Promotion or prevention: regulatory foci as moderators in the job demands-resources model.

BACKGROUND: Building on the job demands-resources (JD-R) model and regulatory focus theory, this study examined how regulatory foci shaped the effects of different job demands and resources on both negative and positive workplace outcomes among medical staff. METHODS: Two independent studies (NStudy 1 = 267; NStudy 2 = 350) were designed for cross-validation. Participants completed a battery of measures evaluating job demands (workload, emotional demands, interpersonal stress), job resources (psychological safety, perceived organizational support, servant leadership), and well-being (job burnout, affective commitment, job satisfaction). RESULTS: Multiple linear regression analyses showed employees' well-being was affected by job demands and resources through energetic and motivational processes, respectively. The deleterious effect of emotional demands on job burnout was pronounced in individuals with weak prevention focus (B = 0.392, standard error [SE] = 0.069, p < .001). Psychological safety (Study 1) and servant leadership (Study 2) had stronger positive associations with motivational outcomes among individuals with weak promotion focus than those with strong promotion focus (B = 0.394, SE = 0.069, p < .001; B = 0.679, SE = 0.121, p < .001; and B = 0.476, SE = 0.072, p < .001, respectively). CONCLUSION: We used two samples to examine and cross-validate the joint effects of job characteristics and personal traits on workplace well-being among Chinese medical staff. Although heterogenous, the results showed regulatory foci were especially important in determining the effects of job demands and resources on well-being when there was (autonomous) self-regulation in the workplace.

MLG-YOLO: A Model for Real-Time Accurate Detection and Localization of Winter Jujube in Complex Structured Orchard Environments.

Our research focuses on winter jujube trees and is conducted in a greenhouse environment in a structured orchard to effectively control various growth conditions. The development of a robotic system for winter jujube harvesting is crucial for achieving mechanized harvesting. Harvesting winter jujubes efficiently requires accurate detection and location. To address this issue, we proposed a winter jujube detection and localization method based on the MobileVit-Large selective kernel-GSConv-YOLO (MLG-YOLO) model. First, a winter jujube dataset is constructed to comprise various scenarios of lighting conditions and leaf obstructions to train the model. Subsequently, the MLG-YOLO model based on YOLOv8n is proposed, with improvements including the incorporation of MobileViT to reconstruct the backbone and keep the model more lightweight. The neck is enhanced with LSKblock to capture broader contextual information, and the lightweight convolutional technology GSConv is introduced to further improve the detection accuracy. Finally, a 3-dimensional localization method combining MLG-YOLO with RGB-D cameras is proposed. Through ablation studies, comparative experiments, 3-dimensional localization error tests, and full-scale tree detection tests in laboratory environments and structured orchard environments, the effectiveness of the MLG-YOLO model in detecting and locating winter jujubes is confirmed. With MLG-YOLO, the mAP increases by 3.50%, while the number of parameters is reduced by 61.03% in comparison with the baseline YOLOv8n model. Compared with mainstream object detection models, MLG-YOLO excels in both detection accuracy and model size, with a mAP of 92.70%, a precision of 86.80%, a recall of 84.50%, and a model size of only 2.52 MB. The average detection accuracy in the laboratory environmental testing of winter jujube reached 100%, and the structured orchard environmental accuracy reached 92.82%. The absolute positioning errors in the X, Y, and Z directions are 4.20, 4.70, and 3.90 mm, respectively. This method enables accurate detection and localization of winter jujubes, providing technical support for winter jujube harvesting robots.

Enhanced fluorescence properties of polyfluorene-based polymer dots through an ascorbic acid-photoaging treatment for living cell imaging.

The polymer dots (Pdots) prepared by the conjugated polymer (PFO, poly (9,9-dihexylfluorene-2,7-diyl)) have high fluorescence intensity and are often used in biological fluorescence imaging. However, due to the chain defects, the PFO Pdots suffer from stability issues such as photoinactivation and photobleaching. To solve this problem, we drew inspiration from the preparation process of organic planar light-emitting devices and added an optimization processing after Pdots was prepared. We used illumination as the driving force to activate defects on its chain, and ascorbic acid as a reducing substance to restore the chain defects of the polymer to a more stable state. Through this method, we increased the fluorescence intensity by nearly 1.9 times, and significantly improving their long and short-term stability. In addition, it ensures other properties remain unchanged. This optimization scheme is also fully compatible with the entire biological imaging process, ensuring that other important properties such as cytotoxicity do not undergo unnecessary changes. Furthermore, we conducted material characterization and theoretical simulation, revealing that the optimization scheme mainly serves to repair C-9 alkyl defects on the polyfluorene unit. This study has improved and enhanced the fluorescence performance of PFO Pdots, and also provides a way to optimize the treatment of other similar conjugated polymer material systems.

Effects of Bony Pelvic and Prostate Dimensions on Surgical Difficulty of Robot-Assisted Radical Prostatectomy: An Original Study and Meta-analysis.

BACKGROUND: Due to the deep location of the prostate within the pelvic cavity, procedures of robot-assisted radical prostatectomy (RARP) might be challenged by the prostate size and the limited pelvic cavity space. This study aimed to investigate the roles of bony pelvic and prostate dimensions in RARP procedures by an original study coupled with a meta-analysis. METHODS: In the original study, patients undergoing multiport RARP between 2021 and 2022 were consecutively assessed. The associations of anatomic features with operative time (OT), estimated blood loss (EBL), and positive surgical margin (PSM) were evaluated using linear and logistic regression analyses as well as restricted cubic spline (RCS) analysis. Based on machine-learning algorithms, this study established predictive models for surgical difficulty and interpreted the model using SHapley Additive exPlanation (SHAP). In the meta-analysis, three databases were searched for eligible studies. Quantitative syntheses were subsequently performed. RESULTS: Overall, 219 patients were enrolled in the original study. Prostate volume (PV) and the prostate volume-to-pelvic cavity index (PCI) ratio (PV-to-PCI ratio) were significantly associated with longer OT (P < 0.05). In the RCS models, U-shaped associations were observed between the prostate anteroposterior diameter (PAD) and OT, and between the prostate height (PH) and EBL, and an L-shaped association was observed between the anteroposterior diameter of the pelvic inlet (API) and EBL. The XGBoost model was superior to the logistic regression model in predicting prolonged OT. The meta-analysis demonstrated that greater PV was significantly associated with longer OT (ß = 0.20; 95% confidence interval [CI] 0.12-0.27; odds ratio [OR] = 1.05; 95% CI 1.00-1.11), and a smaller PV could increase the risk of PSM (OR = 0.82; 95% CI 0.77-0.88). CONCLUSIONS: A large prostate within a narrow and deep pelvis might suggest increased surgical difficulty of RARP. The size of the pelvic inlet also had a great impact on RARP. For PAD and PH, there seemed to be an optimal range with the lowest surgical difficulty. Machine-learning models based on the XGBoost algorithm could be successfully applied to predict the surgical difficulty of RARP.

Cationic liposomes as a drug-free system for efficient anticancer therapy by intracytoplasmic delivery of sodium bicarbonate.

Developing the delivery systems with high therapeutic efficacy and low side effects is of great interest and significance for anticancer therapy. Compared to the high cost in synthesizing new chemotherapeutic drugs, exploring the anticancer potentials of existing chemicals is more convenient and efficient. Sodium bicarbonate (BC), a simple inorganic salt, has shown its tumor inhibition capacity via regulating the acidity of tumor microenvironment. However, the effects of intracytoplasmic BC on tumor growth and the potentials of BC to serve as an anticancer agent are still unknown. Herein, we developed a BC-loaded cationic liposome system (BC-CLP) to deliver BC into the cytosol of cancer cells. The in vitro studies showed that the BC-CLP containing 1% BC (w/v) had a size of 112.9 nm and a zeta potential of 19.1 mV, which reduced the viability of the model cancer cells (human oral squamous cell carcinoma HSC-3 cells) to 13.7%. In contrast, the neutral BC-LP caused less than 50% viability reduction. We further found that BC-CLP released BC directly into cytoplasm via membrane fusion pathway rather than endocytosis, leading to the remarkable increase of cytosolic pH, which may contribute to the anticancer effect of BC-CLP. Our findings indicate that BC-CLP is a potential system for high-efficiency cancer therapy without causing drug-related side effects or resistance.

Nanomaterials-based advanced systems for photothermal / photodynamic therapy of oral cancer.

The traditional clinical approaches for oral cancer consist of surgery, chemotherapy, radiotherapy, immunotherapy, and so on. However, these treatments often induce side effects and exhibit limited efficacy. Photothermal therapy (PTT) emerges as a promising adjuvant treatment, utilizing photothermal agents (PTAs) to convert light energy into heat for tumor ablation. Another innovative approach, photodynamic therapy (PDT), leverages photosensitizers (PSs) and specific wavelength laser irradiation to generate reactive oxygen species (ROS), offering an effective and non-toxic alternative. The relevant combination therapies have been reported in the field of oral cancer. Simultaneously, the advancement of nanomaterials has propelled the clinical application of PTT and PDT. Therefore, a comprehensive understanding of PTT and PDT is required for better application in oral cancer treatment. Here, we review the use of PTT and PDT in oral cancer, including noble metal materials (e.g., Au nanoparticles), carbon materials (e.g., graphene oxide), organic dye molecules (e.g., indocyanine green), organic molecule-based agents (e.g., porphyrin-analog phthalocyanine) and other inorganic materials (e.g., MXenes), exemplify the advantages and disadvantages of common PTAs and PSs, and summarize the combination therapies of PTT with PDT, PTT/PDT with chemotherapy, PTT with radiotherapy, PTT/PDT with immunotherapy, and PTT/PDT with gene therapy in the treatment of oral cancer. The challenges related to the PTT/PDT combination therapy and potential solutions are also discussed.

Semiconducting polymer dots for multifunctional integrated nanomedicine carriers.

The expansion applications of semiconducting polymer dots (Pdots) among optical nanomaterial field have long posed a challenge for researchers, promoting their intelligent application in multifunctional nano-imaging systems and integrated nanomedicine carriers for diagnosis and treatment. Despite notable progress, several inadequacies still persist in the field of Pdots, including the development of simplified near-infrared (NIR) optical nanoprobes, elucidation of their inherent biological behavior, and integration of information processing and nanotechnology into biomedical applications. This review aims to comprehensively elucidate the current status of Pdots as a classical nanophotonic material by discussing its advantages and limitations in terms of biocompatibility, adaptability to microenvironments in vivo, etc. Multifunctional integration and surface chemistry play crucial roles in realizing the intelligent application of Pdots. Information visualization based on their optical and physicochemical properties is pivotal for achieving detection, sensing, and labeling probes. Therefore, we have refined the underlying mechanisms and constructed multiple comprehensive original mechanism summaries to establish a benchmark. Additionally, we have explored the cross-linking interactions between Pdots and nanomedicine, potential yet complete biological metabolic pathways, future research directions, and innovative solutions for integrating diagnosis and treatment strategies. This review presents the possible expectations and valuable insights for advancing Pdots, specifically from chemical, medical, and photophysical practitioners' standpoints.

Narrow-linewidth and low RIN Tm/Ho co-doped fiber laser based on self-injection locking.

A narrow-linewidth and low relative intensity noise (RIN) Tm/Ho co-doped fiber laser based on a saturable absorber and self-injection locking was demonstrated for the first time. Utilizing self-injection locking technology, the frequency noise power spectral density is remarkably reduced by more than 17.1 dB from 1.21 × 106 Hz2/Hz to 7.30 × 103 Hz2/Hz when the frequency is approximately 1 kHz. Furthermore, a laser with a linewidth compressed to a quarter of the original linewidth from 44.386 kHz to 2.850 kHz, a RIN of less than -127.74 dB/Hz, and an optical signal-to-noise ratio of more than 71.6 dB can be obtained. Using a delay fiber, the relaxation oscillation peak frequencies move to lower frequencies, from 27.9 kHz to 15.8 kHz. The proposed laser is highly competitive in advanced coherent light detection fields, including coherent Doppler wind lidar, high-speed coherent optical communication, and precise absolute distance coherent measurement.

Recent advances in biological molecule detection based on a three-dimensional graphene structure.

Graphene has become an attractive material in the field of electrochemical detection owing to its unique electrical properties. Although the simple stacking structures of two-dimensional (2D) graphene sheets can provide excellent detection properties, a macroscopic three-dimensional (3D) structure needs to be constructed to enhance its functional properties. Graphene with a 3D structure has elegant functions, unlike graphene with a 2D structure. These properties include a large specific surface area, easy loading of nanomaterials with electrocatalytic and redox functions, and so on. Herein, we outline the preparation methods (self-assembly, chemical vapor deposition, templates, and 3D printing) for 3D graphene structures for obtaining excellent detection performance and applications in detecting biological molecules, bacteria, and cells. Furthermore, this review focuses on the improvement of the detection performance and enhancement of the applicability of graphene-based electrochemical sensors. We hope that this article will provide a reference for the future development of electrochemical sensors based on 3D graphene composites.

Differentiable Design Galleries: A Differentiable Approach to Explore the Design Space of Transfer Functions.

The transfer function is crucial for direct volume rendering (DVR) to create an informative visual representation of volumetric data. However, manually adjusting the transfer function to achieve the desired DVR result can be time-consuming and unintuitive. In this paper, we propose Differentiable Design Galleries, an image-based transfer function design approach to help users explore the design space of transfer functions by taking advantage of the recent advances in deep learning and differentiable rendering. Specifically, we leverage neural rendering to learn a latent design space, which is a continuous manifold representing various types of implicit transfer functions. We further provide a set of interactive tools to support intuitive query, navigation, and modification to obtain the target design, which is represented as a neural-rendered design exemplar. The explicit transfer function can be reconstructed from the target design with a differentiable direct volume renderer. Experimental results on real volumetric data demonstrate the effectiveness of our method.

Examining Medical Staff Well-Being through the Application and Extension of the Job Demands-Resources Model: A Cross-Sectional Study.

For medical staff, job satisfaction is essential for advancement on an individual and organizational level. This study looked into the relationships between challenging job demands, job resources, personal resources, and well-being. Additionally, it examined the potential mediating effects of emotional exhaustion and work motivation within the framework of the job demands-resources (JD-R) model. Results from a cross-sectional study of 267 medical employees at a second-grade comprehensive hospital in Jiangsu, China's mainland, indicated that challenging job demands and job satisfaction were positively correlated and mediated via (decreasing) emotional exhaustion. The relationship between job resources and job satisfaction was found to be mediated via (decreasing) emotional exhaustion and (increasing) work motivation. The investigation also demonstrated that the two regulatory focuses serve different purposes. It was discovered that promotion focus had a favorable effect on work motivation but a negative effect on emotional exhaustion. Conversely, preventive focus only positively predicted emotional exhaustion. Thus, the JD-R model offers a valuable structure for clarifying the job satisfaction of health personnel. The implications for enhancing individual and job outcomes are discussed.

More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients.

Objective: The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors. Methods: A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources. Results: PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001). Conclusion: By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.

Intratumor delivery of amino-modified graphene oxide as a multifunctional photothermal agent for efficient antitumor phototherapy.

Due to the high selectivity and non-invasive property, phototherapy has attracted increasing attention in the treatment of cancer. Targeted delivery and retention of photoactive agents in tumor tissue is of great significance and importance for safe and efficient phototherapy. Herein, we report a multifunctional nanomaterial photothermal agent, namely amino-modified graphene oxide (AGO) for anti-oral cancer photothermal therapy (PTT). Compared to the parental graphene oxide (GO) which has a negative charge and weak photothermal effect, AGO possesses a positive charge (∼+50 mV) and the significantly enhanced photothermal effect. Positive charge allows AGO to efficiently interact with tumor cells and retain in tumor tissue after intratumor injection. The enhanced photothermal effect allows AGO to achieve the tunable and efficient PTT. In vitro results show that AGO (15 µg/mL) reduces the viability of HSC-3 cells (oral squamous cell carcinoma cell line) to 5% under near infrared (NIR) irradiation (temperature increased to 58.4 °C). In vivo antitumor study shows that intratumor delivery of AGO (200 µg/mouse) has no inhibition effects on tumor growth (454% of initial tumor size) without NIR. With a single dose of NIR irradiation, however, AGO significantly reduces the tumor size to 25% of initial size in 1 of 4 mice, and even induces the complete tumor ablation in 3 of 4 mice. Furthermore, the injected AGO falls off along with the scab after PTT. Our findings indicate that AGO is a potential nano-photothermal agent for tunable, convenient and efficient anticancer PTT.

Prevention of bacterial biofilm formation on orthodontic brackets by non-crosslinked chitosan coating.

During orthodontic treatment, the patients are susceptible to dental caries as a result of the bacterial adhesion and biofilm formation around the orthodontic brackets. Prevention of the caries-related biofilm formation is of significance for maintaining both aesthetics and health of the teeth. Herein, the brackets were functionalized with antibacterial activity via coating a layer of non-crosslinked chitosan (CS). We firstly demonstrated the ability of free CS scaffolds (not coated on brackets) to inhibit the formation of Streptococcus mutans biofilms (inhibition rate 94.3 % for CS-0.3 mg) and to eradicate the mature biofilms (biofilm loss rate 99.8 % for CS-1.2 mg). Further, the inhibition of S. mutans biofilm formation on brackets by CS coating was investigated for the first time. As a result, the CS-coated brackets (Br-CS) kept the great biofilm inhibition capacity of free CS scaffolds. In detail, the Br-CS, prepared by immersing brackets in CS solutions (containing 1.0, 2.5, 5.0 and 10 mg/mL CS) and freeze-drying, showed the biofilm inhibition rate of 48.5 %, 88.6 %, 96.4 % and 99.6 %, respectively. In conclusion, coating orthodontic brackets with the non-crosslinked CS is a potential approach for inhibiting biofilm formation and protecting patients from dental caries.

How serving helps leading: mediators between servant leadership and affective commitment.

Introduction: Servant leadership has long been associated with maintaining employee's affective commitment, yet the underlying mechanism remains unclear. Research from non-western cultures remains scarce. Methods: This study sought to fill in such research gap by introducing insights from social exchange theory perspective, and examined two potential mediators (viz., psychological safety and job burnout) with a largescale, representative Chinese sample. Results: A total of 931 staffs in a Chinese hospital were surveyed, and structural equation models revealed that psychological safety (indirect effect = 0.052, 95% Bootstrap CI = [0.002, 0.101]) and job burnout (indirect effect = 0.277, 95% Bootstrap CI = [0.226, 0.331]) parallelly (and partially) mediated the effect of servant leadership on affective commitment. Moreover, these effects held the same between permanent and temporary staffs, as well as between male and female staffs. Discussion: Results suggested that a leader's orientation to care, validate, and respond to their followers' needs was effective in creating a psychological safe environment and downplaying job burnout in workplace, in exchange to which, followers remained affectively committed to their organization in a long term. Not only did this study contribute to existing literature by providing non-western data for service leadership research, it also provided a deeper understanding of associated mechanisms of how servant leadership might cast on talent retain and organizational development in a long term. These mechanisms shed light on how serving helps leading and advocate servant leadership for hospitals, as well as other serving organizations.

The predictive value of perioperative circulating markers on surgical complications in patients undergoing robotic-assisted radical prostatectomy.

BACKGROUND: The occurrence of postoperative complications was associated with poor outcomes for patients undergoing robotic-assisted radical prostatectomy. A prediction model with easily accessible indices could provide valuable information for surgeons. This study aims to identify novel predictive circulating biomarkers significantly associated with surgical complications. METHODS: We consecutively assessed all multiport robotic-assisted radical prostatectomies performed between 2021 and 2022. The clinicopathological factors and perioperative levels of multiple circulating markers were retrospectively obtained from the included patients. The associations of these indices with Clavien-Dindo grade II or greater complications, and surgical site infection were assessed using univariable and multivariable logistic regression models. Further, the models were validated for the overall performance, discrimination, and calibration. RESULTS: In total, 229 patients with prostate cancer were enrolled in this study. Prolonged operative time could independently predict surgical site infection (OR, 3.39; 95% CI, 1.09-10.54). Higher RBC (day 1-pre) implied lower risks of grade II or greater complications (OR, 0.24; 95% CI, 0.07-0.76) and surgical site infection (OR, 0.23; 95% CI, 0.07-0.78). Additionally, RBC (day 1-pre) independently predicted grade II or greater complications of obese patients (P value = 0.005) as well as those in higher NCCN risk groups (P value = 0.012). Regarding the inflammatory markers, NLR (day 1-pre) (OR, 3.56; 95% CI, 1.37-9.21) and CRP (day 1-pre) (OR, 4.16; 95% CI, 1.69-10.23) were significantly associated with the risk of grade II or greater complications, and both the indices were independent predictors in those with higher Gleason score, or in higher NCCN risk groups (P value < 0.05). The NLR (day 0-pre) could also predict the occurrence of surgical site infection (OR, 5.04; 95% CI, 1.07-23.74). CONCLUSIONS: The study successfully identified novel circulating markers to assess the risk of surgical complications. Postoperative increase of NLR and CRP were independent predictors for grade II or greater complications, especially in those with higher Gleason score, or in higher NCCN risk groups. Additionally, a marked decrease of RBC after the surgery also indicated a higher possibility of surgical complications, especially for the relatively difficult procedures.

Accelerometer-measured intensity-specific physical activity, genetic risk and incident type 2 diabetes: a prospective cohort study.

OBJECTIVE: Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-specific physical activity and incident T2D accounting for and stratified by different levels of genetic risk. METHODS: This prospective cohort study was based on 59 325 participants in the UK Biobank (mean age=61.1 years in 2013-2015). Total/intensity-specific physical activity was collected using accelerometers and linked to national registries until 30 September 2021. We examined the shape of the dose-response association between physical activity and T2D incidence using restricted cubic splines adjusted for and stratified by a polygenic risk score (based on 424 selected single nucleotide polymorphisms) using Cox proportional hazards models. RESULTS: During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity (MVPA) and incident T2D, even after adjusting for genetic risk. Compared with the least active participants, the HRs (95% CI) for higher levels of MVPA were: 0.63 (0.53 to 0.75) for 5.3-25.9 min/day, 0.41 (0.34 to 0.51) for 26.0-68.4 min/day and 0.26 (0.18 to 0.38) for >68.4 min/day. While no significant multiplicative interaction between physical activity measures and genetic risk was found, we found a significant additive interaction between MVPA and genetic risk score, suggesting larger absolute risk differences by MVPA levels among those with higher genetic risk. CONCLUSION: Participation in physical activity, particularly MVPA, should be promoted especially in those with high genetic risk of T2D. There may be no minimal or maximal threshold for the benefits. This finding can inform future guidelines development and interventions to prevent T2D.

Drug-free and non-crosslinked chitosan/hyaluronic acid hybrid hydrogel for synergistic healing of infected diabetic wounds.

The management of infected diabetic wounds remains a major challenge in clinical practice. Recently, multifunctional hydrogels have attracted much attention in the area of wound healing. Herein, we developed the drug-free and non-crosslinked chitosan (CS)/hyaluronic acid (HA) hybrid hydrogel, so as to combine the multiple functions of CS and HA for synergistic healing of the methicillin-resistant Staphylococcus aureus (MRSA)-infected diabetic wound. As a result, CS/HA hydrogel showed the broad-spectrum antibacterial activity, the great capacity for promoting fibroblasts proliferation and migration, the excellent reactive oxygen species (ROS) scavenging ability, and the great cell-protection effects under oxidative stress. In the MRSA-infected diabetic mouse wounds, CS/HA hydrogel significantly promoted the wound healing via eliminating MRSA infection and enhancing epidermal regeneration, collagen deposition and angiogenesis. Considering the drug-free feature, the ready availability, the great biocompatibility and the excellent wound healing efficacy, CS/HA hydrogel may have great potentials in clinical use for the management of chronic diabetic wounds.

Immunotherapy with or without targeted therapy for metastatic upper tract urothelial carcinoma: case report and literature review.

Background: Immune checkpoint inhibitors (ICIs) have been proved having a better safety profile compared to platinum-based chemotherapy and have demonstrated encouraging anti-tumor therapeutic effects for patients with metastatic urothelial carcinoma (mUC). However, few studies have evaluated the efficacy of ICIs in patients with metastatic upper tract urothelial carcinoma (mUTUC). Case reports: Case 1 was a 71-year-old male patient diagnosed with left renal pelvic carcinoma, accompanied by a metastasis to the second lumbar spine. As the patient became refractory to chemotherapy, four cycles of camrelizumab, one of the ICIs, were administered, which helped to control the metastases and extend the patient's progression-free survival to five months. Case 2 was an 88-year-old female with middle and lower right ureter carcinoma with right iliac arteriovenous invasion. The patient received five cycles of camrelizumab plus vascular endothelial growth factor receptor 2 (VEGFR2) inhibitors and achieved stable disease. Conclusion: For patients who are ineligible for chemotherapy, immunotherapy might be a feasible treatment, regardless of whether or not they are given VEGFR2 inhibitors.

Evaluating the accuracy of automated cephalometric analysis based on artificial intelligence.

BACKGROUND: The purpose of this study was to evaluate the accuracy of automatic cephalometric landmark localization and measurements using cephalometric analysis via artificial intelligence (AI) compared with computer-assisted manual analysis. METHODS: Reconstructed lateral cephalograms (RLCs) from cone-beam computed tomography (CBCT) in 85 patients were selected. Computer-assisted manual analysis (Dolphin Imaging 11.9) and AI automatic analysis (Planmeca Romexis 6.2) were used to locate 19 landmarks and obtain 23 measurements. Mean radial error (MRE) and successful detection rate (SDR) values were calculated to assess the accuracy of automatic landmark digitization. Paired t tests and Bland‒Altman plots were used to compare the differences and consistencies in cephalometric measurements between manual and automatic analysis programs. RESULTS: The MRE for 19 cephalometric landmarks was 2.07 ± 1.35 mm with the automatic program. The average SDR within 1 mm, 2 mm, 2.5 mm, 3 and 4 mm were 18.82%, 58.58%, 71.70%, 82.04% and 91.39%, respectively. Soft tissue landmarks (1.54 ± 0.85 mm) had the most consistency, while dental landmarks (2.37 ± 1.55 mm) had the most variation. In total, 15 out of 23 measurements were within the clinically acceptable level of accuracy, 2 mm or 2°. The rates of consistency within the 95% limits of agreement were all above 90% for all measurement parameters. CONCLUSION: Automatic analysis software collects cephalometric measurements almost effectively enough to be acceptable in clinical work. Nevertheless, automatic cephalometry is not capable of completely replacing manual tracing. Additional manual supervision and adjustment for automatic programs can increase accuracy and efficiency.