Unlocking the potential: A novel prognostic index signature for acute myeloid leukemia.

Acute myeloid leukemia (AML) is an aggressive malignancy characterized by challenges in treatment, including drug resistance and frequent relapse. Recent research highlights the crucial roles of tumor microenvironment (TME) in assisting tumor cell immune escape and promoting tumor aggressiveness. This study delves into the interplay between AML and TME. Through the exploration of potential driver genes, we constructed an AML prognostic index (AMLPI). Cross-platform data and multi-dimensional internal and external validations confirmed that the AMLPI outperforms existing models in terms of areas under the receiver operating characteristic curves, concordance index values, and net benefits. High AMLPIs in AML patients were indicative of unfavorable prognostic outcomes. Immune analyses revealed that the high-AMLPI samples exhibit higher expression of HLA-family genes and immune checkpoint genes (including PD1 and CTLA4), along with lower T cell infiltration and higher macrophage infiltration. Genetic variation analyses revealed that the high-AMLPI samples associate with adverse variation events, including TP53 mutations, secondary NPM1 co-mutations, and copy number deletions. Biological interpretation indicated that ALDH2 and SPATS2L contribute significantly to AML patient survival, and their abnormal expression correlates with DNA methylation at cg12142865 and cg11912272. Drug response analyses revealed that different AMLPI samples tend to have different clinical selections, with low-AMLPI samples being more likely to benefit from immunotherapy. Finally, to facilitate broader access to our findings, a user-friendly and publicly accessible webserver was established and available at http://bioinfor.imu.edu.cn/amlpi. This server provides tools including TME-related AML driver genes mining, AMLPI construction, multi-dimensional validations, AML patients risk assessment, and figures drawing.

Evoking C2+ production from electrochemical CO2 reduction by the steric confinement effect of ordered porous Cu2O.

Selective conversion of carbon dioxide (CO2) to multi-carbon products (CO2-to-C2+) at high current densities is in essential demand for the practical application of the resultant valuable products, yet it remains challenging to conduct due to the lack of efficient electrocatalysts. Herein, three-dimensional ordered porous cuprous oxide cuboctahedra (3DOP Cu2O-CO) were designed and synthesized by a molecular fence-assisted hard templating approach. Capitalizing on the merits of interconnected and uniformly distributed pore channels, 3DOP Cu2O-CO exhibited outstanding electrochemical CO2-to-C2+ conversion, achieving faradaic efficiency and partial current density for C2+ products of up to 81.7% and -0.89 A cm-2, respectively, with an optimal formation rate of 2.92 mmol h-1 cm-2 under an applied current density of -1.2 A cm-2. In situ spectroscopy and simulation results demonstrated that the ordered pores of 3DOP Cu2O-CO can effectively confine and accumulate sufficient *CO adsorption during electrochemical CO2 reduction, which facilitates efficient dimerization for the formation of C2+ products. Furthermore, the 3DOP structure induces a higher local pH value, which not only enhances the C-C coupling reaction, but also suppresses competing H2 evolution.

Virtual Dental Articulation Using Computed Tomography Data and Motion Tracking.

Dental articulation holds crucial and fundamental importance in the design of dental restorations and analysis of prosthetic or orthodontic occlusions. However, common traditional and digital articulators are difficult and cumbersome in use to effectively translate the dental cast model to the articulator workspace when using traditional facebows. In this study, we have developed a personalized virtual dental articulator that directly utilizes computed tomography (CT) data to mathematically model the complex jaw movement, providing a more efficient and accurate way of analyzing and designing dental restorations. By utilizing CT data, Frankfurt's horizontal plane was established for the mathematical modeling of virtual articulation, eliminating tedious facebow transfers. After capturing the patients' CT images and tracking their jaw movements prior to dental treatment, the jaw-tracking information was incorporated into the articulation mathematical model. The validation and analysis of the personalized articulation approach were conducted by comparing the jaw movement between simulation data (virtual articulator) and real measurement data. As a result, the proposed virtual articulator achieves two important functions. Firstly, it replaces the traditional facebow transfer process by transferring the digital dental model to the virtual articulator through the anatomical relationship derived from the cranial CT data. Secondly, the jaw movement trajectory provided by optical tracking was incorporated into the mathematical articulation model to create a personalized virtual articulation with a small Fréchet distance of 1.7 mm. This virtual articulator provides a valuable tool that enables dentists to obtain diagnostic information about the temporomandibular joint (TMJ) and configure personalized settings of occlusal analysis for patients.

Force field-inspired transformer network assisted crystal density prediction for energetic materials.

Machine learning has great potential in predicting chemical information with greater precision than traditional methods. Graph neural networks (GNNs) have become increasingly popular in recent years, as they can automatically learn the features of the molecule from the graph, significantly reducing the time needed to find and build molecular descriptors. However, the application of machine learning to energetic materials property prediction is still in the initial stage due to insufficient data. In this work, we first curated a dataset of 12,072 compounds containing CHON elements, which are traditionally regarded as main composition elements of energetic materials, from the Cambridge Structural Database, then we implemented a refinement to our force field-inspired neural network (FFiNet), through the adoption of a Transformer encoder, resulting in force field-inspired Transformer network (FFiTrNet). After the improvement, our model outperforms other machine learning-based and GNNs-based models and shows its powerful predictive capabilities especially for high-density materials. Our model also shows its capability in predicting the crystal density of potential energetic materials dataset (i.e. Huang & Massa dataset), which will be helpful in practical high-throughput screening of energetic materials.

Tuning Smith-Purcell radiation by rotating a metallic nanodisk array.

Smith-Purcell radiation (SPR) refers to the far-field, strong, spike radiation generated by the interaction of the evanescent Coulomb field of the moving charged particles and the surrounding medium. In applying SPR for particle detection and nanoscale on-chip light sources, wavelength tunability is desired. Here we report on tunable SPR achieved by moving an electron beam parallel to a two-dimensional (2D) metallic nanodisk array. By in-plane rotating the nanodisk array, the emission spectrum of the SPR splits into two peaks, with the shorter-wavelength peak blueshifted and the longer-wavelength one redshifted by increasing the tuning angle. This effect originates from the fact that the electrons fly effectively over a one-dimensional (1D) quasicrystal projected from the surrounding 2D lattice, and the wavelength of SPR is modulated by quasiperiodic characteristic lengths. The experimental data are in agreement with the simulated ones. We suggest that this tunable radiation provides free-electron-driven tunable multiple photon sources at the nanoscale.

Huangqin Decoction ameliorates ulcerative colitis by regulating fatty acid metabolism to mediate macrophage polarization via activating FFAR4-AMPK-PPARα pathway.

ETHNOPHARMACOLOGICAL RELEVANCE: Huangqin Decoction (HQD), a traditional Chinese medicine (TCM) formula chronicled in Shang Han Lun, is safe and effective for treatment of ulcerative colitis (UC). AIM OF THE STUDY: To investigate the effect of HQD against dextran sulfate sodium (DSS)-induced UC mice by regulating gut microbiota and metabolites, and further explore the mechanism of fatty acid metabolism on macrophage polarization. MATERIALS AND METHODS: Based on 3% dextran sulfate sodium (DSS)-induced UC mice model, clinical symptoms observation (body weight, DAI, and colon length) and histological inspection were used to evaluate the efficacy of HQD and fecal microbiota transplantation (FMT) from HQD-treated mice. The gut microbiota and metabolites were detected by 16S rRNA sequencing and metabolomics analysis. The parameters of fatty acid metabolism, macrophage polarization, and FFAR1/FFAR4-AMPK-PPARα pathway were analyzed by immunofluorescence analysis, western blotting, and real-time PCR. Then, the effects of FFAR1 and FFAR4 on macrophage polarization were examined by agonists based on LPS-induced RAW264.7 cell model. RESULTS: The results showed that FMT, like HQD, ameliorated UC by improving weight loss, restoring colon length, and reducing DAI scores and histopathological scores. Besides, HQD and FMT both enhanced the richness of gut microbiota, and modulated intestinal bacteria and metabolites to achieve a new balance. Untargeted metabolomics analysis revealed that fatty acids, especially long-chain fatty acids (LCFAs), dominated in HQD against DSS-induced UC by regulating the gut microenvironment. Further, FMT and HQD recovered the expression of fatty acid metabolism-related enzymes, and simultaneously activated FFAR1/FFAR4-AMPK-PPARα pathway but suppressed NF-κB pathway. Combined with cell experiment, HQD and FMT promoted macrophage polarization from M1 toward M2, which were well associated with anti-inflammatory cytokines and combined with the activated FFAR4. CONCLUSIONS: The mechanism of HQD against UC was related to regulating fatty acid metabolism to mediate M2 macrophage polarization by activating the FFAR4-AMPK-PPARα pathway.

Serological surveillance of GI norovirus reveals persistence of blockade antibody in a Jidong community-based prospective cohort, 2014-2018.

Introduction: Herd immunity against norovirus (NoV) is poorly understood in terms of its serological properties and vaccine designs. The precise neutralizing serological features of genotype I (GI) NoV have not been studied. Methods: To expand insights on vaccine design and herd immunity of NoVs, seroprevalence and seroincidence of NoV genotypes GI.2, GI.3, and GI.9 were determined using blockade antibodies based on a 5-year longitudinal serosurveillance among 449 residents in Jidong community. Results: Correlation between human histo-blood group antigens (HBGAs) and GI NoV, and dynamic and persistency of antibodies were also analyzed. Seroprevalence of GI.2, GI.3, and GI.9 NoV were 15.1%-18.0%, 35.0%-38.8%, and 17.6%-22.0%; seroincidences were 10.0, 21.0, and 11.0 per 100.0 person-year from 2014 to 2018, respectively. Blockade antibodies positive to GI.2 and GI.3 NoV were significantly associated with HBGA phenotypes, including blood types A, B (excluding GI.3), and O+; Lewis phenotypes Leb+/Ley+ and Lea+b+/Lex+y+; and secretors. The overall decay rate of anti-GI.2 antibody was -5.9%/year (95% CI: -7.1% to -4.8%/year), which was significantly faster than that of GI.3 [-3.6%/year (95% CI: -4.6% to -2.6%/year)] and GI.9 strains [-4.0%/year (95% CI: -4.7% to -3.3%/year)]. The duration of anti-GI.2, GI.3, and GI.9 NoV antibodies estimated by generalized linear model (GLM) was approximately 2.3, 4.2, and 4.8 years, respectively. Discussion: In conclusion, enhanced community surveillance of GI NoV is needed, and even one-shot vaccine may provide coast-efficient health benefits against GI NoV infection.

Wireless neuromodulation in vitro and in vivo by intrinsic TRPC-mediated magnetomechanical stimulation.

Various magnetic deep brain stimulation (DBS) methods have been developing rapidly in the last decade for minimizing the invasiveness of DBS. However, current magnetic DBS methods, such as magnetothermal and magnetomechanical stimulation, require overexpressing exogeneous ion channels in the central nervous system (CNS). It is unclear whether magnetomechanical stimulation can modulate non-transgenic CNS neurons or not. Here, we reveal that the torque of magnetic nanodiscs with weak and slow alternative magnetic field (50 mT at 10 Hz) could activate neurons through the intrinsic transient receptor potential canonical channels (TRPC), which are mechanosensitive ion channels widely expressed in the brain. The immunostaining with c-fos shows the increasement of neuronal activity by wireless DBS with magnetomechanical approach in vivo. Overall, this research demonstrates a magnetic nanodiscs-based magnetomechanical approach that can be used for wireless neuronal stimulation in vitro and untethered DBS in vivo without implants or genetic manipulation.

Two New Pseudoscorpion Species of the Coastal Genus Garypus L. Koch, 1873 (Garypidae) and an Updated Checklist of the Pseudoscorpiones of Taiwan.

Pseudoscorpions are predatory microarthropods that feed on even smaller animals, such as mites and springtails. While these organisms are generally considered terrestrial and live in the leaf litter or under barks or rocks, some pseudoscorpions live in the intertidal area, including species in the genera Anagarypus, Anchigarypus, and Garypus in the family Garypidae. This study describes two new species of the genus Garypus L. Koch from Southern Taiwan, Garypus wilsoni Lin & Chang sp. nov. and Garypus sanasai Lin, Huang & Chang sp. nov., reviews the pseudoscorpion fauna of Taiwan, and provides an updated checklist of the country. Specimens of the two new species were collected in seashore habitats and their status as new species were supported by both morphology and molecular phylogenetic analysis. Our discovery marks the first new species of pseudoscorpions reported in Taiwan since 1937, as well as the first records of the family Garypidae in Taiwan and of Garypus in East Asia. Moreover, the discovery of these two new species in Taiwan fills the regional distribution gap between Garypus in Thailand and southward and its closely related genus Anchigarypus in South Korea and Japan. The location where Garypus sanasai Lin, Huang & Chang sp. nov. was found also represents the northernmost distribution of the genus Garypus in the West Pacific.

DNA methylation loci identification for pan-cancer early-stage diagnosis and prognosis using a new distributed parallel partial least squares method.

Aberrant methylation is one of the early detectable events in many tumors, which is very promising for pan-cancer early-stage diagnosis and prognosis. To efficiently analyze the big pan-cancer methylation data and to overcome the co-methylation phenomenon, a MapReduce-based distributed and parallel-designed partial least squares approach was proposed. The large-scale high-dimensional methylation data were first decomposed into distributed blocks according to their genome locations. A distributed and parallel data processing strategy was proposed based on the framework of MapReduce, and then latent variables were further extracted for each distributed block. A set of pan-cancer signatures through a differential co-expression network followed by statistical tests was further identified based on their gene expression profiles. In total, 15 TCGA and 3 GEO datasets were used as the training and testing data, respectively, to verify our method. As a result, 22,000 potential methylation loci were selected as highly related loci with early-stage pan-cancer diagnosis. Of these, 67 methylation loci were further identified as pan-cancer signatures considering their gene expression as well. The survival analysis as well as pathway enrichment analysis on them shows that not only these loci may serve as potential drug targets, but also the proposed method may serve as a uniform framework for signature identification with big data.

A systematic scoping review of communication skills training in medical schools between 2000 and 2020.

BACKGROUND: Communication skills training (CST) remains poorly represented and prioritised in medical schools despite its importance. A systematic scoping review (SSR) of CST is proposed to better appreciate current variability in their structure, content, and assessment. This is to guide their future design in medical school curricula. METHODS: The Systematic Evidence-Based Approach (SEBA) was used to guide concurrent SSRs of teaching and assessment in CST. After independent database searches, concurrent thematic and content analysis of included articles were conducted separately. Resultant themes/categories were combined via the jigsaw perspective to provide a more holistic view of the data. These were then compared to tabulated summaries of the included articles to create funnelled domains. RESULTS: 52,300 papers were identified, 150 full-text articles included, and four funnelled domains were identified: Indications, Design, Assessment, and Barriers and Enablers of CST. CSTs confer numerous benefits to physicians and patients. It saw increased confidence, improved diagnostic capabilities and better clinical management, as well as greater patient satisfaction and treatment compliance. Skills may be divided into core, prerequisite competencies, and advanced skills pertinent to more challenging and nuanced scenarios - such as population or setting-specific situations. CST teaching and assessment modalities were found to align with Miller's Pyramid, with didactic teaching gradually infused with experiential approaches to enhance their understanding and integration. A plethora of CST frameworks, teaching and assessment methods were identified and are presented together. CONCLUSION: While variable in approach, content and assessment, CST in medical schools often employ stage-based curricula to instil competency-based topics of increasing complexity throughout medical school education. This process builds on the application of prior knowledge and skills, influencing practice and, potentially, the students' professional identity formation. In addition, the institution plays a critical role in overseeing training, ensuring longitudinal guidance and holistic assessments of the students' progress.

Marine anoxia linked to abrupt global warming during Earth's penultimate icehouse.

Piecing together the history of carbon (C) perturbation events throughout Earth's history has provided key insights into how the Earth system responds to abrupt warming. Previous studies, however, focused on short-term warming events that were superimposed on longer-term greenhouse climate states. Here, we present an integrated proxy (C and uranium [U] isotopes and paleo CO2) and multicomponent modeling approach to investigate an abrupt C perturbation and global warming event (∼304 Ma) that occurred during a paleo-glacial state. We report pronounced negative C and U isotopic excursions coincident with a doubling of atmospheric CO2 partial pressure and a biodiversity nadir. The isotopic excursions can be linked to an injection of ∼9,000 Gt of organic matter­derived C over ∼300 kyr and to near 20% of areal extent of seafloor anoxia. Earth system modeling indicates that widespread anoxic conditions can be linked to enhanced thermocline stratification and increased nutrient fluxes during this global warming within an icehouse.

Mesoporous PdBi nanocages for enhanced electrocatalytic performances by all-direction accessibility and steric site activation.

An effective yet simple approach was developed to synthesize mesoporous PdBi nanocages for electrochemical applications. This technique relies on the subtle utilization of the hydrolysis of a metal salt to generate precipitate cores in situ as templates for navigating the growth of mesoporous shells with the assistance of polymeric micelles. The mesoporous PdBi nanocages are then obtained by excavating vulnerable cores and regulating the crystals of mesoporous metallic skeletons. The resultant mesoporous PdBi nanocages exhibited excellent electrocatalytic performance toward the ethanol oxidation reaction with a mass activity of 3.56 A mg-1_Pd, specific activity of 17.82 mA cm-2 and faradaic efficiency of up to 55.69% for C1 products.

Effects of resveratrol treatment on quality and antioxidant properties of postharvest strawberry fruit.

Strawberry fruit is one of people's favorite fruits. It has high nutritional value and health care effects. Strawberries lose their edible value quickly after being picked because of their thin skin, which is easily damaged. In order to find a method to maintain the quality of strawberries, the effects of resveratrol treatment on the nutritional quality and antioxidant metabolism of strawberry fruit were studied. The result indicated that 100 µM resveratrol was the optimal concentration to delay the occurrence of decay. Strawberry fruit treated with resveratrol delayed the decrease in firmness, total soluble solids (TSS), total phenolics content (TPC), total flavonoid content (TFC), vitamin C (Vc) content,1,1-diphenyl-2-picrylhydrazyl (DPPH), and 2,2'-azino-bis (3-ethylbezothi- azot-hiazoline-6-sulfonic acid) (ABTS) radical scavenging capacities. The malondialdehyde (MDA) content, hydrogen peroxide (H2 O2 ) content, and superoxide anion (O2 •- ) production of control fruit were significantly higher than those of treated fruit. Strawberry fruit treated with resveratrol also increased the activities of superoxide dismutase (SOD), catalase (CAT), and ascorbate peroxidase (APX) during storage. Therefore, resveratrol has been proved to effectively improve the nutritional quality and antioxidant properties of strawberry fruit. PRACTICAL APPLICATIONS: Strawberry fruit is rich in nutrients, which is beneficial to human health. But strawberry fruit has high water content and soft tissue, which is easy to be damaged and decayed. Therefore, it is particularly important to find a way to maintain strawberry fruit quality. In this study, resveratrol has good antioxidant, health care, and antibacterial properties. Resveratrol treatment can maintain the nutritional quality of strawberry fruit and can be used as an effective method for strawberry fruit preservation.

Huangqin decoction ameliorates DSS-induced ulcerative colitis: Role of gut microbiota and amino acid metabolism, mTOR pathway and intestinal epithelial barrier.

BACKGROUND: The clinical treatment of ulcerative colitis (UC) is limited. A traditional Chinese medicinal formula, Huangqin decoction (HQD), is chronicled in Shang Han Lun and is widely used to ameliorate gastrointestinal disorders, such as UC; however, its mechanism is yet to be clarified. PURPOSE: The present study aimed to investigate the effect of HQD on 7-day colitis induced by 3% dextran sulfate sodium (DSS) in mice and further explore the inhibitory effect of metabolites on DSS-damaged FHC cells. METHODS: The therapeutic efficacy of HQD was evaluated in a well-established DSS-induced colitis mice model. The clinical symptoms were analyzed, and biological samples were collected for microscopic examination, metabolomics, metagenomics, and the evaluation of the epithelial barrier function. The mechanism of metabolites regulated by HQD was evaluated in the DSS-induced FHC cell damage model. The samples were collected to detect the physiological functions of the cells. RESULTS: HQD suppressed the inflammation of DSS-induced colitis in vivo, attenuated DSS-induced clinical manifestations, reversed colon length reduction, and reduced histological injury. After HQD treatment, the DSS-induced gut dysbiosis was modulated, and the gut microbiota achieved a new equilibrium state. In addition, HQD activated the mTOR signaling pathway by upregulating amino acid metabolism. Significant phosphorylation of S6 and 4E-BP1 ameliorated intestinal epithelial barrier dysfunction. Moreover, HQD-regulated metabolites protected the epithelial barrier integrity by inhibiting DSS-induced apoptosis of FHC cells and regulating the proteins affecting apoptosis and cell-cell junction. CONCLUSIONS: These findings indicated that the mechanism of HQD was related to regulating the gut microbiota and amino acid metabolism, activating the mTOR signaling pathway, and protecting the intestinal mucosal barrier integrity.

Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore.

INTRODUCTION: Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers. METHODS: A cross-sectional household study was conducted in a public housing estate using a standardised questionnaire to interview Singaporeans and permanent residents aged 40 years and above, who were diagnosed with at least 1 of these chronic diseases: hyperlipidaemia, hypertension or diabetes mellitus. CDSM competency was evaluated with the Partners In Health (PIH) scale and a knowledge based questionnaire. Satisfaction was evaluated using a satisfaction scale. RESULTS: In general, the 420 respondents demonstrated good CDSM competency, with 314 followed up at polyclinics and 106 by general practitioners (GPs). There was no significant difference between patients of polyclinics and GPs in CDSM competency scores (mean PIH score 72.9 vs 75.1, P=0.563), hypertension knowledge scores (90.9 vs 85.4, P=0.16) and diabetes knowledge scores (84.3 vs 79.5, P=0.417), except for hyperlipidaemia knowledge scores (78.6 vs 84.7, P=0.043). However, respondents followed up by GPs had higher satisfaction rates than did those followed up at polyclinics (odds ratio 3.6, confidence interval 2.28-5.78). Favourable personality of the doctors and ideal consultation duration led to higher satisfaction in the GP setting. A longer waiting time led to lower satisfaction in the polyclinic group. CONCLUSION: Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.

Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review.

INTRODUCTION: Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically. METHODS: Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis. RESULTS: 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors. CONCLUSION: Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.

Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore

INTRODUCTION@#Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers.@*METHODS@#A cross-sectional household study was conducted in a public housing estate using a standardised questionnaire to interview Singaporeans and permanent residents aged 40 years and above, who were diagnosed with at least 1 of these chronic diseases: hyperlipidaemia, hypertension or diabetes mellitus. CDSM competency was evaluated with the Partners In Health (PIH) scale and a knowledge based questionnaire. Satisfaction was evaluated using a satisfaction scale.@*RESULTS@#In general, the 420 respondents demonstrated good CDSM competency, with 314 followed up at polyclinics and 106 by general practitioners (GPs). There was no significant difference between patients of polyclinics and GPs in CDSM competency scores (mean PIH score 72.9 vs 75.1, P=0.563), hypertension knowledge scores (90.9 vs 85.4, P=0.16) and diabetes knowledge scores (84.3 vs 79.5, P=0.417), except for hyperlipidaemia knowledge scores (78.6 vs 84.7, P=0.043). However, respondents followed up by GPs had higher satisfaction rates than did those followed up at polyclinics (odds ratio 3.6, confidence interval 2.28-5.78). Favourable personality of the doctors and ideal consultation duration led to higher satisfaction in the GP setting. A longer waiting time led to lower satisfaction in the polyclinic group.@*CONCLUSION@#Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.

Paterson-Brown Kelly Syndrome (also commonly known as Plummer-Vinson Syndrome).

The dysphagia in this condition is usually associated with iron deficiency anemia and esophageal webs. Iron supplementation and regular surveillance are required for monitoring of malignant transformation into esophageal squamous cell carcinoma.

Cinacalcet and primary hyperparathyroidism: systematic review and meta regression.

PURPOSE: Primary hyperparathyroidism (PHPT) is a common condition affecting people of all ages and is mainly treated with parathyroidectomy. Cinacalcet has been widely used in secondary or tertiary hyperparathyroidism, but the use of cinacalcet in PHPT is less clear. METHODS: Searches were conducted in Medline and Embase for cinacalcet use in PHPT from induction to 10 April 2020. Articles and conferences abstracts describing the use of cinacalcet for PHPT in prospective or retrospective cohorts and randomized controlled trials restricted to English language only. We initially identified 1301 abstracts. Each article went extraction by two blinded authors on a structured proforma. Continuous outcomes were pooled with weight mean difference (WMD). Quality of included articles was assessed with Newcastle Ottwa Scale and Cochrane Risk of Bias 2.0. RESULTS: Twenty-eight articles were included. Normalization rate of serum Ca levels was reported at 90% (CI: 0.82 to 0.96). Serum levels of Ca and PTH levels were significantly reduced (Ca, WMD: 1.647, CI: -1.922 to -1.371; PTH, WMD: -31.218, CI: -41.671 to -20.765) and phosphate levels significantly increased (WMD: 0.498, CI: 0.400 to 0.596) after cinacalcet therapy. The higher the baseline Ca levels, the greater Ca reduction with cinacalcet treatment. Age and gender did not modify the effect of cinacalcet on serum Ca levels. CONCLUSION: The results from the meta-analysis support the use of cinacalcet as an alternative or bridging therapy to treat hypercalcemia in people with PHPT.