The Analysis of Transition Readiness of Adolescent Epilepsy Patients from Childhood to Adult from the Perspective of Disease Self-management: A Cross-sectional Study in Southwest China.

Objective: The objective of this study was to investigate the transition readiness of juvenile epilepsy patients during the transition period from childhood to adulthood and analyze the impact of patients' basic characteristics and self-management on their transition readiness. Methods: A total of 376 adolescent epileptic patients were selected as research objects from 3A general hospitals located in Chongqing, Guizhou, and Yunnan respectively, and a 3A children's specialist hospital in Chongqing, Jiangxi from May 2021 to February 2022. The readiness for transition was assessed using a transition readiness questionnaire, and patients' self-management skills were evaluated using the Self-Management Scale for Epilepsy Patients. Data analysis was conducted to determine the readiness for transition and examine the factors influencing it. Results: The mean overall transition readiness score in adolescent epilepsy patients was (56.60±12.51). Among the six dimensions, drug management, disease understanding, doctor-patient interaction, health responsibility, medical involvement, and resource utilization were ranked highest to lowest. The examination identified age, epilepsy duration, medication types, and primary caregivers as the primary factors influencing transition readiness in adolescent epilepsy patients (P < .001). Additionally, there was a favorable correlation between the total disease self-management score and transition readiness (r=0.487, P < .01), signifying the positive predictive impact of self-management skills on transition readiness. Conclusion: Adolescent epilepsy patients exhibited moderate readiness for the transition from childhood to adulthood. Older patients with longer disease duration and stronger self-management skills displayed a higher level of readiness. Targeted clinical interventions that prioritize self-management skills are essential for facilitating a smoother transition into adulthood for patients.

Comparison of organic and synthetic amendments for poplar phytomanagement in copper and lead-contaminated calcareous soil.

Soil remediation can be achieved through organic and synthetic amendments, but the differences in the phytomanagement of trace metal-contaminated land are unclear. We conducted an outdoor microcosm experiment to simulate the effects of organic amendment citric acid and synthetic amendments EDTA and EGTA on poplar phytomanagement of copper (Cu)- and lead (Pb)-contaminated calcareous land at doses of 0, 1, 3, and 9 mmol kg-1. We found that soil-bioavailable Cu and Pb contents increased by 2.11-27.27 and 1.48-269 times compared to the control, respectively. Additionally, synthetic amendments had a long-lasting (within 25 days) effect on metal bioavailability relative to organic amendments. Consequently, organic amendments increased the root Cu and Pb contents by 2.68-48.61% and 6.60-49.51%, respectively, whereas synthetic amendments increased them by 65.94-260% and 12.50-103%. The Cu and Pb contents in the leaves were lower than those in the roots, and increased significantly by 47.04-179% and 237-601%, respectively, only under synthetic amendments. Interestingly, none of the amendments increased the Cu and Pb content in poplar stems (<5 mg kg-1), which remained within the normal range for terrestrial plants. Regardless of the type and addition level, the amendments did not affect poplar growth. Nevertheless, synthetic amendments caused a significant redistribution of metals (Cu: 22-32%; Pb: 23-53%) from the topsoil into the subsoil within the root zone at medium and high levels relative to organic amendments. Therefore, organic and synthetic amendments can assist poplar phytomanagement with a phytostabilization strategy for Cu- and Pb-contaminated calcareous land and obtain marketable wood biomass. Moreover, collecting leaf litter is crucial when using synthetic amendments at optimum concentration levels.

Temporal changes of calcareous soil properties and their effects on cadmium uptake by wheat under wastewater irrigation for over 50 years.

Calcareous soil has a strong buffering capacity for neutralizing acid and stabilizing cadmium (Cd) because of the high calcium carbonate (CaCO3) content. However, it is not clear whether the buffering capacity of calcareous soil can be maintained after long-term wastewater irrigation. We selected a typical area in western China that has been irrigated with wastewater for over 50 years to study the temporal changes of soil properties and their effects on Cd uptake by wheat. The results showed that compared with the background level before the 1960s, the soil pH and CaCO3 content in 2018 were lower by 0.80 units and 35%, respectively, while the soil organic matter (SOM) content, Olsen phosphorus (P) content, and soil total Cd content in 2018 increased by 1.54, 13.05, and 164 times, respectively. Due to the significant decrease in the soil pH and CaCO3, the high load of soil total Cd and electrical conductivity, the low soil clay content, and the coupling of SOM with soil nitrogen and P, the input Cd was activated. Furthermore, the activated Cd was effectively taken up by wheat roots and transported to grains with the assistance of dissolved organic carbon. Our results highlight that long-term wastewater irrigation caused irreversible damage to soil buffering capacity, resulting in the Cd activation and the enhancement of Cd uptake by wheat.

Association of survival and genomic mutation signature with immunotherapy in patients with hepatocellular carcinoma.

BACKGROUND: Current guidelines lack recommendations for the use of immunotherapy and immune-related biomarkers for hepatocellular carcinoma (HCC). We aim to provide reliable evidence of the association of survival with HCC immunotherapy and to demonstrate that genomic mutation signature could be an effective biomarker to predict immunotherapy efficacy of HCC patients. METHODS: We conducted a meta-analysis of 17 randomized trials with 2055 patients and an individual patient-level analysis of 31 patients. Trial data were identified in PubMed, EMBASE and Cochrane Central library, and individual patient data were obtained from the cBioPortal database. Overall survival (OS) and progression-free survival (PFS) were assessed with the hazard ratio (HR) and 95% CI. This study is registered with PROSPERO, number CRD42018083991. RESULTS: The meta-analysis showed that compared to conventional therapy, immunotherapy resulted in prolonged OS (HR =0.65, P<0.0001, high quality) and PFS (HR =0.81, P<0.0001, high quality); the benefits were observed for cellular immunotherapy, tumor vaccine, and cytokine immunotherapy. Findings were robust to subgroup and trial sequential analyses. In the individual patient-level analysis of patients treated with immune checkpoint inhibitor, mutations in TERT, CTNNB1, BRD4, or MLL, and co-mutations in TP53 and TERT or BRD4 were associated with significantly worse survival. These oncogenes were used to develop a novel integrated mutation risk score, which exhibited better utility in predicting survival than the tumor mutation burden (TMB). Patients with low- versus high- mutation risk score had longer OS (HR =0.18, P=0.02) and PFS (HR =0.33, P=0.018). A nomogram comprising the mutation risk score and essential clinical factors further improved the predictive accuracy (AUC =0.840 for both 1- and 2-year OS). CONCLUSIONS: Immunotherapy showed longer OS and PFS than conventional therapy among HCC patients, especially patients with a low mutation risk score. The nomogram based on genomic and clinical characteristics is effective in predicting survival of HCC patients undergoing immune checkpoint inhibitor.