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BACKGROUND: Digital technologies have impacted health care delivery globally, and are increasingly being deployed in clinical practice. However, there is limited research on patients' expectations of doctors' clinical competencies when using digital health care technologies (DHTs) in medical care. Understanding these expectations can reveal competency gaps, enhance patient confidence, and contribute to digital innovation initiatives. OBJECTIVE: This study explores patients' perceptions of doctors' use of DHTs in clinical care. Using Singapore as a case study, it examines patients' expectations regarding doctors' communication, diagnosis, and treatment skills when using telemedicine, health apps, wearable devices, electronic health records, and artificial intelligence. METHODS: Findings were drawn from individual semistructured interviews with patients from outpatient clinics. Participants were recruited using purposive sampling. Data were analyzed qualitatively using thematic analysis. RESULTS: Twenty-five participants from different backgrounds and with various chronic conditions participated in the study. They expected doctors to be adept in handling medical data from apps and wearable devices. For telemedicine, participants expected a level of assessment of their medical conditions akin to in-person consultations. In addition, they valued doctors recognizing when a physical examination was necessary. Interestingly, eye contact was appreciated but deemed nonessential by participants across all age bands when electronic health records were used, as they valued the doctor's efficiency more than eye contact. Nonetheless, participants emphasized the need for empathy throughout the clinical encounter regardless of DHT use. Furthermore, younger participants had a greater expectation for DHT use among doctors compared to older ones, who preferred DHTs as a complement rather than a replacement for clinical skills. The former expected doctors to be knowledgeable about the algorithms, principles, and purposes of DHTs such as artificial intelligence technologies to better assist them in diagnosis and treatment. CONCLUSIONS: By identifying patients' expectations of doctors amid increasing health care digitalization, this study highlights that while basic clinical skills remain crucial in the digital age, the role of clinicians needs to evolve with the introduction of DHTs. It has also provided insights into how DHTs can be integrated effectively into clinical settings, aligning with patients' expectations and preferences. Overall, the findings offer a framework for high-income countries to harness DHTs in enhancing health care delivery in the digital era.
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Competencia Clínica , Relaciones Médico-Paciente , Investigación Cualitativa , Telemedicina , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Singapur , Satisfacción del Paciente , Entrevistas como Asunto , Anciano , Médicos/psicología , Salud DigitalRESUMEN
Aim: Although lactate supplementation at the reperfusion stage of ischemic stroke has been shown to offer neuroprotection, whether the role of accumulated lactate at the ischemia phase is neuroprotection or not remains largely unknown. Thus, in this study, we aimed to investigate the roles and mechanisms of accumulated brain lactate at the ischemia stage in regulating brain injury of ischemic stroke. Methods and Results: Pharmacological inhibition of lactate production by either inhibiting LDHA or glycolysis markedly attenuated the mouse brain injury of ischemic stroke. In contrast, additional lactate supplement further aggravates brain injury, which may be closely related to the induction of neuronal death and A1 astrocytes. The contributing roles of increased lactate at the ischemic stage may be related to the promotive formation of protein lysine lactylation (Kla), while the post-treatment of lactate at the reperfusion stage did not influence the brain protein Kla levels with neuroprotection. Increased protein Kla levels were found mainly in neurons by the HPLC-MS/MS analysis and immunofluorescent staining. Then, pharmacological inhibition of lactate production or blocking the lactate shuttle to neurons showed markedly decreased protein Kla levels in the ischemic brains. Additionally, Ldha specific knockout in astrocytes (Aldh1l1 CreERT2; Ldha fl/fl mice, cKO) mice with MCAO were constructed and the results showed that the protein Kla level was decreased accompanied by a decrease in the volume of cerebral infarction in cKO mice compared to the control groups. Furthermore, blocking the protein Kla formation by inhibiting the writer p300 with its antagonist A-485 significantly alleviates neuronal death and glial activation of cerebral ischemia with a reduction in the protein Kla level, resulting in extending reperfusion window and improving functional recovery for ischemic stroke. Conclusion: Collectively, increased brain lactate derived from astrocytes aggravates ischemic brain injury by promoting the protein Kla formation, suggesting that inhibiting lactate production or the formation of protein Kla at the ischemia stage presents new therapeutic targets for the treatment of ischemic stroke.
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Astrocitos , Accidente Cerebrovascular Isquémico , Ácido Láctico , Neuronas , Animales , Astrocitos/metabolismo , Ratones , Ácido Láctico/metabolismo , Masculino , Accidente Cerebrovascular Isquémico/metabolismo , Accidente Cerebrovascular Isquémico/patología , Neuronas/metabolismo , Neuronas/patología , Modelos Animales de Enfermedad , Ratones Noqueados , Encéfalo/metabolismo , Encéfalo/patología , Ratones Endogámicos C57BL , Isquemia Encefálica/metabolismo , Isquemia Encefálica/patología , Lesiones Encefálicas/metabolismo , Lactato Deshidrogenasa 5/metabolismo , Fármacos Neuroprotectores/farmacologíaRESUMEN
Elucidating the seasonal patterns of water sources for dominant species in the sub-tropical humid mountainous forest, analyzing the eco-hydrological complementarity and competition mechanisms among coexisting species, investigating the responses of plant water utilization to precipitation, could provide a theoretical basis for vegetation restoration and management. Based on the stable hydrogen and oxygen isotope technique, we analyzed the δ2H and δ18O characteristics of precipitation, xylem water from Pinus massoniana and Quercus variabilis, and soil water from 0-100 cm depth in Mount Lushan, China. The MixSIAR model, Levins index, and PS index were used to calculate the relative contribution rate of each water source, the hydrological niche breadth, and niche overlap of P. massoniana and Q. variabilis. The results showed that, in the wet season (March to July), P. massoniana primarily utilized soil water from the 0-20 cm and 20-40 cm depths, while Q. variabilis primarily utilized that from the 20-40 cm and 40-60 cm depths. During the dry season (August to September), P. massoniana and Q. variabilis utilized 40-60 cm and 60-80 cm of soil water, respectively, resulting in an increase in the depth of water absorption. In the early growing season (March to April) and the late growing season (September), there was a high hydrological niche overlap between P. massoniana and Q. variabilis, resulting in intensitive water competition. In the middle of the growing season (May to August), the water source was adequately allocated, and the hydrolo-gical niche was segregated to meet the high transpiration demand. Q. variabilis primarily utilized soil water from a depth of 60-80 cm and 60-80 cm before a precipitation event, and from a depth of 0-20 cm and 20-40 cm after the event. In contrast, P. massoniana primarily utilized soil water from a depth of 0-20 cm and 20-40 cm both before and after a precipitation event. In conclusion, water utilization patterns of P. massoniana and Q. variabilis exhibited a seasonal trend, with shallow water uptake during the rainy season and deep water uptake during the dry season. These species are capable of efficiently allocating water resources during the peak growth season, and their root systems actively respond to change in soil moisture level. They have strong adaptability to extreme precipitation events and exhibit remarkable water conservation capabilities.
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Bosques , Pinus , Quercus , Lluvia , Estaciones del Año , Agua , China , Agua/análisis , Agua/metabolismo , Quercus/crecimiento & desarrollo , Pinus/crecimiento & desarrollo , Ecosistema , Suelo/químicaRESUMEN
AIMS: To investigate the effect of Self-designed Metabolic Equivalent Exercises (SMEE) on cancer-related fatigue in patients with gastric cancer. METHODS: 130 patients with gastric cancer admitted to Department of Oncology of a tertiary hospital in Shanghai were enrolled and assessed for eligibility. After excluding 1 patient who declined to participate, 129 eligible patients were randomly assigned into SMEE (n = 65) and control (n = 64) groups. The Revised Piper Fatigue Scale (RPFS) and EORTC QLQ-C30 Quality of Life Scale were used to measure cancer-caused fatigue and quality of life, respectively, in both groups at the first admission and after 3 months. RESULTS: After excluding patients who did not receive allocated intervention due to medical (n = 3) and personal (n = 2) reasons, those who were lost to follow-up (n = 3), and those who had discontinued intervention (n = 2), 119 patients (64 in the SMEE group and 55 in the control group) were included for analysis. There were no statistically significant differences in the RPFS or QLQ-C30 score between the two groups at baseline. After 3 months, the total RPFS score of the SMEE group was significantly lower than that of the control group (2.86 ± 1.75 vs. 4.65 ± 1.29, p = 0.009), with significant improvements in affective meaning (0.83 ± 0.92 vs. 1.13 ± 0.77, p = 0.044) and sensory (0.70 ± 0.71 vs. 1.00 ± 0.54, p < 0.001) subscales; in the SMEE group, QLQ-C30 scores in somatic (2.00 ± 0.27 vs. 1.31 ± 0.26, p < 0.001), emotional (2.67 ± 0.58 vs. 2.07 ± 0.48, p < 0.001), and social (3.23 ± 0.58 vs. 1.64 ± 0.51, p < 0.001) functioning were significantly higher than those in the control group, with significant improvements in fatigue (p < 0.001), nausea/vomiting (p = 0.014), shortness of breath (p < 0.001), constipation (p < 0.001), and diarrhea (p = 0.001) dimensions. CONCLUSION: The self-programmed metabolic equivalent manipulation as an exercise intervention could effectively reduce the degree of cancer-caused fatigue and improve quality of life in patients with gastric cancer.
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Terapia por Ejercicio , Fatiga , Calidad de Vida , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/psicología , Masculino , Femenino , Fatiga/etiología , Fatiga/terapia , Persona de Mediana Edad , Terapia por Ejercicio/métodos , Anciano , Resultado del Tratamiento , AdultoRESUMEN
The ecological environment along the Qinghai-Xizang highway is an important part of the construction of the ecological civilization in the Xizang region, and current research generally suffers from difficulties in data acquisition, low timeliness, and failure to consider the unique "alpine saline" environmental conditions in the study area due to the unique geographical environment of the Qinghai-Xizang plateau. Based on the GEE platform and the unique geographical environment of the study area, the remote sensing ecological index (RSEI) was improved, and a new saline remote sensing ecological index (SRSEI) applicable to the alpine saline region was constructed by using principal component analysis as an ecological environment quality evaluation index. The spatial distribution pattern and temporal variation trend of ecological environment quality along the Qinghai-Xizang Highway Nagqu-Amdo section were analyzed at multiple spatial and temporal scales using the ArcGIS 10.3 platform and geographic probes, and the driving mechanisms of eight control factors, including natural and human-made, on the spatial and temporal changes in SRSEI were investigated. The results showed that:â compared with RSEI, SRSEI was more sensitive to vegetation and had a stronger discriminatory ability in areas with sparse vegetation and severe salinization, which is suitable for ecological quality evaluation in alpine saline areas. â¡ The spatial scale of ecological environment quality in the study area had obvious geographical differentiation, and the areas with poor ecological quality were mainly concentrated in the northern Amdo County, whereas the areas with excellent and good quality grades were mainly distributed in the central-western and southeastern Nagqu areas. On the temporal scale, the ecological environment of the study area as a whole showed an improvement trend over 32 years, and the vegetation cover in the central-western and southeastern areas increased significantly, which had a strong improvement effect on the ecological environment. The improvement area was 1 425.98 km2, accounting for 99.82%. The mean value of SRSEI was 0.49, with an overall fluctuating upward trend and an average increase of 0.015 7 a-1. ⢠The land use pattern was the most driving influence factor in the change of ecological environment quality in the study area, with an average q value of 0.157 6 over multiple years, and the influence of environmental factors was low. The multi-factor interaction results showed that the ecological environment in the study area was the result of multiple factors acting together, all factors had synergistic enhancement under the interaction, the influence of human factors was gradually increasing, and the interaction of the net primary productivity (NPP) of vegetation and land use pattern was the main interactive control factor of ecological environment quality in the study area. This study can provide a theoretical basis for ecological environmental protection and sustainable development along the Nagqu to Amdo section.
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Ecosistema , Tecnología de Sensores Remotos , Humanos , Monitoreo del Ambiente , Conservación de los Recursos Naturales , Análisis de Componente Principal , ChinaRESUMEN
Endocardial fibroelastosis (EFE) is commonly considered to be an inflammatory reactive lesion of hyperplasia and deposition of tissue fibers and collagen in the endocardium and/or subendocardium, which is strongly associated with endocardial sclerosis, ventricular remodeling and acute and chronic heart failure, and is one of the important causes for pediatric heart transplantation. Early diagnosis and treatment are the key factors in determining the prognosis of the children. In this paper, we would like to highlight the potential unintended consequences of the use of sedation and biopsy for pediatric acute heart failure caused by EFE and the comprehensive considerations prior to clinical diagnosis.
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A split-type photoelectrochemical (PEC) sensor was designed for the detection of profenofos (PFF) depending on the magnetic-assisted exciton-plasmon interactions (EPI) between the semiconductor substrate and Au NPs. The core-shell Bi2S3 nanorods@MoS2 nanosheets (Bi2S3 NRs@MoS2 NSs) heterostructure nanomaterial with fascinating performance was synthesized and used as the photovoltaic conversion substrate and signal molecules absorption platform. The PEC sensor is operated by co-incubating with the released Au NPs-cDNA from the surface of magnetic beads, originating from the target-triggered DNA double-stranded structure opening event. Due to the strong EPI effects, the photocurrent of Bi2S3 NRs@MoS2 NSs decreased and varied with the PFF concentrations. The proposed PEC sensor exhibited outstanding analytical performances, including a wide linear range (1.0 pg mL-1~1.0 µg mL-1), low detection limitation (0.23 pg mL-1, at 3 σ/m), excellent specificity, high stability, and applicability. Overall, this work provides a new signal strategy for PEC biosensors and extends its application in environmental analysis.
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Molibdeno , Nanotubos , Molibdeno/química , Técnicas Electroquímicas , Nanotubos/química , Fenómenos MagnéticosRESUMEN
Purposes: This study aimed to analyze the predictive ability of the complete blood count and derived inflammatory indicators for BD patients with different states to identify potential biomarkers. Methods: We collected the data of BD in-patients from January 2021 to March 2023. The complete blood count and derived inflammatory indicators were computed by univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis. Results: In terms of BD patients, the levels of MON (p<0.0001), hs-CRP (p = 0.018), and NLR (p = 0.002) were independent risk factors in logistic regression analysis, as well as the cut-off values were 0.405 109/L, 2.600 mg/L, and 2.321, respectively. Regarding BD-M patients, the levels of MON (p<0.0001), hs-CRP (p = 0.012), and NLR (p = 0.002) were predictors in logistic regression analysis, and the cut-off values were, respectively, 0.505 109/L, 2.600 mg/L, and 2.620. Additionally, the levels of NLR (p = 0.006) and MHR (p<0.0001) were important indicators for BD-D and the cut-off values were 1.735 and 0.487, respectively. Furthermore, our findings showed that the level of MON (p = 0.001) was related to BD-mixed and the cut-off value was 0.340 109/L. Notably, MON+hs-CRP + NLR, MON+hs-CRP + NLR, and NLR + MHR had the highest diagnostic accuracy to predict BD, BD-M, and BD-D patients, respectively. Conclusion: Our findings showed that distinct inflammatory indicators were closely associated with BD and its different states. Additionally, we also identified their cut-off values and optimal combined predictive indicators in different states of BD, helping us improve diagnostic accuracy and better assess them to manage early targeted interventions.
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It is difficult and challenging to design and construct high-nuclearity Ln(III)-based clusters due to the high coordination numbers and versatile coordination geometries of Ln(III) ions. Herein, two novel octanuclear Ln(III)-based clusters [Ln8(H2L-)4(HL2-)4(NO3)6 (CO3)2](NO3)2·2CH3CN (Ln = Nd (1) and Sm (2)) have been synthesized under solvothermal conditions. The X-ray single analysis reveals that both 1 and 2 are octanuclear structures and the eight central Ln(III) ions are bridged by two CO32- anions. Catalytic study revealed that 1 and 2 can effectively catalyze the cycloaddition reaction of CO2 and aziridines or epoxides simultaneously under mild conditions. What is more, cluster 1, as a heterogeneous catalyst, can be reused at least three times without obvious loss in catalytic activity for coupling of CO2 and epoxides. To our knowledge, cluster 1 is the first Ln(III)-based cluster catalyst used for the conversion of CO2 with aziridines or epoxides simultaneously. This work provides a successful strategy to integrate high-nuclear Ln(III)-based clusters for CO2 conversion, which may open a new space for the construction of multifunctional high-nuclear Ln(III)-based clusters as efficient catalysts for CO2 conversion.
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The anchor drilling operations generate massive airborne dust particles in the tunnel heading face that raises the pneumoconiosis morbidity and explosion risk. In this paper, a full-scale tunnel physical model is constructed to study the effect of the wind velocity and drilling site position on the airborne dust regional pollution scope based on the actual anchor drilling craft. The research indicates that the four extensive vortex areas keep the dust suspension at 14 m from the heading face and make the deposition dust particle refloat. The average respirable dust rate reaches the maximum value at section 5 m and presents a gradual decline as the dust particle migrates along the outlet direction. Raising the wind velocity contributes to alleviating the airborne dust pollution in the anchor drilling operation. As the wind velocity increases from 3 to 24 m/s, the high dust concentration area and number higher than 200 mg/m3 pose overall decrease trends, and the average dust concentration displays a linear decrease until 26.14-58.65 mg/m3 around the anchor worker head. Moving the drilling site positions closer to the exhaust air duct aggravates the airborne dust pollution in the front breathing zone. As the anchor drilling operation switches from the return air side to the supply air side, the dust concentration area ascends by 59.4-84.4% in the personnel respiratory space.
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Contaminantes Ocupacionales del Aire , Exposición Profesional , Exposición Profesional/análisis , Contaminantes Ocupacionales del Aire/análisis , Tamaño de la Partícula , Polvo/análisis , Monitoreo del AmbienteRESUMEN
The brain metabolic changes caused by the interruption of blood supply are the initial factors of brain injury in ischemic stroke. Electroacupuncture (EA) pretreatment has been shown to protect against ischemic stroke, but whether its neuroprotective mechanism involves metabolic regulation remains unclear. Based on our finding that EA pretreatment significantly alleviated ischemic brain injury in mice by reducing neuronal injury and death, we performed a gas chromatography-time of flight mass spectrometry (GC-TOF/MS) to investigate the metabolic changes in the ischemic brain and whether EA pretreatment influenced these changes. First, we found that some glycolytic metabolites in the normal brain tissues were reduced by EA pretreatment, which may lay the foundation of neuroprotection for EA pretreatment against ischemic stroke. Then, 6[Formula: see text]h of cerebral ischemia-induced brain metabolic changes, especially the enhanced glycolysis, were partially reversed by EA pretreatment, which was manifested by the brain levels of 11 of 35 up-regulated metabolites and 18 of 27 down-regulated metabolites caused by cerebral ischemia significantly decreasing and increasing, respectively, due to EA pretreatment. A further pathway analysis showed that these 11 and 18 markedly changed metabolites were mainly involved in starch and sucrose metabolism, purine metabolism, aspartate metabolism, and the citric acid cycle. Additionally, we found that EA pretreatment raised the levels of neuroprotective metabolites in both normal and ischemic brain tissues. In conclusion, our study revealed that EA pretreatment may attenuate the ischemic brain injury by inhibiting glycolysis and increasing the levels of some neuroprotective metabolites.
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Lesiones Encefálicas , Isquemia Encefálica , Electroacupuntura , Accidente Cerebrovascular Isquémico , Daño por Reperfusión , Accidente Cerebrovascular , Ratones , Animales , Electroacupuntura/métodos , Neuroprotección , Isquemia Encefálica/metabolismo , Metabolómica , Daño por Reperfusión/prevención & control , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & controlRESUMEN
Pachymic acid (Pac), a major bioactive constituent of Poria cocos, is an antioxidant that inhibits triglyceride (TG) accumulation. To the best of our knowledge, the present study investigated for the first time whether Pac activated sirtuin 6 (SIRT6) signaling to alleviate oleic acid (OA)-palmitic acid (PA)-induced lipid metabolism disorders in mouse primary hepatocytes (MPHs). In the present study, MPHs challenged with Pac were used to test the effects of Pac on intracellular lipid metabolism. Molecular docking studies were performed to explore the potential targets of Pac in defending against lipid deposition. MPHs isolated from liver-specific SIRT6-deficient mice were subjected to OA + PA incubation and treated with Pac to determine the function and detailed mechanism. It was revealed that Pac activated SIRT6 by increasing its expression and deacetylase activity. Pa prevented OA + PA-induced lipid deposition in MPHs in a dose-dependent manner. Pac (50 µM) administration significantly reduced TG accumulation and increased fatty acid oxidation rate in OA + PA-incubated MPHs. Meanwhile, as per the results of molecular docking and relative mRNA levels, Pac activated SIRT6 and increased SIRT6 deacetylation levels. Furthermore, SIRT6 deletions in MPHs abolished the protective effects of Pac against OA + PA-induced hepatocyte lipid metabolism disorders. The present study demonstrated that Pac alleviates OA + PA-induced hepatocyte lipid metabolism disorders by activating SIRT6 signaling. Overall, SIRT6 signaling increases oxidative stress burden and promotes hepatocyte lipolysis.
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Compelling experimental evidence confirms that the robustness and longevity of mixed chimerism (MC) relies on the persistence and availability of donor-derived hematopoietic stem cell (HSC) niches in recipients. Based on our prior work in rodent vascularized composite allotransplantation (VCA) models, we hypothesize that the vascularized bone components in VCA bearing donor HSC niches, thus may provide a unique biologic opportunity to facilitate stable MC and transplant tolerance. In this study, by utilizing a series of rodent VCA models we demonstrated that donor HSC niches in the vascularized bone facilitate persistent multilineage hematopoietic chimerism in transplant recipients and promote donor-specific tolerance without harsh myeloablation. In addition, the transplanted donor HSC niches in VCA facilitated the donor HSC niches seeding to the recipient bone marrow compartment and contributed to the maintenance and homeostasis of stable MC. Moreover, this study provided evidences that chimeric thymus plays a role in MC-mediated transplant tolerance through a mechanism of thymic central deletion. Mechanistic insights from our study could lead to the use of vascularized donor bone with pre-engrafted HSC niches as a safe, complementary strategy to induce robust and stable MC-mediated tolerance in VCA or solid organ transplantation recipients.
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Quimerismo , Trasplante de Células Madre Hematopoyéticas , Humanos , Donantes de Tejidos , Timo , Células Madre HematopoyéticasRESUMEN
In order to understand the heavy metal pollution of the industrial and mining area in northern Guangdong Province, topsoil samples (0-20 cm) from 209 sites in study area were collected, and the concentrations of As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn were analyzed. The source and distribution characteristics of Cd, Cr, Hg, Ni, Pb, As, Cu, and Zn in soil samples were analyzed using the geographic information system (GIS) and principal component analysis (PCA), and the geo-accumulation index and potential ecological hazard index were used to evaluate their pollution status and ecological risk. The results showed that:â Except Ni, all seven heavy metal elements exceeded the national soil background value but were below the pollution risk screening value. The soil environment as a whole was relatively clean. â¡ The spatial distribution of heavy metals in soil differed. The contents of As and Pb showed northwest-southeast zonal distribution. The contents of Cd, Cu, Hg, and Zn generally decreased from the middle to the surrounding, which was consistent with the industrial and mining enterprise locations. However, the spatial distribution of Cr and Ni had no direct relationship with the location of pollution sources such as industrial enterprises. ⢠The eight heavy metals could be identified as three principal components (PCs). PC1 (Cd, Cu, Pb, and Zn) was mainly affected by human activities such as lead-zinc deposit dressing, traffic emissions, and agricultural production. However, PC2 (Cr and Ni) was a natural source, mainly affected by soil parent material. In addition, PC3 (As and Hg) was mainly affected by industrial activities such as non-ferrous metal smelting and thermal power generation. ⣠According to the geo-accumulation index method, the risk degree of the eight heavy metals was:Cd>As>Zn>Hg>Pb>Cu>Cr=Ni. The contents of Cr and Ni in soil were at a no-risk level; the contents of As, Cu, Hg, Pb, and Zn were at a low-risk level; and the content of Cd was at a high-risk level. Most potential ecological hazards for single elements in the study area were at a mild risk level. In contrast, a small proportion of the surface soils in areas of intense industrial activity were subject to substantial levels of heavy metal stress and require further attention.
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Background: Despite making the influenza vaccine accessible and affordable, vaccination rates remained low among community-dwelling older adults. Therefore, this study aimed to explore the factors influencing vaccine uptake and the impact of COVID-19 on vaccine uptake among community-dwelling older adults in Singapore. Methods: A mixed methods study involving a survey and semi-structured interviews were conducted between September 2020 and July 2021. Community-dwelling older adults aged ≥ 65 years were recruited from 27 Community Nurse Posts. Data on participants' demographics, health condition(s), vaccination status, attitudes towards influenza infections and vaccinations, willingness to pay, intention for future vaccination and source of information were collected via the survey. Semi-structured interviews were conducted to understand vaccination experiences, key enablers and barriers, and the impact of COVID-19 on vaccine uptake. All interviews were analysed using Braun and Clarke's thematic analysis. Quantitative data were analysed using descriptive statistics, chi-square tests and multinomial logistic regressions. Results: A total of 235 participants completed the survey. Living arrangement was a statistically significant contributing factor for influenza vaccine uptake (ê2= -0.139; p = 0.03). Participants who lived alone were 2.5 times more likely to be vaccinated than those living with others (OR = 2.504, 95% CI: 1.294-4.842, p = 0.006). Avoidance of getting infected (82.5%), avoidance of transmission to others (84.7%), and advice from healthcare professionals to receive vaccination (83.4%) were key enablers, while concerns about possible side effects (41.2%), the effectiveness of the vaccine (42.6%), and not having enough information (48.1%) were barriers. Twenty participants were interviewed. The findings were congruent with the survey results. Five themes were identified as follows: (1) Perceived importance of influenza vaccination, (2) Sphere of influence, (3) Healthcare schemes and medical subsidies, (4) Psychological impediments, and (5) Inconsistent emphases at various touch points. Conclusions: Greater public health efforts are needed to reach out to the larger population of older adults of different living arrangements and those concerned about the possible side effects and effectiveness of the influenza vaccine. Healthcare professionals need to provide more information to address these concerns, especially during COVID-19, to encourage vaccine uptake.
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Background: The clinical applications of stromal vascular fraction (SVF) therapy for osteoarthritis (OA) have attracted academic and clinical attention. However, data of the effects of stromal vascular fraction therapy on regeneration of degenerated cartilage are limited in the literature. Meanwhile, there is a great need for a simple and non-invasive evaluation method to analyze the changes of joint cartilage qualitatively and quantitatively in clinical trials. This study entitled "stromal vascular fraction Therapy for Human Knee Osteoarthritis" was registered in ClinicalTrial.gov # NCT05019378. Materials and Methods: We designed and conducted a single center, open labeled clinical phase I/II study, and 6 osteoarthritis patients with both knee cartilage defect I-II were enrolled in this study. The two knees of each patient were randomly assigned to autologous stromal vascular fraction treatment group or non-treatment control group to evaluate the safety and therapeutic effect of stromal vascular fraction therapy for human knee osteoarthritis. We have also established a novel protocol to provide 3D MRI imaging for human knee cartilage enabling us to qualitatively and quantitatively evaluate cartilage degeneration and regeneration in this study. Results: The qualitative and quantitative evaluation of 3D Magnetic Resonance Imaging (MRI) imaging of knee cartilage demonstrated that the stromal vascular fraction therapy reduced the cartilage defects; and significant increase of cartilage value both in defect cartilage area and whole cartilage area of treated group and significant increase of thickness and area of both femoral and tibia cartilage in vertical sections of the stromal vascular fraction treated Group at 12 and 24 W post treatment in cartilage defect I-II osteoarthritis patients. Conclusion: This clinical phase I/II study indicated that stromal vascular fraction therapy is a safe clinical procedure and provided evidence that the stromal vascular fraction therapy significantly facilitated cartilage regeneration, opening the opportunity to a phase III trial investigating authentic efficacy of the procedure. This study is the first qualitative and quantitative evaluation of the efficacy of autologous stromal vascular fraction cellular therapy on cartilage regeneration. Through early and definite diagnosis of knee osteoarthritis patients, and providing safe and efficient therapy to facilitate cartilage regeneration, we will be able to control or reverse cartilage degeneration and completely change the epidemiology of osteoarthritis worldwide.
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A series of side-chain liquid crystalline polymers P4VP(CN-DBE)x , where x is the molar ratio of cyanostilbene (CN-DBE) to poly(4-vinylpyridine) (P4VP) repeating unit, was synthesized based on the intermolecular hydrogen bonding between P4VP and CN-DBE. Their luminescent property, liquid crystalline structure and photo-thermo-electric property were elucidated using photoluminescence spectra, X-ray diffraction, thermal imaging and thermoelectric experiments. With the increase of x, the supramolecular system can be changed from lamellar structure to hexagonal columnar structure. Moreover, the P4VP(CN-DBE)x polymer with columnar structure exhibits more efficient photothermal effect. The temperature of P4VP(CN-DBE)0.6 can rise to 130 °C within 10â s under the irradiation of ultraviolet lamp. In addition, the supramolecular system possesses unique photo-thermo-electric conversion ability, and 25â mA current can be detected in the circuit coupled with the thermoelectric module. This work broadens the potential applications of hydrogen-bonded polymer, and provides a simple and facile strategy to prepare liquid crystalline polymers with photo-thermo-electric property.
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OBJECTIVES: To investigate microvascular alterations in the Glisson system of biliary atresia (BA) patients after Kasai portoenterostomy (KP) using three-dimensional (3D) virtual histopathology based on X-ray phase-contrast CT (PCCT). METHODS: Liver explants from BA patients were imaged using PCCT, and 32 subjects were included and divided into two groups: KP (n = 16) and non-KP (n = 16). Combined with histological analysis and 3D visualization technology, 3D virtual histopathological assessment of the biliary, arterial, and portal venous systems was performed. According to loop volume ratio, 3D spatial density, relative surface area, tortuosity, and other parameters, pathological changes of microvasculature in the Glisson system were investigated. RESULTS: In the non-KP group, bile ducts mostly manifested as radial multifurcated hyperplasia and twisted into loops. In the KP group, the bile duct hyperplasia was less, and the loop volume ratio of bile ducts decreased by 13.89%. Simultaneously, the arterial and portal venous systems presented adaptive alterations in response to degrees of bile duct hyperplasia. Compared with the non-KP group, the 3D spatial density of arteries in the KP group decreased by 3.53%, and the relative surface area decreased from 0.088 ± 0.035 to 0.039 ± 0.015 (p < .01). Deformed portal branches gradually recovered after KP, with a 2.93% increase in 3D spatial density and a decrease in tortuosity from 1.17 ± 0.06 to 1.14 ± 0.04 (p < .01) compared to the non-KP group. CONCLUSION: 3D virtual histopathology via PCCT clearly reveals the microvascular structures in the Glisson system of BA patients and provides key insights into the morphological mechanism of microvascular adaptation induced by biliary tract dredging after KP in BA disease. KEY POINTS: ⢠3D virtual histopathology via X-ray phase-contrast computed tomography clearly presented the morphological structures and pathological changes of microvasculature in the Glisson system of biliary atresia patients. ⢠The morphological alterations of microvasculature in the Glisson system followed the competitive occupancy mechanism in the process of biliary atresia.
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Atresia Biliar , Humanos , Lactante , Atresia Biliar/diagnóstico por imagen , Atresia Biliar/cirugía , Portoenterostomía Hepática/métodos , Hiperplasia , Rayos X , Tomografía Computarizada por Rayos XRESUMEN
Esophageal cancer is a common malignant tumor in China. For resectable ones, surgery is still the primary treatment. At present, the extent of lymph node dissection remains controversial. Extended lymphadenectomy makes metastatic lymph nodes more likely to be resected, which contributed to pathological staging and postoperative treatment. However,it may also increase the risk of postoperative complications and affect prognosis. Therefore, it is controversial how to balance the optimal extent/number of dissected lymph nodes for radical resection with the lower risk of severe complications. In addition, whether the lymph node dissection strategy should be modified after neoadjuvant therapy needs to be investigated, especially for patients who have a complete response to neoadjuvant therapy. Herein, we summarize the clinical experience on the extent of lymph node dissection in China and worldwide, aiming to provide guidence for the extent of lymph node dissection in esophageal cancer.
Asunto(s)
Humanos , Metástasis Linfática/patología , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Pronóstico , Neoplasias Esofágicas/patología , Estadificación de Neoplasias , EsofagectomíaRESUMEN
OBJECTIVES@#To study new biomarkers for the early diagnosis of retinopathy of prematurity (ROP) by analyzing the differences in blood metabolites based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) and metabolomics.@*METHODS@#Dried blood spots were collected from 21 infants with ROP (ROP group) and 21 infants without ROP (non-ROP group) who were hospitalized in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2013 to December 2016. LC-MS/MS was used to measure the metabolites, and orthogonal partial least squares-discriminant analysis was used to search for differentially expressed metabolites and biomarkers.@*RESULTS@#There was a significant difference in blood metabolic profiles between the ROP and non-ROP groups. The pattern recognition analysis, Score-plot, and weight analysis obtained 10 amino acids with a relatively large difference. Further statistical analysis showed that the ROP group had significant increases in blood levels of glutamic acid, leucine, aspartic acid, ornithine, and glycine compared with the non-ROP group (P<0.05). The receiver operating characteristic curve analysis showed that glutamic acid and ornithine had the highest value in diagnosing ROP.@*CONCLUSIONS@#Blood metabolites in preterm infants with ROP are different from those without ROP. Glutamic acid and ornithine are the metabolic markers for diagnosing ROP. LC-MS/MS combined with metabolomics analysis has a potential application value in the early identification and diagnosis of ROP.