior visible light absorption and charge transfer ability compared to g-C3N4. The results of the mechanism studies suggest that ·OH would play the most significant role from the HRP/Zn-CN-ZIF in indole degradation. This research provides an efficient approach for the removal of indole from water environments.

[A multi-center epidemiological study on pneumococcal meningitis in children from 2019 to 2020]

OBJECTIVES

To investigate the clinical characteristics and prognosis of pneumococcal meningitis (PM), and drug sensitivity of Streptococcus pneumoniae (SP) isolates in Chinese children.

METHODS

A retrospective analysis was conducted on clinical information, laboratory data, and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.

RESULTS

Among the 160 children with PM, there were 103 males and 57 females. The age ranged from 15 days to 15 years, with 109 cases (68.1%) aged 3 months to under 3 years. SP strains were isolated from 95 cases (59.4%) in cerebrospinal fluid cultures and from 57 cases (35.6%) in blood cultures. The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87) and 27% (21/78), respectively. Fifty-five cases (34.4%) had one or more risk factors for purulent meningitis, 113 cases (70.6%) had one or more extra-cranial infectious foci, and 18 cases (11.3%) had underlying diseases. The most common clinical symptoms were fever (147 cases, 91.9%), followed by lethargy (98 cases, 61.3%) and vomiting (61 cases, 38.1%). Sixty-nine cases (43.1%) experienced intracranial complications during hospitalization, with subdural effusion and/or empyema being the most common complication [43 cases (26.9%)], followed by hydrocephalus in 24 cases (15.0%), brain abscess in 23 cases (14.4%), and cerebral hemorrhage in 8 cases (5.0%). Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old, with rates of 91% (39/43) and 83% (20/24), respectively. SP strains exhibited complete sensitivity to vancomycin (100%, 75/75), linezolid (100%, 56/56), and meropenem (100%, 6/6). High sensitivity rates were also observed for levofloxacin (81%, 22/27), moxifloxacin (82%, 14/17), rifampicin (96%, 25/26), and chloramphenicol (91%, 21/23). However, low sensitivity rates were found for penicillin (16%, 11/68) and clindamycin (6%, 1/17), and SP strains were completely resistant to erythromycin (100%, 31/31). The rates of discharge with cure and improvement were 22.5% (36/160) and 66.2% (106/160), respectively, while 18 cases (11.3%) had adverse outcomes.

CONCLUSIONS

Pediatric PM is more common in children aged 3 months to under 3 years. Intracranial complications are more frequently observed in children under 1 year old. Fever is the most common clinical manifestation of PM, and subdural effusion/emphysema and hydrocephalus are the most frequent complications. Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates. Adverse outcomes can be noted in more than 10% of PM cases. SP strains are high sensitivity to vancomycin, linezolid, meropenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.

Dysphagia screening among stroke patients in a tertiary hospital: a best practice implementation project

OBJECTIVES

The study aimed to promote nurses' compliance with best practices for dysphagia screening in patients with stroke.

INTRODUCTION

Dysphagia can significantly increase the risk of complications, especially aspiration pneumonia, leading to increased risk of disability, death, and high medical expenses. Dysphagia screening can reduce aspiration risk and is recommended as a crucial step in dysphagia management; however, not all patients with stroke undergo dysphagia screening in the neurology ward.

METHODS

The JBI Evidence Implementation Framework was used in this study. A baseline audit was conducted by interviewing 22 nurses and reviewing 48 medical records to evaluate current practice against best practice recommendations. The JBI Getting Research into Practice (GRiP) tool was used to identify barriers and strategies for practice change. A follow-up audit of 19 nurses and 48 medical records was conducted after implementation of improvement strategies.

RESULTS

The follow-up audit results showed improvement in three criteria compared with the baseline audit: for Criterion 1, compliance increased by 27.3%, rising from 72.7% to 100%; for Criteria 3 and 4, compliance increased by 77.1%, rising from 20.8% to 97.9%. The difference in nurses' knowledge, attitude, and behavior scores for dysphagia screening between the baseline and follow-up audits was statistically significant (all p < 0.05).

CONCLUSIONS

The project showed improvements in evidence-based practice in the dysphagia screening of stroke patients in a neurology ward. However, more work needs to be done to ensure the sustainability of best practices, such as regular training for nurses, supervision from managers, and regular audits of dysphagia screening.

Complications of Injected Exogenous Growth Factor for Cosmetic Facial Rejuvenation: A Case Series and Sequential Therapy

BACKGROUND

Exogenous growth factor presents promising soft tissue regeneration, but the complications from injectable exogenous growth factor seem to be growing. However, there is no detailed summary of complications and sequential treatment protocols. It is noted that the injection of exogenous growth factor into the soft tissue is an unreasonable or even illegal procedure, which could cause uncontrollable tissue growth and some other complications.

METHODS

A total of 65 patients underwent analysis retrospectively for complications related to the injection of exogenous growth factor from 2017to 2022 at Xijing Hospital in China. Initially the symptoms mainly consisted of redness, skin temperature arisen, itching, tissue hypertrophy, localized swelling, mass, and lump, with later manifestations including ulcerations and purulent discharge. A comprehensive treatment scheme was formulated based on the location and size of the lumps as well as the type of complication. Post-treatment satisfaction was evaluated over a mean 16-month follow-up (range 6-39 months).

RESULTS

A total of 65 patients participated in the treatment. Drug injection therapy was initially performed on all patients. If injections were not effective, surgical treatment (debridement/excision/liposuction) was performed. Twenty-eight patients were managed with intralesional injections alone. Patients reported improved satisfaction in 23 cases (82.14%), full symptom resolution in 3 cases (10.72%), and no improvement in 2 cases (7.14%). Surgery was required for 37 patients. Postoperative improved satisfaction was reported in 30 cases (81.08%), full symptom resolution was recorded in 4 cases (10.82%), and no improvement was seen in 3 cases (8.10%).

CONCLUSIONS

This study highlights the management of complications arising from exogenous growth factor injections through the implementation of a sequential therapy approach. Specifically, this approach involves the initial administration of drug injection therapy, and if drug injection therapy proves ineffective, then surgical treatment is pursued. In conclusion, the injection of exogenous growth factors into soft tissues should be forbidden.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A highly selective and sensitive fluorescence probe based on BODIPY-cyclen for hydrogen sulfide detection in living cells and serum

Hydrogen sulfide (H2S) is a multifunctional gaseous signaling molecule that plays a vital role in several biological processes. In the present study, a BODIPY-based fluorescent probe called 8-[4-((1,4,7,10-tetraazacyclododecane)methyl)phenyl]-4,4-difluoro-1,3,5,7-tetramethyl-4-bora-3a, 4a-diaza-s-indacene (BA-Cyclen)-Cu was designed and synthesized; this probe is a Cu(Ⅱ) complex that uses Cu(Ⅱ) decomplexation to achieve the sensitive and rapid detection of aqueous H2S via the "turn-on" mode. We observed that BA-Cyclen-Cu exhibited good membrane permeability, low toxicity, and lysosome-targeting ability, facilitating H2S detection in living cells. Furthermore, we demonstrated the potential biological applications of the probe by measuring exogenous H2S originating from Na2S and GYY4137, a slow-release donor, and endogenous H2S generated via the catalysis of cystathionine-β-synthase in both normal (H9c2) and cancerous (U87) cells. Moreover, BA-Cyclen-Cu was successfully used to detect exogenous H2S by the external standard method in fetal bovine serum, the serum of a healthy person, and the serum of a patient with liver cancer.

Experiences of cancer survivors returning to work decision-making: a meta-synthesis of qualitative studies

PURPOSE

Return to work for cancer survivors (CSs) may be challenging, and there is a research gap in integrating the relevant experiences of the return-to-work decision-making process for CSs. Our aim was to synthesize existing qualitative research that integrates the dynamic experiences of CSs in the return-to-work decision-making process and highlights the factors influencing the return-to-work decisions of CSs.

METHODS

We retrieved qualitative studies on a relevant theme published in the PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, and CINAHL databases since construction to December 2023. Literature screening, quality evaluation, and data analysis followed the PRISMA, Joanna Briggs Institute Critical Appraisal Tool (2016), and thematic analysis methods to ensure study reliability. The study was registered on PROSPERO (registration number: CRD42023429623).

RESULTS

Ten articles were included, and six key outcomes were identified based on Social Cognitive Career Theory (SCCT) integration: points of concern for individuals, sense of self-efficacy, outcome expectations, work perception and belonging, medical advice and guidance, and effects of the external reactions.

CONCLUSION

The decision-making process for CSs to return to work is affected by various personal and external factors. Effectively addressing personal appearance, financial, and emotional issues can enhance self-efficacy of CSs. Improving external perceptions of cancer patients and enhancing social support in the workplace and medical settings can help CSs make informed decisions regarding their return to work.

IMPLICATIONS FOR CANCER SURVIVORS

The decision of CSs to return to work is a result of integrating personal, job, and medical care considerations. These findings contribute to the development of future interventions for CSs' return-to-work decisions that target an array of potential factors.

Size correction and deep image optimization in optical coherence tomography angiography with structural image-assisted common parts extraction method

Tail artifact elimination is essential in optical coherence tomography angiography (OCTA) for the artifacts will prevent the reconstruction of the 3D vessel image. The tail artifacts of superficial vessels obscure the deep vascular signals and cause the signals at different depths to mix with each other. Most tail artifact elimination methods can shorten the tails but have difficulty in determining the lower boundary of the vessels. In this letter, we introduce a technique to extract vascular signals with more accurate vascular boundaries. With the help of structural image, our method can reconstruct the 3D image of the vascular network more precisely and perform better in deep areas. The images of vessels of palm are used to compare our new technique with previous common parts extraction method experimentally. The results show that our method removes the tail artifacts more thoroughly and has a significant advantage in imaging deep vessels.

High-speed k-linear swept laser using acousto-optic deflectors with Doppler shift compensation for optical coherence tomography

Swept laser based on the acousto-optic deflector (AOD) is a promising swept source in optical coherence tomography (OCT) applications for its high wavenumber linear sweep without mechanical motion. However, the poor coherence length and the elongated cavity of the laser imposed limitations on the acquisition of high-quality images with adequate imaging depth and high imaging speed. In this Letter, we demonstrate a compact high-speed wavenumber linear swept laser based on AOD using Doppler shift compensation, achieving a high linearity of Pearson's R of 0.999991, a duty cycle of ∼100%, an extended coherence length of 5.7 mm, an output power of 18 mW, and excellent phase stability at a sweep speed of 500 kHz. OCT structural images with a system sensitivity of 103.2 dB and OCT angiography (OCTA) of human palm in vivo have been successfully performed, serving as a compelling demonstration of the excellent performance of this swept laser. We believe that the proposed laser will be of high potential in various clinical and industrial applications in the future.

A porous polyacrylonitrile (PAN)/covalent organic framework (COF) fibrous membrane photocatalyst for highly efficient and ultra-stable hydrogen evolution

Photocatalytic water splitting has been regarded as one of the most promising technologies to generate hydrogen as an ideal energy carrier in the future. However, most of the experience for such process are derived from the researches based on the suspension powder photocatalysts under a stirring condition and a practical scaling application is urgently calling for the high-efficient panel reactors based on the membrane photocatalysts. Herein, we develop a new series of flexible and ultrastable membrane photocatalysts through a controllable growth of covalent organic framework (COF) photocatalysts on the polyacrylonitrile (PAN) electrospun fiber membrane. Multiple characterization techniques verify the successful anchoring of the COF-photocatalysts on the PAN fibers, forming a three-dimensional porous PAN/COF membrane photocatalyst with excellent light absorption ability, high specific surface area, and good hydrophily. As a result, the optimized PAN/COF membrane photocatalyst exhibits excellent hydrogen evolution rate up to 1.25 mmol g-1h-1 under visible-light irradiation without stirring, which is even higher than that of the corresponding suspension COF-powder photocatalyst with stirring. In particular, the PAN/COF membrane photocatalyst demonstrates a much more superior hydrogen evolution stability and also a much better recyclability. This study gives some experience for the practical scaling application of solar-driven water splitting.

A new method to treat onychopapilloma with pulsed dye laser irradiation: a 13-case series report

Purpose: Onychopapilloma is a rare benign nail tumor affecting the distal matrix and the nail bed. Currently, the only available treatment is surgical resection, which has a recurrence rate of 20% and may lead to various complications. Here we report a new method to treat onychopapilloma with pulsed dye laser (PDL).Materials and methods: We retrospectively analyzed 13 cases and evaluated disease classification, dermoscopic examination, laser treatment parameters, photographs before and after treatment, and treatment outcome.Results: The site distribution of onychopapilloma was consistent with previous reports. PDL treatment was performed with 595 nm laser, with 1.5 ms pulse duration, spot diameter 3-5 mm, and 11.5-13.5 J/cm² fluence. Irradiation covered the telangiectatic area up to the edge of the nail folds, with the terminal response of purpura occurrence. The overall effective rate was 77%; the effective rates for erythronychia, leukonychia, and melanonychia were 88%, 67%, and 50%, respectively.Conclusions: PDL treatment for onychopapilloma provides an alternative to traditional surgery with comparable effectiveness but much less risk for complications.

Robotic-OCT guided inspection and microsurgery of monolithic storage devices

Data recovery from monolithic storage devices (MSDs) is in high demand for legal or business purposes. However, the conventional data recovery methods are destructive, complicated, and time-consuming. We develop a robotic-arm-assisted optical coherence tomography (robotic-OCT) for non-destructive inspection of MSDs, offering ~7 μm lateral resolution, ~4 μm axial resolution and an adjustable field-of-view to accommodate various MSD sizes. Using a continuous scanning strategy, robotic-OCT achieves automated volumetric imaging of a micro-SD card in ~37 seconds, significantly faster than the traditional stop-and-stare scanning that typically takes tens of minutes. We also demonstrate the robotic-OCT-guided laser ablation as a microsurgical tool for targeted area removal with precision of ±10 μm and accuracy of ~50 μm, eliminating the need to remove the entire insulating layer and operator intervention, thus greatly improving the data recovery efficiency. This work has diverse potential applications in digital forensics, failure analysis, materials testing, and quality control.

Importance sampling-accelerated simulation of full-spectrum backscattered diffuse reflectance

The Monte Carlo (MC) method is one of the most widely used numerical tools to model the light interaction with tissue. However, due to the low photon collection efficiency and the need to simulate the entire emission spectrum, it is computationally expensive to simulate the full-spectrum backscattered diffuse reflectance (F-BDR). Here, we propose an acceleration scheme based on importance sampling (IS). We derive the biasing sampling function tailored for simulating BDR based on the two-term scattering phase function (TT). The parameters of the TT function at different wavelengths are directly obtained by fitting the Mie scattering phase function. Subsequently, we incorporate the TT function and its corresponding biased function into the redefined IS process and realize the accelerated simulation of F-BDR. Phantom simulations based on the Fourier-domain optical coherence tomography (FD-OCT) are conducted to demonstrate the efficiency of the proposed method. Compared to the original simulator without IS, our proposed method achieves a 373× acceleration in simulating the F-BDR of the multi-layer phantom with a relative mean square error (rMSE) of less than 2%. Besides, by parallelly computing A-lines, our method enables the simulation of an entire B-scan in less than 0.4 hours. To our best knowledge, it is the first time that a volumetric OCT image of a complex phantom is simulated. We believe that the proposed acceleration method can be readily applied to fast simulations of various F-BDR-dependent applications. The source codes of this manuscript are also publicly available online.

Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial

BACKGROUND

Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients' recovery.

METHODS

This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group (n = 665) and fasting group (n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle.

RESULTS

The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t = 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26-0.71, P <0.001) and 0.76 (95% CI: 0.57-0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05-0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39-0.95, P = 0.028) in the multivariable models.

CONCLUSION

Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.

TRAIL REGISTRATION

ClinicalTrials.gov, No. NCT03075280.

Geoherbalism Metabolomic Analysis of Atractylodes lancea (Thunb.) DC. by LC-Triple TOF-MS/MS and GC-MS

The rhizome of Atractylodes lancea (Thunb.) DC. (AL), called Maocangzhu in Chinese, is a geoherbalism medical herb in Jiangsu Province that is often used in the prescription of traditional Chinese medicine (TCM), such as for the treatment of COVID-19. The landform and climatic environment of each province varies greatly from south to north, which has an important influence on the chemical constituents in AL. However, there is a lack of research on the significance of its geoherbalism, especially in water-soluble parts other than volatile oil. In this study, eight known compounds were isolated and obtained as reference substances from AL. In addition, liquid chromatography coupled with triple-quadrupole time-of-flight tandem mass spectrometry (LC-triple TOF-MS/MS) and gas chromatography-mass spectrometry (GC-MS) were used to analyze and characterize chemical constituents from different habitats. Moreover, orthogonal partial least-squares discriminant analysis (OPLS-DA) was applied to reveal the differential metabolomics in AL from different habitats based on the qualitative information of the chemical constituents. Results showed that a total of 33 constituents from GC-MS and 106 constituents from LC-triple TOF-MS/MS were identified or inferred, including terpenoids, polyacetylenes, and others; meanwhile, the fragmentation pathways of different types of compounds were preliminarily deduced from the fragmentation behavior of the major constituents. According to the variable importance in projection (VIP) and p-values, only one volatile differential metabolite was identified by GC-MS screening: β-eudesmol. Overall, five differential metabolites were identified by LC-triple TOF-MS/MS screening: sucrose, 4(15),11-eudesmadiene; atractylenolide I, 3,5,11-tridecatriene-7,9-diyne-1,2-diacetate, and (3Z,5E,11E)-tridecatriene-7,9-diynyl-1-O-(E)-ferulate. This study provides metabolomic information for the establishment of a comprehensive quality evaluation system for AL.

Polarization-isolated stretched-pulse mode-locked swept laser for 10.3-MHz A-line rate optical coherence tomography

Stretched-pulse mode-locked (SPML) lasing based on a chirped fiber Bragg grating (CFBG) has proven to be a powerful method to generate wavelength-swept lasers at speeds of tens of megahertz. However, light transmitted through the CFBG may lead to undesirable laser oscillation that disrupts the mechanism of the laser active mode locking in the theta ring cavity. In this Letter, we demonstrate a simple and low-cost approach to suppress the transmitted light and achieve an effective duty cycle of ∼100% with only one CFBG and no need for intra-cavity semiconductor optical amplifier (SOA) modulation, extra-cavity optical buffering, and post amplification. By utilizing polarization isolation of the bi-directional CFBG, a swept laser centered at 1305 nm, with repetition rate of 10.3 MHz, optical power of 84 mW, and 3 dB bandwidth of 109 nm, is demonstrated. Ultrahigh speed 3D optical coherence tomography (OCT) structural imaging of a human palm in vivo using this swept laser is also demonstrated. We believe that this ultrahigh speed swept laser will greatly promote the OCT technique for industrial and biomedical applications.

Primary hepatic Burkitt lymphoma in a child and review of literature

BACKGROUND

Primary hepatic Burkitt lymphoma (PHBL) in children is an extremely rare hepatic malignancy with a dismal prognosis, unless it is detected and treated promptly. An 11-year-old child with abdominal pain was admitted to our hospital. No notable abnormalities were found during his physical examination or laboratory workup, but the abdominal computed tomography and magnetic resonance imaging both indicated a malignant hepatic mass measuring 9.2 × 7.1 × 7.5 cm in size. His postoperative pathology revealed an unexpected primary hepatic Burkitt lymphoma following a laparoscopic liver lobectomy. He then received rituximab and intense multi-agent chemotherapy as treatment. Despite post-chemotherapy bone marrow suppression, the patient eventually made a full recovery and had a good overall state.

CONCLUSION

In this study, we describe a rare case of pediatric primary hepatic Burkitt lymphoma and review the literature on clinical features, diagnosis, and treatment for primary hepatic Burkitt lymphoma in children. We stress that this diagnosis should be taken into account in the absence of other single hepatic lesions or primary tumors of hematological disorders, particularly when there is a normal AFP level.

Potentially migrating and residual components of biochar: Effects on phosphorus adsorption performance and storage capacity of black soil

Biochar has great potential to increase the soil nutrient storage capacity. However, with aging, biochar gradually disintegrates and releases fractions with migration potential, resulting in unknown effects on soil nutrient regulation. Based on this problem, we used ultrasound to separate original biochar (TB) into potentially migrating biochar (DB) and residual biochar (RB). The elemental composition and pore characteristics of TB, DB and RB were analyzed. Different fractions of biochar were applied to black soil, and the kinetic model and isothermal adsorption models were used to explore the adsorption characteristics of different treatments. Then, the effects of initial pH and coexisting ions on adsorption were compared. The adsorption mechanism and potential leaching process of phosphorus in soil were investigated. The results showed that RB had higher O and H contents and was less stable than TB, while RB was more aromatic. The phosphorus adsorption capacity of different treatments was SRB (1.3318 mg g^-1) > STB (1.2873 mg g^-1) > SDB (1.3025 mg g^-1) > SCK (1.1905 mg g^-1). SRB had optimal phosphorus adsorption performance and storage capacity, with a maximum adsorption capacity of 1.6741 mg g^-1 for the Langmuir isotherm, and it also showed excellent applicability in a pH gradient and with coexisting ions. The main adsorption mode of phosphorus by different treatments was monolayer chemisorption, related to electrostatic repulsion and oxygen-containing functional groups. DB was less effective in inhibiting soil phosphorus migration, with the cumulative leaching of SDB reaching 8.99 mg and the percentage of phosphorus in the 0-6 cm soil layer reaching only 15.42%. Overall, the results can help elucidate potential trends in the adsorption performance and migration process of soil phosphorus by biochar, and improve the comprehensive utilization efficiency of biochar.

Multimodal-based machine learning strategy for accurate and non-invasive prediction of intramedullary glioma grade and mutation status of molecular markers: a retrospective study

BACKGROUND

Determining the grade and molecular marker status of intramedullary gliomas is important for assessing treatment outcomes and prognosis. Invasive biopsy for pathology usually carries a high risk of tissue damage, especially to the spinal cord, and there are currently no non-invasive strategies to identify the pathological type of intramedullary gliomas. Therefore, this study aimed to develop a non-invasive machine learning model to assist doctors in identifying the intramedullary glioma grade and mutation status of molecular markers.

METHODS

A total of 461 patients from two institutions were included, and their sagittal (SAG) and transverse (TRA) T2-weighted magnetic resonance imaging scans and clinical data were acquired preoperatively. We employed a transformer-based deep learning model to automatically segment lesions in the SAG and TRA phases and extract their radiomics features. Different feature representations were fed into the proposed neural networks and compared with those of other mainstream models.

RESULTS

The dice similarity coefficients of the Swin transformer in the SAG and TRA phases were 0.8697 and 0.8738, respectively. The results demonstrated that the best performance was obtained in our proposed neural networks based on multimodal fusion (SAG-TRA-clinical) features. In the external validation cohort, the areas under the receiver operating characteristic curve for graded (WHO I-II or WHO III-IV), alpha thalassemia/mental retardation syndrome X-linked (ATRX) status, and tumor protein p53 (P53) status prediction tasks were 0.8431, 0.7622, and 0.7954, respectively.

CONCLUSIONS

This study reports a novel machine learning strategy that, for the first time, is based on multimodal features to predict the ATRX and P53 mutation status and grades of intramedullary gliomas. The generalized application of these models could non-invasively provide more tumor-specific pathological information for determining the treatment and prognosis of intramedullary gliomas.

Optical coherence tomography angiography with adaptive multi-time interval

Optical coherence tomography angiography (OCTA) can provide in vivo three-dimensional microvasculature information of bio-tissues, but it is sensitive to motion and time-consuming. To overcome these limitations, we propose an adaptive multiple time interval correlation mapping OCTA with a time-efficient scanning protocol and motion compensation algorithms. A spectral-domain OCT with a center wavelength of 850 nm, A-scan rate of 120 kHz and spatial resolution of 4.1 μm (axial) × 6.9 μm (lateral) is built to reconstruct the microvascular networks in the human arm. By adaptive optimization of the weights of different time interval B-scan angiograms, our novel OCTA technique achieves better performance with a visible vascular density increase of ~67% and a signal-to-noise ratio enhancement of ~11.6%.

Influencing factors analysis of adaptability of cancer patients to return-to-work

OBJECTIVES

To clarify the adaptability of cancer patients to return to work and explore its influencing factors.

DESIGN

A cross-sectional study.

SETTINGS/PARTICIPANTS

From March to October 2021, 283 cancer patients in the follow-up period were recruited from the oncology departments of four secondary and above hospitals and cancer friendship associations in Nantong city using self-developed scale of adaptability to return to work for cancer patients by convenience sampling method.

METHODS

The contents included general sociodemographic data, disease-related data, cancer patients' readability to work Scale, Medical Coping Style Questionnaire, Social Support Rating Scale, Family Closeness and Readability Scale, General self-efficacy Scale and Social impact Scale. Paper questionnaires were used for face-to-face data collection, and SPSS17.0 was used for statistical analysis. Univariable analyses and multiple linear regression analysis were conducted.

RESULTS

The overall score of cancer patients' adaptability to return to work was (87.05±20.255), (22.54±4.234) for the dimension of focused rehabilitation, (32.02±9.013) for the dimension of reconstruction effectiveness, and (32.49±9.023) for the dimension of adjustment planning. Multiple linear regression analysis showed that the current return to full-time work (β =0.226, P 0.05), the current return to non-full-time work (β =0.184, P 0.05), yield response (β = -0.132, P 0.05), and general self-efficacy (β =0.226, P 0.05) could affect their return to work adaptation.

CONCLUSION

The results of status quo and influencing factors showed that the adaptability of cancer patients to return to work was generally higher in this study. Cancer patients who had participated in work, had lower yield coping scores and stigma scores, and higher self-efficacy scores and family adjustment and intimacy scores had better adaptability to return to work again.

ETHICAL APPROVAL

It has been approved by the Human Research Ethics Committee of the Affiliated Hospital of Nantong University (Project No.202065).

Inhibition of mammalian target of rapamycin complex 1 in the brain microvascular endothelium ameliorates diabetic Aβ brain deposition and cognitive impairment via the sterol-regulatory element-binding protein 1/lipoprotein receptor-associated protein 1 signaling pathway

AIMS

Mammalian target of rapamycin complex 1 (mTORC1) is highly activated in diabetes, and the decrease of low-density lipoprotein receptor-associated protein 1 (LRP1) in brain microvascular endothelial cells (BMECs) is a key factor leading to amyloid-β (Aβ) deposition in the brain and diabetic cognitive impairment, but the relationship between them is still unknown.

METHODS

In vitro, BMECs were cultured with high glucose, and the activation of mTORC1 and sterol-regulatory element-binding protein 1 (SREBP1) was observed. mTORC1 was inhibited by rapamycin and small interfering RNA (siRNA) in BMECs. Betulin and siRNA inhibited SREBP1, observed the mechanism of mTORC1-mediated effects on Aβ efflux in BMECs through LRP1 under high-glucose conditions. Constructed cerebrovascular endothelial cell-specific Raptor-knockout (Raptor^fl/+ ) mice to investigate the role of mTORC1 in regulating LRP1-mediated Aβ efflux and diabetic cognitive impairment at the tissue level.

RESULTS

mTORC1 activation was observed in HBMECs cultured in high glucose, and this change was confirmed in diabetic mice. Inhibiting mTORC1 corrected the reduction in Aβ efflux under high-glucose stimulation. In addition, high glucose activated the expression of SREBP1, and inhibiting of mTORC1 reduced the activation and expression of SREBP1. After inhibiting the activity of SREBP1, the presentation of LRP1 was improved, and the decrease of Aβ efflux mediated by high glucose was corrected. Raptor^fl/+ diabetic mice had significantly inhibited activation of mTORC1 and SREBP1, increased LRP1 expression, increased Aβ efflux, and improved cognitive impairment.

CONCLUSION

Inhibiting mTORC1 in the brain microvascular endothelium ameliorates diabetic Aβ brain deposition and cognitive impairment via the SREBP1/LRP1 signaling pathway, suggesting that mTORC1 may be a potential target for the treatment of diabetic cognitive impairment.

Modified ultrasound scalpel haemorrhoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial

BACKGROUND

Haemorrhoids are common and frequently occurring diseases in the clinical setting, and severe haemorrhoids require surgical treatment. There are various surgical methods to treat haemorrhoids, but each has advantages and disadvantages. In recent years, ultrasonic scalpels have been used in haemorrhoid surgery and have achieved good results. Ultrasonic scalpel haemorrhoidectomy is safer and more effective in the surgical treatment of grade III and IV haemorrhoids, with less intraoperative bleeding, less postoperative pain, and fewer complications than diathermic therapy, electrosurgical haemorrhoidectomy, PROXIMATE® PPH haemorrhoidal circular stapler haemorrhoidopexy (PPH), and traditional haemorrhoidectomy. In previous reports, the majority of ultrasonic scalpel haemorrhoidectomies were performed as open procedures, with only the body of the haemorrhoid removed with the ultrasonic scalpel and the wound left open for drainage and natural healing. However, we performed a preliminary experiment with 12 patients who underwent open ultrasonic scalpel haemorrhoidectomy in the early stage. The results showed that 8 patients had different degrees of postoperative bleeding, and 4 of them required a second haemostatic surgery under anaesthesia. Therefore, we modified the open ultrasonic scalpel haemorrhoidectomy procedure by removing the mucosa of the internal haemorrhoid and closing the base of the incision with figure-eight penetrating sutures and designed this study protocol to evaluate its clinical efficacy and safety.

METHODS

A randomised single-blind parallel-controlled trial is proposed for this project, and patients who meet the inclusion criteria will be divided into a test group and a control group, with 39 patients in each group. The experimental group will be treated with modified ultrasonic scalpel haemorrhoidectomy, and the control group will be treated with the Milligan-Morgan operation. The effectiveness of modified ultrasonic scalpel haemorrhoidectomy for haemorrhoids will be objectively evaluated, including the incision healing time and the time for patients to return to normal activities, postoperative complications, evaluations of anal function 3 months and 6 months after surgery, an evaluation of quality of life 6 months after surgery, and an evaluation of the patient satisfaction rate 6 months after surgery. The safety assessment will consider all adverse and serious adverse events associated with the study treatment.

DISCUSSION

The study was approved by the ethics committee. The first patient was registered on July 1 2021. The purpose of this trial will be to evaluate the clinical efficacy and safety of the modified ultrasonic scalpel haemorrhoidectomy procedure for the treatment of mixed haemorrhoids and to provide an evidence base for the clinical promotion and application of the procedure. A limitation of this study is that only the patients will be single-blinded because the researchers and the patients cannot be blinded at the same time, which may produce certain bias in the results. In addition, the sample size of this study will be small, and the test results will only represent the findings from this clinical trial. In later stages, the sample size needs to be further expanded to improve the level of evidence. Despite its limitations, we hope the present study will help provide a more optimised surgical approach in the selection of haemorrhoid surgery.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (Registration ID: ChiCTR2100047229). Registered on June 11, 2021.

Identification of resection plane for anatomical liver resection using ultrasonography-guided needle insertion

Purposes

To set up an easy-handled and precise delineation of resection plane for hepatic anatomical resection (AR).

Methods

Cases of AR using ultrasonography-guided needle insertion to trace the target hepatic vein for delineation of resection planes [new technique (NT) group, n = 22] were retrospectively compared with those without implementation of this surgical technique [traditional technique (TT) group, n = 29] in terms of perioperative courses and surgical outcomes.

Results

The target hepatic vein was successfully exposed in all patients of the NT group, compared with a success rate of 79.3% in the TT group (P < 0.05). The average operation time and intraoperative blood loss were 280 ± 32 min and 550 ± 65 ml, respectively, in the NT group. No blood transfusion was required in either group. The postoperative morbidities (bile leakage and peritoneal effusion) were similar between groups. No mortality within 90 days was observed.

Conclusions

Ultrasonography-guided needle insertion is a convenient, safe and efficient surgical approach to define a resection plane for conducting AR.

Reversible Regulation of Polar Gas Molecules by Azobenzene-Based Photoswitchable Metal-Organic Framework Thin Films

The development of tunable molecule separation membranes requires materials with remote controllability and ultra-high separation capability. In this paper, a novel photoswitchable metal organic framework (MOF) thin film (Cu₂(AzoBPDC)₂) was prepared by liquid phase epitaxial layer-by-layer assembly to realize the reversible remote-controlled switching. The azobenzene side groups in the Cu₂(AzoBPDC)₂ thin film showed excellent reversible photoswitching performance under UV (365 nm) and Vis (450 nm) irradiation, achieving the remote-controlled mode of the diffusion flux of polar gas molecules in the MOF thin film.

Systemic Inflammatory Biomarkers Predict Survival of Patients Treated With Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma

OBJECTIVE

We aimed to retrospectively investigate whether the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR) can predict the prognosis of patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib or sorafenib.

METHODS

We retrospectively identified 210 patients with mRCC treated with sunitinib or sorafenib from 2007 to 2017 at Fudan University- and Hexi University-affiliated hospitals. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method. Multivariate regression analysis was used to evaluate predictors of PFS and OS.

RESULTS

Low NLR (<2.85) and MLR (<.30) were strongly associated with increased PFS and OS. Multivariable analyses verified that the NLR and MLR were both independent prognostic factors. Additionally, the NLR was negatively correlated with CD8+ and CD4+ T-cell infiltration in tumors.

CONCLUSION

In patients with mRCC treated with sunitinib and sorafenib, an NLR <2.85 and MLR <.30 was associated with superior PFS and OS, which may be related to the reduced lymphocytic infiltration of tumors.

Effect of Nano-SiO2 on Different Stages of UHMWPE/HDPE Fiber Preparation via Melt Spinning

Ultra-high molecular weight polyethylene (UHMWPE)/high-density polyethylene (HDPE) blend with lower viscosity is more suitable for melt spinning compared to pure UHMWPE; however, the mechanical property of the blend fiber is hard to dramatically improve (the maximum tensile strength of 998.27 MPa). Herein, different content modified-nano-SiO₂ is incorporated to UHMWPE/HDPE blend fiber. After adding 0.5 wt% nano-SiO₂, the tensile strength and initial modulus of UHMWPE/HDPE/nano-SiO₂ fiber are increased to 1211 MPa and 12.81 GPa, respectively, 21.57% and 43.32% higher than that of UHMWPE/HDPE fiber. Meanwhile, the influence of the nano-SiO₂ content on the performance for as-spun filament and fiber are emphatically analyzed. The crystallinity and molecular chain orientation of as-spun filament reduces with the addition of nano-SiO₂. On the contrary, for fiber, the addition of nano-SiO₂ promoted the crystallinity, molecular chain orientation and grain refinement more obvious at a lower content. Furthermore, the possible action mechanism of nano-SiO₂ in the as-spun filament extrusion and fiber hot drawing stage is explained.

Lasers treatment for traumatic facial tattoo

Effective treatment for traumatic tattoo is lacking. We aimed to compare the effectiveness and safety between Q-1064 nm laser as monotherapy and alternating Q-1064 nm laser with CO2 AFL in treating traumatic facial tattoo (black or blue color) and accompanied scars. Clinical data of 98 patients were grouped and analyzed based on the different treatment lasers. Tattoo clearance was evaluated with a 4-point scale, and scar improvement was analyzed with modified VOSAS scores. Patient satisfaction of the tattoo clearance and scar improvement, and treatment-related complications were analyzed. Significant increased clinical effects with patient satisfaction and decreased worsened scar were confirmed with the two alternated lasers, relative to those with Q-1064 nm laser alone (P < 0.05). Consequently, alternating Q-1064 nm laser and CO2 AFL treatment could be used for traumatic facial tattoo with black or blue color removal safely and effectively.

Monte Carlo-based full-wavelength simulator of Fourier-domain optical coherence tomography

Monte Carlo (MC) simulation has been widely used to study imaging procedures, including Fourier-domain optical coherence tomography (FD-OCT). Despite the broadband nature of FD-OCT, the results obtained at a single wavelength are often used in previous studies. Some wavelength-relied imaging applications, such as spectroscopic OCT (S-OCT), are unlikely to be simulated in this way due to the lack of information from the entire spectrum. Here, we propose a novel simulator for full-wavelength MC simulation of FD-OCT. All wavelengths within the emission spectrum of the light source will be simulated, and the optical properties derived from Mie theory will be applied. We further combine the inverse discrete Fourier transform (IDFT) with a probability distribution-based signal pre-processing to combat the excessive noises in the OCT signal reconstruction, which is caused by the non-uniform distribution of the scattering events at different wavelengths. Proof-of-concept simulations are conducted to show the excellent performance of the proposed simulator on signal reconstruction and optical properties extraction. Compared with the conventional method, the proposed simulator is more accurate and could better preserve the wavelength-dependent features. For example, the mean square error (MSE) computed between the backscattering coefficient extracted by the proposed simulator and the ground truth is 0.11, which is far less than the value (7.67) of the conventional method. We believe this simulator could be an effective tool to study the wavelength dependency in FD-OCT imaging as well as a preferred solution for simulating spectroscopic OCT.

Shrinking Working-Age Population and Food Demand: Evidence from Rural China

China is facing a rapidly aging population, and the proportion of the working-age population (WAP) is showing a decreasing trend. In this study, we use a two-stage budgeting quadratic almost-ideal demand system framework to estimate the distribution of food demand elasticity under different proportions of the WAP in rural China. The results show that the income elasticities of rural residents' demand for fruits and vegetables, animal products, oils and fats, and grains were 0.73, 0.65, 0.55, and 0.48, respectively. Additionally, the income elasticity of rural residents tended to increase as the household proportion of the WAP decreased. These results can provide a deeper understanding of the food consumption patterns of rural residents in China, and could be used in general or partial equilibrium models to forecast food supply and demand.

Tail artifacts removal of three-dimensional optical coherence tomography angiography with common parts extraction method

In optical coherence tomography angiography (OCTA), each blood vessel has a tail artifact. These tails of superficial vessels will shadow underlying the deep vascular images and make it difficult to reconstruct the three-dimensional (3D) image of the vessels. As 3D structure can provide much more information than two-dimensional (2D) images, it is important to develop a method to remove the artifacts. In this letter, we introduce an image processing technique based on common parts extraction to remove the artifacts. With the help of subtraction operation and erode operation, our method can reconstruct the 3D image of vascular network by extracting the common parts of adjacent B-Scan OCTA images. Vessels of palm are used as samples to experimentally demonstrate our technique. In the 3D image, we can see the interesting phenomenon that the ends of the blood vessels which close to the surface of the skin point toward the surface.

[A multicenter epidemiological study of acute bacterial meningitis in children]

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.

A miR-15a related polymorphism affects NSCLC prognosis via altering ERCC1 repair to platinum-based chemotherapy

Platinum‐based chemotherapy is regarded as a preferential curative‐intent option for non‐small cell lung cancer (NSCLC), while the acquired drug resistance has become a major obstacle that limits its clinical application. Since the repair efficiency of tumour cells to platinum‐DNA adducts plays a crucial role in chemotherapy resistance, we aimed to explore whether several meaningful polymorphisms of DNA repair genes were associated with the benefits of platinum‐based chemotherapy in NSCLC patients. Firstly, six single nucleotide polymorphisms (SNPs) located in the 3'untranslated region (3'UTR) of three DNA repair genes were detected in 246 NSCLC patients receiving platinum‐based chemotherapy and analysed the correlation of these candidate SNPs with the overall survival. Cox proportional hazard model showed that NSCLC patients carrying ERCC1 rs3212986 AA genotype had a shorter overall survival compared to those with CC. Mechanistically, we performed tumour chemosensitivity assay to observe the convincing linkage of rs3212986 polymorphism with ERCC1 expression and cisplatin sensitivity. The subsequent in vitro experiments identified that rs3212986 polymorphism altered the post‐transcriptional regulation of ERCC1 via affecting the binding of miR‐15a, and further changed the sensitivity to platinum analogue. It reminded that patients carrying ERCC1 rs3212986 CC homozygote were expected to respond better to platinum‐based chemotherapy due to a lower expression of ERCC1. Compared with previous studies, our current comprehensive study suggested that rs3212986, a 3'UTR polymorphism in ERCC1, might have clinical relevance in predicting the prognosis of NSCLC patients receiving platinum‐based chemotherapy.

Long non-coding RNA HOXB-AS1 is a prognostic marker and promotes hepatocellular carcinoma cells' proliferation and invasion

Long non-coding RNAs (lncRNAs) are broadly transcribed in the genome of human and play critical roles in the progression of multiple diseases. Long non-coding HOXB cluster antisense RNA 1 (HOXB-AS1) is a tumor exciter in various cancers. This study aimed to investigate the involvement of HOXB-AS1 in hepatocellular carcinoma (HCC). In the following study, HOXB-AS1 was unveiled to be highly expressed in HCC tissues as opposed to normal tissues. Silencing of HOXB-AS1 led to the loss of proliferation, migration, and invasiveness of HCC cells, namely Hep3B and Huh7. Moreover, the data showed that expression levels of HOXB-AS1 contribute significantly to the patient's survival rates. Otherwise, HOXB-AS1 levels in the serum of patients proved HOXB-AS1 as a biomarker for analysis and treatment of HCC. In summary, this study highlights HOXB-AS1 as key upregulated lncRNA in HCC which being an oncogene can cause proliferation and metastasis of HCC cells. The results also highlighted HOXB-AS1 as a promising biomarker for early diagnosis and prognosis of patients with HCC.

Impacts of COVID-19 on Nutritional Intake in Rural China: Panel Data Evidence

The COVID-19 pandemic introduced risks and challenges to global food and nutrition security. In this paper, we examine the impact of the COVID-19 pandemic on the nutritional intake of China’s rural residents using panel data and a fixed effects model. The data were collected in 2019 and 2020 and covered nine provinces and 2631 households in rural China. The results reveal that an increase of 100 confirmed cases in a county resulted in a 1.30% (p < 0.01), 1.42% (p < 0.01), 1.65% (p < 0.01), and 1.15% (p < 0.01) decrease in per capita intake of dietary energy, carbohydrates, fats, and proteins, respectively. Moreover, the COVID-19 pandemic had a significant and negative effect on dietary macronutrient intake in the low-income group at the 5% level of significance. Our study indicates that the potential insufficient nutrition situation, nutritional imbalance, and dietary imbalance of low-income rural residents should be addressed appropriately.

Correction: Recent developments of a co-immobilized laccase-mediator system: a review

Correction for ‘Recent developments of a co-immobilized laccase–mediator system: a review’ by Yaohua Gu et al., RSC Adv., 2021, 11, 29498–29506, https://doi.org/10.1039/D1RA05104K.

[World Health Organization guidance Ethical and Governance of Artificial Intelligence for health and implications for China]

With the explosive growth of deep learning and big data technology, artificial intelligence has penetrated into various fields of medical and health care, bringing efficient and high-quality health services to patients, but also a series of ethical and social governance issues have emerged. In order to avoid and eliminate the foreseeable ethical risks and governance challenges in the development of medical artificial intelligence, the World Health Organization (WHO) first released the Ethical and Governance of Artificial Intelligence for Health guidance on June 28, 2021, aimed to provide a framework for ethical guidelines on the deployment of artificial intelligence in clinical practice. At present, there are still shortcomings and this paper takes Healthy China 2030 agenda and the WHO guidelines as strategic ideas, and proposes to shape a consensus on the ethics of medical artificial intelligence, establish rules for human subjects and ownership of responsibilities, improve the legal and regulatory system, and determine human decision-making and moral subject status, taking into account the cultivation of interdisciplinary talents' ethical literacy and other Chinese inspirations are expected to promote the development of medical artificial intelligence ethics governance.

Interfacial Self-assembly of Organics/MXene Hybrid Cathodes Toward High-Rate-Performance Sodium Ion Batteries

Conjugated quinones are promising cathode materials for sodium-ion batteries. However, the contemporary primary conjugated quinones cathodes still hold to limited capacity, poor rate performance and low cyclability, due to the poor electronic and ionic conductivity. Herein, a series of high-performance conjugated-quinones@MXene hybrid cathodes is constructed by an in situ polymerization-assembly strategy based on the hydrogen bond and S-Ti interaction. The PAQS@Ti₃C₂T_x MXene hybrid, as a typical example, exhibits sandwiched structure with intimate PAQS@MXene contact, resulting in efficient interfacial mass transfer. The assembled MXene is able to build interconnected conductive channels in the hybrid cathodes for continuous and fast electrons/ions transport, which is verified by both the experimental results and density functional theory (DFT) calculations. As a result, the optimal PAQS@MXene hybrid electrode delivers excellent electrochemical performances with high capacity (∼242 mA h g^-1 at 100 mA g^-1), superior fast-charge/discharge ability (∼148 and 121 mA h g^-1 at 5 and 10 A g^-1, respectively), and ultralong cycle life (capacity as high as 57 mA h g^-1 after 9000 cycles at 5 A g^-1), which are more superior to that of the pure PAQS electrodes. Besides, the analogous PPTS@Ti₃C₂T_x MXene hybrid cathode also shows better performances compared to the pure materials.