Patient Autonomy in Medical Education: Navigating Ethical Challenges in the Age of Artificial Intelligence.

The increasing integration of Artificial Intelligence (AI) in the medical domain signifies a transformative era in healthcare, with promises of improved diagnostics, treatment, and patient outcomes. However, this rapid technological progress brings a concomitant surge in ethical challenges permeating medical education. This paper explores the crucial role of medical educators in adapting to these changes, ensuring that ethical education remains a central and adaptable component of medical curricula. Medical educators must evolve alongside AI's advancements, becoming stewards of ethical consciousness in an era where algorithms and data-driven decision-making play pivotal roles in patient care. The traditional paradigm of medical education, rooted in foundational ethical principles, must adapt to incorporate the complex ethical considerations introduced by AI. This pedagogical approach fosters dynamic engagement, cultivating a profound ethical awareness among students. It empowers them to critically assess the ethical implications of AI applications in healthcare, including issues related to data privacy, informed consent, algorithmic biases, and technology-mediated patient care. Moreover, the interdisciplinary nature of AI's ethical challenges necessitates collaboration with fields such as computer science, data ethics, law, and social sciences to provide a holistic understanding of the ethical landscape.

Perceived vulnerability to disease and children's COVID behavioral response: The role of health consciousness and family financial status.

This study investigated the impact of family financial status on Chinese children's health-related traits and their behavior in controlling COVID-19. When the children were 7 years old, their guardians provided information on family financial status. When the children reached 10 years old, they completed questionnaires concerning their own health consciousness and health status. At age 11, during the COVID-19 pandemic in 2020, they filled out questionnaires on perceived vulnerability to disease and disease control behavior. The findings revealed that higher health consciousness is associated with better health, particularly among children from financially challenged families. Additionally, a greater perception of vulnerability to disease is linked to increased COVID-19 control behaviors, particularly in children with high health consciousness in affluent families. These results contribute to our understanding of how children's personal health-related traits and family financial status interact to shape their response to the COVID-19 pandemic.

Improved Thoracoscopic-Assisted Surgery for the Treatment of Metastatic Thoracic Vertebral Tumors.

The significant progress made in the diagnosis and treatment of malignant tumors has led to improved patient survival rates. However, the metastatic spread of these tumors to the thoracic vertebrae remains a significant challenge, often resulting in bone-related adverse events, such as pathological fractures and severe complications. To address this issue, a refined multidisciplinary approach has been explored, which utilizes thoracoscopic techniques for tumor resection and spinal interventions. Thoracoscopic techniques offer a minimally invasive alternative to traditional open surgical methods, aiming to reduce the overall trauma experienced by patients. By leveraging the advantages of thoracoscopy, clinicians can effectively resect metastatic tumors within the thoracic vertebrae while minimizing the impact on surrounding tissues and structures. This approach, combined with targeted spinal interventions, has the potential to improve patient outcomes and quality of life by mitigating the debilitating effects of pathological fractures and other complications associated with metastatic bone disease. The implementation of this multidisciplinary strategy, incorporating thoracoscopic tumor resection and spinal interventions, represents a promising avenue for the management of metastatic tumors within the thoracic vertebrae. Further research and clinical evaluation are necessary to fully elucidate the long-term benefits and establish the optimal treatment protocols for this patient population, ultimately enhancing the care and outcomes for individuals afflicted by this challenging condition.

Insights into the role of electrochemical stimulation on sulfur-driven biodegradation of antibiotics in wastewater treatment.

The presence of antibiotics in wastewater poses significant threat to our ecosystems and health. Traditional biological wastewater treatment technologies have several limitations in treating antibiotic-contaminated wastewaters, such as low removal efficiency and poor process resilience. Here, a novel electrochemical-coupled sulfur-mediated biological system was developed for treating wastewater co-contaminated with several antibiotics (e.g., ciprofloxacin (CIP), sulfamethoxazole (SMX), chloramphenicol (CAP)). Superior removal of CIP, SMX, and CAP with efficiencies ranging from 40.6 ± 2.6 % to 98.4 ± 1.6 % was achieved at high concentrations of 1000 µg/L in the electrochemical-coupled sulfur-mediated biological system, whereas the efficiencies ranged from 30.4 ± 2.3 % to 98.2 ± 1.4 % in the control system (without electrochemical stimulation). The biodegradation rates of CIP, SMX, and CAP increased by 1.5∼1.9-folds under electrochemical stimulation compared to the control. The insights into the role of electrochemical stimulation for multiple antibiotics biodegradation enhancement was elucidated through a combination of metagenomic and electrochemical analyses. Results showed that sustained electrochemical stimulation significantly enriched the sulfate-reducing and electroactive bacteria (e.g., Desulfobulbus, Longilinea, and Lentimicrobiumin on biocathode and Geobactor on bioanode), and boosted the secretion of electron transport mediators (e.g., cytochrome c and extracellular polymeric substances), which facilitated the microbial extracellular electron transfer processes and subsequent antibiotics removal in the sulfur-mediated biological system. Furthermore, under electrochemical stimulation, functional genes associated with sulfur and carbon metabolism and electron transfer were more abundant, and the microbial metabolic processes were enhanced, contributing to antibiotics biodegradation. Our study for the first time demonstrated that the synergistic effects of electrochemical-coupled sulfur-mediated biological system was capable of overcoming the limitations of conventional biological treatment processes. This study shed light on the mechanism of enhanced antibiotics biodegradation via electrochemical stimulation, which could be employed in sulfur-mediated bioprocess for treating antibiotic-contaminated wastewaters.

MeCP2 deficiency alters the response selectivity of prefrontal cortical neurons to different social stimuli.

Rett syndrome (RTT), a severe neurodevelopmental disorder caused by mutations in the MeCP2 gene, is characterized by cognitive and social deficits. Previous studies have noted hypoactivity in the medial prefrontal cortex (mPFC) pyramidal neurons of MeCP2-deficient mice (RTT mice) in response to both social and nonsocial stimuli. To further understand the neural mechanisms behind the social deficits of RTT mice, we monitored excitatory pyramidal neurons in the prelimbic region of the mPFC during social interactions in mice. These neurons' activity was closely linked to social preference, especially in wild-type mice. However, RTT mice showed reduced social interest and corresponding hypoactivity in these neurons, indicating that impaired mPFC activity contributes to their social deficits. We identified six mPFC neural ensembles selectively tuned to various stimuli, with RTT mice recruiting fewer neurons to ensembles responsive to social interactions and consistently showing lower stimulus-ON ensemble transient rates. Despite these lower rates, RTT mice exhibited an increase in the percentage of social-ON neurons in later sessions, suggesting a compensatory mechanism for the decreased firing rate. This highlights the limited plasticity in the mPFC caused by MeCP2 deficiency and offers insights into the neural dynamics of social encoding. The presence of multifunctional neurons and those specifically responsive to social or object stimuli in the mPFC emphasizes its crucial role in complex behaviors and cognitive functions, with selective neuron engagement suggesting efficiency in neural activation that optimizes responses to environmental stimuli.Significance Statement Unlike previous studies that have only shown altered prefrontal activity in response to stimuli in MeCP2 deficient models, our study identifies specific stimulus-tuned ensembles in the prefrontal cortex and their dysregulated activity patterns underlying social deficits in Rett syndrome. Utilizing innovate neural activity visualization tools, we revealed circuit-level evidence of the impairment caused by MeCP2-deficiency. The current research not only adds to the field of neurodevelopmental disorders and insights into the neurocircuitry of social behavior, but sheds light on the circuit-level mechanisms underlying a key behavioral phenotype of Rett syndrome.

Interfacial SbOC bond and structural confinement synergistically boosting the reaction kinetics and reversibility of Sb2Se3/NC nanorods anode for sodium storage.

Antimony selenide (Sb2Se3) has been considered as a prospective material for sodium-ion batteries (SIBs) because of its large theoretical capacity. Whereas, grievous volume expansion caused by the conversion-alloying reaction leads to fast capacity decay and inferior cycle stability. Herein, the confined Sb2Se3 nanorods in nitrogen-doped carbon (Sb2Se3/NC) with interfacial chemical bond is designed to further enhance sodium storage properties of Sb2Se3. The robust enhancing effect of interfacial SbOC bonds can significantly promote electron transfer, Na+ ions diffusion kinetics and alloying reaction reversibility, combining the synergistic effect of the unique confinement structure of N-doped carbon shells can efficiently alleviate the volume change to ensure the structural integrity. Moreover, in-situ X-ray diffraction reveals intercalation/de-intercalation, conversion/reversed conversion reaction and alloying/de-alloying reaction mechanisms, and the kinetics analysis demonstrates the diffusion-controlled to contribute high capacity. As a result, Sb2Se3/NC anode delivers a high reversible capacity of 612.6 mAh/g at 0.1 A/g with a retentive specific capacity of 471.4 mAh/g after 1000 cycles, and long-cycle durability of over 2000 cycle with the reversible capacities of 371.1 and 297.3 mAh/g at 1 and 2 A/g are achieved, respectively, and an good rate capability. This distinctive interfacial chemical bonds and confinement effect design shows potential applications in the improved conversion/alloying-type materials for SIBs.

Unraveling the role of NLRP3 inflammasome in allergic inflammation: implications for novel therapies.

Allergic diseases like asthma, allergic rhinitis and dermatitis pose a significant global health burden, driving the search for novel therapies. The NLRP3 inflammasome, a key component of the innate immune system, is implicated in various inflammatory diseases. Upon exposure to allergens, NLRP3 undergoes a two-step activation process (priming and assembly) to form active inflammasomes. These inflammasomes trigger caspase-1 activation, leading to the cleavage of pro-inflammatory cytokines (IL-1ß and IL-18) and GSDMD. This process induces pyroptosis and amplifies inflammation. Recent studies in humans and mice strongly suggest a link between the NLRP3 inflammasome, IL-1ß, and IL-18, and the development of allergic diseases. However, further research is needed to fully understand NLRP3's specific mechanisms in allergies. This review aims to summarize the latest advances in NLRP3 activation and regulation. We will discuss small molecule drugs and natural products targeting NLRP3 as potential therapeutic strategies for allergic diseases.

Prelacrimal-Transmaxillary Approach to Lateral Sphenoid Recess Skull Base Defects.

The lateral recess of a well-pneumatized sphenoid sinus is challenging to access surgically. Traditional methods require the use of multiple angled endoscopes and curved instruments which may limit visualization. We describe a prelacrimal-transpterygoid/maxillary approach which offers direct access to this region with a 0° endoscope. Laryngoscope, 2024.

Risk Factors and Electromyographic Characteristics of Acquired Weakness in Critically Ill Patients: A Retrospective Study.

Objective: This retrospective study examines risk factors and electromyographic (EMG) characteristics associated with acquired weakness in critically ill patients and assesses their impact on patient prognosis. Methods: Ninety-seven critically ill patients, ventilated for over 48 hours, were included. Patient data, encompassing general condition, medical history, Medical Research Council (MRC) scores, serum markers (c-reactive protein, calcitonin gene, albumin, brain natriuretic peptide, urea nitrogen, creatinine), EMG characteristics, respiratory treatment modalities, and parameters, were recorded. Mechanical ventilation duration, ICU stay duration, hospitalization duration, and patient prognosis were documented. Based on MRC scores, patients were categorized into the ICU-acquired weakness (ICU-AW) group (MRC <48 points) and the non-ICU-AW group (MRC ≥48 points). Results: The study comprised 47 ICU-AW and 50 non-ICU-AW patients. Significant differences (p <0.05) were observed in age, MRC scores, albumin levels, c-reactive protein, calcitonin gene, brain natriuretic peptide, urea nitrogen, creatinine, mechanical ventilation duration, ICU stay duration, and hospitalization duration between groups. In the ICU-AW group, nerve conduction examinations revealed slow conduction velocity, reduced wave amplitude, and in severe cases, a complete loss of motor and sensory potentials. Multivariate logistic analysis identified low serum albumin levels and MRC scores as potential ICU-AW risk factors. Conclusion: This study suggests that low serum albumin levels and MRC scores may contribute to ICU-AW risk. The ICU-AW group exhibited varied peripheral nerve damage and slow conduction velocities on EMG. Additionally, severe systemic inflammatory responses, renal function, brain natriuretic peptide levels, prolonged mechanical ventilation, and peripheral nerve damage may be associated with ICU-AW. Follow-up studies are essential for further understanding these complex interactions.

Control efficacy and joint toxicity of broflanilide mixed with commercial insecticides to an underground pest, the black cutworm in highland barley.

BACKGROUND: The highland barley, Hordeum vulgare L., is a staple food crop with superior nutritional functions in Xizang, China. It is often damaged by the black cutworm, Agrotis ipsilon (Hufnagel), which is an underground pest and difficult to effectively manage. To introduce a novel insecticide with unique mode of action, broflanilide (BFL) and its binary mixtures with chlorantraniliprole (CAP), fluxametamide, ß-cypermethrin or imidacloprid were screened out as seed treatment to control black cutworm in highland barley in the present study. RESULTS: In the laboratory bioassays, BFL had outstanding insecticidal activity to black cutworm with a median lethal dose (LD50) of 0.07 mg kg-1. The mixture of BFL × CAP at the concentration ratio of 7:40 exhibited the highest synergistic effect with a co-toxicity coefficient of 280.48. In the greenhouse pot experiments, BFL and BFL × CAP seed treatments at 8 g a.i. kg-1 seed could effectively control black cutworm, with a low percentage of injured seedlings <20% and high control efficacies of 93.33-100% during a period of 3-12 days after seed emergence. Moreover, BFL and BFL × CAP seed treatments could promote the seed germination and seedling growth of highland barley at the tested temperatures of 15, 20 and 25 °C. CONCLUSION: Our results indicated that BFL and BFL × CAP were effective and promising insecticides as seed treatment to control black cutworm in highland barley. © 2024 Society of Chemical Industry.

Junction Piezotronic Transistor Arrays Based on Patterned ZnO Nanowires for High-Resolution Tactile and Photo Mapping.

Recently, a great deal of interest has been focused on developing sensors that can measure both pressure and light. However, traditional sensors are difficult to integrate into silicon (Si)-based integrated circuits. Therefore, it is particularly important to design a sensor that operates on a new principle. In this paper, junction piezotronic transistor (JPT) arrays based on zinc oxide (ZnO) nanowire are demonstrated. And the JPT arrays show high spatial resolution pressure and light mapping with 195 dpi. Because ZnO nanowires are arranged vertically above the p-type Si channel's center of the transistor, the width of the heterojunction depletion region is constricted by the positive piezoelectric potential generated by strained ZnO. In addition, photogenerated charge carriers can be created in the Si channel when JPT is stimulated by light, which increases its electrical conductivity. Consequently, the external pressure and light distribution information can be obtained from the variation in the output current of the device. The prepared JPT arrays can be compatible with Si transistors, which make them highly competitive and make it possible to incorporate both pressure and light sensors into large integrated circuits. This work will contribute to many applications, such as intelligent clothing, human-computer interaction, and electronic skin.

[Effect of Selinexor on Proliferation and Apoptosis of Acute Myeloid Leukemia Kasumi-1 Cells].

OBJECTIVE: To investigate the effects of selinexor, a inhibitor of nuclear export protein 1 (XPO1) on the proliferation inhibition and apoptosis of Kasumi-1 cells in acute myeloid leukemia (AML). METHODS: MTS method was used to detect the inhibitory effect of different concentrations of selinexor on the proliferation of Kasumi-1 cells at different time points. The apoptosis rate and cell cycle changes after treatment with different concentration of selinexor were detected by flow cytometry. RESULTS: Selinexor inhibited the growth of Kasumi-1 cells at different time points in a concentration-dependent manner (r 24 h=0.7592, r 48 h=0.9456, and r 72 h=0.9425). Selinexor inhibited Kasumi-1 cells growth in a time-dependent manner (r =0.9057 in 2.5 µmol/L group, r =0.9897 in 5 µmol/L group and r =0.9994 in 10 µmol/L group). Selinexor could induce apoptosis of Kasumi-1 cells in a dose-dependent manner (r =0.9732), and the apoptosis of Kasumi-1 cells was more obvious with the increase of drug concentration. The proportion of G0/G1 phase was significantly increased and the proportion of S phase was significantly decreased after the treatment of Kasumi-1 cells by selinexor. With the increase of drug concentration, the proportion of Kasumi-1 cells cycle arrest in G0/G1 phase was increased and the cell synthesis was decreased. CONCLUSION: Selinexor can promote the death of tumor cells by inhibiting Kasumi-1 cells proliferation, inducing apoptosis and blocking cell cycle.

Iron driven organic carbon capture, pretreatment, recovery and upgrade in wastewater: Process technologies, mechanisms, and implications.

Wastewater treatment plants face significant challenges in transitioning from energy-intensive systems to carbon-neutral, energy-saving systems, and a large amount of chemical energy in wastewater remains untapped. Iron is widely used in modern wastewater treatment. Research shows that leveraging the coupled redox relationship of iron and carbon can redirect this energy (in the form of carbon) towards resource utilization. Therefore, re-examining the application of iron in existing wastewater carbon processes is particularly important. In this review, we investigate the latest research progress on iron for wastewater carbon flow restructuring. During the iron-based chemically enhanced primary treatment (CEPT) process, organic carbon is captured into sludge and its bioavailability is enhanced through iron-based advanced oxidation processes (AOP) pretreatment, further being recovered or upgraded to value-added products in anaerobic biological processes. We discuss the roles and mechanisms of iron in CEPT, AOP, anaerobic biological processes, and biorefining in driving organic carbon conversion. The dosage of iron, as a critical parameter, significantly affects the recovery and utilization of sludge carbon resources, particularly by promoting effective electron transfer. We propose a pathway for beneficial conversion of wastewater organic carbon driven by iron and analyze the benefits of the main products in detail. Through this review, we hope to provide new insights into the application of iron chemicals and current wastewater treatment models.

Human brain organoids for understanding substance use disorders.

Substance use disorders (SUDs) are complex mental health conditions involving a problematic pattern of substance use. Challenges remain in understanding their neural mechanisms, which are likely to lead to improved SUD treatments. Human brain organoids, brain-like 3D in vitro cultures derived from human stem cells, show unique potential in recapitulating the response of a developing human brain to substances. Here, we review the recent progress in understanding SUDs using human brain organoid models focusing on neurodevelopmental perspectives. We first summarize the background of SUDs in humans. Moreover, we introduce the development of various human brain organoid models and then discuss current progress and findings underlying the abuse of substances like nicotine, alcohol, and other addictive drugs using organoid models. Furthermore, we review efforts to develop organ chips and microphysiological systems to engineer better human brain organoids for advancing SUD studies. Lastly, we conclude by elaborating on the current challenges and future directions of SUD studies using human brain organoids.

Thyroid Cancer Central Lymph Node Metastasis Risk Stratification Based on Homogeneous Positioning Deep Learning.

Due to the absence of definitive diagnostic criteria, there remains a lack of consensus regarding the risk assessment of central lymph node metastasis (CLNM) and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer. The localization of thyroid nodules is a recognized predictor of CLNM; however, quantifying this relationship is challenging due to variable measurements. In this study, we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules, thereby predicting CLNM. We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node (CLN) surgery and utilized these images to train our predictive model, ACE-Net. Furthermore, we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions. ACE-Net demonstrated superior performance in 6 external multicenter tests (AUC = 0.826), surpassing the predictive accuracy of human experts (accuracy = 0.561). The risk heatmap enabled the identification of high-risk areas for CLNM, likely correlating with lymphatic metastatic pathways. Additionally, it was observed that the likelihood of metastasis exceeded 80% when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm. ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%, without missing positive cases, thus offering a valuable tool for clinical decision-making.

Advances in spatial multi-omics in tumors.

Single-cell techniques have convincingly demonstrated that tumor tissue usually contains multiple genetically defined cell subclones with different gene mutation sets as well as various transcriptional profiles, but the spatial heterogeneity of the microenvironment and the macrobiological characteristics of the tumor ecosystem have not been described. For the past few years, spatial multi-omics technologies have revealed the cellular interactions, microenvironment, and even systemic tumor-host interactions in the tumor ecosystem at the spatial level, which can not only improve classical therapies such as surgery, radiotherapy, and chemotherapy but also promote the development of emerging targeted therapies in immunotherapy. Here, we review some emerging spatial omics techniques in cancer research and therapeutic applications and propose prospects for their future development.

Generation of an infectious cDNA clone for NADC30-like PRRSV.

The porcine reproductive and respiratory syndrome virus (PRRSV) is a highly significant infectious disease that poses a substantial threat to the global pig industry. In recent years, the NADC30-like strain has gradually emerged as prevalent in China, causing a profound impact on the country's pig farming industry. Therefore, it is important to conduct an in-depth study on the characteristics and gene functions of the NADC30-like strain. An infectious cDNA clone is an indispensable tool for investigating the functions of viral genes. In this current study, we successfully isolated a NADC30-like strain and constructed its full-length infectious cDNA clone. The utilization of this clone will facilitate our investigation into the viral replication, pathogenesis, and immune response associated with the PRRSV NADC30-like strain.

Full-space metasurfaces for independent manipulation of transmission and reflection.

In recent years, beam manipulation using metasurfaces has evolved from being limited to either a transmission or reflection space to encompassing a full space. However, existing methods still inevitably require complex systems and are unable to achieve continuous and arbitrary phase manipulation. Here, one type of a bilayer metasurface is proposed to simultaneously manipulate reflection and transmission phases continuously and independently, which also makes the optical system more compact without requiring any analyzers and enhances the degree of freedom for full-space beam manipulation. As a proof-of-concept demonstration, one device is designed to show different holograms in transmission and reflection spaces. Additionally, the Dammann grating designed in the reflection hologram increases the information capacity. The proposed method may pave the way toward achieving a variety of applications such as multi-channel beam manipulation and multifunctional optical devices.