Myopia information on TikTok: analysis factors that impact video quality and audience engagement.

BACKGROUND: TikTok is emerging as a vital platform for health information dissemination. Despite myopia being a global public health issue, the high-quality myopia information shared by health educators often fails to go viral. It is imperative to analyze the factors influencing video quality and popularity, especially from diverse perspectives of researchers, health educators, and audiences. METHODS: TikTok myopia-related videos were retrieved using TikTok's default comprehensive search (DCS) and most liked search (MLS) strategies. Venn diagrams were employed to illustrate the relationships and commonalities between the two strategies across four sample sizes (top 200, 150, 100, and 50). Video metadata, including details such as creator information, production properties, upload time, video duration, and viewer engagement, were collected. Video quality was assessed using the DISCERN tool. Video content covering six aspects of myopia were evaluated. The impact of search strategies, video sample sizes, production properties, and myopia content on video quality and audience engagement was analyzed through single-factor or multi-factor analysis. RESULTS: DCS and MLS retrieval strategies, as well as varying sample sizes, resulted in differences in audience engagement for myopia videos (P < 0.039), while The DISCERN quality scores remained comparable (P > 0.221). Videos published by healthcare professionals (HCPs) and non-profit organizations (NPOs) were associated with high-quality (P ≤ 0.014) but comparatively lower popularity (P < 0.033). Videos that reported contents of risk factors, management, and outcomes showed high popularity (P < 0.018), while longer video duration (> 60s) exhibited the opposite trend (P < 0.032). Content on myopia evaluation (P ≤ 0.001) and management (P ≤ 0.022) and video duration were positively correlated with higher DISCERN quality. CONCLUSION: Videos created by HCPs and NPOs deserve greater attention. Rather than pursuing entertaining effects, professional educators should emphasize producing concise, and high-quality myopia content that readily resonates with the audience and has the potential to go viral on the platform.

Evaluation of effects of 3% diquafosol ophthalmic solution on preocular tear film stability after trabeculectomy.

OBJECTIVES: To determine the potential effects of 3% diquafosol (DQS) on tear film stability after glaucoma surgery. METHODS: We retrospectively reviewed consecutive patients who underwent glaucoma surgery at the glaucoma division of the Henan Eye Institute from January 2020 to January 2021. Clinical parameters, including age, sex, intraocular pressure, and number of glaucoma medications, were tested. Tear film parameters, such as tear meniscus height (TMH), first and average noninvasive tear break-up time (FBUT and ABUT, respectively), and tear film lipid layer grade (TFLL), were evaluated using the Oculus Keratograph 5M. We investigated the differences in clinical and tear film parameters pre- and postoperatively. We compared the baseline and different time points after surgery between the DQS and HA groups and identified the factors associated with changes in the tear film at 8 weeks postoperatively. RESULTS: A total of 101 eyes were included. Early administration of DQS increased TMH, FBUT, ABUT, and TFLL after trabeculectomy (all p < 0.05). In addition, the DQS group showed significantly higher ABUT than the HA group (p < 0.05). DQS use served as an associated parameter for better TMH, FBUT, ABUT, and the TFLL (p < 0.05). DQS and preoperative FBUT were significant independent parameters of postoperative FBUT (p < 0.05). CONCLUSIONS: The present study showed that postoperative TMH, FBUT, ABUT, and TFLL significantly increased after early application of DQS, and the efficacy of ABUT was better than that of HA at the early stage in 8 weeks after trabeculectomy (p < 0.05).

Detection of superficial and buried optic disc drusen with swept-source optical coherence tomography.

BACKGROUND: To detect the superficial and buried optic disc drusen (ODD) with swept-source optical coherence tomography (SS-OCT). METHODS: Retrospective cross-sectional study. Twenty patients (age 18-74 years) diagnosed with ODD via B-scan ultrasonography were analysed. All patients underwent color fundus photography (CFP), B-scan ultrasonography, fundus autofluorescence (FAF), and SS-OCT. We defined each hyporeflective signal mass of SS-OCT as an ODD, recorded its location and relationship with Bruch's membrane opening (BMO), and other ophthalmic imaging characteristics. RESULTS: Twenty (33 eyes) patients had 54 ODDs in all, except one eye did not show abnormal optic disc findings on SS-OCT. We classified ODD into three categories: ODD above BMO, ODD across BMO, and ODD below BMO. The ODDs across BMO were the largest, followed by ODDs below BMO, and those above BMO. The location of the ODDs: One (1.9%) was in the border tissue of Elschnig, 6 (11.1%) might span across the lamina cribrosa, 16 (29.6%) were above BMO located in the neuroepithelial layer, 9 (16.7%) spanned across BMO located near the center of the optic disc, 18 (33.3%) were below BMO located near the center of the optic disc, 4 (7.4%) were below BMO located within the optic disc rim. When the anterior margin was ≥ 100 µm from the BMO, clear autofluorescence could be seen. CONCLUSION: Multimodal imaging provided a deeper understanding of ODD. SS-OCT illustrated more details about the relationship between the posterior surface of ODD, BMO and the lamina cribrosa.

The potential biological effects of quercetin based on pharmacokinetics and multi-targeted mechanism in vivo.

Quercetin is a plant-derived polyphenol flavonoid that has been proven to be effective for many diseases. However, the mechanism and in vivo metabolism of quercetin remains to be clarified. It achieves a wide range of biological effects through various metabolites, gut microbiota and its metabolites, systemic mediators produced by inflammation and oxidation, as well as by multiple mechanisms. The all-round disease treatment of quercetin is achieved through the organic combination of multiple channels. Therefore, this article clarifies the metabolic process of quercetin in the body, and explores the new pattern of action of quercetin in the treatment of diseases.

Atmospheric oxidation of fluoroalcohols initiated by ˙OH radicals in the presence of water and mineral dusts: mechanism, kinetics, and risk assessment.

The transport and formation of fluorinated compounds are greatly significant due to their possible environmental risks. In this work, the ˙OH-mediated degradation of CF3CF2CF2CH2OH and CF3CHFCF2CH2OH in the presence of O2/NO/NO2 was studied by using density functional theory and the direct kinetic method. The formation mechanisms of perfluorocarboxylic/hydroperfluorocarboxylic acids (PFCAs/H-PFCAs), which were produced from the reactions of α-hydroxyperoxy radicals with NO/NO2 and the ensuing oxidation of α-hydroxyalkoxy radicals, were clarified and discussed. The roles of water and silica particles in the rate constants and ˙OH reaction mechanism with fluoroalcohols were investigated theoretically. The results showed that water and silica particles do not alter the reaction mechanism but obviously change the kinetic properties. Water could retard fluoroalcohol degradation by decreasing the rate constants by 3-5 orders of magnitude. However, the heterogeneous ˙OH-rate coefficients on the silica particle surfaces, including H4SiO4, H6Si2O7, and H12Si6O18, are larger than that of the naked reaction by 1.20-24.50 times. This finding suggested that these heterogeneous reactions may be responsible for the atmospheric loss of fluoroalcohols and the burden of PFCAs. In addition, fluoroalcohols could be exothermically trapped by H12Si6O18, H6Si2O7, and H4SiO4, in which the chemisorption on H12Si6O18 is stronger than that on H6Si2O7 or H4SiO4. The global warming potentials and radiative forcing of CF3CF2CF2CH2OH/CF3CHFCF2CH2OH were calculated to assess their contributions to the greenhouse effect. The toxicities of individual species were also estimated via the ECOSAR program and experimental measurements. This work enhances the understanding of the environmental formation of PFCAs and the transformation of fluoroalcohols.

Evaluation of a novel artificial intelligence-based screening system for diabetic retinopathy in community of China: a real-world study.

PURPOSE: To evaluate the performance of an AI-based diabetic retinopathy (DR) grading model in real-world community clinical setting. METHODS: Participants with diabetes on record in the chosen community were recruited by health care staffs in a primary clinic of Zhengzhou city, China. Retinal images were prospectively collected during December 2018 and April 2019 based on intent-to-screen principle. A pre-validated AI system based on deep learning algorithm was deployed to screen DR graded according to the International Clinical Diabetic Retinopathy scale. Kappa value of DR severity, the sensitivity, specificity of detecting referable DR (RDR) and any DR were generated based on the standard of the majority manual grading decision of a retina specialist panel. RESULTS: Of the 193 eligible participants, 173 (89.6%) were readable with at least one eye image. Mean [SD] age was 69.3 (9.0) years old. Total of 321 eyes (83.2%) were graded both by AI and the specialist panel. The κ value in eye image grading was 0.715. The sensitivity, specificity and area under curve for detection of RDR were 84.6% (95% CI: 54.6- 98.1%), 98.0% (95% CI: 94.3-99.6%) and 0.913 (95% CI: 0.797-1.000), respectively. For detection of any DR, the upper indicators were 90.0% (95% CI: 68.3-98.8), 96.6% (95% CI: 92.1-98.9) and 0.933 (95% CI: 0.933-1.000), respectively. CONCLUSION: The AI system showed relatively good consistency with ophthalmologist diagnosis in DR grading, high specificity and acceptable sensitivity for identifying RDR and any DR. TRANSLATIONAL RELEVANCE: It is feasible to apply AI-based DR screening in community. PRECIS: Deployed in community real-world clinic setting, AI-based DR screening system showed high specificity and acceptable sensitivity in identifying RDR and any DR. Good DR diagnostic consistency was found between AI and manual grading. These prospective evidences were essential for regulatory approval.

Quercetin protects against chronic prostatitis in rat model through NF-κB and MAPK signaling pathways.

BACKGROUND: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common disease of urology, of which the pathogenesis and therapy remain to be further elucidated. Quercetin has been reported to improve the symptoms of CP/CPPS patients. We aimed to verify the therapeutic effect of quercetin on CP/CPPS and identify the mechanism responsible for it. METHODS: A novel CP/CPPS model induced with Complete Freund Adjuvant in Sprague Dawley rats was established and the prostates and blood specimens were harvested for further measurement after oral administration of quercetin for 4 weeks. RESULTS: Increased prostate index and infiltration of lymphocytes, up-regulated expression of IL-1ß, IL-2, IL-6, IL-17A, MCP1, and TNFα, decreased T-SOD, CAT, GSH-PX, and increased MDA, enhanced phosphorylation of NF-κB, P38, ERK1/2, and SAPK/JNK were detected in CP/CPPS rat model. Quercetin was identified to ameliorate the histo-pathologic changes, decrease the expression of pro-inflammatory cytokines IL-1ß, IL-2, IL-6, IL-17A, MCP1, and TNFα, improve anti-oxidant capacity, and suppress the phosphorylation of NF-κB and MAPKs. CONCLUSIONS: Quercetin has specific protective effect on CP/CPPS, which is mediated by anti-inflammation, anti-oxidation, and at least partly through NF-κB and MAPK signaling pathways.

Helium Nanobubbles Enhance Superelasticity and Retard Shear Localization in Small-Volume Shape Memory Alloy.

The intriguing phenomenon of metal superelasticity relies on stress-induced martensitic transformation (SIMT), which is well-known to be governed by developing cooperative strain accommodation at multiple length scales. It is therefore scientifically interesting to see what happens when this natural length scale hierarchy is disrupted. One method is producing pillars that confine the sample volume to micrometer length scale. Here we apply yet another intervention, helium nanobubbles injection, which produces porosity on the order of several nanometers. While the pillar confinement suppresses superelasticity, we found the dispersion of 5-10 nm helium nanobubbles do the opposite of promoting superelasticity in a Ni53.5Fe19.5Ga27 shape memory alloy. The role of helium nanobubbles in modulating the competition between ordinary dislocation slip plasticity and SIMT is discussed.

[Plasmakinetic enucleation of the prostate versus holmium laser enucleation of the prostate for benign prostatic hyperplasia].

OBJECTIVE: To evaluate the clinical effects of plasmakinetic enucleation of the prostate (PKERP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of BPH. METHODS: We retrospectively analyzed the clinical data on 78 BPH patients treated by PKERP (n = 38) or HoLEP (n = 40) from January 2016 to October 2017. We recorded the operation time, intraoperative hemoglobin level, catheter-indwelling time, bladder irrigation time, hospital stay, 6-month postoperative IPSS, quality of life (QOL), maximum urinary flow rate (Qmax), postvoid residual urine (PVR), PSA level, International Index of Erectile Function (IIEF) and postoperative complications, and compared the obtained parameters between the two groups and some of them with the baseline. RESULTS: In comparison with the baseline, both the PKERP and HoLEP groups showed statistically significant differences at 6 months after surgery in the QOL score (4.82 ± 0.56 and 4.70 ± 0.67 vs 2.44 ± 0.69 and 2.92 ± 0.49, P < 0.01), IPSS (19.52 ± 4.96 and 19.44 ± 4.08 vs 9.56 ± 2.5 and 9.81 ± 2.5, P < 0.01), Qmax (ï¼»4.54 ± 1.86ï¼½ and ï¼»4.42 ± 2.89ï¼½ ml/s vs ï¼»17.72 ± 3.46ï¼½ and ï¼»17.27 ± 4.42ï¼½ ml/s, P < 0.01), and PVR (ï¼»83.73±55.33ï¼½ and ï¼»109.65 ± 89.58ï¼½ ml vs ï¼»19.93 ± 11.07ï¼½ and ï¼»18.31 ± 15.03ï¼½ ml, P < 0.01). Statistically significant differences were also found between the PKERP and HoLEP groups in the reduced hemoglobin level (ï¼»21.04 ± 16.96ï¼½ vs ï¼»7.88 ± 6.65ï¼½ g/dl, P = 0.01), catheter-indwelling time (ï¼»7.67 ± 2.27ï¼½ vs ï¼»3.93 ± 2.18ï¼½ d, P = 0.01), bladder irrigation time (ï¼»1.67 ± 0.62ï¼½ vs ï¼»1.3 ± 0.54ï¼½ d, P = 0.05), hospital stay (ï¼»4.22 ± 1.55ï¼½ vs ï¼»3.26 ± 0.9ï¼½ d, P = 0.01), and 6-month postoperative QOL score (ï¼»2.44 ± 0.69ï¼½ vs ï¼»2.92 ± 0.49ï¼½, P = 0.05), but not in the other parameters. CONCLUSIONS: Both PKERP and HoLEP are safe and effective for the treatment of BPH, the former more feasible in primary hospitals, while the latter with the advantages of less bleeding, shorter catheterization and hospital stay, and higher 6-month postoperative QOL score.

Radiation-Induced Helium Nanobubbles Enhance Ductility in Submicron-Sized Single-Crystalline Copper.

The workability and ductility of metals usually degrade with exposure to irradiation, hence the phrase "radiation damage". Here, we found that helium (He) radiation can actually enhance the room-temperature deformability of submicron-sized copper. In particular, Cu single crystals with diameter of 100-300 nm and containing numerous pressurized sub-10 nm He bubbles become stronger, more stable in plastic flow and ductile in tension, compared to fully dense samples of the same dimensions that tend to display plastic instability (strain bursts). The sub-10 nm He bubbles are seen to be dislocation sources as well as shearable obstacles, which promote dislocation storage and reduce dislocation mean free path, thus contributing to more homogeneous and stable plasticity. Failure happens abruptly only after significant bubble coalescence. The current findings can be explained in light of Weibull statistics of failure and the beneficial effects of bubbles on plasticity. These results shed light on plasticity and damage developments in metals and could open new avenues for making mechanically robust nano- and microstructures by ion beam processing and He bubble engineering.

Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience.

PURPOSE: To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes. MATERIALS AND METHODS: From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration. RESULTS: All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively. CONCLUSIONS: This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority.

Nanobubble Fragmentation and Bubble-Free-Channel Shear Localization in Helium-Irradiated Submicron-Sized Copper.

Helium bubbles are one of the typical radiation microstructures in metals and alloys, significantly influencing their deformation behavior. However, the dynamic evolution of helium bubbles under straining is less explored so far. Here, by using in situ micromechanical testing inside a transmission electron microscope, we discover that the helium bubble not only can coalesce with adjacent bubbles, but also can split into several nanoscale bubbles under tension. Alignment of the splittings along a slip line can create a bubble-free channel, which appears softer, promotes shear localization, and accelerates the failure in the shearing-off mode. Detailed analyses unveil that the unexpected bubble fragmentation is mediated by the combination of dislocation cutting and internal surface diffusion, which is an alternative microdamage mechanism of helium irradiated copper besides the bubble coalescence.

[Longbishu Capsule combined with mesylate doxazosin: an efficacious therapy for benign prostatic hyperplasia].

OBJECTIVE: To assess the clinical effect and safety of the Chinese medicine Longbishu Capsule combined with mesylate doxazosin in the treatment of benign prostatic hyperplasia (BPH) of the kidney deficiency and blood stagnation type. METHODS: This was a randomized, double-blind, double-simulation control study. We equally assigned 60 men diagnosed with BPH of the kidney deficiency and blood stagnation type to an experimental and a control group, the former treated with mesylate doxazosin plus Longbishu Capsule and the latter with mesylate doxazosin plus placebo. We compared the International Prostate Symptom Score (IPSS), quality of life (QOL), Chinese symptom score (CSS), maximal urinary flow rate (Qmax), and prostate volume between the two groups of patients before and after 6 months of medication. RESULTS: After treatment, there were 5 cured cases, 13 markedly effective cases, 9 effective cases, 1 ineffective case, and 2 eliminated cases in the experimental group, as compared with 2 cured cases, 8 markedly effective cases, 10 effective cases, 7 ineffective cases, and 3 eliminated cases in the control group. The total effectiveness rate was obviously higher in the former (96.4%) than in the latter (74.1%). IPSS, Qmax, and CSS were improved in both of the groups after medication, even more significantly in the experimental than in the control group (IPSS: 15.22 ± 2.98 vs 18.15 ± 5.88, P <0.05; Qmax: [13.56 ± 2.26] ml/s vs [11.78 ± 2.97] ml/s, P <0.05; CSS: 6.18 ± 2.13 vs 9.52 ± 3.15, P <0.05). Because of the difference in the QOL score between the two groups at the baseline (P = 0.038 <0.05), no more comparison was made in this aspect after treatment. CONCLUSION: The combination of Longbishu Capsule with mesylate doxazosin is safe and effective for the treatment of BPH.

Prognosis of concurrent endoscopic dacryocystorhinostomy and nasal septoplasty for chronic dacryocystitis with moderate nasal septum deviation.

CONTEXT: The prognosis of combined septoplasty and endoscopic dacryocystorhinostomy (En-DCR) for moderate nasal septum deviation (NSD) has not yet been fully investigated. PURPOSE: To evaluate whether septoplasty improves the prognosis of En-DCR for moderate NSD. SETTINGS AND DESIGN: A retrospective cohort study in a real-world clinical setting. METHODS: The postoperative FICI DCR ostium grading scores and functional and anatomical information at 1, 2, 3, and 6 months were determined for consecutive patients with chronic dacryocystitis (CD) and moderate NSD who underwent En-DCR. STATISTICAL ANALYSIS USED: Univariate and generalized estimating equation multivariate analyses were used to compare the outcomes of the septoplasty and non-septoplasty groups. RESULTS: En-DCR and septoplasty were concurrently performed for 32 (20.1%, 32/158) cases. The total FICI DCR ostial scores for the septoplasty and non-septoplasty groups were highest at the first (4.97 ± 0.177 vs. 4.97 ± 0.176, P > 0.05) and lowest at the sixth (4.41 ± 1.341 vs. 4.50 ± 1.355, P > 0.05) postoperative months. At the end of follow-up, the two groups showed comparable proportions of patients requiring definitive intervention for the ostium (6.3% vs. 7.1%, P > 0.05), comparabe functional success rates (87.5% vs. 90.5%, P > 0.05) and anatomical success rates (93.8% vs. 92.9%, P > 0.05). Only the non-septoplasty group experienced nasal mucosal adhesions (3.2%, 4/126). CONCLUSIONS: In patients with CD and moderate NSD, nasal septoplasty did not impact En-DCR prognosis, but reduced the complications. Skilled surgeons should reconsider septoplasty in the absence of otolaryngological indications.

Recent advances in sonodynamic therapy strategies for pancreatic cancer.

Pancreatic cancer, a prevalent malignancy of the digestive system, has a poor 5-year survival rate of around 10%. Although numerous minimally invasive alternative treatments, including photothermal therapy and photodynamic therapy, have shown effectiveness compared with traditional surgical procedures, radiotherapy, and chemotherapy. However, the application of these alternative treatments is constrained by their depth of penetration, making it challenging to treat pancreatic cancer situated deep within the tissue. Sonodynamic therapy (SDT) has emerged as a promising minimally invasive therapy method that is particularly potent against deep-seated tumors such as pancreatic cancer. However, the unique characteristics of pancreatic cancer, including a dense surrounding matrix, high reductivity, and a hypoxic tumor microenvironment, impede the efficient application of SDT. Thus, to guide the evolution of SDT for pancreatic cancer therapy, this review addresses these challenges, examines current strategies for effective SDT enhancement for pancreatic cancer, and investigates potential future advances to boost clinical applicability. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.

[Sero-conversion of HIV sero-negative partners among discordant couples in a city of Henan province].

OBJECTIVE: To understand the overall HIV sero-conversion rate and its trend and risk factors of uninfected partners in sero-discordant couples. METHODS: A total of 3088 uninfected partners, whose HIV positive partners infected via former plasma donation or blood transfusion from July, 2006 to December 2010, were chosen as a fix cohort. They were tested for HIV antibodies twice a year using ELISA by local CDC from July, 2006 to December, 2010. Data regarding demographic, sexual behavior information of uninfected partners and infection, serologic characteristics of positive partners were retrospectively surveyed and collected to analyze possible risky factors. RESULTS: A total of 132 in 3088 uninfected partners were sero-converted, with a sero-conversion rate of 1.17/100 person years (95%CI: 0.99/100 person years -1.39/100 person years). Sero-conversion rate reached the peak (0.82%) in the following interval of January and June in 2008 and have a bottom conversion rate (0.13%) in the same month interval in 2010. Conversion rate outcome showed a downward trend in following(χ(2)trend = 8.907, P < 0.05). In the survey, 56.6% (1513/2673) uninfected partners were males, 56.2% (1501/2673) were with lower education level. Among uninfected partners, as reported by themselves, having sex in recently 6 months accounted for a proportion of 81.4% (2176/2673), sex frequency of less than 4 times per month accounted for 45.7% (1169/2558) and consistent using of condom accounted for 94.5% (2418/2558). The proportion of the index partners' most recently CD4 cell count less than 200 cells per µl was 17.4% (437/2505). Results from multivariate of Cox regression showed that male negative partners (RR = 1.58, 95%CI: 1.02 - 2.43), negative partners with lower education level(RR = 2.77, 95%CI: 1.68 - 4.57), having sexual activity in latest one year(RR = 4.39, 95%CI: 1.53 - 12.56) and CD4 count less than 200 cells per µl (RR = 2.36, 95%CI: 1.42 - 3.93) were associated with increased risk of HIV sero-conversion, while intercourse frequency less than 4 times per month(RR = 0.18, 95%CI: 0.10 - 0.32), consistent using of condom(RR = 0.07, 95%CI: 0.05 - 0.12) decreased the risk of conversion. CONCLUSION: In this city, the conversion rate of negative partners whose positive partner infected via former plasma donation or blood transfusion is relatively low and behave a downward trend. Serologic surveillance, education and intervention based on couple are needed to be enhanced.

Development and external validation of a prediction model for brain metastases in patients with metastatic breast cancer.

BACKGROUND: Breast cancer patients with brain metastasis (BM) have a poor prognosis. This study aims to identify the risk factors of BM in patients with metastatic breast cancer (MBC) and establish a competing risk model for predicting the risk of brain metastases at different time points along the course of disease. METHODS: Patients with MBC admitted to the breast disease center of Peking University First Hospital from 2008 to 2019 were selected and retrospectively analyzed to establish a risk prediction model for brain metastases. Patients with MBC admitted to eight breast disease centers from 2015 to 2017 were selected for external validation of the competing risk model. The competing risk approach was used to estimate cumulative incidence. Univariate Fine-Gray competing risk regression, optimal subset regression, and LASSO Cox regression were used to screen potential predictors of brain metastases. Based on the results, a competing risk model for predicting brain metastases was established. The discrimination of the model was evaluated using AUC, Brier score, and C-index. The calibration was evaluated by the calibration curves. The model was assessed for clinical utility by decision curve analysis (DCA), as well as by comparing the cumulative incidence of brain metastases between groups with different predicted risks. RESULTS: From 2008 to 2019, a total of 327 patients with MBC in the breast disease center of Peking University First Hospital were admitted into the training set for this study. Among them, 74 (22.6%) patients developed brain metastases. From 2015 to 2017, a total of 160 patients with MBC in eight breast disease centers were admitted into the validation set for this study. Among them, 26 (16.3%) patients developed brain metastases. BMI, age, histological type, breast cancer subtype, and extracranial metastasis pattern were included in the final competing risk model for BM. The C-index of the prediction model in the validation set was 0.695, and the AUCs for predicting the risk of brain metastases within 1, 3, and 5 years were 0.674, 0.670, and 0.729, respectively. Time-dependent DCA curves demonstrated a net benefit of the prediction model with thresholds of 9-26% and 13-40% when predicting the risk of brain metastases at 1 and 3 years, respectively. Significant differences were observed in the cumulative incidence of brain metastases between groups with different predicted risks (P < 0.05 by Gray's test). CONCLUSIONS: In this study, a competing risk model for BM was innovatively established, with the multicenter data being used as an independent external validation set to confirm the predictive efficiency and universality of the model. The C-index, calibration curves, and DCA of the prediction model indicated good discrimination, calibration, and clinical utility, respectively. Considering the high risk of death in patients with metastatic breast cancer, the competing risk model of this study is more accurate in predicting the risk of brain metastases compared with the traditional Logistic and Cox regression models.

Spine-Related Malpractice Claims in China: A 2-year National Analysis.

STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVE: To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period. METHODS: The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff's main allegations, and arbitration outcomes. RESULTS: A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff's favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant's favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability. CONCLUSION: The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.

Role of Charlson comorbidity index in predicting the ICU admission in patients with thoracic aortic aneurysm undergoing surgery.

OBJECTIVES: This study aimed to explore the value of the Charlson comorbidity index (CCI) in predicting ICU admission in patients with aortic aneurysm (AA). METHODS: The clinical data of patients were obtained from the Medical Information Mart for Intensive Care-IV database. The association between CCI and ICU admission was explored by restricted cubic spline (RCS), threshold effect analysis, generalized linear model, logistic regression, interaction, and mediation analyses. Its clinical value was evaluated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), DeLong's test, and net reclassification index (NRI) analyses. RESULTS: The ICU admission was significantly associated with the thoracic AA (TAA), unruptured status, and surgery status. Therefore, 288 candidate patients with unruptured TAA who received surgery were enrolled in the further analysis. We found that CCI was independently associated with the ICU admission of candidates (P = 0.005). Further, their nonlinear relationship was observed (adjusted P = 0.008), and a significant turning point of 6 was identified. The CCI had a favorable performance in predicting ICU admission (area under curve = 0.728) and achieved a better clinical net benefit. New models based on CCI significantly improved the accuracy of prediction. Besides the importance of CCI in ICU admission, CCI also exerted important interaction effect (rather than mediating effects) on the association of other variables (such as age and blood variables) with ICU admission requirements (all P < 0.05). CONCLUSIONS: The CCI is an important predictor of ICU admission after surgery in patients with unruptured TAA.

Assessment of delivered dose in prostate cancer patients treated with ultra-hypofractionated radiotherapy on 1.5-Tesla MR-Linac.

Objective: To quantitatively characterize the dosimetric effects of long on-couch time in prostate cancer patients treated with adaptive ultra-hypofractionated radiotherapy (UHF-RT) on 1.5-Tesla magnetic resonance (MR)-linac. Materials and methods: Seventeen patients consecutively treated with UHF-RT on a 1.5-T MR-linac were recruited. A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate. We collected data for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan. Results: Overall, 290 MR scans were collected (85 pre-MR, 85 PV-MR, 49 Bn-MR and 71 post-MR scans). With a median on-couch time of 49 minutes, the mean planning target volume (PTV)-V95% of all scans was 97.83 ± 0.13%. The corresponding mean clinical target volume (CTV)-V100% was 99.93 ± 0.30%, 99.32 ± 1.20%, 98.59 ± 1.84%, and 98.69 ± 1.85%. With excellent prostate-V100% dose coverage, the main reason for lower CTV-V100% was slight underdosing of seminal vesicles (SVs). The median V29 Gy change in the rectal wall was -1% (-20%-17%). The V29 Gy of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow. Conclusions: This 3D-MR-based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period with adaptive ATS workflow on 1.5-T MR-linac, albeit with a relatively long on-couch time. The 3-mm CTV-PTV margin was adequate for prostate irradiation but occasionally insufficient for SVs. More attention should be paid to restricting high-dose RT to the rectal wall when optimizing the ATS plan.