Assessment and clinical utility of metagenomic next-generation sequencing for suspected lower respiratory tract infections.

OBJECTIVES: This study aims to compare the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) to traditional diagnostic methods in patients with lower respiratory tract infections (LRTIs), elucidate the etiological spectrum of these infections, and explore the impact of mNGS on guiding antimicrobial therapy. METHODS: We retrospectively analyzed data from 128 patients admitted to the Respiratory Department of Anqing 116 Hospital between July 2022 and July 2023. All patients had undergone both mNGS and conventional microbiological techniques (CMT) for LRTI diagnosis. We assessed the diagnostic performance of these methods and examined the influence of mNGS on antimicrobial decision-making. RESULTS: Overall, mNGS demonstrated superior sensitivity (96.8%) and accuracy (96.8%) compared to CMT. For Mycobacterium tuberculosis detection, the accuracy and sensitivity of mNGS was 88.8% and 77.6%, which was lower than the 94.7% sensitivity of the T-spot test and the 79.6% sensitivity of CMT. In fungal pathogen detection, mNGS showed excellent sensitivity (90.5%), specificity (86.7%), and accuracy (88.0%). Bacteria were the predominant pathogens detected (75.34%), with Mycobacterium tuberculosis (41.74%), Streptococcus pneumoniae (21.74%), and Haemophilus influenzae (16.52%) being most prevalent. Bacterial infections were most common (62.10%), followed by fungal and mixed infections (17.74%). Of the 118 patients whose treatment regimens were adjusted based on mNGS results, 102 (86.5%) improved, 7 (5.9%) did not respond favorably, and follow-up was lost for 9 patients (7.6%). CONCLUSIONS: mNGS offers rapid and precise pathogen detection for patients with suspected LRTIs and shows considerable promise in diagnosing Mycobacterium tuberculosis and fungal infections. By broadening the pathogen spectrum and identifying polymicrobial infections, mNGS can significantly inform and refine antibiotic therapy.

Safety assessment of Acori Tatarinowii Rhizoma: acute and subacute oral toxicity.

Introduction: Acori Tatarinowii Rhizoma (ATR) is a well-known traditional Chinese medicine that is used for treating neuropathic diseases. However, there is little information about the safety of ATR. Methods: The present study evaluated the acute and subacute oral toxicity of a water extract of ATR in Institute of Cancer Research (ICR) mice. In acute trials, a single administration of extract at a dose 5,000 mg/kg body weight led to no clinical signs of toxicity or mortality, indicating that the lethal dose (LD50) exceeded 5,000 mg/kg. A subacute toxicity test was done using daily doses of 1,250, 2,500, and 5,000 mg/kg of the ATR extract for 28 days, which did not show any adverse clinical symptoms or mortality. However, the male renal organ index and urea level in mice given 5,000 mg/kg was obviously abnormal, which was consistent with pathological results and suggested that this dose might cause kidney injury. Results: Doses of ATR lower than 2,500 mg/kg could be regarded as safe, although the potential cumulative effects of long-term use of high doses of ATR need to be considered. Discussion: The study highlights the function of ATR in reducing blood lipids and provides a new idea for its widespread clinical use in the future.

Financial big data management and intelligence based on computer intelligent algorithm.

With the acceleration of China's economic integration process, enterprises have gained greater advantages in the fierce market competition, and gradually formed the trend of grouping and large-scale. However, as the scale of the company increases, the establishment of a branch also causes many problems. For example, in order to obtain more benefits, the business performance of the company can generate false growth, resulting in financial and operational risks. This paper analyzed the current situation and needs of enterprise financial control from two aspects of theory and practice, combined with specific engineering projects, taking ZH Group as an example, according to the actual situation of the enterprise. The article first introduces the basic situation of the enterprise; Then, the financial control strategy was designed, and different modules were designed to achieve financial control; Afterwards, use a reverse neural network to evaluate the effectiveness of financial management and risk warning; Relying on particle swarm optimization algorithm to seek the optimal solution and applying it to financial management and risk warning, in order to improve the level of introspection and risk management in decision-making. Finally, the value of computer intelligence algorithms in financial big data management is evaluated by constructing a financial risk indicator system. Through the analysis of enterprise financial management, the total asset turnover rate of ZH Group decreased by 0.39 times in 5 years. After 5 years of adjustment of the company's business, the company's overall operational capabilities still needed to be improved, and the company's comprehensive business capabilities also still needed to be improved. Therefore, the application of intelligent algorithms for financial control is very necessary.

Real-world retrospective study of prostate-specific antigen and safety assessment with darolutamide plus androgen deprivation therapy for metastasis hormone-sensitive prostate cancer.

Background: ARASENS has demonstrated the efficacy and safety for darolutamide (DARO) with androgen deprivation therapy (ADT) plus docetaxel in metastasis hormone-sensitive prostate cancer (mHSPC). There is a lack of reports for DARO with ADT in mHSPC though the regimen is used in clinical from time to time. Moreover, recent studies have supported the importance of early and rapid prostate-specific antigen (PSA) reduction, which correlates with reduced disease progression and improved survival in patients with mHSPC. This study aims to evaluate PSA reduction as a primary endpoint for DARO with ADT in the treatment of mHSPC and to evaluate the real-world short-term PSA control of DARO with ADT from two leading medical centers in China. Methods: We retrospectively reviewed the clinical records of patients with mHSPC receiving ADT and DARO (600 mg, b.i.d.). The collection of data spanned from March 1, 2022, to July 31, 2023. The main observation indicators were PSA level and drug-related adverse events (AE) after medication. PSA levels were closely monitored prior to treatment initiation and at 2-week intervals, as well as at 1, 3, and 6 months after the initiation of treatment. We also conducted an analysis to determine the proportion of patients achieving a PSA reduction of 50% or more (PSA50) and 90% or more (PSA90) as well as the percentage of patients with a notable decrease in PSA level to 0.2 ng/mL and PSA nadir of ≤0.02 ng/mL. Results: Fifty-one patients were included in the study, with a median age of 73 years. At diagnosis of HSPC, the majority of patients had a Gleason score ≥8 (n=40, 78.40%) and a median baseline PSA level of 88 ng/mL. Approximately 45.1% (n=23) of patients had a Charlson Comorbidity Index over 1 and were receiving one or more nontumor-related treatments. The median follow-up time was 9.3 months (range, 1.16-15.8 months). The median reductions in PSA levels compared to baseline were 84.37%, 91.48%, 94.67% and 99.81% at 2 weeks, 1 month, 3 months and 6 months after administration of DARO with ADT, respectively. The median time to PSA50, PSA90, significant PSA reduction (PSA <0.2 ng/mL), and PSA nadir (PSA <0.02 ng/mL) was 0.97, 1.27, 1.98, and 2.08 months, respectively. AE mainly included fatigue (two patients) and arm pain (one patient), all of which were grade I or II AE. No grade III or AE were observed. Conclusions: For treating prostate cancer, DARO with ADT has good early efficacy, demonstrating prompt and substantial control of PSA levels, with a favorable safety profile.

Thematic Analysis of Alzheimer's Medication Management Discussion in a Non-Moderated Online Forum.

BACKGROUND: Managing medications for Alzheimer's disease and related dementias is challenging for caregivers. Information about caregivers' strategies to manage these challenges is needed to inform intervention development. OBJECTIVE: This study aimed to understand caregivers' medication management experiences by analyzing online community discussions. METHODS: Posts were extracted from the ALZConnected® Forum using keywords "medication" and "drug" via web scraping. The researchers applied thematic analysis. RESULTS: Four major themes emerged: (1) role transition of medication management responsibilities, (2) caregivers' uncertainty about medication purpose and values, (3) conflicts between the care recipients and caregivers, and (4) difficulty accessing and affording medications. CONCLUSIONS: The experiences shared on a non-moderated, unstructured online forum indicate that medication management is challenging and overwhelming for caregivers of people living with Alzheimer's disease and related dementias. Since this is a progressive disease with various stages and changing needs, caregivers' strategies vary and are often limited by available resources and support. Health care providers should offer training and support for caregivers to navigate the transfer of medication management responsibilities and changing care needs as the disease progresses.

Spatial-temporal differentiation of urban eco-efficiency and its driving factors: A comparison of five major urban agglomerations in China.

This paper utilizes an improved undesirable output DEA model to measure the eco-efficiency of cities in five major urban agglomerations in China during 2006-2020. It employs the Theil Index and Geodetector to investigate the spatial-temporal distribution differentiation characteristics and driving factors of urban eco-efficiency. The main findings are as follows. Firstly, the eco-efficiency of all urban agglomerations showed a fluctuating upward trend, but the eco-efficiency performance of different urban agglomerations in China shows a stratification characteristic. Specifically, the Pearl River Delta urban agglomeration consistently ranks first in China, while the mean values of the Yangtze River Delta urban agglomeration, Beijing-Tianjin-Hebei urban agglomeration, and Chengdu-Chongqing urban agglomeration are lower than the national average. Secondly, the overall differences in the urban eco-efficiency of all sample cities show a consistently fluctuating downward trend. The factor that affects the level differences of eco-efficiency in different cities is the intra-regional differences. Last but not least, the top three factors affecting the spatial distribution difference of urban eco-efficiency in the whole sample are environmental pollution control investments, innovation level, and environmental infrastructure investments. In the end, this paper proposes that reducing the intra-regional differences is the primary task to achieve the coordinated improvement of urban eco-efficiency in urban agglomerations, and then puts forward some policy suggestions to improve eco-efficiency for the five major urban agglomerations.

Quality assessment of health science-related short videos on TikTok: A scoping review.

OBJECTIVE: The aims of this review are to clarify the current state of research in terms of assessment tools and assessors of the quality of health science-related short videos on TikTok, to identify limitations in existing research; and to provide a reference for future studies. METHODS: A scoping review was conducted. The Cochrane Library, PubMed, MEDLINE, Web of Science, Embase, Scopus, EBSCO, CNKI, VIP, Wanfang Data, and CBM databases were searched from September 2016 to November 2022. Manual searching was also performed to identify additional eligible studies. A total of 2620 documents were initially retrieved, and 29 were ultimately included. The literature was screened and collected, and data were extracted and summarized by 2 researchers. RESULTS: (1) The quality evaluation tools used in the 29 papers included the DISCERN, PEMAT(A/V), GQS, JAMA, HONcode, guidelines and self-developed tools. Twenty-four of the included articles used the DISCERN for quality assessment, which was the most frequently used evaluation tool. However, most of these tools were not developed to assess health science-related short videos, lacked credibility tests, and had poor applicability; therefore, the accuracy of the evaluation results might be biased. (2) The assessors of the quality of health science-related short videos on TikTok were mainly experts in related fields and medical students, with doctors (12/14) being the most common evaluators. Fifteen studies did not report the identity of the evaluators, and 12 studies did not report interrater reliability. CONCLUSION: This scoping review found that there is a lack of specific quality assessment tools for health science-related short videos on TikTok. Second, the current quality assessors of health science-related short videos on TikTok are limited. Future research should focus on the development of reliable, scientific quality assessment tools for health science-related short videos; unifying the evaluation standards; inviting users with different backgrounds and different health literacy levels to conduct quality assessments; exploring the quality assessment of health science-related short videos on TikTok from different perspectives.

Assessment of progression of pulmonary fibrosis based on metabonomics and analysis of intestinal microbiota.

The main purpose of this study was to explore the changes of biomarkers in different developmental stages of bleomycin-induced pulmonary fibrosis (PF) in rats via comprehensive pathophysiology, UPLC-QTOF/MS metabonomic technology, and 16S rRNA gene sequencing of intestinal microbiota. The rats were randomly divided into normal control and 1-, 2- and 4-week model group. The rat model of PF was established by one-time intratracheal instillation of bleomycin. The levels of inflammatory and fibrosis-related factors such as hydroxyproline (HYP), type III procollagen (COL-III), type IV collagen (COL-IV), hyaluronidase (HA), laminin (LN), interleukin (IL)-1ß, IL-6, malondialdehyde (MDA) increased and superoxide dismutase (SOD) decreased as the PF cycle progressed. In the 1-, 2- and 4-week model group, 2, 19 and 18 potential metabolic biomarkers and 3, 16 and 12 potential microbial biomarkers were detected, respectively, which were significantly correlated. Glycerophospholipid metabolism pathway was observed to be an important pathway affecting PF at 1, 2 and 4 weeks; arginine and proline metabolism pathways significantly affected PF at 2 weeks. Linoleic acid metabolism pathway exhibited clear metabolic abnormalities at 2 and 4 weeks of PF, and alpha-linolenic acid metabolism pathway significantly affected PF at 4 weeks.

In this study, metabolomics technology and intestinal microbiota 16S rRNA gene sequencing were used to search for biomarkers with significant differences in each stage of pulmonary fibrosis. Finally, the variation characteristics of each stage of the disease were discussed. The hope is to provide new insights into the development of diagnostic biomarkers and potential therapeutic targets at all stages.

Cost-Effective Preparation of Hydrophobic and Thermal-Insulating Silica Aerogels.

The aim of this study is to reduce the manufacturing cost of a hydrophobic and heat-insulating silica aerogel and promote its industrial application in the field of thermal insulation. Silica aerogels with hydrophobicity and thermal-insulation capabilities were synthesized by using water-glass as the silicon source and supercritical drying. The effectiveness of acid and alkali catalysis is compared in the formation of the sol. The introduction of sodium methyl silicate for the copolymerization enhances the hydrophobicity of the aerogel. The resultant silica aerogel has high hydrophobicity and a mesoporous structure with a pore volume exceeding 4.0 cm3·g-1 and a specific surface area exceeding 950 m2·g-1. The obtained silica aerogel/fiber-glass-mat composite has high thermal insulation, with a thermal conductivity of less than 0.020 W·m-1·K-1. The cost-effective process is promising for applications in the industrial preparation of silica aerogel thermal-insulating material.

Digital inclusive finance, R&D investment, and green technology innovation nexus.

Green technology innovation is an effective means to achieve high-quality economic development. The impact and mechanism of digital financial inclusion on regional green technology innovation are tested using a threshold regression model and the panel fixed effect model, based on China's provincial Panel data (provincial Panel data are regional annual report data) from 2011 to 2020. According to the study, there is a direct link between local green technology innovation and digital financial inclusion. This paper highlights the differences in their influence by location and usage depth and underscores the necessity of government engagement to improve these characteristics. Information infrastructure needs to be strengthened, especially in areas with gaps. Greater investment in research and development (R&D) indirectly supports regional green technology innovation since it is impacted by digital financial inclusion. Interestingly, a threshold effect becomes most noticeable when digital financial inclusion rises above a particular threshold. Promoting utilizing digital financial inclusion to lessen regional differences in green technology innovation is important.

The impact of digital economy on environmental pollution: Evidence from 267 cities in China.

Environmental pollution has become a pressing global issue, severely threatening human health and ecosystems. As an emerging driver of economic development in countries worldwide, the digital economy (DE) has the potential to enhance resource utilization efficiency and promote the development of clean technologies, thereby reducing environmental pollution. Based on the panel data of 267 cities in China from 2012 to 2021, the spatial econometric model is used to test the impact of DE on environmental pollution. The mediating effect model is used to explore the transmission mechanism of DE affecting environmental pollution. The panel threshold model is used to examine the threshold effect of marketization. The results are as follows: (1) DE can significantly reduce environmental pollution. The conclusion is still valid after conducting robustness tests such as selecting historical data as instrumental variables and the "Broadband China" pilot as a quasi-natural experiment. (2) From the perspective of transmission mechanism, DE can reduce environmental pollution through green technology innovation and industrial structure upgrading. (3) From the perspective of spatial spillover effect, DE can reduce the environmental pollution level of surrounding cities. (4) From the perspective of threshold effect, DE has obvious market-oriented single threshold effect on environmental pollution. When the marketization level crosses the threshold of 11.6611, the emission reduction effect of DE is significant. (5) From the perspective of heterogeneity, DE has a heterogeneous impact on environmental pollution in cities with different geographic locations, resource endowments and administrative level. Regarding geographical heterogeneity, DE can effectively reduce environmental pollution in eastern and central regions, but has no significant impact on environmental pollution in western regions. Regarding the heterogeneity of resource endowment, compared to non-resource-based cities, resource-based cities suffer more from the negative effects of DE on their environment. Regarding the heterogeneity of administrative levels, compared with non-central cities, the DE of central cities has a greater emission reduction effect. Based on empirical results, this paper proposes strategic recommendations in areas such as enhancing the application of DE in emission reduction, upgrading industrial structures, promoting green technology innovation, and improving the level of marketization. This study not only enriches the research of DE and environmental pollution, but also provides a reference for the formulation of environmental pollution control policies.

Agricultural insurance and rural revitalization-an empirical analysis based on China's provincial panel data.

Agricultural insurance is a kind of compensation insurance designed to provide protection for the economic losses caused by insured accidents suffered by agricultural producers in agricultural production. Rural revitalization refers to the strategy of improving the level of rural economic, social and cultural development and achieving coordinated and sustainable development of urban and rural development. Agricultural insurance can effectively diversify risks and reduce losses for agricultural producers, which plays an important role in stabilizing farmers' income, helping rural economic development, and promoting rural revitalization. Based on the theoretical analysis of the mechanism of agricultural insurance on rural revitalization, this paper empirically studies the effect of agricultural insurance on rural revitalization by using panel data from various provinces in China from 2011 to 2020. In this paper, the TOPSIS entropy weight method, the system generalized method of moments (GMM) and the threshold model are used to calculate the actual development level of rural revitalization in each province of China, the promotion effect of agricultural insurance on the development level of rural revitalization and the promotion of rural revitalization in five dimensions, and whether there is a threshold effect of agricultural insurance on rural revitalization. The empirical results show that: (1) The level of rural revitalization in various provinces in China shows a dynamic trend of "overall slow rise, with obvious differences between provinces." (2) Improving the development level of agricultural insurance can drive the improvement of China's rural revitalization level, and every 1 unit increase in the development level of agricultural insurance will drive the level of China's rural revitalization to increase by 0.1633 units. At the same time, the role of agricultural insurance on social etiquette and civility is not significant, and the role of the remaining four rural revitalization goals is significant. (3) Agricultural insurance has a significant effect on the level of rural revitalization in eastern provinces, but does not play a significant role in rural revitalization in central and western provinces. (4) The role of agricultural insurance on rural revitalization has a double threshold effect. Accordingly, this paper puts forward some suggestions for increasing the capital investment in agricultural insurance, innovating the new mode of agricultural insurance operation, promoting the in-depth development of agricultural insurance according to local conditions, and reasonably adjusting the capital investment of agricultural insurance. Finally, because the data used in this paper do not cover the entire process of rural revitalization and the research is mainly carried out from a macro perspective, there are still some shortcomings in this paper.

Delivery and Transcriptome Assessment of an In Vitro Three-Dimensional Proximal Tubule Model Established by Human Kidney 2 Cells in Clinical Gelatin Sponges.

The high prevalence of kidney diseases and the low identification rate of drug nephrotoxicity in preclinical studies reinforce the need for representative yet feasible renal models. Although in vitro cell-based models utilizing renal proximal tubules are widely used for kidney research, many proximal tubule cell (PTC) lines have been indicated to be less sensitive to nephrotoxins, mainly due to altered expression of transporters under a two-dimensional culture (2D) environment. Here, we selected HK-2 cells to establish a simplified three-dimensional (3D) model using gelatin sponges as scaffolds. In addition to cell viability and morphology, we conducted a comprehensive transcriptome comparison and correlation analysis of 2D and 3D cultured HK-2 cells to native human PTCs. Our 3D model displayed stable and long-term growth with a tubule-like morphology and demonstrated a more comparable gene expression profile to native human PTCs compared to the 2D model. Many missing or low expressions of major genes involved in PTC transport and metabolic processes were restored, which is crucial for successful nephrotoxicity prediction. Consequently, we established a cost-effective yet more representative model for in vivo PTC studies and presented a comprehensive transcriptome analysis for the systematic characterization of PTC lines.

Is Alpelisib Plus Fulvestrant Cost-Effective for Treating PIK3CA-Mutation, HR+/HER2- Advanced Breast Cancer in the USA?

BACKGROUND AND OBJECTIVE: There is a considerable survival benefit of alpelisib in patients with PIK3CA-mutated, hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced breast cancer (HR+/HER2- ABC), yet the financial burden may limit its use. Therefore, this study evaluated the cost-effectiveness of alpelisib plus fulvestrant in patients with PIK3CA-mutated, HR+/HER2- ABC in the USA. METHODS: A Markov model was constructed to simulate the progression of PIK3CA-mutated, HR+/HER2- ABC. Efficacy and safety data were derived from the SOLAR-1 trial. A parametric survival model was used to explore the long-term effect. From a US payer perspective, only direct medical costs were considered. The cost data were estimated based on local pricing and relevant literature. The health outcomes were expressed in quality-adjusted life years (QALYs). Model stability was assessed using one-way sensitivity analysis and probability sensitivity analysis. Subgroup analyses were performed to explore cost-effectiveness outcomes for patients with different clinical characteristics. RESULTS: The QALY increased by 0.28 with alpelisib plus fulvestrant with an additional cost of $94,345.87 compared with placebo plus fulvestrant, leading to an incremental cost-effectiveness ratio (ICER) of $340,153.30/QALY gained. Sensitivity analyses suggested that the model is most sensitive to the price of alpelisib. At a willingness-to-pay (WTP) threshold of $150,000/QALY, alpelisib plus fulvestrant was cost effective when the cost of alpelisib was less than $71 per 300 mg (36.5 % of the original price), whereas this cost would be less than $168 per 300 mg (86.5 % of the original price) at a WTP threshold of $300,000/QALY. In addition, alpelisib + fulvestrant was not cost effective in all subgroups compared with placebo + fulvestrant at the WTP threshold of $150,000/QALY. In contrast, at the WTP threshold of $300,000/QALY, alpelisib + fulvestrant was cost effective in nearly all subgroups except for endocrine-sensitive patients. CONCLUSION: At current drug prices, alpelisib plus fulvestrant is not cost effective for patients with PIK3CA-mutated, HR+/HER2- ABC from a US payer perspective. Given the considerable progression-free survival (PFS) and overall survival (OS) benefits observed with alpelisib in this setting, further discussion and negotiation of the price of alpelisib are warranted to provide more favorable economic outcomes and thereby increase the value of the alpelisib plus fulvestrant regimen in patients.

The value of believing in free will: A prediction on seeking and experiencing meaning in life.

Despite abundant philosophical pondering and experiential evidence demonstrating the need for freedom in leading a meaningful life, the literature lacks an investigation of whether and how free will beliefs contribute to one's meaningful life as an antecedent variable. Based on the coupling of the life-affirming hypothesis and Chinese culture, we used a manipulation experiment (Study 1, n = 242) and a two-wave longitudinal study (Study 2, n = 378) to test the potential causality between laypeople's daily beliefs in free will and meaning in life (presence of and search for meaning) with two samples of Chinese undergraduates. The results show that belief in free will positively predicts the presence of meaning and search for meaning, immediately (Study 1) and 2 months later (Study 2). The present work corroborated that the belief in free will is an antecedent variable that imbues life with meaning and sparks actions seeking meaning, supporting the life-affirming hypothesis instead of the deficit-correcting hypothesis.

Phytotoxicity assessment of dandelion exposed to microplastics using membership function value and integrated biological response index.

Microplastic (MP) pollution is a critical environmental issue. Dandelions could be used as a biomonitor of environmental pollution. However, the ecotoxicology of MPs in dandelions remains unclear. Therefore, the toxic effects of polyethylene (PE), polystyrene (PS), and polypropylene (PP) at concentrations of 0, 10, 100, and 1000 mg L-1 on the germination and early seedling growth of dandelion were investigated. PS and PP inhibited seed germination and decreased root length and biomass while promoting membrane lipid peroxidation, increasing O2•-, H2O2, SP, and proline contents, and enhancing the activities of SOD, POD, and CAT. Principal component analysis (PCA) and membership function value (MFV) analysis indicated that PS and PP could be more harmful than PE in dandelion, especially at 1000 mg L-1. In addition, according to the integrated biological response (IBRv2) index analysis, O2•-, CAT, and proline were sensitive biomarkers of dandelion contamination by MPs. Here we provide evidence that dandelion has the potential to be a biomonitor to assess the phytotoxicity of MPs pollution, especially PS with high toxicity. Meanwhile, we believe that if dandelion is to be used as a biomonitor for MPs, attention should also be paid to the practical safety of dandelion.

Global, regional, and national burdens of myocarditis, 1990-2019: systematic analysis from GBD 2019 : GBD for myocarditis.

OBJECTIVES: Myocarditis, a health-threatening heart disease, is attracting increasing attention. This systematic study was conducted to study the prevalence of disease through the trends of incidence, mortality, disability-adjusted life years (DALYs) over the last 30 years, which would be helpful for the policymakers to better the choices for reasonable decisions. METHODS: The global, regional, and national burdens of myocarditis from 1990-2019 were analyzed by using the 2019 Global Burden of Disease (GBD) database. This study on myocarditis produced new findings according to age, sex, and Social-Demographic Index (SDI) by investigating DALYs, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and corresponding estimated annual percentage change (EAPC). RESULTS: The number of myocarditis incidence increased by 62.19%, from 780,410 cases in 1990 to 1,265,770 cases in 2019. The ASIR decreased by 4.42% (95%CI, from -0.26% to -0.21%) over the past 30 years. The number of deaths from myocarditis increased by 65.40% from 19,618 in 1990 to 324,490 in 2019, but the ASDR was relatively stable over the investigated period. ASDR increased in low-middle SDI regions (EAPC=0.48; 95%CI, 0.24 to 0.72) and decreased in low SDI regions (EAPC=-0.97; 95%CI, from -1.05 to -0.89). The age-standardized DALY rate decreased by 1.19% (95%CI, from -1.33% to -1.04%) per year. CONCLUSIONS: Globally, the ASIR and DALY for myocarditis decreased and the ASDR was stable over the past 30 years. The risk of incidences and death cases increased with age. Measures should be taken to control the risk of myocarditis in high-burden regions. Medical supplies should be improved in the high-middle SDI regions and middle SDI regions to reduce the deaths from myocarditis in these regions.

National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time.

BACKGROUND: The Dual Pathway for Certification in Pediatrics and Anesthesiology was created in 2011 to develop leaders in caring for children with complex medical and surgical conditions. While existing dual-trained practitioners report continued practice in both pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM), recent surveys of dual pathway trainees have shown that only one-quarter still currently plan to pursue training in PCCM, a change from their initial plans to complete training in both PA and PCCM. The aim of this study was to further characterize the motivations driving shifts in career trajectory during training as well as factors affecting the combined training experience. METHODS: We conducted an online mixed-methods survey of all individuals who had matriculated at 1 of the 7 Accreditation Council for Graduate Medical Education-accredited combined pediatrics-anesthesiology residencies from 2011 to 2018. The survey consisted of a 30-item questionnaire addressing training experience, anticipated career trajectory, and respondent demographics. Descriptive statistics were used for closed-format questions. Responses to open-ended questions were systematically analyzed through inductive iterative review by 2 of the authors to elicit a set of overarching themes. RESULTS: We achieved a response rate of 85% (n = 53/62) with respondents from 7 of 7 combined residency programs. When asked about career goals, the majority of respondents planned to pursue both PA and PCCM (60%, n = 32) at the start of residency. However, at the time of survey completion, the percentage of respondents who were still planning to (or had already completed) train in both PA and PCCM had decreased to 23% (n = 12). Factors such as lifestyle and length of training contributed more to career choices during/after training compared to before residency. Thematic analysis of open-ended questions regarding transition between specialties, impact of dual training, and general comments revealed 3 major themes: (1) challenges of transitioning between specialties, (2) dual training is mutually beneficial, and (3) the need for an established fellowship training pathway. CONCLUSIONS: While there is continued interest in dual training in PA/PCCM for residents who enter the combined pediatrics-anesthesiology residency, factors such as duration of training and lifestyle become more important during residency and alter their career trajectories, often away from PCCM. Optimization of dual-subspecialty fellowship training will be critical to sustaining interest in dual-subspecialty training in PA/PCCM.

Error assessment and correction for extrusion-based bioprinting using computer vision method.

299Bioprinting offers a new approach to addressing the organ shortage crisis. Despite recent technological advances, insufficient printing resolution continues to be one of the reasons that impede the development of bioprinting. Normally, machine axes movement cannot be reliably used to predict material placement, and the printing path tends to deviate from the predetermined designed reference trajectory in varying degrees. Therefore, a computer vision-based method was proposed in this study to correct trajectory deviation and improve printing accuracy. The image algorithm calculated the deviation between the printed trajectory and the reference trajectory to generate an error vector. Furthermore, the axes trajectory was modified according to the normal vector approach in the second printing to compensate for the deviation error. The highest correction efficiency that could be achieved was 91%. More significantly, we discovered that the correction results, for the first time, were in a normal distribution instead of a random distribution.

Longitudinal Assessment of Chest CT Findings and Pulmonary Function after COVID-19 Infection.

Background Information on pulmonary sequelae and pulmonary function 2 years after recovery from SARS-CoV-2 infection is lacking. Purpose To longitudinally assess changes in chest CT abnormalities and pulmonary function in individuals after SARS-CoV-2 infection. Materials and Methods In this prospective study, participants discharged from the hospital after SARS-CoV-2 infection from January 20 to March 10, 2020, were considered for enrollment. Participants without chest CT scans at admission or with complete resolution of lung abnormalities at discharge were excluded. Serial chest CT scans and pulmonary function test results were obtained 6 months (June 20 to August 31, 2020), 12 months (December 20, 2020, to February 3, 2021), and 2 years (November 16, 2021, to January 10, 2022) after symptom onset. The term interstitial lung abnormality (ILA) and two subcategories, fibrotic ILAs and nonfibrotic ILAs, were used to describe residual CT abnormalities on follow-up CT scans. Differences between groups were compared with the χ2 test, Fisher exact test, or independent samples t test. Results Overall, 144 participants (median age, 60 years [range, 27-80 years]; 79 men) were included. On 2-year follow-up CT scans, 39% of participants (56 of 144) had ILAs, including 23% (33 of 144) with fibrotic ILAs and 16% (23 of 144) with nonfibrotic ILAs. The remaining 88 of 144 participants (61%) showed complete radiologic resolution. Over 2 years, the incidence of ILAs gradually decreased (54%, 42%, and 39% of participants at 6 months, 12 months, and 2 years, respectively; P < .001). Respiratory symptoms (34% vs 15%, P = .007) and abnormal diffusing capacity of lung for carbon monoxide (43% vs 20%, P = .004) occurred more frequently in participants with ILAs than in those with complete radiologic resolution. Conclusion More than one-third of participants had persistent interstitial lung abnormalities 2 years after COVID-19 infection, which were associated with respiratory symptoms and decreased diffusion pulmonary function. Chinese Clinical Trial Registry no. ChiCTR2000038609 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by van Beek in this issue.