[Family Decision-Making Path for the Referral of Terminal Patients in Tertiary Hospitals].

Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals. Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis. Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital's medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed. Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

Layered Ferromagnetic Structure Caused by the Proximity Effect and Interlayer Charge Transfer for LaNiO3/LaMnO3 Superlattices.

Magnetic proximity-induced magnetism in paramagnetic LaNiO3 (LNO) has spurred intensive investigations in the past decade. However, no consensus has been reached so far regarding the magnetic order in LNO layers in relevant heterostructures. This paper reports a layered ferromagnetic structure for the (111)-oriented LNO/LaMnO3 (LMO) superlattices. It is found that each period of the superlattice consisted of an insulating LNO-interfacial phase (five unit cells in thickness, ∼1.1 nm), a metallic LNO-inner phase, a poorly conductive LMO-interfacial phase (three unit cells in thickness, ∼0.7 nm), and an insulating LMO-inner phase. All four of these phases are ferromagnetic, showing different magnetizations. The Mn-to-Ni interlayer charge transfer is responsible for the emergence of a layered magnetic structure, which may cause magnetic interaction across the LNO/LMO interface and double exchange within the LMO-interfacial layer. This work indicates that the proximity effect is an effective means of manipulating the magnetic state and associated properties of complex oxides.

[Phytoplankton Community Structure, Diversity, and Functional Groups in Urban River Under Different Black and Odorous Levels].

Phytoplankton community characteristics, diversity, and functional group analysis can respond to the environmental quality status of water bodies. To investigate the influence of urban river black odors on the phytoplankton community, from November 2020 to March 2021, 16 urban rivers in the Sichuan Basin were surveyed for water quality with 38 sampling points, and the degree of urban river black odor was evaluated based on the improved fuzzy mathematical model method and the k-mean principal color extraction method. The rivers were classified into four types:non-black and non-odorous, black and non-odorous, black and odorous, and black and odorous. The results showed that, with black and odorous water, the phytoplankton abundance increased from 1.329×105 cells·L-1 to 6.627×105 cells·L-1, and the dominant phytoplankton phylum decreased from Cyanophyta-Chlorophyta-Bacillariophyta to Cyanophyta. The phytoplankton biomass increased from 64.056 µg·L-1 to 120.465 µg·L-1, and the dominant phytoplankton phylum changed from Chlorophyta-Bacillariophyta type, adapted to a nutrient environment, to Pyrrophyta-Bacillariophyta-Cryptophyta type, adapted to an organic matter environment. The Shannon-Weaver diversity index decreased from 2.45 to 1.98, and Simpson's index decreased from 0.84 to 0.73. Twenty nine functional groups of phytoplankton were observed in the study area, and the growth strategy was reduced from S, R, C, CR, and CS to R with black and odorous water. In summary, phytoplankton indicators can better reflect the state of river black odor, and phytoplankton monitoring is a promising tool for urban river black odor management.

Comparison of the predictive value of anthropometric indicators for the risk of benign prostatic hyperplasia in southern China.

This study aimed to compare the predictive value of six selected anthropometric indicators for benign prostatic hyperplasia (BPH). Males over 50 years of age who underwent health examinations at the Health Management Center of the Second Xiangya Hospital, Central South University (Changsha, China) from June to December 2020 were enrolled in this study. The characteristic data were collected, including basic anthropometric indices, lipid parameters, six anthropometric indicators, prostate-specific antigen, and total prostate volume. The odds ratios (ORs) with 95% confidence intervals (95% CIs) for all anthropometric parameters and BPH were calculated using binary logistic regression. To assess the diagnostic capability of each indicator for BPH and identify the appropriate cutoff values, receiver operating characteristic (ROC) curves and the related areas under the curves (AUCs) were utilized. All six indicators had diagnostic value for BPH (all P ≤ 0.001). The visceral adiposity index (VAI; AUC: 0.797, 95% CI: 0.759-0.834) had the highest AUC and therefore the highest diagnostic value. This was followed by the cardiometabolic index (CMI; AUC: 0.792, 95% CI: 0.753-0.831), lipid accumulation product (LAP; AUC: 0.766, 95% CI: 0.723-0.809), waist-to-hip ratio (WHR; AUC: 0.660, 95% CI: 0.609-0.712), waist-to-height ratio (WHtR; AUC: 0.639, 95% CI: 0.587-0.691), and body mass index (BMI; AUC: 0.592, 95% CI: 0.540-0.643). The sensitivity of CMI was the highest (92.1%), and WHtR had the highest specificity of 94.1%. CMI consistently showed the highest OR in the binary logistic regression analysis. BMI, WHtR, WHR, VAI, CMI, and LAP all influence the occurrence of BPH in middle-aged and older men (all P ≤ 0.001), and CMI is the best predictor of BPH.

Mechanism of ciRS-7 silencing to reverse cisplatin resistance in gastric cancer cells by targeting miR-944 / 中国药理学通报

Aim To investigate the effect of silencing circRNA ciRS-7 on cisplatin resistance of gastric cancer cells and its related mechanism. Methods Cisplatin-resistant gastric cancer cells HGC-27/DDP were constructed, ciRS-7 was silenced and HGC-27/DDP cells were treated with cisplatin. Real-time quantitative PCR (qRT-PCR) was used to detect the expression levels of ciRS-7 and microrNA-944 (miR-944). Cell counting kit-8 (CCK-8) was used to detect cell survival rate. Clone formation assay was used to detect the number of clones. Western blot was used to detect the protein expression levels of CyclinD1, proliferating cell nuclear antigen (PCNA), B-lymphocytoma-2-associated X protein (Bax), B-lymphocytoma-2 (Bcl-2) and cleaved aspartate-specific cysteine proteinase 3 (cleaved-caspase-3). Flow cytometry was used to detect cell apoptosis rate. In situ end labeling (TUNEL) was used to detect apoptosis index. Dual luciferase assay was used to verify the targeting relationship between ciRS-7 and miR-944. Results CiRS-7 was highly expressed in cisplatin-resistant gastric cancer tissues and cells, while miR-944 was low expressed in cisplatin-resistant gastric cancer tissues and cells. The survival rate, clonal formation number, protein expression levels of CyclinD1, PCNA and Bcl-2 in cisplatin-treated HGC-27/DDP cells were significantly reduced by silencing ciRS-7, while ciRS-7 expression level, apoptosis rate, apoptosis index, Bax, cleaved-caspase-3 protein expression levels of cisplatin-treated HGC-27/DDP cells were significantly raised. CiRS-7 targetedly inhibited the expression of miR-944. Conclusions Silencing ciRS-7 can reverse cisplatin resistance of gastric cancer cells, and the mechanism may be related to the promotion of miR-944 expression by silencing ciRS-7.

Enhanced dewaterability of anaerobically fermented sludge through acid-driven indigenous enzymatic hydrolysis.

The poor dewaterability of fermented sludge is an important factor limiting the development of anaerobic fermentation applications. Herein we reported an efficient strategy, i.e., using acidic regulation to stimulate the release of indigenous enzymes, to enhance the hydrolysis and dewatering of fermented sludge. The results showed that after acidic regulation at pH 4.0 for 1 day, the activity of protease and α-glucosidase were improved by 131.4% and 146.0%, while the capillary suction time and specific resistance to filtration were decreased by 93.8% and 69.5%, respectively. Mechanism study revealed that the method firstly destroyed the slime and bound EPS and cells of fermented sludge, causing the release of indigenous enzymes (i.e., protease and α-glucosidase) contained in. Then, the released enzymes directly accelerated the hydrolysis and acidification of fragmentized extracellular polymeric substances, thereby benefited the release of bound water in sludge particles. Finally, such acidic condition decreased the electrostatic repulsive interactions between destroyed sludge particles, further improving their flocculation. The findings not only deepen the understanding of indigenous enzymes contained in fermented sludge affecting sludge dewatering, but also might guide engineers to develop promising strategies to facilitate fermented sludge dewatering and fermentation liquid recovery in the future.

Compressive-Strain-Facilitated Fast Oxygen Migration with Reversible Topotactic Transformation in La0.5Sr0.5CoOx via All-Solid-State Electrolyte Gating.

Modifying the crystal structure and corresponding functional properties of complex oxides by regulating their oxygen content has promising applications in energy conversion and chemical looping, where controlling oxygen migration plays an important role. Therefore, finding an efficacious and feasible method to facilitate oxygen migration has become a critical requirement for practical applications. Here, we report a compressive-strain-facilitated oxygen migration with reversible topotactic phase transformation (RTPT) in La0.5Sr0.5CoOx films based on all-solid-state electrolyte gating modulation. With the lattice strain changing from tensile to compressive strain, significant reductions in modulation duration (∼72%) and threshold voltage (∼70%) for the RTPT were observed, indicating great promotion of RTPT by compressive strain. Density functional theory calculations verify that such compressive-strain-facilitated efficient RTPT comes from significant reduction of the oxygen migration barrier in compressive-strained films. Further, ac-STEM, EELS, and sXAS investigations reveal that varying strain from tensile to compressive enhances the Co 3d band filling, thereby suppressing the Co-O hybrid bond in oxygen vacancy channels, elucidating the micro-origin of such compressive-strain-facilitated oxygen migration. Our work suggests that controlling electronic orbital occupation of Co ions in oxygen vacancy channels may help facilitate oxygen migration, providing valuable insights and practical guidance for achieving highly efficient oxygen-migration-related chemical looping and energy conversion with complex oxides.

Metal-organic frameworks as a good platform for the fabrication of multi-metal nanomaterials: design strategies, electrocatalytic applications and prospective.

MOF-derived multi-metal nanomaterials are attracting numerous attentions in widespread applications such as catalysis, sensors, energy storage and conversion, and environmental remediation. Compared to the monometallic counterparts, the presence of foreign metal is expected to bring new physicochemical properties, thus exhibiting synergistic effect for enhanced performance. MOFs have been proved as a good platform for the fabrication of polymetallic nanomaterials with requisite features. Herein, various design strategies related to constructing multi-metallic nanomaterials from MOFs are summarized for the first time, involving metal nodal substitution, seed epitaxial growth, ion-exchange strategy, guest species encapsulation, solution impregnation and combination with extraneous substrate. Afterwards, the recent advances of multi-metallic nanomaterials for electrocatalytic applications, including oxygen reduction reaction (ORR), oxygen evolution reaction (OER) and hydrogen evolution reaction (HER), are systematically discussed. Finally, a personal outlook on the future trends and challenges are also presented with hope to enlighten deeper understanding and new thoughts for the development of multi-metal nanomaterials from MOFs.

Effect of lignin on short-chain fatty acids production from anaerobic fermentation of waste activated sludge.

Lignin, a biological resource with great potential, can be as high as ∼16% of the total organics in the waste activated sludge (WAS). This work therefore aims to fill the knowledge gap about the effect of lignin on short-chain fatty acids (SCFAs) production from anaerobic fermentation of sludge. Experimental results showed that lignin promoted rather than inhibited SCFAs production. Specifically, the presence of 15% lignin promoted the SCFAs production from 129.1 ± 6.5 to 223.14 ± 7.8 mg COD/g VSS compared with the control, and the proportion of acetic increased by 61.8%, while that of propionic decreased by 44.9%. Mechanism exploration revealed that lignin improved the solubilization of biodegradable substrates due to its hydrophobic characteristics. In addition, lignin enhanced the acidogenesis process, possibly by perfecting the electron transfer chain in the fermentation system, and the quinone structure in lignin may compete electrons with methanogens to inhibit the consumption of SCFAs. Microbiological analysis showed that the abundance of microorganisms related to acidogenesi, especially the acetogenesis, including Proteiniclasticum sp., Acetoanaerobium sp., in the fermenter with lignin increased, which caused the community to shift towards specialized and diverse SCFAs production.

Metallic Co and crystalline Co-Mo oxides supported on graphite felt for bifunctional electrocatalytic hydrogen evolution and urea oxidation.

Oxygen evolution reaction (OER) and urea oxidation reaction (UOR) play important roles in the field of hydrogen energy preparation and pollution treatment. In this work, by merging bimetallic Co-Mo oxides with metallic Co on the graphite felt (GF), we effectively manufacture a 3D bifunctional and highly efficient electrocatalyst (CoMoO@Co/GF) with multi-site functionality for the simultaneous reduction of water and the oxidation of urea in an alkaline medium. The presence of metallic Co causes Co-Mo oxides to evolve from amorphous to crystalline structures. The coupling interface produced between metallic Co and Co-Mo oxides is proven to facilitate electron transport in addition to extensively accessible and highly electroactive Co-Mo oxide nanoflower architecture. The experimental results reveal that the overpotentials for OER and UOR in the CoMoO@Co/GF electrode require only 269 and 115 mV to obtain a current density of 10 mA cm-2, respectively. Furthermore, with the aid of urea, the overpotential for HER at the current density of 10 mA cm-2 is lowered to 155 mV. Most notably, the constructed CoMoO@Co/GF-based electrolytic cell only requires a 1.5 V dry battery to achieve effective H2 evolution and noteworthy stability, outperforming the commercial catalyst-based device and many previous results. The combination of experiments and theoretical calculations further clarifies the active sites in the catalyst. What's more, the pathway of electron transfer in the catalytic process is defined.

Uniform polypyrrole electrodeposition triggered by phytic acid-guided interface engineering for high energy density flexible supercapacitor.

Unevenly distributed polypyrrole (PPy) films/coatings with extensive "dead volumes" via electrodeposition have emerged as a main challenge for high energy density flexible supercapacitor. In this work, we have fabricated a phytic acid-guided graphite carbon felt/polypyrrole (GF@PA@PPy) 3D porous composite with less "dead volumes" via electrodeposition. After the activation of phytic acid (PA), the quantity and content of defects and oxygen-containing groups on the surface of carbon felt (GF) have increased. First, these functional groups improve the hydrophilicity of the surface of GF, resulting in the preferential uniform distribution of pyrrole monomer (Py). While significantly, the synergistic effects between the defects and oxygen-containing groups boost the attraction of pyrrole ring, and thus promotes the formation of perfect PPy films with less "dead volume" on GF. Finally, the supercapacitor assembled from the GF@PA@PPy-40 displays a high areal energy density of 0.0732 mWh cm-2, exceeding the previously reported PPy-based electrodes values. The deeper understanding of the role for the defects and oxygen-containing groups in the synthesis of PPy/carbon materials offers a new strategy to construct advanced PPy-based supercapacitors.

Recent progress of noble metals with tailored features in catalytic oxidation for organic pollutants degradation.

With the increasing serious water pollutions, an increasing interest has given for the nanocomposites as environmental catalysts. To date, noble metals-based nanocomposites have been extensively studied by researchers in environmental catalysis. In detail, serving as key functional parts, noble metals are usually combined with other nanomaterials for rationally designing nanocomposites, which exhibit enhanced catalytic properties in pollutants removal. Noble metals in the nanocomposites possess tailored properties, thus playing different important roles in catalytic oxidation reactions for pollutants removal. To motivate the research and elaborate the progress of noble metals, this review (i) summarizes advanced characterization techniques and rising technology of theoretical calculation for evaluating noble metal, and (ii) classifies the roles according to their disparate mechanism in different catalytic oxidation reactions. Meanwhile, the enhanced mechanism and influence factors are discussed. (iii) The conclusions, facing challenges and perspectives are proposed for further development of noble metals-based nanocomposites as environmental catalysts.

Large Low-Field Magnetoresistance (LFMR) Effect in Free-Standing La0.7Sr0.3MnO3 Films.

The realization of a large low-field magnetoresistance (LFMR) effect in free-standing magnetic oxide films is a crucial goal toward promoting the development of flexible, low power consumption, and nonvolatile memory devices for information storage. La0.7Sr0.3MnO3 (LSMO) is an ideal material for spintronic devices due to its excellent magnetic and electronic properties. However, it is difficult to achieve both a large LFMR effect and high flexibility in LSMO films due to the lack of research on LFMR-related mechanisms and the strict LSMO growth conditions, which require rigid substrates. Here, we induced a large LFMR effect in an LSMO/mica heterostructure by utilizing a disorder-related spin-polarized tunneling effect and developed a simple transfer method to obtain free-standing LSMO films for the first time. Electrical and magnetic characterizations of these free-standing LSMO films revealed that all of the principal properties of LSMO were sustained under compressive and tensile conditions. Notably, the magnetoresistance of the processed LSMO film reached up to 16% under an ultrasmall magnetic field (0.1 T), which is 80 times that of a traditional LSMO film. As a demonstration, a stable nonvolatile multivalue storage function in flexible LSMO films was successfully achieved. Our work may pave the way for future wearable resistive memory device applications.

A Distinct Spin Structure and Giant Baromagnetic Effect in MnNiGe Compounds with Fe-Doping.

Spin structure of a magnetic system results from the competition of various exchange couplings. Pressure-driven spin structure evolution, through altering interatomic distance, and hence, electronic structure produces baromagnetic effect (BME), which has potential applications in sensor/actuator field. Here, we report a new spin structure(CyS-AFMb) with antiferromagnetic(AFM) nature in Fe-doped Mn0.87Fe0.13NiGe. Neutron powder diffraction (NPD) under in situ hydrostatic pressure and magnetic field was conducted to reveal the spin configuration and its instabilities. We discovered that a pressure higher than 4 kbar can induce abnormal change of Mn(Fe)-Mn(Fe) distances and transform the CyS-AFMb into a conical spiral ferromagnetic(FM) configuration(45°-CoS-FMa) with easily magnetized but shortened magnetic moment by as much as 22%. The observed BME far exceeds previous reports. Our first-principles calculations provide theoretical supports for the enhanced BME. The compressed lattice by pressure favors the 45°-CoS-FMa and significantly broadened 3d bandwidth of Mn(Fe) atoms, which leads to the shortened magnetic moment and evolution of spin structure.

Adolescent IgG4-related retroperitoneal fibrosis with left lower extremity edema as the first symptom: A case report. / 以左下肢水肿为首发症状的青少年IgG4ç›¸å ³æ€§è ¹è†œåŽçº¤ç»´åŒ–1例.

IgG4-related retroperitoneal fibrosis is a type of IgG4-related diseases. The etiology is still unclear. It is often classified as idiopathic retroperitoneal fibrosis, but the pathological process and clinical results between them are different. Therefore, the differential diagnosis of them is very important. An 18-year-old patient was admitted to the Second Xiangya Hospital of Central South University due to "left lower extremity edema for 1 and a half month" on December 19, 2019. In examination of PET/CT, the starting point of the left aorta-intra-thoracic artery showed a soft tissue density lump with increased sugar metabolism, which indicated a suspected malignant tumor, and dilatation of the left renal pelvis and ureter. On January 8, 2020, the patient was performed pelvic edema excision, ureterectomy and anastomosis. The postoperative examination results were considered as IgG4-related disease. As a rare systemic disease, early correct diagnosis and precise and individualized treatment can alleviate the suffering of patients and ensure that patients are minimally traumatized.

[Primary ciliary dyskinesia complicated by male infertility: An update].

Primary ciliary dyskinesia (PCD) is an autosomal recessive genetic disease. Gene mutation leads to ciliary structural abnormalities or functional defects, resulting in respiratory diseases. Male patients with PCD are prone to infertility, which pathogenically may be attributed to gene mutation-induced dysfunction of respiratory cilia and sperm flagella. This reviews focuses on the research progress in microtubule structure, gene mutation and outcomes of assisted reproduction relating to PCD complicated by male infertility.

FGF21 Enhances Therapeutic Efficacy and Reduces Side Effects of Dexamethasone in Treatment of Rheumatoid Arthritis.

In order to investigate efficacy of FGF21 combine dexamethasone (Dex) on rheumatoid arthritis (RA) meanwhile reduce side effects of dexamethasone. We used combination therapy (Dex 15 mg/kg + FGF21 0.25 mg/kg, Dex 15 mg/kg + FGF21 0.5 mg/kg or Dex 15 mg/kg + FGF21 1 mg/kg) and monotherapy (Dex 15 mg/kg or FGF21 1 mg/kg) to treat CIA mice induced by chicken type II collagen, respectively. The effects of treatment were determined by arthritis severity score, histological damage, and cytokine production. The levels of oxidative stress parameters, liver functions, and other blood biochemical indexes were detected to determine FGF21 efficiency to side effects of dexamethasone. Oil red O was performed to detect the effects of FGF21 and dexamethasone on fat accumulation in HepG2 cells. The mechanism of FGF21 improves the side effects of dexamethasone which was analyzed by Western blotting. This combination proved to be therapeutically more effective than dexamethasone or FGF21 used singly. FGF21 regulates oxidative stress and lipid metabolism by upregulating dexamethasone-inhibited SIRT-1 and then activating downstream Nrf-2/HO-1and PGC-1. FGF21 and dexamethasone are highly effective in the treatment of arthritis; meanwhile, FGF21 may overcome the limited therapeutic response and Cushing syndrome associated with dexamethasone.

[Clinical features of testicular torsion and its misdiagnosis:analysis of 274 cases].

OBJECTIVE: To summarize the clinical characteristics of testicular torsion and explore the relationship between its incidence and temperature, the value of supplementary examinations, and the factors causing misdiagnosis and testicular lesions. METHODS: We retrospectively analyzed the clinical data of the patients with testicular torsion diagnosed in 9 hospitals in Hunan Province from May 1, 2009 to November 1, 2018. The temperature at onset and WBC value after onset were analyzed. The misdiagnosis rate and testicular lesion rate in the first-visit hospitals were compared between the large general hospitals and local hospitals. The factors that affected the diagnosis and treatment of testicular torsion were analyzed. RESULTS: A total of 274 cases were included in this study, and misdiagnoses occurred in 151 cases (61.9%). The initial diagnosis was made in large general hospitals in 59 cases; misdiagnosis occurred in 30.5% of the cases and the rate of testicular lesions was 57.6%. Of the 215 cases first diagnosed in local hospitals, only 82 cases were diagnosed correctly, and the misdiagnosis rate was as high as 61.9%; the rate of testicular lesion was 85.6% in these cases. There were significant differences in the misdiagnosis rate and testicular lesion rate between the two groups (P < 0.05). CONCLUSIONS: The first-visit misdiagnosis rate of testicular torsion is much lower and the probability of testicle preservation is significantly higher in large general hospitals than in the local hospitals, suggesting the importance of health education for testicular torsion, enhancing the awareness of this condition and training of the surgeons in primary hospitals.

Factors of hospitalization expenditure of the genitourinary system diseases in the aged based on "System of Health Account 2011" and neural network model.

BACKGROUND: Hospitalization expenditure of genitourinary system diseases among the aged is often overlooked. The aim of our research is to analyze the basic situation and influencing factors of hospitalization expenditure of the genitourinary system diseases and provide better data for the health system. METHODS: A total of 1 377 681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and "System of Health Account 2011" (SHA2011) was conducted to analyze the expenditure of the diseases. The corresponding samples were extracted, the neural network model was utilized to fit the regression model of the diseases among the aged, and sensitivity analysis was used to rank the influencing factors. RESULTS: Total hospitalization expenditure in Liaoning was 51.286 billion yuan, and curative care expenditure of diseases of the genitourinary system was 3.350 billion yuan, accounting for 6.53%. In the neural network model, the training set of R2 was 0.71. The test set of R2 was 0.74. In the sensitivity analysis, top-three influencing factors were the length of stay, type of institutions and type of insurances; the weight was 0.28, 0.19 and 0.14, respectively. CONCLUSIONS: This research used SHA2011 to grab a large amount of data and analyzed them depending upon the corresponding dimensions. The neural network can analyze the influencing factors of hospitalization expenditure of genitourinary diseases in elderly patients accurately and directly, and can clearly describe the extent of its impact by combining sensitivity analysis.