Development of a haematological indices-based nomogram for prognostic prediction and immunotherapy response assessment in primary pulmonary lymphoepithelioma-like carcinoma patients.

Background: Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare yet aggressive malignancy. This study aims to investigate a deep learning model based on hematological indices, referred to as haematological indices-based signature (HIBS), and propose multivariable predictive models for accurate prognosis prediction and assessment of therapeutic response to immunotherapy in PPLELC. Methods: This retrospective study included 117 patients with PPLELC who received immunotherapy and were randomly divided into a training (n=82) and a validation (n=35) cohort. A total of 41 hematological features were extracted from routine laboratory tests and the least absolute shrinkage and selection operator (LASSO) algorithm were utilized to establish the HIBS. Additionally, we developed a nomogram using the HIBS and clinical characteristics through multivariate Cox regression analysis. To evaluate the nomogram's predictive performance, we used calibration curves and calculated the time-dependent area under the curve (AUC). Kaplan-Meier survival analysis was performed to estimate progression-free survival (PFS) in both cohorts. Results: The proposed HIBS comprised 14 hematological features and showed that patients who experienced disease progression had significantly higher HIBS scores compared to those who did not progress (P<0.001). Five prognostic factors, including HIBS, tumor-node-metastasis (TNM) stage, presence of bone metastasis and the specific immunotherapy regimen, were found to be independent factors and were used to construct a nomogram, which effectively categorized PPLELC patients into a high-risk and a low-risk group, with patients in the high-risk patients demonstrating worse PFS (7.0 vs. 18.0 months, P<0.001) and lower overall response rates (22.2% vs. 52.7%, P<0.001). The nomogram showed satisfactory discrimination for PFS, with AUC values of 0.837 and 0.855 in the training and validation cohorts, respectively. Conclusions: The HIBS-based nomogram could effectively predict the PFS and response of patients with PPLELC regarding immunotherapy and serve as a valuable tool for clinical decision making.

Organisational innovation climate and innovation behaviour among nurses in China: A mediation model of psychological empowerment.

AIM: This study aimed to explore the effect of organisational innovation climate on nurse innovation behaviour and the mediating role of psychological empowerment. BACKGROUND: Encouraging nurses to generate more innovative behaviours has become an important development direction for improving the quality of nursing services. METHOD: We employed a self-report questionnaire to collect data in Jinan City, China. A total of 2018 valid surveys were obtained. Hierarchical multiple regression model analysis was conducted to test the study hypothesis. RESULT: The mean values of innovation behaviour and organisational innovation climate were 35.29 and 83.30, respectively. Psychological empowerment was found to have partially mediating effect on the relationship between organisational innovation climate and innovation behaviour. CONCLUSION: Organisational innovation climate has significant impact on innovation behaviour, and it can indirectly affect innovation behaviour via the mediating role of psychological empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should enhance innovation climate through formal rules, procedures and training activities. They can establish resource guarantee system and information sharing platform, and strengthen work autonomy for nurses to improve their psychological empowerment.

Ethnic disparities in demographic, clinicopathologic and biological behaviours and prognosis of gastric cancer in northwest China.

This retrospective study aimed to investigate ethnic disparities in demographic, clinicopathologic, and biological behaviours of gastric cancer (GC) in a high GC incidence area of China. There were 5022 GC patients, including 3987 Han (79.4%) and 987 Hui (14.4%) patients from Northwest China. All patient data were retrieved from 2009 to 2017. Median survival was estimated using the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used to assess the impact of covariates. Similarly, low 5-year OS rates were observed in both the Hui and Han groups (23.8% and 24.2% respectively). Hui patients with stage T1 or N0 or with tumours <5 cm had 2.144-fold, 1.426-fold and 1.305-fold increased risks of poor prognosis compared with Han patients with these characteristics respectively (all p < 0.05). Further, Hui patients had 1.265-fold, 1.364-fold and 1.401-fold increased risks of poor prognosis compared with Han patients among those with high expression of Ki67, EGFR and VEGF respectively (all p < 0.05). There are ethnic disparities in the prognosis of GC patients in Northwest China. Understanding the effects of ethnicity on GC will guide reasonable evaluations of prognosis and future interventions to equalise access to high-quality care for GC patients of different ethnicities in China.

Calculation of Toxicity Coefficient of Potential Ecological Risk Assessment of Rare Earth Elements.

Rare earth elements (REEs) are applied in various industries. They have entered the environment through different pathways and caused serious pollutions. So far, due to the lack of calculated toxicity coefficient of rare earth elements, it is still difficult to evaluate their ecological risks. The potential ecological risk index method is commonly used in the pollution assessment of heavy metals. And rare earth elements are similar to heavy metals. Herein, we used this method to calculate the toxicity coefficient of 15 rare earth elements (La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, Lu, and Y). The calculation was based on two principles, rare earth elements coexist with each other because of their similar chemical properties, and the elemental abundance and release effect determine their toxicity. The results are as follows: La = 1, Ce = 1, Pr = 5, Nd = 2, Sm = 5, Eu = 10, Gd = 5, Tb = 10, Dy = 5, Ho = 10, Er = 5, Tm = 10, Yb = 5, Lu = 20, Y = 2. Our results can provide a reference to the potential ecological risk assessment of rare earth elements.

Cost-effectiveness of Medical Expulsive Therapy with ?-blockers for Large Distal Ureteral Stones in China.

PURPOSE: To assess the cost-effectiveness of medical expulsive therapy (MET) versus observation for large distal ureteral stones in China and provide preliminary evidence for the determination of the course of MET by mathematical estimation. MATERIALS AND METHODS: With linear success rate assumptions, a decision tree was constructed by TreeAge Pro 2011 software. The stones passage rates after observation or receiving 0.4 mg daily tamsulosin were estimated according to a large randomized clinical trial (RCT). The costs of ureteroscopy, drugs and examinations were estimated according to related price from pharmacies or hospitals, or the guidance price published by the government. MET was also compared with observation by the sensitivity analysis. The effectiveness of MET or observation was presented by quality-adjusted life-day. Mathematical estimation of stone expulsion time was made by using a decision-analytic Markov model under the assumption that the daily stone expulsion probability is constant. RESULTS: In China, the MET was associated with a $295.1 cost advantage over observation. The cost of ureteroscopy has to decrease to $77.8 to reach cost equivalence between observation and MET. Observation is cost-effective only if ureteroscopy is very cheap or the difference of stone expulsion rates is insignificant. The estimated expulsion time was much longer than those reported in above mentioned RCT. CONCLUSION: Due to the high cost of ureteroscopy, MET showed a cost advantage over observation in treating distal ureteral stones in China. The daily stone passage rate was inconstant. More studies are needed to find the appropriate duration of MET.

Spatial misallocation of ecological restoration and resulting economic costs in the red soil hilly region of China: a case study of the Zhuxi watershed.

The spatial misallocation of ecological restoration and its associated economic costs may lead to ecological restoration failure. We analyzed environmental effects of ecological restoration measures, using data from runoff plots, and estimated the ecosystem states under different types of ecological restoration measures using a catastrophe model. We then assessed the spatial misallocation of restoration between sites, where natural restoration can still be used versus those where artificial restoration should be used instead, and estimated the resulting economic costs due to this misallocation in the Zhuxi watershed in the red soil hilly region of China. Results using the catastrophe model were different from those obtained solely based on linear analyses of the runoff plots. Linear models were found to not apply well to the distribution of ecological restoration measures because Changting County reapplied for funding from 2012 to 2017 to maintain projects. There was much spatial misallocation in the studied region, with artificial restoration used at many sites where natural restoration can still be used, which resulted in economic costs of 2453.00 × 104 Chinese renminbi (RMB) from 2012 to 2017. The catastrophe model could analyze the spatial misallocation of ecological restoration and its associated economic costs, and it could reveal the catastrophic phenomena that traditional approaches could not.

Risk Assessment and Prevention of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission for Hospitalized Urological Patients After the COVID-19 Pandemic in Wuhan, China.

BACKGROUND: Emerging asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were detected and multiple cases were found to be SARS-CoV-2 positive again, which raised an alarm for the patients hospitalized after the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: We investigated the risk and prevention of hospital transmission of SARS-CoV-2 to hospitalized urological patients. DESIGN SETTING AND PARTICIPANTS: This is a retrospective study of 319 hospitalized urological patients enrolled between April 20, 2020 and May 11, 2020 from two tertiary hospitals in Wuhan, China. INTERVENTION: Chest computed tomography (CT) images, nucleic acid tests (NATs), and serum antibody were examined at the outpatient department and 1 wk after admission for all patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The chest CT images, NATs, serum antibody results, and clinical data were collected and analyzed. RESULTS AND LIMITATIONS: None of the 319 patients was found to be SARS-CoV-2 NAT positive. Ten and four patients were detected to be immunoglobulin (Ig)G and IgM positive, respectively. The chest CT features of 116 patients showed abnormal lung findings. During the 1-wk isolation, one patient initially being IgG positive only was found to be IgM positive, and another initially IgM-positive patient had a rising IgG level. Through risk assessment, we identified seven patients with very high and high risk for hospital transmission, and delayed the surgery while maintaining close follow-up. Five intermediate-risk patients were operated on successfully under paravertebral block or epidural anesthesia to avoid opening the airway with endotracheal intubation. The remaining 104 low-risk and 203 normal patients underwent normal surgery. CONCLUSIONS: Of the 319 patients, seven were identified as very high and high risk, which reinforced the importance of epidemic surveillance of discharged COVID-19 patients and asymptomatic infections. Five intermediate-risk patients were operated on successfully under regional anesthesia. PATIENT SUMMARY: Our experience of risk assessment and management practice may provide a strategy to prevent severe acute respiratory syndrome coronavirus 2 transmission to hospitalized urological patients after the coronavirus disease 2019 (COVID-19) pandemic.

Compton-based prompt gamma imaging using ordered origin ensemble algorithm with resolution recovery in proton therapy.

Prompt gamma ray (PG) imaging based on Compton camera (CC) is promising to realize in vivo verification during the proton therapy. However, the finite spatial and energy resolution of current CC, as well as the Doppler broaden effect, degrade the quality and resolution of PG images. In addition, due to the inherent geometrical complexity of Compton camera data, PG imaging can be time-consuming and difficult to reconstruct in real-time, while using standard techniques such as filtered back-projection or maximum likelihood-expectation maximization. In this paper, we propose three modifications of origin ensembles with resolution recovery (OE-RR) algorithm based on Markov chains to accelerate the convergence to equilibrium of OE-RR algorithm and improve the image quality. For evaluation, we performed a Monte Carlo simulation of a three-stage CZT Compton camera with resolution loss to detect the PG produced by a proton beam in a water phantom, and evaluate image quality of the gamma rays emitted during proton irradiation. The results show that our ordered OE-RR algorithm realized a good resolution recovery and accurate estimation of the position, including the peak and the distal falloff of the PG emission with remarkably faster reconstruction, thus demonstrating the feasibility of this new method in non-idealized PG-based proton range verification.

Assessment of maturity during co-composting of penicillin mycelial dreg via fluorescence excitation-emission matrix spectra: Characteristics of chemical and fluorescent parameters of water-extractable organic matter.

To investigate characteristics of water-extractable organic matter (WEOM) from different stages and evaluate the maturity for co-composting penicillin mycelial dreg (PMD) via fluorescence regional integration (FRI) of fluorescence excitation-emission matrix (EEM), a pilot-scale co-composting was carried out. The results showed that a classical temperature profile showed and a degradation rate of 98.1% for residual penicillin was obtained on the 6th day. DOC and DOC/DON ratio were in a low level of 4.0 g kg(-1) and 3.7, respectively, after the 32nd day. In addition, respirometric rate (SOUR) decreased to 0.87 mg O2 g(-1) VS h(-1) finally. The EEM showed that the specific Ex/Em peak related to microbial byproduct-like vanished on the 32nd day, while those related to fulvic-like and humic acid-like appearing on the 24th day. The fluorescence regional integration (FRI) results demonstrated that PV,n/PIII,n increased to 3.28 finally, suggesting a desirable maturity for co-composting PMD. The EEM-FRI consequently has the potential for characterizing the WEOM from the co-composting of PMD.

Maturity and security assessment of pilot-scale aerobic co-composting of penicillin fermentation dregs (PFDs) with sewage sludge.

In this work, penicillin fermentation dregs (PFDs) and sewage sludge (SWS) were co-composted to analyze the possibility of recycling nutrients in PFDs. The temperature was maintained above 55°C for more than 3 days, and the final electrical conductivity (EC), pH and C/N all met the national standards in maturity. A nearly 100% removal of the residual penicillin was achieved, and the seed germination index (GI) increased from 0.02% to 83.54±3.1% by the end of the composting process. However, monitoring the quantity of antibiotic resistance genes (ARGs) showed that the logarithm of the number of copies of blaTEM increased from 4.17±0.19 at the initial phase to 8.92±0.27 by the end of the composting process, which means that there is a high risk for land use when using PFD compost products.

A human health risk assessment of rare earth elements in soil and vegetables from a mining area in Fujian Province, Southeast China.

Contaminated food through dietary intake has become the main potential risk impacts on human health. This study investigated concentrations of rare earth elements (REEs) in soil, vegetables, human hair and blood, and assessed human health risk through vegetables consumption in the vicinity of a large-scale mining area located in Hetian Town of Changting County, Fujian Province, Southeast China. The results of the study included the following mean concentrations for total and bio-available REEs of 242.92 ± 68.98 (135.85-327.56)µg g(-1) and 118.59 ± 38.49 (57.89-158.96)µg g(-1) dry weight (dw) in agricultural soil, respectively, and total REEs of 3.58 ± 5.28 (0.07-64.42)µg g(-1) dw in vegetable samples. Concentrations of total REEs in blood and hair collected from the local residents ranged from 424.76 to 1274.80 µg L(-1) with an average of 689.74 ± 254.25 µg L(-1) and from 0.06 to 1.59 µg g(-1) with an average of 0.48 ± 0.59 µg g(-1) of the study, respectively. In addition, a significant correlation was observed between REEs in blood and corresponding soil samples (R(2)=0.6556, p<0.05), however there was no correlation between REEs in hair and corresponding soils (p>0.05). Mean concentrations of REEs of 2.85 (0.59-10.24)µg L(-1) in well water from the local households was 53-fold than that in the drinking water of Fuzhou city (0.054 µg L(-1)). The health risk assessment indicated that vegetable consumption would not result in exceeding the safe values of estimate daily intake (EDI) REEs (100-110 µg kg(-1)d(-1)) for adults and children, but attention should be paid to monitoring human beings health in such rare earth mining areas due to long-term exposure to high dose REEs from food consumptions.

[Current situation and prospect on post-surgery assessment of peri-operative gastrointestinal functions].

Under the guidance of the concept of fast tract surgery (FTS), peri-operative managements including pre-operative, intra-operative and post-operative treatments can be optimized to accelerate the rehabilitation of surgery patients. Post-operative recovery of gastrointestinal functions is one of the key links of FTS, in which Chinese medicine has certain features and advantages over it. Current assessments on post-operative gastrointestinal functions recovery include clinical and laboratory assessments, but there is still no industrial assessment received by all. The current situation of post-surgery assessment of peri-operative gastrointestinal functions was studied in this paper, and the research orientation of this field was analyzed and prospected.

Biosynthesis of polyhydroxyalkanoate by Gamma proteobacterium WD-3 from volatile fatty acids.

The production of copolymers of poly-ß-hydroxyalkanoates (PHA) is generally a high cost process. To reduce the production costs, inexpensive carbon sources such as volatile fatty acids (VFAs) from acidified wastewater can be used. Therefore, isolation of bacterial strains that can produce PHA copolymers using VFAs as a sole carbon source would be a beneficial alternative. In this study, a strain of PHA accumulating bacterium was isolated from the wastewater treatment plant of a soybean processing facility in Harbin. The strain was identified as γ-proteobacterium according to its 16S rDNA information and was originally named as strain WD-3. The strain accumulated a mass of PHA up to 45% of its dry cell weight when it was cultured under the optimum fermentation condition in this study when butyrate was used as the carbon source. In addition, WD-3 could synthesize PHA copolymers of poly-hydroxybutyrate and poly-hydroxyvalerate (PHV) either from C-even substrates or from C-odd substrates, and one-third of the copolymer was PHV. Results from this study demonstrated that small molecule organic acids can be used by the strain of WD-3 as the carbon source for growth and PHA production. The maximum PHA yield in the study was 0.45 g g(-1) dry cell.

Progress of the National Pediatric Free Antiretroviral Therapy program in China.

In 2003, the Chinese Government initiated a free antiretroviral therapy (ART) program focusing on adult AIDS patients. Pediatric antiretroviral (ARV) formulations were yet unavailable. It was not until July 2005, with the initiation of a two-stage program implemented by the Chinese Ministry of Health, that pediatric formulations became accessible in China. Initially, the pediatric ART program was piloted in six provinces with the highest incidences of pediatric HIV/AIDS. The pilot stage allowed the Chinese Center for Disease Control and Prevention (CCDC) to finalize entry criteria, treatment regimen, and patient monitoring and follow-up procedures. The second stage commenced at the end of 2006 when the program was scaled-up nationally. In order to guarantee treatment of pediatric patients, extensive training in the selection of appropriate ARV drug regimen and dosage was provided to doctors, often through on-site collaboration with domestic and international experts. The CCDC simultaneously established a pediatric ARV management system and a pediatric ART information system. CD4 count and other laboratory tests are being routinely performed on these pediatric patients. By the end of June 2009, 1529 pediatric patients had received ARV under the national program. However, challenges remain. Firstly, many children infected with HIV/AIDS live in rural areas where the treatment quality is hindered by the limited number of medical facilities and skilled medical workers. Secondly, much of the pediatric ARV drug supply depends on donation. An effort needs to be made by the Chinese Government to establish China's own drug procurement and supply system.