Identification of nuclear membrane SUN proteins and components associated with wheat fungal stress responses.

In eukaryotes, the nuclear membrane that encapsulates genomic DNA is composed of an inner nuclear membrane (INM), an outer nuclear membrane (ONM), and a perinuclear space. SUN proteins located in the INM and KASH proteins in the ONM form the SUN-KASH NM-bridge, which functions as the junction of the nucleocytoplasmic complex junction. Proteins containing the SUN domain showed the highest correlation with differentially accumulated proteins (DAPs) in the wheat response to fungal stress. To understand the characteristics of SUN and its associated proteins in wheat responding to pathogen stress, here we investigated and comprehensive analyzed SUN- and KASH-related proteins among the DAPs under fungi infection based on their conserved motifs. In total, four SUN proteins, one WPP domain-interacting protein (WIP), four WPP domain-interacting tail-anchored proteins (WIT), two WPP proteins and one Ran GTPase activating protein (RanGAP) were identified. Following transient expression of Nicotiana benthamiana, TaSUN2, TaRanGAP2, TaWIT1 and TaWIP1 were identified as nuclear membrane proteins, while TaWPP1 and TaWPP2 were expressed in both the nucleus and cell membrane. RT-qPCR analysis demonstrated that the transcription of TaSUN2, TaRanGAP2 and TaWPP1 were strongly upregulated in response to fungal infection. Furthermore, using the bimolecular fluorescence complementation, the luciferase complementation and a nuclear and split-ubiquitin-based membrane yeast two-hybrid systems, we substantiated the interaction between TaSUN2 and TaWIP1, as well as TaWIP1/WIT1 and TaWPP1/WPP2. Silencing of TaSUN2, TaRanGAP2 and TaWPP1 in wheat leaves promoted powdery mildew infection and hyphal growth, and reduced the expression of TaBRI1, TaBAK1 and Ta14-3-3, indicating that these NM proteins play a positive role in resistance to fungal stress. Our study reveals the characteristics of NM proteins and propose the preliminary construction of SUN-WIP-WPP-RanGAP complex in wheat, which represents a foundation for detail elucidating their functions in wheat in future.

Ion channel-mediated mitochondrial volume regulation and its relationship with mitochondrial dynamics.

The mitochondrion, one of the important cellular organelles, has the major function of generating adenosine triphosphate and plays an important role in maintaining cellular homeostasis, governing signal transduction, regulating membrane potential, controlling programmed cell death and modulating cell proliferation. The dynamic balance of mitochondrial volume is an important factor required for maintaining the structural integrity of the organelle and exerting corresponding functions. Changes in the mitochondrial volume are closely reflected in a series of biological functions and pathological changes. The mitochondrial volume is controlled by the osmotic balance between the cytoplasm and the mitochondrial matrix. Thus, any disruption in the influx of the main ion, potassium, into the cells can disturb the osmotic balance between the cytoplasm and the matrix, leading to water movement between these compartments and subsequent alterations in mitochondrial volume. Recent studies have shown that mitochondrial volume homeostasis is closely implicated in a variety of diseases. In this review, we provide an overview of the main influencing factors and research progress in the field of mitochondrial volume homeostasis.

Validation of administrative claims to identify ultrasound enhancing agent use.

BACKGROUND: Ultrasound enhancing agents (UEAs) are an invaluable adjunct to stress and transthoracic echocardiography (STE) to improve left ventricular visualization. Despite multiple single center studies evaluating UEA use, investigation into the rates, sources of variation, and outcomes of UEA use on a national level in the United States (US) has been limited by lack of validation of UEA codes for claims analyses. METHODS: We conducted a retrospective cross-sectional study, 2019-2022, using linked multicenter electronic medical record (EMR) data from > 30 health systems linked to all-payor claims data representing > 90% of the US population. Individuals receiving STE in both EMR and claims data on the same day during the study window were included. UEA receipt as identified by presence of a Current Procedural Terminology (CPT) or National Drug Code (NDC) for UEA use within 1-day of the index STE event. We evaluated the performance of claims to identify UEA use, using EMR data as the gold standard, stratified by inpatient and outpatient status. RESULTS: Amongst 54,525 individuals receiving STE in both EMR and claims data, 12,853 (23.6%) had a UEA claim in EMR, 10,461 (19.2%) had a UEA claim in claims, and 9140 (16.8%) had a UEA claim in both within the 1-day window. The sensitivity, specificity, accuracy, positive, and negative predictive values for UEA claims were 71.1%, 96.8%, 90.8%, 87.4%. and 91.6% respectively. However, amongst inpatients, the sensitivity of UEA claims was substantially lower (6.8%) compared to outpatients (79.7%). CONCLUSIONS: While the overall accuracy of claims to identify UEA use was high, there was substantial under-capture of UEA use by claims amongst inpatients. These results call into question published rates of UEA use amongst inpatients in studies using administrative claims, and highlight ongoing need to improve inpatient coding for UEA use.

Profiling dynamics of the Southeast Asia's largest lake, Tonle Sap Lake.

Lakes, as vital components of the Earth's ecosystem with crucial roles in global biogeochemical cycles, are experiencing pervasive and irreparable worldwide losses due to natural factors and intensive anthropogenic interferences. In this study, we investigated the long-term dynamic patterns of the Tonle Sap Lake, the largest freshwater lake in the Mekong River Basin, using a series of hydrological data and remote sensing images between 2000 and 2020. Our findings revealed a significant decline in the annual average water level of the lake by approximately 2.1 m over 20 years, accompanied by an annual average reduction in surface area of about 1400 km2. The Tonle Sap Lake exhibited episodic declines in water level and surface area, characterized by the absence of flooding during the flood season and increasing aridity during the dry season. Furthermore, the shoreline of the lake has significantly advanced towards the lake in the northwestern and southern regions during the dry season, primarily due to sedimentation-induced shallowing of the lake edge depth and decreased water levels. In contrast, lake shorelines in the eastern region remained relatively stable due to the constructed embankments for the protection of the cultivated farmland. While the seasonal fluctuations of the Tonle Sap Lake are regulated by regional precipitation in the Mekong River Basin, the prolonged shrinking of the lake can be mainly ascribed to intensive anthropogenic activities. The interception of dams along the upper Mekong River has resulted in a decrease in the inflow to Tonle Sap Lake, exacerbating its shrinkage. Moreover, there are minor impacts from agricultural land expansion and irrigation on the lake. This study highlights the driving forces behind the evolution of Tonle Sap Lake, providing valuable information for lake managers to develop strategies aimed at conserving and restoring the ecological integrity of the Tonle Sap Lake.

Systemic Type 2 Inflammation-Associated Atopic Dermatitis Exacerbates Periodontitis.

INTRODUCTION: Atopic dermatitis (AD) is a prevalent and chronic inflammatory skin disease characterized by Th2 cell-mediated type 2 inflammation. Emerging evidence indicated that AD patients exhibit an increased incidence of oral disorders. In the present study, we sought mechanistic insights into how AD affects periodontitis. METHODS: Onset of AD was induced by 2,4-dinitrochlorobenzene (DNCB). Furthermore, we induced periodontitis (P) in AD mice. The effect of AD in promoting inflammation and bone resorption in gingiva was evaluated. Hematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, immunofluorescence assay, and flow cytometry were used to investigate histomorphology and cytology analysis, respectively. RNA sequencing of oral mucosa is used tissues to further understand the dynamic transcriptome changes. 16S rRNA microbial analysis is used to profile oral microbial composition. RESULTS: Compared to control group, mice in AD group showed inflammatory signatures and infiltration of a proallergic Th2 (Th2A)-like subset in oral mucosa but not periodontitis, as identified by not substantial changes in mucosa swelling, alveolar bone loss, and TRAP+ osteoclasts infiltration. Similarly, more Th2A-like cell infiltration and interleukin-4 levels were significantly elevated in the oral mucosa of DNCB-P mice compared to P mice. More importantly, AD exacerbates periodontitis when periodontitis has occurred and the severity of periodontitis increased with aggravation of dermatitis. Transcriptional analysis revealed that aggravated periodontitis was positively correlated with more macrophage infiltration and abundant CCL3 secreted. AD also altered oral microbiota, indicating the re-organization of extracellular matrix. CONCLUSIONS: These data provide solid evidence about exacerbation of periodontitis caused by type 2 dermatitis, advancing our understanding in cellular and microbial changes during AD-periodontitis progression.

CCR2 is a potential therapeutic target in peri-implantitis.

AIM: CCR2 (C-C chemokine receptor type 2) plays a crucial role in inflammatory and bone metabolic diseases; however, its role in peri-implantitis remains unclear. This study aimed to explore whether CCR2 contributes to peri-implantitis and the treatment effects of cenicriviroc (CVC) on peri-implant inflammation and bone resorption. MATERIALS AND METHODS: The expression of CCR2 was studied using clinical tissue analysis and an in vivo peri-implantitis model. The role of CCR2 in promoting inflammation and bone resorption in peri-implantitis was evaluated in Ccr2-/- mice and wild-type mice. The effect of CVC on peri-implantitis was evaluated using systemic and local dosage forms. RESULTS: Human peri-implantitis tissues showed increased CCR2 and CCL2 levels, which were positively correlated with bone loss around the implants. Knocking out Ccr2 in an experimental model of peri-implantitis resulted in decreased monocyte and macrophage infiltration, reduced pro-inflammatory cytokine generation and impaired osteoclast activity, leading to reduced inflammation and bone loss around the implants. Treatment with CVC ameliorated bone loss in experimental peri-implantitis. CONCLUSIONS: CCR2 may be a potential target for peri-implantitis treatment by harnessing the immune-inflammatory response to modulate the local inflammation and osteoclast activity.

Biochar and soil properties affect remediation of Zn contamination by biochar: A global meta-analysis.

Zinc (Zn) is one of the most common heavy metals that pollute soils and can threaten both environmental and human health. Biochar is a potential solution for remediating soil Zn contamination. This meta-analysis investigates the effect of biochar application on the remediation of Zn-contaminated soils and the factors affecting the remediation efficiency. We found that biochar application in Zn-contaminated soils reduced Zn bioavailability by up to 77.2% in urban soils, 55.1% in acidic soils, and 50.8% in coarse textured soils. Moreover, the remediation efficiency depends on the biochar production condition, with crop straw and sewage sludge feedstocks, high pyrolysis temperature (450-550 °C), low heating rate (<10 °C min-1), and short residence time (<180 min) producing high performing biochars. Biochar affects soil Zn bioavailability by changing soil pH and organic carbon, as well as through its high surface area, ash content, and O-containing surface functional groups. Our findings highlight the role of biochar as a promising and environmentally friendly material for remediating Zn contamination in acidic and/or coarse textured soils. We conclude that soil properties must be considered when selecting biochars for remediating soil Zn contamination.

Virus-like Particle Vaccines of Infectious Bursal Disease Virus Expressed in Escherichia coli Are Highly Immunogenic and Protect against Virulent Strain.

OBJECTIVES: Infectious bursal disease virus (IBDV) is a highly contagious, acutely infectious agent that causes immunosuppression in chickens. We expressed IBDV VP2 proteins in Escherichia coli (E. coli) to develop an effective virus-like-particles (VLPs) vaccine and evaluated its immunogenicity. METHODS: The VLPs produced in E. coli were used as an immunogen mixed with a water-in-mineral-oil adjuvant (MontanideTM ISA 71 VG, ISA 71 RVG) or a white oil (7#) adjuvant. VLPs without an adjuvant, commercial subunit vaccine, inactivated vaccine, and attenuated vaccine were used as controls. These test vaccines were intramuscularly injected into 19-day-old SPF chickens, which were challenged with the IBDV virulent strain at 30 days after vaccination. RESULTS: The adjuvants boosted antibody production, and the adjuvant groups (except white oil) produced higher antibody levels than the non-adjuvanted controls and the commercial vaccine groups. In terms of cellular immunity, the VLPs plus adjuvant combinations produced higher levels of cytokines, IL-2, IL-4, and IFN-γ than the controls. CONCLUSION: IBDV VLPs plus the ISA 71 RVG adjuvant can be used as an optimal vaccine combination for improving the immune efficacy of IBD subunit vaccines, which can protect against the virulent strain.

CCL2 is a key regulator and therapeutic target for periodontitis.

AIM: Our previous study revealed that the C-C motif chemokine receptor 2 (CCR2) is a promising target for periodontitis prevention and treatment. However, CCR2 is a receptor with multiple C-C motif chemokine ligands (CCLs), including CCL2, CCL7, CCL8, CCL13 and CCL16, and which of these ligands plays a key role in periodontitis remains unclear. The aim of the present study was to explore the key functional ligand of CCR2 in periodontitis and to evaluate the potential of the functional ligand as a therapeutic target for periodontitis. MATERIALS AND METHODS: The expression levels and clinical relevance of CCR2, CCL2, CCL7, CCL8, CCL13 and CCL16 were studied using human samples. The role of CCL2 in periodontitis was evaluated by using CCL2 knockout mice and overexpressing CCL2 in the periodontium. The effect of local administration of bindarit in periodontitis was evaluated by preventive and therapeutic medication in a mouse periodontitis model. Microcomputed tomography, haematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, real-time quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, bead-based immunoassays and flow cytometry were used for histomorphology, molecular biology and cytology analysis. RESULTS: Among different ligands of CCR2, only CCL2 was significantly up-regulated in periodontitis gingival tissues and was positively correlated with the severity of periodontitis. Mice lacking CCL2 showed milder inflammation and less bone resorption than wild-type mice, which was accompanied by a reduction in monocyte/macrophage recruitment. Adeno-associated virus-2 vectors overexpressing CCL2 in Ccl2-/- mice gingiva reversed the attenuation of periodontitis in a CCR2-dependent manner. In ligation-induced experimental periodontitis, preventive or therapeutic administration of bindarit, a CCL2 synthesis inhibitor, significantly inhibited the production of CCL2, decreased the osteoclast number and bone loss and reduced the expression levels of proinflammatory cytokines TNF-α, IL-6 and IL-1ß. CONCLUSIONS: CCL2 is a pivotal chemokine that binds to CCR2 during the progression of periodontitis, and targeting CCL2 may be a feasible option for controlling periodontitis.

Staying Home, Tweeting Hope: Mixed Methods Study of Twitter Sentiment Geographical Index During US Stay-At-Home Orders.

BACKGROUND: Stay-at-home orders were one of the controversial interventions to curb the spread of COVID-19 in the United States. The stay-at-home orders, implemented in 51 states and territories between March 7 and June 30, 2020, impacted the lives of individuals and communities and accelerated the heavy usage of web-based social networking sites. Twitter sentiment analysis can provide valuable insight into public health emergency response measures and allow for better formulation and timing of future public health measures to be released in response to future public health emergencies. OBJECTIVE: This study evaluated how stay-at-home orders affect Twitter sentiment in the United States. Furthermore, this study aimed to understand the feedback on stay-at-home orders from groups with different circumstances and backgrounds. In addition, we particularly focused on vulnerable groups, including older people groups with underlying medical conditions, small and medium enterprises, and low-income groups. METHODS: We constructed a multiperiod difference-in-differences regression model based on the Twitter sentiment geographical index quantified from 7.4 billion geo-tagged tweets data to analyze the dynamics of sentiment feedback on stay-at-home orders across the United States. In addition, we used moderated effects analysis to assess differential feedback from vulnerable groups. RESULTS: We combed through the implementation of stay-at-home orders, Twitter sentiment geographical index, and the number of confirmed cases and deaths in 51 US states and territories. We identified trend changes in public sentiment before and after the stay-at-home orders. Regression results showed that stay-at-home orders generated a positive response, contributing to a recovery in Twitter sentiment. However, vulnerable groups faced greater shocks and hardships during the COVID-19 pandemic. In addition, economic and demographic characteristics had a significant moderating effect. CONCLUSIONS: This study showed a clear positive shift in public opinion about COVID-19, with this positive impact occurring primarily after stay-at-home orders. However, this positive sentiment is time-limited, with 14 days later allowing people to be more influenced by the status quo and trends, so feedback on the stay-at-home orders is no longer positively significant. In particular, negative sentiment is more likely to be generated in states with a large proportion of vulnerable groups, and the policy plays a limited role. The pandemic hit older people, those with underlying diseases, and small and medium enterprises directly but hurt states with cross-cutting economic situations and more complex demographics over time. Based on large-scale Twitter data, this sociological perspective allows us to monitor the evolution of public opinion more directly, assess the impact of social events on public opinion, and understand the heterogeneity in the face of pandemic shocks.

[Effects of Low-density Polyethylene Microplastics on the Growth and Physiology Characteristics of Ipomoea aquatica Forsk].

Microplastic pollution in soil and its toxicological effects have attracted increasing attention from researchers, but the mechanisms of microplastics affecting crop growth and physiology remain unclear. A pot experiment was conducted to evaluate the impacts of various mass concentrations (0%, 0.2%, 5%, and 10%) of low-density polyethylene microplastics (LDPE MPs) on the germination rate, photosynthetic pigment content, biomass, antioxidant enzyme activity, soluble protein, and soluble sugar content of water spinach (Ipomoea aquatica Forsk). The results showed that LDPE MPs significantly inhibited (P<0.05) the seed vigor of water spinach, and the inhibitory effect increased with increasing concentration of LDPE MPs. However, the 5% LDPE MPs significantly promoted the aboveground biomass of water spinach. The 0.2% and 10% LDPE MPs significantly improved the superoxide dismutase (SOD) activity and catalase (CAT) and peroxidase (POD) activities, respectively. Further, malondialdehyde (MDA) content decreased with increasing concentration of LDPE MPs, and the reductions reached 15.53%-27.39% in comparison to that in the control. The LDPE MPs also significantly increased the soluble sugar content of water spinach leaves. In summary, LDPE MPs could inhibit the seed vigor and promote biomass accumulation in water spinach. Water spinach could relieve the oxidative stress caused by LDPE MPs by regulating antioxidant enzyme activity and soluble protein content. Therefore, this study may provide basic information for assessing the influences of microplastics on vegetables.

Highly sensitive droplet digital PCR for detection of RET fusion in papillary thyroid cancer.

BACKGROUND: Thyroid cancer is the most frequent malignancy of the endocrine system, of which papillary thyroid cancer (PTC) is the predominant form with a rapid increasing incidence worldwide. Rearranged during transfection (RET) fusions are common genetic drivers of PTC and the potent RET inhibitor selpercatinib has been recently approved for treating advanced or metastatic RET fusion-positive thyroid cancer. In this study we aimed to develop a droplet digital PCR (ddPCR) system to accurately detect RET fusion in PTC samples. METHODS: The frequency and distribution of RET fusions in PTC were analyzed using genomic data of 402 PTC patients in The Cancer Genome Atlas (TCGA) database. To establish the ddPCR system for detecting CCDC6::RET fusion, a plasmid containing CCDC6::RET infusion fragment was constructed as standard template, the annealing temperature and concentrations of primers and probe were optimized. The analytical performance of ddPCR and quantitative reverse transcription PCR (qRT-PCR) were assessed in standard templates and tissue samples from 112 PTC patients. Sanger sequencing was performed in all the RET fusion-positive samples identified by ddPCR. RESULTS: RET fusions were observed in 25 (6.2%) of the 402 TCGA samples, and 15 (60%) of the RET fusion-positive patients had the CCDC6::RET fusion. Compared with qRT-PCR, the ddPCR method showed a lower limit of detection (128.0 and 430.7 copies/reaction for ddPCR and qRT-PCR, respectively). When applying the two methods to 112 tissue samples of PTC, eleven (9.8%) CCDC6::RET fusion-positive samples were detected by qRT-PCR, while ddPCR identified 4 additional positive samples (15/112, 13.4%). All the CCDC6::RET fusion-positive cases identified by ddPCR were confirmed by Sanger sequencing except for one case with 0.14 copies/uL of the fusion. CONCLUSION: The accurate and sensitive ddPCR method reported here is powerful to detection CCDC6::RET fusion in PTC samples, application of this method would benefit more RET fusion-positive patients in the clinic.

Joint Cancer Segmentation and PI-RADS Classification on Multiparametric MRI Using MiniSegCaps Network.

MRI is the primary imaging approach for diagnosing prostate cancer. Prostate Imaging Reporting and Data System (PI-RADS) on multiparametric MRI (mpMRI) provides fundamental MRI interpretation guidelines but suffers from inter-reader variability. Deep learning networks show great promise in automatic lesion segmentation and classification, which help to ease the burden on radiologists and reduce inter-reader variability. In this study, we proposed a novel multi-branch network, MiniSegCaps, for prostate cancer segmentation and PI-RADS classification on mpMRI. MiniSeg branch outputted the segmentation in conjunction with PI-RADS prediction, guided by the attention map from the CapsuleNet. CapsuleNet branch exploited the relative spatial information of prostate cancer to anatomical structures, such as the zonal location of the lesion, which also reduced the sample size requirement in training due to its equivariance properties. In addition, a gated recurrent unit (GRU) is adopted to exploit spatial knowledge across slices, improving through-plane consistency. Based on the clinical reports, we established a prostate mpMRI database from 462 patients paired with radiologically estimated annotations. MiniSegCaps was trained and evaluated with fivefold cross-validation. On 93 testing cases, our model achieved a 0.712 dice coefficient on lesion segmentation, 89.18% accuracy, and 92.52% sensitivity on PI-RADS classification (PI-RADS ≥ 4) in patient-level evaluation, significantly outperforming existing methods. In addition, a graphical user interface (GUI) integrated into the clinical workflow can automatically produce diagnosis reports based on the results from MiniSegCaps.

Investigation on the quality regulating mechanism of antifreeze peptides on frozen surimi: From macro to micro.

Freeze denaturation of protein caused by ice crystals is the main motivation for the quality deterioration of surimi during circulation and storage. This investigation aimed to cryoprotect surimi by adding antifreeze peptides from Takifugu obscurus skin (TsAFP) which can inhibit ice recrystallization, and to elucidate regulating mechanism. The comprehensive results showed that 4% TsAFP, half dosage of commercial cryoprotectant, had good cryoprotection on surimi by reducing the moisture variation and maintaining protein solubility of surimi at macro level, as well as inhibiting the degeneration and structure changes of myofibrillar proteins at micro level. Meanwhile, TsAFP could directly bind to the structural cavity of myosin, inhibit protein freezing-induced oxidation, maintain the spatial structure of myosin and water retention ability to preserve the surimi quality. This study helped better comprehend the protective mechanisms of antifreeze peptides in frozen surimi and was expected to provide a promising cryoprotectant for low-sweetness and low-calorie surimi.

Clinical Significance of a Circulating Tumor Cell-based Classifier in Stage IB Lung Adenocarcinoma: A Multicenter, Cohort Study.

OBJECTIVE: To investigate the effectiveness of a CTC-based classifier in stratifying stage IB LUAD. SUMMARY OF BACKGROUND DATA: Stage IB LUADs have an approximately 70% 5-year survival rate. The clinical application of ACT is controversial due to inconsistent results in a series of trials and few useful guide biomarkers. Thus, there is a pressing need for robust biomarkers to stratify stage IB patients to define which group would most likely benefit from ACT. Methods: Two hundred twelve stage IB LUAD patients were enrolled and were divided into 3 independent cohorts. The aptamer-modified NanoVelcro system was used to enrich the CTCs. RESULTS: A cutoff of <4 or >4 CTCs as the optimal prognostic threshold for stage IB LUAD was generated to stratify the patients in a 70-patient cohort into low-risk and high-risk groups. Patients with ≥ 4 CTCs in the training cohort had shorter progression-free survival ( P < 0.0001) and overall survival ( P < 0.0001) than patients with <4 CTCs. CTC number remained the strongest predictor of progression-free survival and overall survival even in a multivariate analysis including other clinicopathological parameters. Furthermore, a nomogram based on the CTC count was developed to predict the 3-year and 5-year survival in the training cohort and performed well in the other 2 validation cohorts (C-index: 0.862, 0.853, and 0.877). CONCLUSION: The presence of >4 CTCs can define a high-risk subgroup, providing a new strategy to make optimal clinical decisions for stage IB LUAD.

Parental involvement in postoperative pain management among children in a urology ward: A best practice implementation project.

AIM: Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence-based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. DESIGN: The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence-Based Nursing Center's Evidence-based Continuous Quality Improvement Model. METHODS: Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre-implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence-based interventions implemented to improve compliance. A follow-up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. RESULTS: At the baseline audit, compliance with the evidence-based criteria was 0%-71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow-up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. PATIENT OR PUBLIC CONTRIBUTION: This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

Analysis of the factors and moderating role of self-care ability among patients with breast cancer-related lymphedema.

AIMS AND OBJECTIVES: To analyse the status quo and influencing factors of self-care ability in breast cancer-related lymphedema (BCRL) patients and explore the moderating role of social support between self-efficacy and self-care ability, to provide references for clinical intervention. BACKGROUND: The 'gold standard' for the treatment of lymphedema is two-stage Complete Decongestion Therapy (CDT). Due to the high frequency of patients seeking treatment and CDT is not covered by medical insurance, resulting the medical cost is high, and a set integrated course of edema treatment cannot be completed. Nevertheless, with sufficient self-care ability, patients can reduce the frequency of outpatient and inpatient treatments, and initiate detumescence procedures with affordable home care. Accordingly, it is necessary to pay attention to the self-care ability of BCRL patients. DESIGN: A descriptive and cross-sectional study following the STROBE guideline checklist. METHODS: From June 2021 to January 2022, 156 BCRL patients were selected as convenience samples. Questionnaires were administered to the patients using the sociodemographic information questionnaire, the exercise of self-care agency scale, Chinese version of strategies used by people to promote health, and social support rating scale. Spearman rank correlation was used to analyse the relationship among the three, and univariate and multiple linear regression were used for factor analysis and process to explore the moderating role of social support. RESULTS: The total score of self-care ability of BCRL patients was 41.00 (32.50, 51.00). The self-efficacy and social support of BCRL patients were positively correlated with the total score and its dimensions of self-care ability. Disease duration, severity and difficulty raising limbs were negative correlation factors influencing the self-care ability of BCRL patients, and self-efficacy and social support were positive correlation factors, which could explain 77.8% of the total variation. The moderating role of social support between self-efficacy and self-care ability was significant, and its moderating role boundary value was 15.70. CONCLUSIONS: The self-care ability of BCRL patients is at a low level. The longer duration of lymphedema, the more serious degree of edema, the more difficulty raising limbs, the lower self-efficacy and the less social support, the poorer self-care ability of BCRL patients. Self-efficacy has a greater impact on the self-care ability of patients with high levels of social support. RELEVANCE TO CLINICAL PRACTICE: Factors and moderator-based models are the first to identify predictors of self-care ability and the moderating role of social support in Chinese BCRL patients, which may facilitate healthcare practitioners to develop appropriate interventions to manage self-care ability.

Complex torcular dural arteriovenous fistula leading to cortical venous reflux-induced severe varix and subsequent bilateral cerebral hemispheric hemorrhage: a case report.

Background and importance: Dural arteriovenous fistulas (dAVFs) with cortical venous reflux (CVR) are associated with a higher incidence of intracranial hemorrhage (ICH). We report a rare case of a complex torcular dAVF with severe cortical veins (CV) varix leading to extensive bilateral cerebral hemorrhages. This discovery suggests a potential new subtype of dAVF. The case underscores the necessity of a comprehensive understanding of hemodynamic changes in dAVFs and the importance of considering venous compensatory capacity in treatment. This case challenges existing classifications and treatment strategies for dAVFs, highlighting the need for further research and discussion within the neurosurgical community. Clinical presentation: A 56-year-old male was admitted to the hospital presenting with dizziness, fatigue, and numbness. Brain CT scans revealed extensive bilateral cerebral hemorrhages. Digital subtraction angiography (DSA) identified a complex torcular dAVF. No cerebral sinus venous thrombosis was detected, but a venous variation in the left transverse sinus was observed. Preoperative DSA demonstrated the patient's well-developed venous compensatory ability. Subsequently, the patient underwent transarterial embolization. The patient made a good recovery. Follow-up DSA and MR angiography at 3 months and 1 year post-treatment showed no recurrence. Conclusion: DAVFs are rare lesions, prone to ICH, particularly when CVR is involved. We report a rare case of CVR with severe varix leading to hemorrhagic lesions in both cerebral hemispheres. Our aim is to alert neurosurgical colleagues worldwide to this potential new subtype and to evaluate treatment options, in order to assist those who may encounter such cases in the future.

Integrated analysis of the salivary microbiome and metabolome in chronic and aggressive periodontitis: A pilot study.

This pilot study was designed to identify the salivary microbial community and metabolic characteristics in patients with generalized periodontitis. A total of 36 saliva samples were collected from 13 patients with aggressive periodontitis (AgP), 13 patients with chronic periodontitis (ChP), and 10 subjects with periodontal health (PH). The microbiome was evaluated using 16S rRNA gene high-throughput sequencing, and the metabolome was accessed using gas chromatography-mass spectrometry. The correlation between microbiomes and metabolomics was analyzed by Spearman's correlation method. Our results revealed that the salivary microbial community and metabolite composition differed significantly between patients with periodontitis and healthy controls. Striking differences were found in the composition of salivary metabolites between AgP and ChP. The genera Treponema, Peptococcus, Catonella, Desulfobulbus, Peptostreptococcaceae_[XI] ([G-2], [G-3] [G-4], [G-6], and [G-9]), Bacteroidetes_[G-5], TM7_[G-5], Dialister, Eikenella, Fretibacterium, and Filifactor were present in higher levels in patients with periodontitis than in the healthy participants. The biochemical pathways that were significantly different between ChP and AgP included pyrimidine metabolism; alanine, aspartate, and glutamate metabolism; beta-alanine metabolism; citrate cycle; and arginine and proline metabolism. The differential metabolites between ChP and AgP groups, such as urea, beta-alanine, 3-aminoisobutyric acid, and thymine, showed the most significant correlations with the genera. These differential microorganisms and metabolites may be used as potential biomarkers to monitor the occurrence and development of periodontitis through the utilization of non-invasive and convenient saliva samples. This study reveals the integration of salivary microbial data and metabolomic data, which provides a foundation to further explore the potential mechanism of periodontitis.