RBM39 is a potential prognostic biomarker with functional significance in hepatocellular carcinoma.

Background: RNA-binding motif protein 39 (RBM39) is a well-known RNA-binding protein involved in tumorigenesis; however, its role in hepatocellular carcinoma (HCC) remains unclear. The aim of this study was to investigate the role of RBM39 in HCC. Methods: The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases were used to analyze the differential expression of RBM39 in HCC and normal tissues. The prognostic and diagnostic value of RBM39 in HCC was accessed by Kaplan-Meier analysis, Cox regression, and receiver operating characteristic (ROC) curve analyses. Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry were used to validate the mRNA and protein expression of RBM39 in HCC. Moreover, gene set enrichment analysis (GSEA) was performed to identify key pathways related to RBM39. The correlation between RBM39 expression and immune cell infiltration was evaluated using a single-sample gene set enrichment analysis (ssGSEA). CCK8 and wound healing assays were performed to investigate the proliferation and migration abilities of HCC cells with RBM39 knockdown. Results: RBM39 expression was upregulated in the HCC tissues. High RBM39 expression was significantly associated with advanced T stage, histological grade, and pathological stage and predicted poor overall survival (OS), disease-specific survival (DSS), and progress-free interval (PFI) in HCC patients. The upregulation of RBM39 expression was an independent prognostic factor for OS. Moreover, GSEA enrichment analysis indicated that RBM39 was functionally involved in pathways associated with the cell cycle, DNA replication, the p53 signaling pathway, and primary immunodeficiency. RBM39 expression was associated with infiltration of Th2 cells and dendritic cells (DC). RBM39 knockdown significantly inhibited the proliferation and migration of HCC cells. Conclusions: These findings suggest that high RBM39 expression is associated with poor prognosis and promotes HCC cell proliferation and migration. Based on these results, RBM39 is a promising prognostic biomarker with functional significance for HCC.

Stoichiometry-Tunable Synthesis and Magnetic Property Exploration of Two-Dimensional Chromium Selenides.

Emerging 2D chromium-based dichalcogenides (CrXn (X = S, Se, Te; 0 < n ≤ 2)) have provoked enormous interests due to their abundant structures, intriguing electronic and magnetic properties, excellent environmental stability, and great application potentials in next generation electronics and spintronics devices. Achieving stoichiometry-controlled synthesis of 2D CrXn is of paramount significance for such envisioned investigations. Herein, we report the stoichiometry-controlled syntheses of 2D chromium selenide (CrxSey) materials (rhombohedral Cr2Se3 and monoclinic Cr3Se4) via a Cr-self-intercalation route by designing two typical chemical vapor deposition (CVD) strategies. We have also clarified the different growth mechanisms, distinct chemical compositions, and crystal structures of the two type materials. Intriguingly, we reveal that the ultrathin Cr2Se3 nanosheets exhibit a metallic feature, while the Cr3Se4 nanosheets present a transition from p-type semiconductor to metal upon increasing the flake thickness. Moreover, we have also uncovered the ferromagnetic properties of 2D Cr2Se3 and Cr3Se4 below ∼70 K and ∼270 K, respectively. Briefly, this research should promote the stoichiometric-ratio controllable syntheses of 2D magnetic materials, and the property explorations toward next generation spintronics and magneto-optoelectronics related applications.

Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis.

BACKGROUND: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. OBJECTIVE: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. METHODS: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. RESULTS: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. CONCLUSIONS: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.

Comprehensive insight on protein modification by V-type agent: A chemical proteomic approach employing bioorthogonal reaction.

Organophosphorus compounds (OPs) such as chemical agents and pesticides are posing critical threats to civilians due to their irreversible phosphonylation of diverse amino acids residues forming different protein adducts. However, traditional analytical approaches are quite limited in capturing the myriad of post-translational events that affect protein functions, especially in identifying the low-abundance OP adducts. Herein a systematic proteomic strategy based on a typical click-enrich-release-identify bioorthogonal operation was firstly developed by employing an alkynyl-tagged V-type agent probe (AVP) and a biotin-based azido-enrichment linker (BTP-N3 ). AVP targeting peptides from human serum albumin (HSA) or plasma were captured by BTP-N3 via CuAAC click reaction, enriched by streptavidin beads, released by selective alkaline hydrolysis of phenacyl ester bond, and subsequently sequenced by LC-MS/MS. This strategy has helped identifying 1115 unique OP adduction sites on 163 proteins in human plasma, and covers lots of OP adducts that cannot be achieved by traditional detection methods. The comprehensive coverage of novel OP substrates provided a general and sensitive approach to retrospective verification and/or dose assessment of toxic OPs.

Construction and identification of lncRNA/circRNA-coregulated ceRNA networks in gemcitabine-resistant bladder carcinoma.

OBJECTIVES: To explore the regulatory networks that underlie the development of chemoresistance in bladder cancer. METHODS: We analyzed profiles of differentially expressed long non-coding RNAs (lncRNAs), circular RNAs (circRNAs), microRNAs (miRNAs) and messenger RNA (mRNAs) in gemcitabine-resistant/sensitive bladder cancer cells using next-generation sequencing data. RESULTS: Hundreds of differentially expressed lncRNAs and miRNAs and thousands of circRNAs and mRNAs were identified. Bioinformatics analysis revealed the chromosomal localizations, classification and coexpression of mRNAs, as well as candidates for cis and trans regulation by lncRNAs. Furthermore, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of differentially expressed mRNAs and circRNAs indicated important functional roles of coregulated RNAs, thus establishing competing endogenous RNA (ceRNA) and protein-protein interactions networks that may underlie chemoresistance in bladder cancer. We demonstrated that lncRNA LINP1 can act as a ceRNA by inhibiting miR-193a-5p to increase TP73 expression; and that lncRNA ESRG and hsa_circ_0075881 can simultaneously bind miR-324-3p to increase ST6GAL1 expression. Modulation of ceRNA network components using ablation and overexpression approaches contributed to gemcitabine resistance in bladder cancer cells. CONCLUSIONS: These results elucidate mechanisms by which lncRNAs and circRNAs coregulate the development of bladder cancer cell resistance to gemcitabine, thus laying the foundation for future research to identify biomarkers and disease targets.

Implementation, service effectiveness and satisfaction with teleconsultation services in China during the COVID-19 pandemic: from the Perspective of Primary Health Care Professionals.

OBJECTIVE: This study aims to evaluate satisfaction and service effectiveness of primary hospital physicians participating in the National Telemedicine Center of China during the COVID-19 period, and to identify potential improvement suggestions. METHODS: An online questionnaire was developed to assess the impact and satisfaction of teleconsultation services. A teleconsultation manager from each of the 98 hospitals randomly invited the medical staff involved in teleconsultation to complete the online questionnaire. RESULTS: A total of 379 health care professionals responded to the online questionnaire, with a mean age of 36.74 years. Out of these respondents, 95.5% had a positive attitude towards teleconsultation during the epidemic. Only 6.6% believed that teleconsultation systems were not useful in preventing and controlling the COVID-19 pandemic. Those respondents who were very satisfied with teleconsultation participated in it 1.81 times per week averagely. Factors related to satisfaction included weekly participation frequency（P=.003）, patient data quality(P=.023), equipment operation proficiency（P=.006）, audio and video clarity and smoothness（P=.004, P=.020）, environmental satisfaction（P=.032）, and incentive measures of title promotion（P=.003）. The main challenges in teleconsultation were the lack of understanding of medical staff and the public, insufficiently advanced software and hardware equipment, and the lack of optimization of service processes. CONCLUSIONS: Primary hospital doctors demonstrate high satisfaction levels, suggesting that teleconsultation could be an effective tool for patients seeking medical care in areas under lockdown during the COVID-19 pandemic. The primary barriers to teleconsultation include lack of public understanding and unadvanced equipment. These findings should inform future efforts to establish regional telemedicine programs in the post-COVID-19 era.

Epitaxial Growth of High-Quality Monolayer MoS2 Single Crystals on Low-Symmetry Vicinal Au(101) Facets with Different Miller Indices.

Epitaxial growth of wafer-scale monolayer semiconducting transition metal dichalcogenide single crystals is essential for advancing their applications in next-generation transistors and highly integrated circuits. Several efforts have been made for the growth of monolayer MoS2 single crystals on high-symmetry Au(111) and sapphire substrates, while more prototype growth systems still need to be discovered for clarifying the internal mechanisms. Herein, we report the epitaxial growth of unidirectionally aligned monolayer MoS2 domains and single-crystal films on low-symmetry Au(101) vicinal facets via a facile chemical vapor deposition method. On-site scanning tunneling microscopy observations reveal the formation of a specific rectangular Moiré pattern along the [101̅] step edge of Au(101) and along its perpendicular direction. The perfect lattice constant matching of MoS2/Au(101) along the substrate high-symmetry directions (i.e., Au[101̅], Au [010]) as well as the step-edge-guiding effect are proposed to facilitate the robust epitaxy. Multiscale characterizations further confirm the domain-boundary-free feature of the monolayer MoS2 films merged by unidirectionally aligned monolayer domains. This work hereby puts forward a symmetry mismatched epitaxial system for the direct synthesis of monolayer MoS2 single crystals, which should deepen our understanding about the epitaxy of 2D layered materials and propel their applications in various fields.

Composition-Controllable Syntheses and Property Modulations from 2D Ferromagnetic Fe5 Se8 to Metallic Fe3 Se4 Nanosheets.

Exploring new-type 2D magnetic materials with high magnetic transition temperature and robust air stability has attracted wide attention for developing innovative spintronic devices. Recently, intercalation of native metal atoms into the van der Waals gaps of 2D layered transition metal dichalcogenides (TMDs) has been developed to form 2D non-layered magnetic TMDs, while only succeeded in limited systems (e.g., Cr2 S3 , Cr5 Te8 ). Herein, composition-controllable syntheses of 2D non-layered iron selenide nanosheets (25% Fe-intercalated triclinic Fe5 Se8 and 50% Fe-intercalated monoclinic Fe3 Se4 ) are firstly reported, via a robust chemical vapor deposition strategy. Specifically, the 2D Fe5 Se8 exhibits intrinsic room-temperature ferromagnetic property, which is explained by the change of electron spin states from layered 1T'-FeSe2 to non-layered Fe-intercalated Fe5 Se8 based on density functional theory calculations. In contrast, the ultrathin Fe3 Se4 presents novel metallic features comparable with that of metallic TMDs. This work hereby sheds light on the composition-controllable synthesis and fundamental property exploration of 2D self-intercalation induced novel TMDs compounds, by propelling their application explorations in nanoelectronics and spintronics-related fields.

Usage and perceptions of telemedicine among health care professionals in China.

OBJECTIVE: To explore health care professionals' usage and perceptions of telemedicine, including their experience, evaluation and attitude towards telemedicine, and the factors affecting their satisfaction, using intention, and willingness to recommend telemedicine. METHODS: A nationwide and web-based survey was conducted. Statistical charts were used to describe the usage and perceptions of telemedicine by health care professionals. And the ordinal logistic regression was applied to analyze the influencing factors. RESULTS: A total of 1349 valid questionnaires were collected. In the survey, 74.0 % of Chinese health care professionals used telemedicine once a week. The average duration of participating in telemedicine services lasted mainly 11-30 min (64.0 %). More than half (52.5 %) of participants' hospitals adopted fee subsidy measures, followed by the award for excellent evaluation (36.4 %). The majority (92.5 %) believed that telemedicine could reduce patient referral rates. More than 95 % were satisfied with telemedicine, were willing to continue, and would recommend telemedicine for patients, respectively. The main problems existing were: incomplete system equipment, insufficient timeliness, high costs, inability to reimburse medical insurance, non-standardized medical records, inadequate publicity, cumbersome processes and long waiting time. Ordinal logistic regression showed that too short service duration (≤10 min) could significantly reduce medical professionals' overall satisfaction, using intention and willingness to recommend (P = 0.026, P = 0.017 and P = 0.040 respectively), while the convenience of the operating system had a significant positive impact (P = 0.005, P = 0.003 and P = 0.001 respectively). And cost subsidy incentive and the promotion of professional titles could significantly enhance their overall satisfaction(P = 0.006, P = 0.030), using intention (P = 0.011, P = 0.001), and willingness to recommend (P = 0.040, P = 0.004). CONCLUSIONS: The usage of telemedicine is relatively insufficient. Most health care professionals have fairly positive opinions toward telemedicine. The most mentioned issues and expectations for telemedicine can be roughly divided into four categories: infrastructure, service process, charge and cost, and popularity. It is possible to improve their evaluation by improving system convenience, enhancing service punctuality, avoiding excessively short service duration and adopting incentive measures.

On-Site Synthesis and Characterizations of Atomically-Thin Nickel Tellurides with Versatile Stoichiometric Phases through Self-Intercalation.

Self-intercalation of native metal atoms in two-dimensional (2D) transition metal dichalcogenides has received rapidly increasing interest, due to the generation of intriguing structures and exotic physical properties, however, only reported in limited materials systems. An emerging type-II Dirac semimetal, NiTe2, has inspired great attention at the 2D thickness region, but has been rarely achieved so far. Herein, we report the direct synthesis of mono- to few-layer Ni-tellurides including 1T-NiTe2 and Ni-rich stoichiometric phases on graphene/SiC(0001) substrates under ultra-high-vacuum conditions. Differing from previous chemical vapor deposition growth accompanied with transmission electron microscopy imaging, this work combines precisely tailored synthesis with on-site atomic-scale scanning tunneling microscopy observations, offering us visual information about the phase modulations of Ni-tellurides from 1T-phase NiTe2 to self-intercalated Ni3Te4 and Ni5Te6. The synthesis of Ni self-intercalated NixTey compounds is explained to be mediated by the high metal chemical potential under Ni-rich conditions, according to density functional theory calculations. More intriguingly, the emergence of superconductivity in bilayer NiTe2 intercalated with 50% Ni is also predicted, arising from the enhanced electron-phonon coupling strength after the self-intercalation. This work provides insight into the direct synthesis and stoichiometric phase modulation of 2D layered materials, enriching the family of self-intercalated materials and propelling their property explorations.

The clinical characteristics and prognostic factors of 410 patients with natural killer/T-cell lymphoma.

PURPOSE: To investigate the clinical characteristics and prognostic factors of natural killer/T-cell lymphoma (NKTCL). METHODS: We retrospectively reviewed 410 NKTCL patients admitted to our lymphoma center from 2000 to 2019. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method, and the differences between the study groups were compared by the log-rank test. RESULTS: The median age of the 410 patients was 44 (range 8-84), and the 5-year OS and PFS were 61.2% and 38.4%, respectively. For patients with stage I/II, the 5-year PFS rate was 57.5%, and the 5-year OS rate was 77.2%. For patients with stage III/IV, the 5-year PFS rate was 17.4%, and the 5-year OS rate was 43.7%. Compared to the patients who received radiotherapy alone or chemotherapy alone as their initial treatment, the patients who received combined chemoradiotherapy had longer PFS (P = 0.013). Independent prognostic factors for OS were stage III/IV (P = 0.001), elevated IPI/aaIPI score (P = 0.019), elevated PINK score (P < 0.001) and elevated plasma EBV-DNA (P = 0.003). An elevated PINK score (P < 0.001) was an independent prognostic factor for PFS. CONCLUSION: Stage III/IV, elevated IPI/aaIPI score, elevated PINK score and elevated plasma EBV-DNA were independent prognostic factors for OS. Elevated PINK score was an independent prognostic factor for PFS. In stage III/IV patients, the patients who received combined chemoradiotherapy had significantly longer PFS.

Epitaxial growth of inch-scale single-crystal transition metal dichalcogenides through the patching of unidirectionally orientated ribbons.

Two-dimensional (2D) semiconductors, especially transition metal dichalcogenides (TMDs), have been envisioned as promising candidates in extending Moore's law. To achieve this, the controllable growth of wafer-scale TMDs single crystals or periodic single-crystal patterns are fundamental issues. Herein, we present a universal route for synthesizing arrays of unidirectionally orientated monolayer TMDs ribbons (e.g., MoS2, WS2, MoSe2, WSe2, MoSxSe2-x), by using the step edges of high-miller-index Au facets as templates. Density functional theory calculations regarding the growth kinetics of specific edges have been performed to reveal the morphological transition from triangular domains to patterned ribbons. More intriguingly, we find that, the uniformly aligned TMDs ribbons can merge into single-crystal films through a one-dimensional edge epitaxial growth mode. This work hereby puts forward an alternative pathway for the direct synthesis of inch-scale uniform monolayer TMDs single-crystals or patterned ribbons, which should promote their applications as channel materials in high-performance electronics or other fields.

Epitaxial Growth of Step-Like Cr2 S3 Lateral Homojunctions Towards Versatile Conduction Polarities and Enhanced Transistor Performances.

For expanding the applications of 2D transition metal dichalcogenides (TMDCs), integrating functional devices with diverse conduction polarities in the same parent material is a very promising direction. Improving the contact issue at the metal-semiconductor interface also holds fundamental significance. To achieve these concurrently, step-like Cr2 S3 vertical stacks with varied thicknesses are achieved via a one-step chemical vapor deposition (CVD) method route. Various types of 2D Cr2 S3 lateral homojunctions are thus naturally evolved, that is, pm -ambipolar/n, p/ambipolar, ambipolar/n, and nm -ambipolar/n junctions, allowing the integration of diverse conduction polarities in single Cr2 S3 homojunctions. Significantly, on-state current density and field-effect mobility of the thinner 2D Cr2 S3 flakes stacked below are detected to be ≈5 and ≈6 times increased in the lateral homojunctions, respectively. This work should hereby provide insights for designing 2D functional devices with simpler structures, for example, multipolar field-effect transistors, photodetectors, and inverters, and provide fundamental references for optimizing the electrical performances of 2D materials related devices.

Construction and Application of an Intelligent Response System for COVID-19 Voice Consultation in China: A Retrospective Study.

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has led to tremendous individuals visit medical institutions for healthcare services. Public gatherings and close contact in clinics and emergency departments may increase the exposure and cross-infection of COVID-19. Objectives: The purpose of this study was to develop and deploy an intelligent response system for COVID-19 voice consultation, to provide suggestions of response measures based on actual information of users, and screen COVID-19 suspected cases. Methods: Based on the requirements analysis of business, user, and function, the physical architecture, system architecture, and core algorithms are designed and implemented. The system operation process is designed according to guidance documents of the National Health Commission and the actual experience of prevention, diagnosis and treatment of COVID-19. Both qualitative (system construction) and quantitative (system application) data from the real-world healthcare service of the system were retrospectively collected and analyzed. Results: The system realizes the functions, such as remote deployment and operations, fast operation procedure adjustment, and multi-dimensional statistical report capability. The performance of the machine-learning model used to develop the system is better than others, with the lowest Character Error Rate (CER) 8.13%. As of September 24, 2020, the system has received 12,264 times incoming calls and provided a total of 11,788 COVID-19-related consultation services for the public. Approximately 85.2% of the users are from Henan Province and followed by Beijing (2.5%). Of all the incoming calls, China Mobile contributes the largest proportion (66%), while China Unicom and China Telecom are accounted for 23% and 11%. For the time that users access the system, there is a peak period in the morning (08:00-10:00) and afternoon (14:00-16:00), respectively. Conclusions: The intelligent response system has achieved appreciable practical implementation effects. Our findings reveal that the provision of inquiry services through an intelligent voice consultation system may play a role in optimizing the allocation of healthcare resources, improving the efficiency of medical services, saving medical expenses, and protecting vulnerable groups.

Integrated Strategy for Unbiased Profiling of the Histidine Phosphoproteome.

Histidine phosphorylation (pHis), which plays a key role in signal transduction in bacteria and lower eukaryotes, has been shown to be involved in tumorigenesis. Due to its chemical instability, substoichiometric properties, and lack of specific enrichment reagents, there is a lack of approaches for specific and unbiased enrichment of pHis-proteins/peptides. In this study, an integrated strategy was established and evaluated as an unbiased tool for exploring the histidine phosphoproteome. First, taking advantage of the lower charge states of pHis-peptides versus the non-modified naked peptides at weak acid solution (∼pH 2.7), strong cation exchange (SCX) chromatography was used to differentiate modified and non-modified naked peptides. Furthermore, selective enrichment of the pHis-peptide was performed by applying Cu-IDA beads enrichment. Finally, stable isotope dimethyl labeling was introduced to guarantee high-confidence assignment of pHis-peptides. Using this integrated strategy, 563 different pHis-peptides (H = 1) in 385 proteins were identified from HeLa lysates. Motif analysis revealed that pHis prefers hydrophobic amino acids and has the consensus motif-HxxK, which covered the reports from different approaches. Thus, our method may provide an unbiased and effective tool to reveal histidine phosphoproteome and to study the biological process and function of histidine phosphorylation.

Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis.

BACKGROUND: Telemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field. OBJECTIVE: Our work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China. METHODS: We collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method. RESULTS: The regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness. CONCLUSIONS: The development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services.

Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study.

BACKGROUND: Whole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data. OBJECTIVE: The main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits. METHODS: Details of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS. RESULTS: From 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year. CONCLUSIONS: The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.

Effect of substrate symmetry on the orientations of MoS2 monolayers.

Two-dimensional (2D) semiconducting transition metal dichalcogenides (TMDs) are promising platforms for developing next-generation electronic and optoelectronic devices due to their unique properties. To achieve this, the growth of large single-crystal TMDs is a critical issue. Unraveling the factors affecting the nucleation and domain orientation should hold fundamental significance. Herein, we design the chemical vapor deposition growth of monolayer MoS2 triangles on Au(111) and Au(100) facets, for exploring the substrate facet effects on the domain orientations. According to multi-scale characterizations, we find that, the obtained triangular MoS2 domains present two preferential orientations on the six-fold symmetric Au(111) facet, whereas four predominant orientations on the four-fold symmetric Au(100) facet. Using on-site scanning tunneling microscopy, we further reveal the preferred alignments of monolayer MoS2 triangles along the close-packed directions of both Au(111) and Au(100) facets. Moreover, bunched substrate steps are also found to form along the close-packed directions of the crystal facets, which guides the preferential nucleation of monolayer MoS2 along the step edges. This work should hereby deepen the understanding of the substrate facet/step effect on the nucleation and orientation of monolayer MoS2 domains, thus providing fundamental insights into the controllable syntheses of large single-crystal TMD monolayers.

Implementation and Application of Telemedicine in China: Cross-Sectional Study.

BACKGROUND: Telemedicine has been used widely in China and has benefited a large number of patients, but little is known about the overall development of telemedicine. OBJECTIVE: The aim of this study was to perform a national survey to identify the overall implementation and application of telemedicine in Chinese tertiary hospitals and provide a scientific basis for the successful expansion of telemedicine in the future. METHODS: The method of probability proportionate to size sampling was adopted to collect data from 161 tertiary hospitals in 29 provinces, autonomous regions, and municipalities. Charts and statistical tests were applied to compare the development of telemedicine, including management, network, data storage, software and hardware equipment, and application of telemedicine. Ordinal logistic regression was used to analyze the relationship between these factors and telemedicine service effect. RESULTS: Approximately 93.8% (151/161) of the tertiary hospitals carried out telemedicine services in business-to-business mode. The most widely used type of telemedicine network was the virtual private network with a usage rate of 55.3% (89/161). Only a few tertiary hospitals did not establish data security and cybersecurity measures. Of the 161 hospitals that took part in the survey, 100 (62.1%) conducted remote videoconferencing supported by hardware instead of software. The top 5 telemedicine services implemented in the hospitals were teleconsultation, remote education, telediagnosis of medical images, tele-electrocardiography, and telepathology, with coverage rates of 86.3% (139/161), 57.1% (92/161), 49.7% (80/161), 37.9% (61/161), and 33.5% (54/161), respectively. The average annual service volume of teleconsultation reached 714 cases per hospital. Teleconsultation and telediagnosis were the core charging services. Multivariate analysis indicated that the adoption of direct-to-consumer mode (P=.003), support from scientific research funds (P=.01), charging for services (P<.001), number of medical professionals (P=.04), network type (P=.02), sharing data with other hospitals (P=.04), and expertise level (P=.03) were related to the effect of teleconsultation. Direct-to-consumer mode (P=.01), research funding (P=.01), charging for services (P=.01), establishment of professional management departments (P=.04), and 15 or more instances of remote education every month (P=.01) were found to significantly influence the effect of remote education. CONCLUSIONS: A variety of telemedicine services have been implemented in tertiary hospitals in China with a promising prospect, but the sustainability and further standardization of telemedicine in China are still far from accomplished.

Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis.

BACKGROUND: The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions. OBJECTIVE: The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose. METHODS: With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015. RESULTS: Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions. CONCLUSIONS: Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.