An important issue of burnout among pre-hospital emergency medical personnel in Chengdu: a cross-sectional study.

OBJECTIVE: This survey aims to comprehensively understand occupational burnout among pre-hospital emergency medical personnel and explore associated risk factors. METHODS: A cross-sectional online survey using a census method was conducted between 15 July, 2023, and ends on 14 August, 2023, in Chengdu, SiChuan province, China. The questionnaire included general demographic information, the Maslach Burnout Inventory-General Survey (MBI-GS) with 15 items, and the Fatigue Scale-14 (FS-14) with 14 items. Univariate analysis was conducted on all variables, followed by multivariate logistic regression models to examine the associations between occupational burnout and the risk factors. RESULTS: A total of 2,299 participants,99.57% completed the survey effectively The participants were from 166 medical institutions in Chengdu, comprising 1,420 nurses (61.50%) and 889 clinical doctors (38.50%). A total of 33.36% participants experienced burnout, predominantly mild (30.27%), followed by moderate (2.78%) and severe (0.3%). Physicians, higher fatigue scores, age, work experience appeared to be related to burnout. Logistic regression models revealed that individuals aged over 50 were less prone to experience burnout compared to medical staff aged 18-30 (OR: 0.269, 95% CI: 0.115-0.627, p = 0.002). Physicians were more prone to experience burnout compared to nursing staff (OR: 0.690, 95% CI: 0.531-0.898, p = 0.006). Those with 0-5 years of experience were more prone to experience burnout compared to those with 6-10 years or over 15 years of experience (OR: 0.734, 95% CI: 0.547-0.986, p = 0.040; OR: 0.559, 95% CI: 0.339-0.924, p = 0.023). Additionally, for each 1-point increase in the fatigue score, the likelihood of burnout in medical staff increased by 1.367 times (OR: 1.367, 95% CI: 1.323-1.412, p < 0.0001). CONCLUSION: Pre-hospital emergency medical personnel demonstrate a notable prevalence of mild job burnout. These results provide a groundwork for future focus on the various stages of job burnout within pre-hospital emergency staff, alerting hospital and departmental managers to promptly address the mental well-being of their personnel and intervene as needed.

SARS-CoV-2 Antiviral Prescribing Gaps Among Non-Hospitalized High-Risk Adults.

Within a multi-state clinical cohort, SARS-CoV-2 antiviral prescribing patterns were evaluated from April 2022-June 2023 among non-hospitalized SARS-CoV-2-infected patients with risk factors for severe COVID-19. Among 3,247 adults, only 31.9% were prescribed an antiviral agent (87.6% nirmatrelvir/ritonavir, 11.9% molnupiravir, 0.5% remdesivir), highlighting the need to identify and address treatment barriers.

Schistosoma japonicum EKLF/KLF1 is a potential immune target to tackle schistosomiasis.

BACKGROUND: Interruption of parasite reproduction by targeting migrating schistosomula is a promising strategy for managing schistosomiasis. Hepatic schistosomula proteins previously identified based on second-generation schistosome DNA sequencing were found to hold excellent potential for schistosomiasis japonica diagnosis and as vaccine candidates. However, there are still many unknown schistosomula proteins that warrant further investigations. Herein, a novel schistosomula protein, the Schistosoma japonicum erythroid Krüppel-like factor (SjEKLF/KLF1), was explored. METHODS: Sequence alignment was carried out to detect the amino acid sequence characteristics of SjEKLF. The expression profile of SjEKLF was determined by western blot and immunofluorescence analysis. Enzyme-linked immunosorbent assay was used to determine the antigenicity of SjEKLF in hosts. Mice immunised with recombinant SjEKLF were challenged to test the potential value of the protein as an immunoprotective target. RESULTS: SjEKLF is defined as EKLF/KLF1 for its C-terminal DNA-binding domain. SjEKLF is mainly expressed in hepatic schistosomula and male adults and located within the intestinal intima of the parasites. Notably, high levels of SjEKLF-specific antibodies were detected in host sera and SjEKLF exhibited outstanding sensitivity and specificity for schistosomiasis japonica immunodiagnosis but failed to distinguish between ongoing infection and previous exposure. In addition, SjEKLF immunisation reduced the infection in vivo, resulting in decreased worm and egg counts, and alleviated body weight loss and hepatomegaly in infected mice. CONCLUSIONS: Overall, these findings demonstrate that SjEKLF is critical for the infection of S. japonicum and may be a potential target to help control S. japonicum infection and transmission.

Renal artery pseudoaneurysm formation and rupture induced by renal abscess: A case report.

Severe consequences can ensue from the rupture and hemorrhage of a renal artery pseudoaneurysm, necessitating immediate intervention upon detection. To date, no reports exist on the development of renal artery pseudoaneurysms as a result of renal abscesses. This document introduces the first reported case of this occurrence.

Contribution of the 5G Smart First-Aid Care Platform to Achieving High-Quality Prehospital Care.

China is gradually becoming an aging society, and the necessity for prehospital first-aid care is increasing. However, there is a long-term information blind spot in traditional prehospital first-aid care. Fifth-generation (5G) network has the advantages of enhanced broadband, multiple connections, and low latency. Combined with the current prehospital first-aid system, the 5G smart medical prehospital first-aid care model creates a new opportunity for the development of prehospital first-aid care. This paper aimed to describe the 5G smart first-aid care platform and offers practical insights into the construction and application of the 5G smart first-aid care platform in small- and medium-sized cities. We first introduced the working principle of the 5G smart first-aid care platform and then chose patients with prehospital chest pain as an example to describe the whole workflow in detail. The application of the 5G smart emergency-care platform is at the stage of pilot exploration in large- and medium-sized cities. Big data statistical analysis of the completed first-aid care tasks has not been performed yet. The 5G smart first-aid care platform realizes real-time interconnection of information between the ambulance and the hospital, performs remote consultation, shortens the treatment time, and enhances treatment efficiency. Future research should focus on quality control analysis of the 5G smart first-aid care platform.

Automatic Detection of Tooth-Gingiva Trim Lines on Dental Surfaces.

Detecting the tooth-gingiva trim line from a dental surface plays a critical role in dental treatment planning and aligner 3D printing. Existing methods treat this task as a segmentation problem, which is resolved with geometric deep learning based mesh segmentation techniques. However, these methods can only provide indirect results (i.e., segmented teeth) and suffer from unsatisfactory accuracy due to the incapability of making full use of high-resolution dental surfaces. To this end, we propose a two-stage geometric deep learning framework for automatically detecting tooth-gingiva trim lines from dental surfaces. Our framework consists of a trim line proposal network (TLP-Net) for predicting an initial trim line from the low-resolution dental surface as well as a trim line refinement network (TLR-Net) for refining the initial trim line with the information from the high-resolution dental surface. Specifically, our TLP-Net predicts the initial trim line by fusing the multi-scale features from a U-Net with a proposed residual multi-scale attention fusion module. Moreover, we propose feature bridge modules and a trim line loss to further improve the accuracy. The resulting trim line is then fed to our TLR-Net, which is a deep-based LDDMM model with the high-resolution dental surface as input. In addition, dense connections are incorporated into TLR-Net for improved performance. Our framework provides an automatic solution to trim line detection by making full use of raw high-resolution dental surfaces. Extensive experiments on a clinical dental surface dataset demonstrate that our TLP-Net and TLR-Net are superior trim line detection methods and outperform cutting-edge methods in both qualitative and quantitative evaluations.

OsPEX1, an extensin-like protein, negatively regulates root growth in a gibberellin-mediated manner in rice.

Leucine-rich repeat extensins (LRXs) are required for plant growth and development through affecting cell growth and cell wall formation. LRX gene family can be classified into two categories: predominantly vegetative-expressed LRX and reproductive-expressed PEX. In contrast to the tissue specificity of Arabidopsis PEX genes in reproductive organs, rice OsPEX1 is also highly expressed in roots in addition to reproductive tissue. However, whether and how OsPEX1 affects root growth is unclear. Here, we found that overexpression of OsPEX1 retarded root growth by reducing cell elongation likely caused by an increase of lignin deposition, whereas knockdown of OsPEX1 had an opposite effect on root growth, indicating that OsPEX1 negatively regulated root growth in rice. Further investigation uncovered the existence of a feedback loop between OsPEX1 expression level and GA biosynthesis for proper root growth. This was supported by the facts that exogenous GA3 application downregulated transcript levels of OsPEX1 and lignin-related genes and rescued the root developmental defects of the OsPEX1 overexpression mutant, whereas OsPEX1 overexpression reduced GA level and the expression of GA biosynthesis genes. Moreover, OsPEX1 and GA showed antagonistic action on the lignin biosynthesis in root. OsPEX1 overexpression upregulated transcript levels of lignin-related genes, whereas exogenous GA3 application downregulated their expression. Taken together, this study reveals a possible molecular pathway of OsPEX1mediated regulation of root growth through coordinate modulation of lignin deposition via a negative feedback regulation between OsPEX1 expression and GA biosynthesis.

Automatic Schelling Point Detection From Meshes.

Mesh Schelling points explain how humans focus on specific regions of a 3D object. They have a large number of important applications in computer graphics and provide valuable information for perceptual psychology studies. However, detecting mesh Schelling points is time-consuming and expensive since the existing techniques are mostly based on participant observation studies. To overcome these limitations, we propose to employ powerful deep learning techniques to detect mesh Schelling points in an automatic manner, free from participant observation studies. Specifically, we utilize the mesh convolution and pooling operations to extract informative features from mesh objects, and then predict the 3D heat map of Schelling points in an end-to-end manner. In addition, we propose a Deep Schelling Network (DS-Net) to automatically detect the Schelling points, including a multi-scale fusion component and a novel region-specific loss function to improve our network for a better regression of heat maps. To the best of our knowledge, DS-Net is the first deep neural network for detecting Schelling points from 3D meshes. We evaluate DS-Net on a mesh Schelling point dataset obtained from participant observation studies. The experimental results demonstrate that DS-Net is capable of detecting mesh Schelling points effectively and outperforms various state-of-the-art mesh saliency methods and deep learning models, both qualitatively and quantitatively.

Evidence for SARS-CoV-2 Delta and Omicron co-infections and recombination.

BACKGROUND: Between November 2021 and February 2022, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta and Omicron variants co-circulated in the United States, allowing for co-infections and possible recombination events. METHODS: We sequenced 29,719 positive samples during this period and analyzed the presence and fraction of reads supporting mutations specific to either the Delta or Omicron variant. FINDINGS: We identified 18 co-infections, one of which displayed evidence of a low Delta-Omicron recombinant viral population. We also identified two independent cases of infection by a Delta-Omicron recombinant virus, where 100% of the viral RNA came from one clonal recombinant. In the three cases, the 5' end of the viral genome was from the Delta genome and the 3' end from Omicron, including the majority of the spike protein gene, though the breakpoints were different. CONCLUSIONS: Delta-Omicron recombinant viruses were rare, and there is currently no evidence that Delta-Omicron recombinant viruses are more transmissible between hosts compared with the circulating Omicron lineages. FUNDING: This research was supported by the NIH RADx initiative and by the Centers for Disease Control Contract 75D30121C12730 (Helix).

Applications of 3D Photography in Craniofacial Surgery.

Three-dimensional (3D) photography is becoming more common in craniosynostosis practice and may be used for research, archiving, and as a planning tool. In this article, an overview of the uses of 3D photography will be given, including systems available and illustrations of how they can be used. Important innovations in 3D computer vision will also be discussed, including the potential role of statistical shape modeling and analysis as an outcomes tool with presentation of some results and a review of the literature on the topic. Potential future applications in diagnostics using machine learning will also be presented.

Development and Evaluation of Duplex MIRA-qPCR Assay for Simultaneous Detection of Staphylococcus aureus and non-aureus Staphylococci

Staphylococcus spp., especially Staphylococcus aureus (S. aureus), is an important pathogen in hospital-acquired infection and food poisoning. Here, we developed a multienzyme isothermal rapid amplification combined with duplex quantitative PCR (duplex MIRA-qPCR) method, which can simultaneously detect the S. aureus species-specific conserved gene FMN-bgsfp and the Staphylococcus genus-specific conserved gene tuf. This assay enabled the amplification of DNA within 20 min at a constant temperature of 39 °C. Specificity analysis indicated that all nine common Staphylococcus species were positive and non-Staphylococcus spp. were negative for tuf gene, whereas S. aureus was positive, non-aureus Staphylococci species and non-Staphylococcus spp. were negative for FMN-bgsfp gene, suggesting that duplex MIRA-qPCR exhibited high specificity. Meanwhile, the sensitivity was tested and the limit of detection (LoD) was 3 × 102 CFU/mL. The coefficient variation values ranged from 0.13% to 2.09%, indicating that the assay had good repeatability. Furthermore, all the nine common Staphylococcus species (including S. aureus) could be detected from four kinds of simulated samples and the LoD of S. aureus was 8.56 × 103 CFU/mL. In conclusion, the duplex MIRA-qPCR has advantages of stronger specificity, lower detection threshold, shorter detection time, and simpler operation, which is an effective tool to detect S. aureus and non-aureus Staphylococci spp. infections rapidly.

Will People Accept a Third Booster Dose of the COVID-19 Vaccine? A Cross-Sectional Study in China.

Objective: The coronavirus disease 2019 (COVID-19) vaccines are considered to be an effective way to prevent the spread of the infection. Our previous study has shown that about 75% of healthcare workers (HCWs) in China were willing to receive the vaccine when it became available. Here, we examined the acceptance of a third booster dose among Chinese people and identified the influencing factors. Methods: A cross-sectional online survey was conducted and the snowball sampling method was utilized. An online questionnaire was provided to all the participants in the form of a quick response (QR) code. The questionnaire included general demographic information, views on vaccines, the General Health Questionnaire-12 (GHQ-12), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The univariate analysis was done between all the variables and our dependent variable. Then, we used the multivariate logistic regression model to examine the influencing factors of the third booster dose acceptance. Results: We collected 1,062 complete answers. Of these, 90.39% (n = 960) declared that they would accept the booster dose. Knowing more about the vaccine and recognizing the efficacy of vaccines were significantly associated with greater acceptance of the booster dose. People willing to take the booster dose had better psychological health. A belief that the booster dose could prevent severe infection caused by COVID-19 and enhance the effectiveness of the first two doses were the main contributing factors to vaccine acceptance. Vaccine hesitancy was mainly due to a low perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and rapid mutation of SARS-CoV-2. Conclusion: This study revealed that Chinese people were very receptive to the third booster dose, which is an inspiring result. More positive attitudes regarding COVID-19 vaccination were supported by its efficacy and few side effects.

Breast Tumor Ultrasound Image Segmentation Method Based on Improved Residual U-Net Network.

In order to achieve efficient and accurate breast tumor recognition and diagnosis, this paper proposes a breast tumor ultrasound image segmentation method based on U-Net framework, combined with residual block and attention mechanism. In this method, the residual block is introduced into U-Net network for improvement to avoid the degradation of model performance caused by the gradient disappearance and reduce the training difficulty of deep network. At the same time, considering the features of spatial and channel attention, a fusion attention mechanism is proposed to be introduced into the image analysis model to improve the ability to obtain the feature information of ultrasound images and realize the accurate recognition and extraction of breast tumors. The experimental results show that the Dice index value of the proposed method can reach 0.921, which shows excellent image segmentation performance.

Adrenomedullin Improves Cardiac Remodeling and Function in Obese Rats with Hypertension.

This study aimed to determine whether adrenomedullin (ADM, 7.2 µg/kg/day, ip), an important endogenous active peptide, has a protective role in cardiac remodeling and function in obesity-related hypertension (OH) rats. A high-fat diet (HFD) was used to induce OH for 20 weeks. H9c2 cells incubated with palmitate (PA, 200 µM) to mimic high free fatty acid in obesity were used as an in vitro model. In OH rats, ADM not only decreased body weight (BW) and blood pressure (BP) but also improved systemic inflammation and oxidative stress. Moreover, ADM still had a greater inhibitory effect on local inflammation and oxidative stress in the hearts of OH rats, and the same anti-inflammatory and antioxidant effects were also confirmed in PA-treated H9c2 cells. The ADM receptor antagonist or Akt inhibitor effectively attenuated the inhibitory effects of ADM on inflammation and oxidative stress in PA-stimulated H9c2 cells. Furthermore, ADM application effectively normalized heart function, and hematoxylin-eosin and Masson staining and collagen volume fraction results showed that ADM improved cardiac remodeling in hearts of OH rats. ADM attenuated cardiac inflammation and oxidative stress via the receptor-Akt pathway, which involves the improvement of cardiac remodeling and function in OH rats.

Adrenomedullin ameliorates palmitic acid-induced insulin resistance through PI3K/Akt pathway in adipocytes.

AIMS: White adipose tissue (WAT) dysfunction has been associated with adipose tissue low-grade inflammation and oxidative stress leading to insulin resistance (IR). Adrenomedullin (ADM), an endogenous active peptide considered as an adipokine, is associated with adipocytes function. METHODS: We evaluated the protective effects of ADM against IR in 3T3-L1 adipocytes treated by palmitic acid (PA) and in visceral white adipose tissue (vWAT) of obese rats fed with high-fat diet. RESULTS: We found that endogenous protein expressions of ADM and its receptor in PA-treated adipocytes were markedly increased. PA significantly induced impaired insulin signaling by affecting phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) axis and glucose transporter-4 (GLUT-4) levels, whereas ADM pretreatment enhanced insulin signaling PI3K/Akt and GLUT-4 membrane protein levels, decreased pro-inflammatory cytokines tumor necrosis factor α (TNFα), interleukin-1ß (IL-1ß) and IL-6 levels, and improved oxidative stress accompanied with reduced reactive oxygen species (ROS) levels and increased anti-oxidant enzymes manganese superoxide dismutase 2 (SOD2), glutathione peroxidase (GPx1) and catalase (CAT) protein expressions. Furthermore, ADM treatment not only improved IR in obese rats, but also effectively restored insulin signaling, and reduced inflammation and oxidative stress in vWAT of obese rats. CONCLUSIONS: This study demonstrates a prevention potential of ADM against obesity-related metabolic disorders, due to its protective effects against IR, inflammation and oxidative stress in adipocytes.

[Feasibility Study of Ultra-High-Resolution Low-Dose Temporal Bone CT with 1 024×1 024 Reconstruction Matrix Size].

OBJECTIVE: To investigate the feasibility of low-dose CT scan of the temporal bone combined with reconstruction matrix size of 1 024×1 024 and the effect of the reconstruction matrix size on image quality. METHODS: Normal-dose and low-dose bilateral temporal bone CT scans were performed on twelve adult male cadaveric skull specimens using the 160-slice multi-detector CT scanning of United Imaging Healthcare. Normal-dose CT images were reconstructed with matrix sizes of 512×512 and 1 024×1 024, while low-dose CT images were reconstructed with the matrix size of 1 024×1 024. CT value, noise, signal-to-noise ratio, contrast-to-noise ratio, the visualization scoring of 15 anatomical structures of the temporal bone, and the result of three-dimensional reconstruction of the ossicular chain were compared among the three groups. RESULTS: The radiation dose of low-dose CT scanning was reduced by about 50% compared with that of normal-dose CT. There was no significant difference in CT values of air, soft tissues and bones among the three groups. Low-dose temporal bone CT with the matrix size of 1 024×1 024 had higher noise, but much better visualization of temporal bone structure than the normal-dose temporal bone CT with matrix size of 512×512. Both the three-dimensional reconstructions of normal-dose and low-dose 1 024×1 024 matrix images were satisfactory and showed no significant difference. The morphology, size and relative position of malleus, incus, stapes, cochlea, and labyrinth, as well as the location of the ossicular chain in the cranium were all clearly displayed. CONCLUSION: Low-dose temporal bone CT with the matrix size of 1 024×1 024 can be used to effectively reduce the radiation dose and significantly improve the spatial resolution and the visualization of the temporal bone anatomical structures compared with the normal-dose temporal bone CT with a matrix size of 512×512.

Tumor Region Location and Classification Based on Fuzzy Logic and Region Merging Image Segmentation Algorithm.

Early diagnosis of tumor plays an important role in the improvement of treatment and survival rate of patients. However, breast tumors are difficult to be diagnosed by invasive examination, so medical imaging has become the most intuitive auxiliary method for breast tumor diagnosis. Although there is no universal perfect method for image segmentation so far, the consensus on the general law of image segmentation has produced considerable research results and methods. In this context, this paper focuses on the breast tumor image segmentation method based on CNN and proposes an improved DCNN method combined with CRF. This method can obtain the information of multiscale and pixels better. The experimental results show that, compared with DCNN without these methods, the segmentation accuracy is significantly improved.

Hydrogen sulfide prevents arterial medial calcification in rats with diabetic nephropathy.

BACKGROUND: Arterial medial calcification (AMC) is associated with a high incidence of cardiovascular risk in patients with type 2 diabetes and chronic kidney disease. Here, we tested whether hydrogen sulfide (H2S) can prevent AMC in rats with diabetic nephropathy (DN). METHODS: DN was induced by a single injection of streptozotocin and high-fat diet (45% kcal as fat) containing 0.75% adenine in Sprague-Dawley rats for 8 weeks. RESULTS: Rats with DN displayed obvious calcification in aorta, and this was significantly alleviated by Sodium Hydrosulfide (NaHS, a H2S donor, 50 µmol/kg/day for 8 weeks) treatment through decreasing calcium and phosphorus content, ALP activity and calcium deposition in aorta. Interestingly, the main endogenous H2S generating enzyme activity and protein expression of cystathionine-γ-lyase (CSE) were largely reduced in the arterial wall of DN rats. Exogenous NaHS treatment restored CSE activity and its expression, inhibited aortic osteogenic transformation by upregulating phenotypic markers of smooth muscle cells SMα-actin and SM22α, and downregulating core binding factor α-1 (Cbfα-1, a key factor for bone formation), protein expressions in rats with DN when compared to the control group. NaHS administration also significantly reduced Stat3 activation, cathepsin S (CAS) activity and TGF-ß1 protein level, and improved aortic elastin expression. CONCLUSIONS: H2S may have a clinical significance for treating AMC in people with DN by reducing Stat3 activation, CAS activity, TGF-ß1 level and increasing local elastin level.