Implantable Flexible Sensors for Health Monitoring.

Flexible sensors, as a significant component of flexible electronics, have attracted great interest the realms of human-computer interaction and health monitoring due to their high conformability, adjustable sensitivity, and excellent durability. In comparison to wearable sensor-based in vitro health monitoring, the use of implantable flexible sensors (IFSs) for in vivo health monitoring offers more accurate and reliable vital sign information due to their ability to adapt and directly integrate with human tissue. IFSs show tremendous promise in the field of health monitoring, with unique advantages such as robust signal reading capabilities, lightweight design, flexibility, and biocompatibility. Herein, a review of IFSs for vital signs monitoring is detailly provided, highlighting the essential conditions for in vivo applications. As the prerequisites of IFSs, the stretchability and wireless self-powered properties of the sensor are discussed, with a special attention paid to the sensing materials which can maintain prominent biosafety (i.e., biocompatibility, biodegradability, bioresorbability). Furthermore, the applications of IFSs monitoring various parts of the body are described in detail, with a summary in brain monitoring, eye monitoring, and blood monitoring. Finally, the challenges as well as opportunities in the development of next-generation IFSs are presented.

Advanced navigation technology enables endobronchial brachytherapy for peripheral lung cancer: An old technique plays a new role.

PURPOSE: To investigate the feasibility of super-selectively endobronchial brachytherapy in the treatment of peripheral lung cancer guided by advanced navigation technology. METHODS AND MATERIALS: Six patients with peripheral lung tumors successfully underwent treatment with super-selectively endobronchial brachytherapy guided by advanced navigation technology following pathway planning and were subsequently followed up to assess survival and treatment-related toxicities. RESULTS: The endobronchial applicators were successfully placed inside the tumors of all patients using advanced navigation techniques according to the pretreatment plan, and brachytherapy was delivered at curative doses after evaluation using radiotherapy planning software. None of the patients showed local progression of the treated lesions during the follow-up for a duration ranging from 11 months to 35 months, with a median follow-up time of 23 months. The patient with the longest follow-up, nearly 3 years, exhibited a stable condition. After undergoing endobronchial brachytherapy, patients predominantly experienced localized fibrosis as indicated. No significant alterations in cardiopulmonary function were detected during the follow-up, and no other adverse effects were found. CONCLUSIONS: The use of endobronchial brachytherapy for the curative treatment of peripheral lung cancers is feasible. Furthermore, the development of novel bronchial navigation techniques has the potential to broaden the application of endobronchial brachytherapy.

Glutamine ameliorates hyperoxia-induced hippocampal damage by attenuating inflammation and apoptosis via the MKP-1/MAPK signaling pathway in neonatal rats.

Glutamine (Gln) is an immunomodulatory protein that mediates oxidative stress, inflammation, and apoptosis, but has not been reported in the treatment of hyperoxia (Hyp)-induced brain injury. The aim of this study was to determine whether Gln could improve hyp-induced brain injury in neonatal rats to and later learning and memory dysfunction, and to explore its possible mechanisms. We prepared a model of neonatal rat brain injury caused by normobaric hyperoxia while administered with Gln for 7 days for evaluation. Learning memory function was assessed with the Morris water maze test. Histological analysis, protein expression analysis, oxidative stress and inflammation level analysis were performed using hippocampal tissue. Gln treatment significantly reduced brain tissue water content, oxidative stress levels, microglia activation and inflammatory factor expression, and attenuated tissue damage and apoptosis in the hippocampal region. Gln ameliorates hyp-induced learning, memory impairment in neonatal rats in water maze test. It also increased MKP-1 protein expression and decreased p-p38, p-ERK and p-JNK. Therefore, it is hypothesized that Gln may exert neuroprotective effects by increasing MKP-1 expression to negatively regulate MAPK signaling, with potential cognitive improvement in hyp-induced brain injury.

Escalation of radiotherapy dose in large locally advanced drug-resistant gastrointestinal stromal tumors by multi-shell simultaneous integrated boost intensity-modulated technique: a feasibility study.

BACKGROUND: Resistance to conventional dose schemes and radiotoxicity of healthy tissue is a clinical challenge in the radiation therapy of large locally advanced drug-resistant gastrointestinal stromal tumor (LADR-GIST). This study aimed to assess the feasibility of using multi-shell Simultaneous Integrated Boost Intensity-Modulated modality (SIB-IMRT) strategy to provide a safe and effective escalation dose regimen for LADR-GIST. METHODS: 7 patients with LADR-GIST were selected in this study. The modified SIB-IMRT plans for all patients were generated by delivering different escalation-dose gradients to four ring shaped regions (shells) within the gross tumor volume (GTV). The doses of the central volume of the tumor (GTVcenter) were escalated up to 70-92.5 Gy (25 fractions), while the doses of planning target volume (PTV) and shell-1 were kept at 50.0 Gy. Based on different escalation-dose gradients, the modified SIB-IMRT plans were divided into four groups (SIB-IMRT groups). For comparison purposes, plans obtained by conventional IMRT technique (Con-IMRT) with 50 Gy (25 fractions) were also generated for all patients (Con-IMRT group). All plans were normalized to cover 95% of the PTV with the prescribed dose of 50.0 Gy. The equivalent uniform dose (EUD), relative equivalent uniform dose (rEUD), dose volume histogram (DVH), dose profile, conformity index (CI) and monitor unit (MU) were evaluated in five groups. The Friedman Test was performed to determine whether there were significant differences (P < 0.05). RESULTS: Compared with the Con-IMRT group, the EUD of GTV (EUDGTV) and rEUD of SIB-IMRT groups were improved when escalation-dose gradient was increased, and the improvement became significant when the escalation-dose gradient reached 20% of the prescription dose. The rEUD tended to be stable as the escalation-dose gradient went up to 25% of the prescription dose. There were no significant differences in CIs and DVH metrics for OARs between the Con-IMRT group and any SIB-IMRT group, but the significant differences were observed between the SIB10-IMRT group and the SIB25-IMRT group. For the SIB-IMRT groups, as the dose gradient became steeper in the dose profiles, the higher dose was mainly accumulated in the inner part of GTV accompanied with a higher MU. CONCLUSIONS: The proposed multi-shell SIB-IMRT strategy is feasible in dosimetry for LADR-GIST and can acquire higher therapeutic gain without sacrifice of healthy tissues. It appears that the scheme of delivering 20% of the prescribed escalation-dose gradient to the target volume can provide satisfactory dose irradiation for LADR-GIST, and it should be evaluated in future clinical study.

A Study on the Preparation and Cavitation Erosion Mechanism of Polyether Polyurethane Coating.

Polyurethane elastomers are anticipated to be applied in the field of cavitation erosion (CE) resistance, but their protection and damage mechanisms are not clear, which greatly restricts their further development. In this article, five polyether polyurethanes (PUx) with different crosslinking densities were prepared. Their mechanical properties, thermal properties, water absorption, surface morphology and chemical structure before and after CE tests were compared with ESEM, OM, TG-DSC, FTIR and XPS in detail. The results showed that with an increase in crosslinking density, the tensile strength of PUx increased first and then decreased, elongation at break and water absorption reduced gradually and thermal decomposition temperature and adhesion strength increased steadily. During the CE process, cavitation load aggravated the degree of microphase separation and made brittle hard segments concentrate on the coating surface; meanwhile, cavitation heat accelerated hydrolysis, pyrolysis, oxidation and the fracture of molecular chains. As a result, the mechano-thermal coupling intensified the formation and propagation of fatigue cracks, which should be the fundamental reason for the CE damage of polyurethane elastomer. PU0.4 exhibited the best CE resistance among the five coatings thanks to its good comprehensive properties and may find potential applications on the surface of hydraulic components.

Prognostic value of lymph node ratio in cervical cancer: A meta-analysis.

BACKGROUND: The role of the lymph node ratio (LNR) in the existing tumor node metastasis classification system should be verified as one of the prognosis prediction factors. This work evaluated LNR's performance in predicting cervical cancer (CC) prognosis through a meta-analysis. METHOD: Related studies were retrieved from the Cochrane Library, EMBASE, and PubMed databases. The language was restricted to English. The combined hazard ratios (HRs) were utilized to analyze the prognostic value of LNR. RESULTS: Our study included 8 articles with 3325 subjects published after 2015. Based on our analysis, high LNR was the adverse prognostic factor for overall survival (OS, HR = 1.45; 95% CI = 1.23-1.73; P = .238) and disease-free survival (DFS, HR = 2.69; 95% CI = 1.98-3.66; P = .597) among the CC cases. Furthermore, as revealed by subgroup analysis, in CC patients, median LNR of about 0.0625 and 0.066 served as the prominent risk factor for DFS and OS. CONCLUSIONS: The current work illustrates that elevated LNR is related to the dismal prognosis of CC. More well-designed clinical studies are warranted for assessing whether LNR is a factor independently predicting the prognosis of CC.

Insulin-like growth factor-1 reduces hyperoxia-induced lung inflammation and oxidative stress and inhibits cell apoptosis through PERK/eIF2α/ATF4/CHOP signaling.

Background: Insulin-like growth factor-1 (IGF-1), a member of the insulin family, has a high degree of homology with insulin and exhibits anti-inflammatory and anti-oxidative stress properties. However, the potential protective effect of IGF-1 on hyperoxia-induced lung injury remains unknown. In this study, we aimed to explore the effects and mechanism of action of IGF-1 in hyperoxia-induced lung injury in neonatal rats. Materials and Methods: Hematoxylin-eosin staining was used to observe pathological changes in lung tissue; transmission electron microscopy was used to examine the ultrastructure, and ELISA was used to detect the level of pro-inflammatory cytokines in bronchoalveolar lavage fluid. Further, malondialdehyde, glutathione, and superoxide dismutase activities in lung tissue were evaluated. TUNEL staining was used to detect cell apoptosis, and western blot analysis was used to detect the expression of Bax, Bcl-2, Caspase-3, p-PERK, p-eIF2α, ATF4, and CHOP in the lung tissue. Moreover, the wet/dry weight ratio of lung tissue was determined. Results: Intraperitoneal injection of IGF-1 effectively reduced lung tissue damage induced by hyperoxia; production of inflammatory cells and release of pro-inflammatory cytokines, oxidative stress, and cell apoptosis. Further, IGF-1 down-regulated the expression of ATF4, CHOP, and Bax/Bcl-2, and inhibited the phosphorylation of PERK and eIF2α. Conclusion: The results suggest that IGF-1 reduces hyperoxia-induced lung inflammation and oxidative stress in neonatal rats through the PERK/eIF2α/ATF4/CHOP signaling pathway and inhibits cell apoptosis.

Optimizing the Region for Evaluation of Global Gamma Analysis for Nasopharyngeal Cancer (NPC) Pretreatment IMRT QA by COMPASS: A Retrospective Study.

Background: The global gamma passing rate is the most commonly used metric for patient-specific pretreatment quality assurance in radiation therapy. However, the optimal region for evaluation and specific action limits (ALs) need to be explored. Therefore, this study was carried out to explore the optimal region for evaluation of the global gamma passing rate and define ALs by using the COMPASS software. Methods: A total of 93 intensity-modulated radiation therapy (IMRT) plans for nasopharyngeal cancer (NPC) patients, including 61 original plans and 32 multileaf collimator (MLC) error-introduced test plans, were selected for retrospective analysis. Firstly, the dose distribution was divided into six isodose regions ("≥10%", "≥20%", "≥30%", "≥40%", "≥50%", and "≥60%") based on the prescribed dose and one clinically oriented region for evaluation ("whole") to perform the three-dimensional (3D) global gamma reanalysis. Meanwhile, the percentage gamma passing rate (%GP), mean gamma index (µGI) based on 3%/2 mm criteria, and percentage dose error (%DE) of the dose-volume histogram (DVH) metrics were recorded by COMPASS application. Secondly, the Pearson's correlation coefficient was used to analyze the correlation between %GP and %DE and between µGI and %DE in different regions. Additionally, receiver operating characteristic (ROC) methodology was applied to quantify the fraction of patient-specific plans evaluated as "fail" and "pass". In order to improve the correlation between gamma analysis result and clinical criteria, ROC analysis was carried out in accordance with hybridization analysis criteria (%DE ≤3%, %GP ≥90% and %DE ≤3%, µGI ≤0.6). ROC was performed for two purposes: 1) to analyze the sensitivity and specificity of %GP and µGI in different regions for evaluation and 2) to define the ALs of %GP and µGI in the optimal region for evaluation. Finally, the plans introduced with MLC errors were prepared for validation. Moreover, we also compared the positive rate of ALs of both %GP and µGI in detecting MLC error-introduced plans in different regions. Results: 1) In our study, a number of DVH-based metrics were found to be correlated with the evaluation parameters. The corresponding number was 4, 2, 1, 1, 1, 1, and 3 in γwhole, γ10%, γ20%, γ30%, γ40%, γ50%, and γ60%, respectively, and 5, 3, 0, 1, 1, 4, and 2 in µGIwhole, µGI10%, µGI20%, µGI30%, µGI40%, µGI50%, and µGI60%, respectively. The results by COMPASS have revealed that the %DE of specific structures has a slightly higher correlation with both %GP and µGI of the "whole" region compared with that of any other region. However, it is a moderate correlation (0.5 ≤ |r| < 0.8). 2) The areas under the curves (AUCs) of γwhole, µGIwhole, µGI40%, µGI50%, and µGI60% were >0.7 based on 3%/2 mm criteria. According to the Youden coefficient, we defined the ALs of γwhole ≥92%, µGIwhole ≤0.36, µGI40% ≤0.43, and µGI60% ≤0.40 based on 3%/2 mm criteria. 3) In the validation, for original plans, the accuracy of ALγwhole, ALγ10%, ALµGIwhole, ALµGI40%, ALµGI50%, and ALµGI60% was 23%, 9.8%, 90%, 80.3%, 9.8%, and 88.5%, respectively. For test plans with systematic MLC errors smaller than 0.8 mm, the positive rates of ALγwhole, ALγ10%, ALµGIwhole, ALµGI40%, ALµGI50%, and ALµGI60% were 25%, 58%, 92%, 92%, 42%, and 100%, respectively. For the plans with systematic MLC errors higher than 0.8 mm, the positive rates of all AL%GP and ALµGI were 100%. From the COMPASS validation results, the accuracy of γwhole, µGIwhole, µGI40%, and µGI60% was higher than that of the conventional γ10% and commonly used µGI50%. Conclusions: Compared with the traditional evaluation region (i.e., the criteria with a threshold of 10% or a threshold of 50%, it was the same with the isodose regions of "≥10%", "≥50%" based on the prescribed dose in our study), the "whole" region is more meaningful to the clinic by COMPASS. The accuracy of µGIwhole is higher than that of the conventional γ10% and the commonly used µGI50%.

Assessment of Statistical Process Control Based DVH Action Levels for Systematic Multi-Leaf Collimator Errors in Cervical Cancer RapidArc Plans.

Background: In the patient-specific quality assurance (QA), DVH is a critical clinically relevant parameter that is finally used to determine the safety and effectiveness of radiotherapy. However, a consensus on DVH-based action levels has not been reached yet. The aim of this study is to explore reasonable DVH-based action levels and optimal DVH metrics in detecting systematic MLC errors for cervical cancer RapidArc plans. Methods: In this study, a total of 148 cervical cancer RapidArc plans were selected and measured with COMPASS 3D dosimetry system. Firstly, the patient-specific QA results of 110 RapidArc plans were retrospectively reviewed. Then, DVH-based action limits (AL) and tolerance limits (TL) were obtained by statistical process control. Secondly, systematic MLC errors were introduced in 20 RapidArc plans, generating 380 modified plans. Then, the dose difference (%DE) in DVH metrics between modified plans and original plans was extracted from measurement results. After that, the linear regression model was used to investigate the detection limits of DVH-based action levels between %DE and systematic MLC errors. Finally, a total of 180 test plans (including 162 error-introduced plans and 18 original plans) were prepared for validation. The error detection rate of DVH-based action levels was compared in different DVH metrics of 180 test plans. Results: A linear correlation was found between systematic MLC errors and %DE in all DVH metrics. Based on linear regression model, the systematic MLC errors between -0.94 mm and 0.88 mm could be caught by the TL of PTV95 ([-1.54%, 1.51%]), and the systematic MLC errors between -1.00 mm and 0.80 mm could also be caught by the TL of PTVmean ([-2.06%, 0.38%]). In the validation, for original plans, PTV95 showed the minimum error detection rate of 5.56%. For error-introduced plans with systematic MLC errors more than 1mm, PTVmean showed the maximum error detection rate of 88.89%, and then was followed by PTV95 (86.67%). All the TL of DVH metrics showed a poor error detection rate in identifying error-induced plans with systematic MLC errors less than 1mm. Conclusion: In 3D quality assurance of cervical cancer RapidArc plans, process-based tolerance limits showed greater advantages in distinguishing plans introduced with systematic MLC errors more than 1mm, and reasonable DVH-based action levels can be acquired through statistical process control. During DVH-based verification, main focus should be on the DVH metrics of target volume. OARs in low-dose regions were found to have a relatively higher dose sensitivity to smaller systematic MLC errors, but may be accompanied with higher false error detection rate.

Effect of Pelvic Bone Marrow Sparing Intensity Modulated Radiation Therapy on Acute Hematologic Toxicity in Rectal Cancer Patients Undergoing Chemo-Radiotherapy.

BACKGROUND: While chemo-radiotherapy improves local control in patients with locally advanced rectal cancer, it can also increase acute hematological toxicity (HT), which leads to poor outcomes. Patients receiving bone marrow radiation have been shown to develop acute HT. However, the safety and efficacy of bone marrow sparing is undetermined. The aim of our study was to explore the feasible dosimetric constraints for pelvic bone marrow (PBM) that can be widely used in rectal cancer patients undergoing chemo-radiotherapy. METHODS: 112 rectal cancer patients were selected and divided into the PBM sparing IMRT group (60 cases) and the non-PBM sparing IMRT group (52 cases). All patients underwent pelvic radiotherapy with concurrent capecitabine-based chemotherapy. The PBM dosimetric constraints in the PBM sparing IMRT group were set to:V10 ≤ 85%, V20 ≤ 65% and V30 ≤ 45%. An independent sample t test was applied for the dose-volume parameters, and Chi-squared analysis was applied for clinical parameters and adverse events. RESULTS: The radiation dose to PBM (V5~V45, Dmean, P<0.05), PBM sub-regions (V10~V35, Dmean, P<0.05) and both femoral heads (V5~V40, Dmean, P<0.05) decreased significantly in the PBM sparing IMRT group compared with that of the non-PBM sparing IMRT group (P<0.05). There was no significant difference in any dose-volume parameters of the bladder and small bowel in either groups, and none in the planning target volume (PTV) dose homogeneity and conformity (P>0.05). For acute HT observation, the incidence of grade 3 acute HT (χ2 = 7.094, P=0.008) was significantly reduced in patients treated with PBM sparing IMRT compared with patients treated with non-PBM sparing IMRT. There was no statistical difference in the incidence of vomiting, diarrhea, fatigue, anorexia, nausea, hand-foot syndrome, cystitis, perianal pain and perianal dermatitis in patients of both groups (P >0.05). CONCLUSIONS: Applying PBM dosimetric constraints (V10 ≤ 85%, V20 ≤ 65% and V30 ≤ 45%) can significantly reduce the radiation dose to PBM. The patients treated with PBM sparing IMRT had a lower incidence of acute HT compared with those treated with non-PBM sparing IMRT. Applying the PBM dosimetric constraints proposed by our study can benefits the patients with rectal cancer undergoing capecitabine-based chemo-radiotherapy.

Simultaneous Integrated Boost Intensity-Modulated Radiotherapy for Locally Advanced Drug-Resistant Gastrointestinal Stromal Tumors: A Feasibility Study.

BACKGROUND: As an emerging clinical problem, locally advanced drug-resistant gastrointestinal stromal tumors (LADRGISTs) has relatively few therapeutic schemes. Although radiotherapy is not often considered for GISTs, it could be a valuable contributing modality. The aim of our study is to explore a safe and effective radiation regimen for LADR-GISTs. METHODS: Three patients with LADR-GISTs were treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) plans. In the SIB-IMRT plans, gross target volume (GTV) was divided into GTV-outer, GTV-mid, and GTV-center. And the prescribed dose of planning gross target volume (PGTV) and GTV-outer were both set to 50.4 Gy in 28 fractions. GTV-mid and GTV-center were simultaneously boosted to 60-62 Gy and 62-64 Gy respectively. For comparison purposes, conventional IMRT (Con-IMRT) plans with uniform dose distribution were generated for same optimization objectives without a dose boost to GTV-mid and GTV-center. All plans were optimized to make sure that deliver at least 95% of the prescription dose was delivered to PGTV. Isodose distribution, dose profiles, conformity indexes (CIs), monitor units (MUs), and dose volume histogram (DVH) was evaluated for each individual patient. After the three patients were treated with SIB-IMRT plans, the relative changes in the tumor size and CT values by CT scanning were also tracked. RESULTS: Compared with Con-IMRT plans, SIB-IMRT plans saw a significant increase from D95 to D2 of the GTV. With steeper dose gradients in the dose profiles, SIB-IMRT plans had GTV-mid and GTV-center accumulated with higher dose mainly by delivering extra 93 MUs in average. However, there was no significant difference in CIs and organs at risks (OARs) DVH. The relative changes in tumor size and CT values of the three patients in follow up were up to the Choi criteria and the three patients were all assessed as partial response. CONCLUSIONS: The proposed SIB-IMRT may be a potential technique for achieving objective response and prolonging survival of selected GISTs patients.

A comprehensive and clinical-oriented evaluation criteria based on DVH information and gamma passing rates analysis for IMRT plan 3D verification.

PURPOSE: To accomplish the 3D dose verification to IMRT plan by incorporating DVH information and gamma passing rates (GPs) (DVH_GPs) so as to better correlate the patient-specific quality assurance (QA) results with clinically relevant metrics. MATERIALS AND METHODS: DVH_GPs analysis was performed to specific structures of 51 intensity-modulated radiotherapy (IMRT) treatment plans (17 plans each for oropharyngeal neoplasm, esophageal neoplasm, and cervical neoplasm) with Delta4 3D dose verification system. Based on the DVH action levels of 5% and GPs action levels of 90% (3%/2 mm), the evaluation results of DVH_GPs analysis were categorized into four regions as follows: the true positive (TP) (%DE> 5%, GPs < 90%), the false positive (FP) (%DE ≤ 5%, GPs < 90%), the false negative (FN) (%DE> 5%, GPs ≥ 90%), and the true negative (TN) (%DE ≤ 5%, GPs ≥ 90%). Considering the actual situation, the final patient-specific QA determination was made based on the DVH_GPs evaluation results. In order to exclude the impact of Delta4 phantom on the DVH_GPs evaluation results, 5 cm phantom shift verification was carried out to structures with abnormal results (femoral heads, lung, heart). RESULTS: In DVH_GPs evaluation, 58 cases with FN, 5 cases with FP, and 2 cases with TP were observed. After the phantom shift verification, the extremely abnormal FN of both lung (%DE = 21.52%±8.20%) and heart (%DE = 19.76%) in the oropharyngeal neoplasm plans and of the bilateral formal heads (%DE = 26.41%±13.45%) in cervical neoplasm plans disappeared dramatically. DVH_GPs analysis was performed to all evaluation results in combination with clinical treatment criteria. Finally, only one TP case from the oropharyngeal neoplasm plans and one FN case from the esophageal neoplasm plans did not meet the treatment requirements, so they needed to be replanned. CONCLUSION: The proposed DVH_GPs evaluation method first make up the deficiency of conventional gamma analysis regarding intensity information and space information. Moreover, it improves the correlation between the patient-specific QA results and clinically relevant metrics. Finally, it can distinguish the TP, TN, FP, and FN in the evaluation results. They are affected by many factors such as the action levels of DVH and GPs, the feature of the specific structure, the QA device, etc. Therefore, medical physicist should make final patient-specific QA decision not only by taking into account the information of DVH and GPs, but also the practical situation.

Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study.

BACKGROUND: In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo's database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. OBJECTIVE: This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. METHODS: We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. RESULTS: We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor's consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. CONCLUSIONS: These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.

Nanozyme-based catalytic theranostics.

Nanozymes, a type of nanomaterial with intrinsic enzyme-like activities, have emerged as a promising tool for disease theranostics. As a type of artificial enzyme mimic, nanozymes can overcome the shortcomings of natural enzymes, including high cost, low stability, and difficulty in storage when they are used in disease diagnosis. Moreover, the multi-enzymatic activity of nanozymes can regulate the level of reactive oxygen species (ROS) in various cells. For example, superoxide dismutase (SOD) and catalase (CAT) activity can be used to scavenge ROS, and peroxidase (POD) and oxidase (OXD) activity can be used to generate ROS. In this review, we summarize recent progress on the strategies and applications of nanozyme-based disease theranostics. In addition, we address the opportunities and challenges of nanozyme-based catalytic theranostics in the near future.

QCM-nanomagnetic beads biosensor for lead ion detection.

As lead poses a serious threat to humans even in small amounts, all kinds of lead detection sensors with high sensitivity and selectivity are being constantly improved and put forward. In this report, a novel, simple and label-free quartz crystal microbalance (QCM) biosensor is proposed for detecting lead ions (Pb2+). The biosensor takes full advantage of the high specificity of GR-5 DNAzyme to Pb2+ and the high sensitivity of QCM. In particular, nanomagnetic beads (NMBs) are used as a novel and effective mean of signal amplification in the biosensor because of their mass and their ability to enhance the inductive effect, which are very beneficial for both higher sensitivity and a lower detection limit. In practice, GR-5 DNAzyme, innovatively combined with NMBs, was modified on the gold electrode of the QCM through gold-sulfur self-assembly. When the electrode was exposed to Pb2+ solution, DNAzyme was severed into two parts at the RNA site (rA), along with the release of NMBs, which caused a great increase in frequency shift of the QCM electrode. Finally, a perfect linear correlation between the logarithm of Pb2+ concentration and the change in frequency was obtained from 1 pM to 50 nM, with a detection limit as low as 0.3 pM. Moreover, the biosensor shows both an average recovery of 97 ± 6% in a drinking water sample and an excellent specificity for Pb2+ compared with other metal ions.

Microstructured-core photonic-crystal fiber for ultra-sensitive refractive index sensing.

We propose a novel photonic crystal fiber refractive index sensor which is based on the selectively resonant coupling between a conventional solid core and a microstructured core. The introduced microstructured core is realized by filling the air-holes in the core with low index analyte. We show that a detection limit (DL) of 2.02×10⁻6 refractive index unit (RIU) and a sensitivity of 8500 nm/RIU can be achieved for analyte with refractive index of 1.33.

[Study on spectroscopic properties of Eu and Tb mixed solid complexes with a diamide ligand].

In the present work, Eu(NO3)3 and Tb(NO3)3 complexes with a diamide ligand 1,6-bis[(2'-benzylaminoformyl)phenoxyl]hexane (L) were prepared in the solution of chloroform and ethyl acetate. Their mixed complexes with different molar ratio also synthesized by coprecipitation. Eu and Tb complexes were mixed with different molar ratio, mechanically ground, and a series of mixed solid complexes were obtained. These mixed complexes were characterized by elemental analysis, UV-Vis, IR and XPS spectra. The analytical data were obtained by a Vario EL CHN and indicated that Eu and Tb complexes formed a 2:3 metal-to-ligand stoichiometries 2RE(NO3)3 x 3L x 4H2O. Their IR spectra were recorded on a Bruke FTS66V/S spectrophotometer. The results indicate that all complexes have similar IR spectra, of which the characteristic bands have similar shifts, suggesting that they have a similar coordination structure. UV-Vis spectra were recorded on a Hitachi U-3010 spectrophotometer and showed that under the influence of the mixed ions, the absorbance of the mixed complexes is not identical with that of the pure complexes. XPS spectra were analyzed on a PHI-5702 X-ray photoelectron spectroscope (XPS) operating with monochromatic Mg K alpha irradiation at pass energy of 29.4 eV. The binding energies of O (1s), Eu (3d) and Tb (4d) in the two kinds of mixed complexes were changed compared with Eu-L and Tb-L complexes. This indicates that these two synthetic methods were not a simple physical mixing process, but there was some chemical effect between the mixed Eu-L and Tb-L complexes. The fluorescence spectra of the mixed complexes were obtained on a Hitachi F-4500 spectrophotometer at room temperature. The excitation and emission slit widths was 1.0 nm. It was concluded from the excitation spectra that the best excitation wavelengths for Eu and Tb complexes are 396 and 320 nm respectively. For the convenience of comparing the fluorescence intensities with each other, the excitation wavelengths were set to 320 nm. For the mixed complexes prepared by coprecipitation, the peak positions of the 5 D4-->7 F6 and 5 D4-->7 F5 transitions were not changed. The peak at 590 nm was assigned to the 5D0-->7 F1 and 5 D4-->7 F4 transitions. Its position is dependent on the content of Eu and Tb complexes. When the content of Eu complex is large, this peak is near to the position of the 5 D0-->7 F1 transition, but when the content of Tb complex is large, it is near to the position of the 5 D4-->7 F4 transition. The peak at 620 nm is a combined peak of the 5 D0-->7 F2 and 5 D4-->7 F3 transitions. It has a similar change with the peak at 590 nm. The change of these peak positions could indicate that there was interaction between Eu and Tb complexes. The fluorescence intensities of the mixed solid complexes were changed obviously as compared with the pure Eu and Tb complexes. The fluorescence intensities of their 5 D4-->7 F6 and 5 D4-->7 F5 transitions were lower than those of the Tb complex as well as the theoretical values calculated by the molar ratio of Tb complex, and decreased with the increase in the content of Eu complex, which shows that the fluorescence intensities of terbium ions were quenched by europium ions. The fluorescence intensities of the two combined peaks at 590 and 620 nm are higher than that of Eu complex but lower than that Tb complex and they increased with the increase in the content of Tb complex, which indicates that the fluorescence intensities of Eu3+ were sensitized by Tb3+. In the mixed complexes prepared by grinding, the fluorescence intensities of Eu3+ were also sensitized by Tb3+ and the fluorescence intensities of Tb3+ are also quenched by Eu3+. Under the excitation of UV light, the mixed complexes resulted by coprecipitation exhibit different fluorescence color.

Synthesis and luminescent properties of lanthanide complexes with a novel multipodal ligand.

Solid complexes of lanthanide nitrates, picrates and perchlorates with a novel multipodal ligand, 1,2,4,5-tetramethyl-3,6-bis{N,N-bis[((2'-benzylaminoformyl)phenoxyl)ethyl]-aminomethyl}-benzene (L) have been synthesized and characterized by elemental analysis, infrared spectra and molar conductivity measurements. At the same time, the luminescent properties of the Eu and Tb complexes in solid state were investigated. Under the excitation of UV light, these complexes exhibited characteristic emission of central metal ions. The lowest triplet state energy level T(1) of this ligand matches better to the lowest resonance energy level of Tb(III) than to Eu(III) ion. The influence of the counter anion on the luminescent intensity was also discussed.

Universal precautions in the era of HIV/AIDS: perception of health service providers in Yunnan, China.

With a rising HIV/AIDS epidemic, it has become especially important for health service providers in China to understand and correctly adhere to universal precautions. Using qualitative interview data, perspectives from both health administrators and service providers working at all levels of China's health care system were examined. Service providers admitted selective adherence and non-adherence to universal precautions in their daily medical practice, and gave their explanations for such behaviors. Lack of time to put on protective gear, gear's interference with medical procedures, lack of administrative support, heavy workload in hospitals, inaccurate risk assessment, and beliefs that compliance with universal precautions is unnecessary, time consuming and costly were mentioned as reasons behind noncompliance. Effective universal precaution interventions need to target both administrators and providers, and address both structural barriers and individual attitudinal and behavioral factors.

Synthesis and infrared and fluorescent spectra of rare earth complexes with a new amide ligand.

Solid complexes of rare earth nitrates and picrates with a new amide ligand, 1,6-bis[(2'-benzylaminoformyl)phenoxyl]hexane (L) have been prepared. These complexes are characterized by elemental analysis, UV-vis spectra and IR spectra. The fluorescent and luminescent properties of the Eu(III) and Tb(III) nitrates and picrates complexes in solid state are also investigated. Under the excitation of UV light, these complexes except Tb(III) picrate complex exhibit characteristic emission of europium and terbium ions. The influence of the counter anion on the fluorescent intensity is also discussed.