Amorphous Bismuth-Tin Oxide Nanosheets with Optimized C-N Coupling for Efficient Urea Synthesis.

Closing the carbon and nitrogen cycles by electrochemical methods using renewable energy to convert abundant or harmful feedstocks into high-value C- or N-containing chemicals has the potential to transform the global energy landscape. However, efficient conversion avenues have to date been mostly realized for the independent reduction of CO2 or NO3-. The synthesis of more complex C-N compounds still suffers from low conversion efficiency due to the inability to find effective catalysts. To this end, here we present amorphous bismuth-tin oxide nanosheets, which effectively reduce the energy barrier of the catalytic reaction, facilitating efficient and highly selective urea production. With enhanced CO2 adsorption and activation on the catalyst, a C-N coupling pathway based on *CO2 rather than traditional *CO is realized. The optimized orbital symmetry of the C- (*CO2) and N-containing (*NO2) intermediates promotes a significant increase in the Faraday efficiency of urea production to an outstanding value of 78.36% at -0.4 V vs RHE. In parallel, the nitrogen and carbon selectivity for urea formation is also enhanced to 90.41% and 95.39%, respectively. The present results and insights provide a valuable reference for the further development of new catalysts for efficient synthesis of high-value C-N compounds from CO2.

Association between body mass index and early renal function after kidney transplantation: observational and Mendelian randomization study.

Introduction The relationship between BMI and early renal function recovery after kidney transplantation is important due to the rising global obesity rates. Methods A retrospective study on 320 patients who received allograft kidney transplantation at Guangxi Medical University Hospital explored the BMI-kidney function relationship using various statistical methods. Mendelian randomization（MR） was also employed to investigate causality. Results Based on the univariate analysis, multivariate linear regression models, and trend analysis, it was found that there were significant positive correlations between BMI and creatinine, urea, and cystatin C on the 7th day after kidney transplantation (P<0.05). The sensitivity analysis further confirmed these correlations in different gender stratification, adolescents, and adults. However, the positive correlation with cystatin C was only significant in males. Additionally, after conducting smooth curve fitting analysis and threshold saturation analysis, it was revealed that the negative correlation between early renal function recovery was most significant when BMI was between 22.0-25.5kg/m2, and early postoperative renal function may be optimal when BMI was at 22.2kg/m2. Finally, the MR analysis confirmed a causal relationship between BMI and renal failure, as indicated by the IVW method (P=0.003), as well as the weighted median estimator (P=0.004). Conclusion This study on kidney transplant patients found that maintaining a BMI within the range of 22.0 to 25.5 kg/m2, with an optimal BMI of 22.2 kg/m2, improves early renal function recovery. This correlation holds true for different age groups and genders. Monitoring and controlling BMI in high-risk patients can enhance post-transplantation renal function.

Healthcare providers' attitudes and associated factors on palliative care referral: A qualitative systematic review and meta-aggregation.

BACKGROUND: Early referral to palliative care has been viewed as providing opportunity for accomplishing end-of-life care goals of life closure, comfortable dying and effective grieving. However, previous studies have shown that palliative care referrals are being made too late. Healthcare providers play important role in helping terminally ill patients to early access and being referred to palliative care. It is necessary to understand healthcare providers' attitudes on palliative care referral and associated factors regarding referrals. OBJECTIVES: This review aimed to identify and synthesise healthcare providers' attitudes and associated factors on palliative care referrals systematically. DESIGN: A systematic review of qualitative evidence and meta-aggregation was conducted and guided according to PRISMA guideline. DATA SOURCES: PubMed, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane databases from inception to 24 October 2022. RESULTS: Database searches yielded 5856 references. Twenty-two studies met eligibility criteria and of moderate to high methodological quality were included. Studies occurred in USA, UK, Australia and France with 716 healthcare providers participants were included. A total of 378 codings were finally extracted and integrated into 41 categories, forming three synthesised findings: (1) Healthcare providers' attitudes towards palliative care referrals, (2) the influence of subjective norms on palliative care referral behaviour and (3) perceived behavioural control on palliative care referral behaviour. CONCLUSION: This review demonstrates a series of factors that affect the palliative care referrals, including the attitudes of healthcare providers, the participation of patients and families, the support of colleagues and supervisors, inter-professional collaboration, the availability of hospice resource, disease trajectory and socio-economic factors. Further research that addresses these factors and design relevant trainings on improving healthcare providers' attitudes, enhancing patient and family engagement, strengthening support networks and optimising resource allocation may aid to meet increasing demands of patients. RELEVANCE TO CLINICAL PRACTICE: This review not only guides healthcare providers in making better decisions about patient referrals by identifying and addressing barriers but also aids in the development of effective interventions that facilitate the early initiation of referrals. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The impact of arbuscular mycorrhizal fungi and endophytic bacteria on peanuts under the combined pollution of cadmium and microplastics.

It remains unclear how symbiotic microbes impact the growth of peanuts when they are exposed to the pollutants cadmium (Cd) and microplastics (MPs) simultaneously. This study aimed to investigate the effects of endophytic bacteria Bacillus velezens SC60 and arbuscular mycorrhizal fungus Rhizophagus irregularis on peanut growth and rhizosphere microbial communities in the presence of Cd at 40 (Cd40) or 80 (Cd80) mg kg-1 combined without MP or the presence of low-density polyethylene (LDPE) and poly butyleneadipate-co-terephthalate (PBAT). This study assessed soil indicators, plant parameters, and Cd accumulation indicators. Results showed that the application of R. irregularis and B. velezens significantly enhanced soil organic carbon and increased Cd content under the conditions of Cd80 and MPs co-pollution. R. irregularis and B. velezens treatment increased peanut absorption and the enrichment coefficient for Cd, with predominate concentrations localized in the peanut roots, especially under combined pollution by Cd and MPs. Under treatments with Cd40 and Cd80 combined with PBAT pollution, soil microbes Proteobacteria exhibited a higher relative abundance, while Actinobacteria showed a higher relative abundance under treatments with Cd40 and Cd80 combined with LDPE pollution. In conclusion, under the combined pollution conditions of MPs and Cd, the co-treatment of R. irregularis and B. velezens effectively immobilized Cd in peanut roots, impeding its translocation to the shoot.

Association between dietary live microbe intake and Life's Essential 8 in US adults: a cross-sectional study of NHANES 2005-2018.

Background: Assessing the impact of dietary live microbe intake on health outcomes has gained increasing interest. This study aimed to elucidate the relationship between dietary live microbe intake and Life's Essential 8 (LE8) scores, a metric for cardiovascular health (CVH), in the U.S. adult population. Methods: We analyzed data from 10,531 adult participants of the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. Participants were stratified into low, medium, and high intake groups of dietary live microbe based on Marco's classification system. We employed weighted logistic and linear regression analyses, along with subgroup, interaction effect, and sensitivity analyses. Additionally, Restricted Cubic Splines (RCS) were used to explore the dose-response relationship between food intake and CVH in different groups. Results: Compared to the low live microbe intake group, the medium and high live microbe intake groups had significantly higher LE8, with ß coefficients of 2.75 (95% CI: 3.89-5.65) and 3.89 (95% CI: 6.05-8.11) respectively. Additionally, moderate and high groups significantly reduced the risk of high cardiovascular health risk, defined as an LE8 score below 50, with odds ratios (OR) of 0.73 and 0.65 respectively. Subgroup analysis and sensitivity analysis proved the stability of the results. In the low intake group, food intake shows a linear negative correlation with LE8, whereas in the high intake group, it exhibits a linear positive correlation. In contrast, in the moderate live microbe intake group, the relationship between food intake and LE8 presents a distinct inverted "U" shape. Conclusion: This study highlights the potential benefits of medium to high dietary intake of live microbe in improving LE8 scores and CVH in adults. These findings advocate for the inclusion of live microbes in dietary recommendations, suggesting their key role in CVH enhancement.

Ag-based coordination polymer-enhanced photocatalytic degradation of ciprofloxacin and nitrophenol.

Transition-metal coordination complexes have attracted wide attention in molecular chemistry, but their applications still confront a tremendous challenge. Herein, a novel silver coordination polymer with a formula of {[Ag9(TIPA)6](NO3)9·12H2O}n (Ag-TIPA) was prepared by a solvothermal reaction of silver nitrate with triangular tris(4-imidazolylphenyl)amine (TIPA). The crystalline molecular structure was determined by single-crystal X-ray diffraction, which showed that each Ag(I) was coordinated with two nitrogen atoms of TIPA ligands. Such Ag-TIPA was used as a catalyst for the photodegradation of ciprofloxacin and 4-nitrophenol under UV-visible light irradiation. The results exhibited excellent photocatalytic performance and reusability due to high structure stability in an acidic, neutral and alkaline environment. The experimental findings and density functional theory calculations revealed that metal-ligand charge transfer in Ag-TIPA extended the absorption range of light and improved the charge transfer properties of TIPA. To further understand the photodegradation process, the intermediates were predicted and analysed through electrostatic potential, orbital weighted dual descriptor, and liquid chromatography-mass spectrometry techniques. Based on these findings, a possible degradation mechanism was proposed. This study provides new insights into the design and synthesis of Ag-based coordination polymers with novel structures, excellent catalytic activity, and good durability.

Programmable and Surface-Conformable Origami Design for Thermoelectric Devices.

Thermoelectric devices (TEDs) show great potential for waste heat energy recycling and sensing. However, existing TEDs cannot be self-adapted to the complex quadratic surface, leading to significant heat loss and restricting their working scenario. Here, surface-conformable origami-TEDs (o-TEGs) are developed through programmable crease-designed origami substrates and the screen-printing TE legs. Compared with "π" structured TEDs, the origami design (with heat conductive materials) changed the heat-transferring direction of the laminated TE legs, resulting in an enhancement in enlarging ΔT/THot and Vout by 5.02 and 3.51 times. Four o-TEDs with different creases designs are fabricated to verify the heat recycling ability on plane and central quadratic surfaces. Demonstrating a high Vout density (up to 0.98 -2 at ΔT of 50 K) and good surface conformability, o-TEDs are further used in thermal touch panels attached to multiple surfaces, allowing information to be wirelessly transferred on a remote display via finger-writing.

The practice and facilitators of, and barriers to, implementing individualized repositioning frequency: A national cross-sectional survey of critical care nurses.

AIMS: To understand the clinical status of implementing individualized repositioning frequency-and its barriers and facilitators-among critical care nurses in China, in view of developing targeted intervention strategies and improving guideline implementation. DESIGN: A cross-sectional survey. METHODS: A self-report questionnaire was developed with reference to the Theoretical Domains Framework and administered to critical care nurses in 15 hospitals across eastern, southern, western, northern, and central geographical areas of China from 20 February 2023 to 16 March 2023. Data were collected for personal demographics, clinical practice status, and from Likert-type responses about barriers to and facilitators of implementing individualized repositioning frequency. RESULTS: In total, 574 effective questionnaires were collected. Only 3.8 % of respondents reported that their hospital/ward uses an individualized repositioning frequency rule. Six facilitator domains identified were: social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; and intentions. Seven barrier domains were: knowledge; skills; goals; memory, attention and decision processes; environmental context and resources; social influences; and behavioral regulation. Inferential analysis showed that critical care nurses who had higher degrees, more years of work, more environmental support, and more nursing experience were prone to being more positive in response to the implementation of individualized repositioning frequency. CONCLUSION: The clinical practice status of implementing individualized repositioning frequency among critical care nurses in China is unsatisfactory. Implementation is essential but complex and is influenced by several factors. Theory-based suggestions for improving this situation are provided on the basis of identified barriers.

Exploring the needs and coping strategies of family caregivers taking care of dying patients at home: a field study.

BACKGROUND: Most Chinese patients chose to die at home, therefore there is a reliance on the family caregivers to be involved in their palliative care. The needs and coping strategies of family caregivers in home-based palliative care are rooted in culture. Little is known about the needs and coping strategies of family caregivers taking care of dying patients at home. METHODS: A field study using semi-structured interview, participant observation, documents and records collection was employed. The study was conducted in two palliative care outpatient departments in tertiary hospitals and four communities in Beijing, China from March 2021 to July 2022. Using purposive sampling, twenty-five family caregivers were recruited. All collected data were analyzed using content analysis approach. RESULTS: Five themes emerged, including three care needs and two coping strategies. Family caregivers need to learn care skills and acquire care resources, including (i) decision-making about home-based palliative care, (ii) improving patient's quality of life, and (iii) signs of final hours and funeral procedures. In facing the care burden, family caregivers coped by (iv) balancing the roles of caregivers and individuals: giving priority to patient care while maintaining their own normal life. In facing the death of a loved one, family caregivers responded by (v) making room for coming death by facing death indirectly and "rescuing" patients for consolation while preparing for the coming death. CONCLUSION: Family caregivers strive to balance the roles of being caregivers and being themselves. As caregivers, they actively prepare patients for good death with no regrets. As individuals, they preserve themselves from being hurt to maintain normal life. The needs of family caregivers focus on caregiver role and are manifested in care skills and resources. TRIAL REGISTRATION: Not registered.

Design and implementation of a smart Internet of Things chest pain center based on deep learning.

The data input process for most chest pain centers is not intelligent, requiring a lot of staff to manually input patient information. This leads to problems such as long processing times, high potential for errors, an inability to access patient data in a timely manner and an increasing workload. To address the challenge, an Internet of Things (IoT)-driven chest pain center is designed, which crosses the sensing layer, network layer and application layer. The system enables the construction of intelligent chest pain management through a pre-hospital app, Ultra-Wideband (UWB) positioning, and in-hospital treatment. The pre-hospital app is provided to emergency medical services (EMS) centers, which allows them to record patient information in advance and keep it synchronized with the hospital's database, reducing the time needed for treatment. UWB positioning obtains the patient's hospital information through the zero-dimensional base station and the corresponding calculation engine, and in-hospital treatment involves automatic acquisition of patient information through web and mobile applications. The system also introduces the Bidirectional Long Short-Term Memory (BiLSTM)-Conditional Random Field (CRF)-based algorithm to train electronic medical record information for chest pain patients, extracting the patient's chest pain clinical symptoms. The resulting data are saved in the chest pain patient database and uploaded to the national chest pain center. The system has been used in Liaoning Provincial People's Hospital, and its subsequent assistance to doctors and nurses in collaborative treatment, data feedback and analysis is of great significance.

A C. elegans neuron both promotes and suppresses motor behavior to fine tune motor output.

How neural circuits drive behavior is a central question in neuroscience. Proper execution of motor behavior requires precise coordination of many neurons. Within a motor circuit, individual neurons tend to play discrete roles by promoting or suppressing motor output. How exactly neurons function in specific roles to fine tune motor output is not well understood. In C. elegans, the interneuron RIM plays important yet complex roles in locomotion behavior. Here, we show that RIM both promotes and suppresses distinct features of locomotion behavior to fine tune motor output. This dual function is achieved via the excitation and inhibition of the same motor circuit by electrical and chemical neurotransmission, respectively. Additionally, this bi-directional regulation contributes to motor adaptation in animals placed in novel environments. Our findings reveal that individual neurons within a neural circuit may act in opposing ways to regulate circuit dynamics to fine tune behavioral output.

Mesenchymal stem cell-derived extracellular vesicles in skin wound healing: roles, opportunities and challenges.

Skin wounds are characterized by injury to the skin due to trauma, tearing, cuts, or contusions. As such injuries are common to all human groups, they may at times represent a serious socioeconomic burden. Currently, increasing numbers of studies have focused on the role of mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) in skin wound repair. As a cell-free therapy, MSC-derived EVs have shown significant application potential in the field of wound repair as a more stable and safer option than conventional cell therapy. Treatment based on MSC-derived EVs can significantly promote the repair of damaged substructures, including the regeneration of vessels, nerves, and hair follicles. In addition, MSC-derived EVs can inhibit scar formation by affecting angiogenesis-related and antifibrotic pathways in promoting macrophage polarization, wound angiogenesis, cell proliferation, and cell migration, and by inhibiting excessive extracellular matrix production. Additionally, these structures can serve as a scaffold for components used in wound repair, and they can be developed into bioengineered EVs to support trauma repair. Through the formulation of standardized culture, isolation, purification, and drug delivery strategies, exploration of the detailed mechanism of EVs will allow them to be used as clinical treatments for wound repair. In conclusion, MSC-derived EVs-based therapies have important application prospects in wound repair. Here we provide a comprehensive overview of their current status, application potential, and associated drawbacks.

The marriage of immunomodulatory, angiogenic, and osteogenic capabilities in a piezoelectric hydrogel tissue engineering scaffold for military medicine.

BACKGROUND: Most bone-related injuries to grassroots troops are caused by training or accidental injuries. To establish preventive measures to reduce all kinds of trauma and improve the combat effectiveness of grassroots troops, it is imperative to develop new strategies and scaffolds to promote bone regeneration. METHODS: In this study, a porous piezoelectric hydrogel bone scaffold was fabricated by incorporating polydopamine (PDA)-modified ceramic hydroxyapatite (PDA-hydroxyapatite, PHA) and PDA-modified barium titanate (PDA-BaTiO3, PBT) nanoparticles into a chitosan/gelatin (Cs/Gel) matrix. The physical and chemical properties of the Cs/Gel/PHA scaffold with 0-10 wt% PBT were analyzed. Cell and animal experiments were performed to characterize the immunomodulatory, angiogenic, and osteogenic capabilities of the piezoelectric hydrogel scaffold in vitro and in vivo. RESULTS: The incorporation of BaTiO3 into the scaffold improved its mechanical properties and increased self-generated electricity. Due to their endogenous piezoelectric stimulation and bioactive constituents, the as-prepared Cs/Gel/PHA/PBT hydrogels exhibited cytocompatibility as well as immunomodulatory, angiogenic, and osteogenic capabilities; they not only effectively induced macrophage polarization to M2 phenotype but also promoted the migration, tube formation, and angiogenic differentiation of human umbilical vein endothelial cells (HUVECs) and facilitated the migration, osteo-differentiation, and extracellular matrix (ECM) mineralization of MC3T3-E1 cells. The in vivo evaluations showed that these piezoelectric hydrogels with versatile capabilities significantly facilitated new bone formation in a rat large-sized cranial injury model. The underlying molecular mechanism can be partly attributed to the immunomodulation of the Cs/Gel/PHA/PBT hydrogels as shown via transcriptome sequencing analysis, and the PI3K/Akt signaling axis plays an important role in regulating macrophage M2 polarization. CONCLUSION: The piezoelectric Cs/Gel/PHA/PBT hydrogels developed here with favorable immunomodulation, angiogenesis, and osteogenesis functions may be used as a substitute in periosteum injuries, thereby offering the novel strategy of applying piezoelectric stimulation in bone tissue engineering for the enhancement of combat effectiveness in grassroots troops.

First Report of Powdery Mildew Caused by Golovinomyces circumfusus on Scutellaria baicalensis in China.

Scutellaria baicalensis Georgi is a member of the plant family Lamiaceae and is widely cultivated in China as a medicinal plant (Wang et al. 2021). In August 2022, an investigation of a 10-hectare field of S. baicalensis in Longxi county, Gansu province, China (35°18' N, 104°57' E) found that approximately 90% of the plants were infected with 70% leaves symptomatic. Initially, the thin, radial, irregular white colonies appeared on the adaxial surface of the plant leaves. Subsequently, the white colonies expanded and thickened to cover the entire adaxial surface of the leaves, and gradually spread to the stems and abaxial surface of the leaves. Finally, infected leaves dried out and defoliated prematurely. Tissue from infected plants was collected in order to identify the pathogen. Microscopic observations showed that hyphae were septate, branched, flexuous to straight, 3 to 9 µm wide. Appressoria were solitary and slightly to distinctly nipple-shaped. Conidiophores were erect, straight or somewhat flexuous, 105 to 145 × 8 to 13 µm in size (n=30). The conidia were ellipsoid to ovoid in shape, 25 to 39 × 12 to 21 µm (n=50), without obvious fibrosin bodies. Chasmothecia were globose or oblate, scattered to gregarious, dark brown, and 85 to 140 µm in diameter. Appendages were born equatorially on the ascomata, unbranched, 0.5 to 2.5 times as long as the chasmothecial diameter, interlaced with each other, and colorless. Asci were 5 to 12 per chasmothecium (n=30), obovate or suborbicular, 40 to 68 × 20 to 35 µm (n=30), mostly containing 2-3 ascospores. Ascospores were ellipsoid-ovoid, 14 to 24 × 10 to 15 µm (n=30). The fungus was identified as Golovinomyces circumfusus based on these morphological characteristics (Braun and Cook 2012). To validate the identity, the pathogen identification was confirmed through multi-locus phylogeny using internal transcribed spacer (ITS), 28S large ribosomal subunit, intergenic spacer (IGS) and beta-tubulin (TUB2) genes amplified. (Qiu et al. 2020). The resulting sequences were registered in GenBank (OR186707 for ITS, OQ861003 for 28S rDNA, OR193383 for IGS, OR205893 for TUB2). The phylogenetic tree was obtained using maximum parsimony (MP) in PAUP 4.0b. The phylogenetic analysis of the multi-locus sequences indicated that the strain HQ1 and G. circumfusus (type) clustered together on the same branch, confirming its identification. Pathogenicity tests were performed on potted 1-year-old plants of S. baicalensis according to Koch's postulates. Three plants were inoculated by gently pressing the naturally infected leaves onto 30 healthy leaves. Three non-inoculated healthy plants served as controls. Inoculated and control plants were placed in separate growth chamber (light/dark, 14 h/10 h; humidity, 70%; temperature, 25℃). After 12 days, the inoculated plants developed typical powdery mildew symptoms, but the control leaves remained without symptoms. The fungus on inoculated leaves was re-isolated, sequenced and confirmed as G. circumfusus based on morphological characteristics and molecular identification. Powdery mildew caused by G. circumfusus has been reported affecting Eupatorium cannabinum (Asteraceae) in Germany (Qiu et al. 2020), and Bidens pilosa var. radiata and Passiflora. edulis f. flavicarpa in Taiwan (Lin et al. 2020). There is no previous report about G. circumfusus causing powdery mildew on S. baicalensis. Moreover, although powdery mildew has been reported on S. baicalensis in China, the pathogen was not further identified (Zheng et al. 2010). To our knowledge, this is the first report of powdery mildew caused by G. circumfusus on S. baicalensis in China and worldwide.

Bacillus velezensis FX-6 suppresses the infection of Botrytis cinerea and increases the biomass of tomato plants.

Botrytis cinerea causing tomato gray mold is a major cause of economic loss in tomato production. It is urgent and necessary to seek an effective and environmentally friendly control strategy to control tomato grey mold disease. In this study, Bacillus velezensis FX-6 isolated from the rhizosphere of plants displayed significant inhibitory ability against B. cinerea and could promote tomato plant growth. FX-6 could effectively inhibit the growth of Botrytis cinerea mycelium in vitro and in vivo, and the inhibitory rate in vitro could reach 78.63%. According to morphological observations and phylogenetic trees based on sequences of the 16S rDNA and gyrA (DNA gyrase subunit A) genes, the strain FX-6 was identified as Bacillus velezensis. In addition, B. velezensis FX-6 showed antagonistic activity against seven phytopathogens, this indicated that FX-6 had broad-spectrum biocontrol activity. We also found that FX-6 fermentation broth had the strongest antagonistic activity against B. cinerea when the culture time was 72 hours, and the inhibition rate was 76.27%. The growth promotion test revealed that strain FX-6 significantly promoted tomato seed germination and seedling growth. Further deeply study on growth-promoting mechanism indicated that the FX-6 produced IAA and siderophore, and had ACC deaminase activity. The trait of significant biological control activity and growth promoting effect on tomato imply that B. velezensis FX-6 has the potential to be used as a biocontrol agent for tomato gray mold management.

Interventions and strategies to prevent medical device-related pressure injury in adult patients: A systematic review.

BACKGROUND: Current evidence shows that medical device-related pressure injury (MDRPI) has a high prevalence (10%) and incidence (12%), and much research has been done to prevent MDRPI in recent years. However, to our knowledge, there is limited systematic review available on interventions and strategies to prevent MDRPI. AIM: To synthesise research evidence on interventions and strategies used to prevent MDRPI. METHODS: This systematic review adhered to the PRISMA Guidelines. We searched six databases including Medline, CINAHL, EMBASE, Cochrane library, Web of Science and ProQuest with no restriction to year of publication. Data were extracted and checked by two authors independently. A narrative summary technique was used to describe the findings. Implementation strategies were grouped into six classifications: dissemination/implementation process/integration/capacity building/sustainability/scale-up strategies. RESULTS: Twenty-four peer-reviewed papers met the inclusion criteria, which comprised of 11 quality improvement projects and 13 original research. Types of devices included respiratory devices (non-invasive ventilation mask, CPAP/BiPAP mask, endotracheal tube), gastrointestinal/urinary devices and other devices. Interventions used included the use of dressing, hyperoxygenated fatty acids, full-face mask, training, and/or multidisciplinary education, use of special securement devices or tube holder, repositioning, application of stockinette, early removal and foam ring use. Common implementation strategies included ongoing staff education, audit and standardising documentation or guideline development. CONCLUSION: Much work on MDRPI prevention strategies has been undertaken. There were a variety of devices reported, however, it is evident that higher quality research is needed. RELEVANCE TO CLINICAL PRACTICE: Current evidence shows that interventions including use of dressing or special securement device, repositioning, and training/multidisciplinary education can be beneficial for MDRPI prevention. High-quality research, such as randomised controlled trials are needed to test the effectiveness of the interventions and their implementation strategies. No patient or public contribution.

ERα prevents tumorigenesis of both liver and breast cancer cells through CCN5.

Estrogen receptor alpha (ERα)-mediated estrogen signaling has also shown to prevent hepatic tumorigenesis in mice. Consistent with this, hormone replacement therapy with estrogen supplementation dramatically reduced the risk of hepatocellular carcinoma. Silencing of ERα is also a key event for the transformation of ERα-positive breast cancer cells into malignant triple-negative breast cancer cells. However, the mechanisms underlying ERα-mediated prevention of both hepatic and mammary tumorigenesis in humans are still unclear. Here, we present a functional genomics study of ERα targeting by comparing human liver cancer cells with human breast cancer cells using "loss or gain of function" genetic assays of ERα in vitro and in vivo. We discover that cellular communication network factor 5 (CCN5) is a direct downstream target of ERα; ERα suppresses growth and prevents tumorigenesis and malignant transformation of both liver and breast cancer cells through CCN5 in humans. The ERα-CCN5 regulatory axis functions as suppressors for both hepatic and mammary tumors, which is a common mechanism of preventing tumorigenesis for both liver cancer and breast cancer in humans.

Prevalence, predictors, and management for balloon uncrossable or undilatable lesions in patients undergoing percutaneous coronary intervention with in-stent restenosis chronic total occlusion.

Background: Percutaneous coronary intervention for in-stent restenosis (ISR) chronic total occlusion (CTO) has been a great challenge. There are occasions when the balloon is uncrossable or undilatable (BUs) even though the guidewire has passed, leading to failure of the procedure. Few studies have focused on the incidence, predictors, and management of BUs during ISR-CTO intervention. Methods: Patients with ISR-CTO were recruited consecutively between January 2017 and January 2022 and divided into two groups based on the presence of BUs. The clinical data of the two groups (BUs group and non-BUs group) were retrospectively analyzed and compared to explore the predictors and clinical management strategies of BUs. Results: A total of 218 patients with ISR-CTO were included in this study, 23.9% (52/218) of whom had BUs. The percentage of ostial stents, stent length, CTO length, the presence of proximal cap ambiguity, moderate to severe calcification, moderate to severe tortuosity, and J-CTO score were higher in the BUs group than in the non-BUs group (p < 0.05). The technical success rate and the procedural success rate were lower in the BUs group than in the non-BUs group (p < 0.05). Multivariable logistic regression analysis showed that ostial stents (OR: 2.011, 95% CI: 1.112-3.921, p = 0.031), the presence of moderate to severe calcification (OR: 3.383, 95% CI: 1.628-5.921, p = 0.024) and moderate to severe tortuosity (OR: 4.816, 95% CI: 2.038-7.772, p = 0.033) were independent predictors of BUs. Conclusion: The initial rate of BUs in ISR-CTO was 23.9%. Ostial stents, presence of moderate to severe calcification, and moderate to severe tortuosity were independent predictors of BUs.

Bereavement and Professional Competencies: Exploring the Personal Experience of Death Among Nursing Students - A Qualitative Study.

Purpose: To explore the death experiences of nursing students in their personal lives. Methods: This study employed a qualitative descriptive design using the semi-structured interview approach. A purposive sampling method was used to recruit 24 nursing students from September 2020 to July 2022. Data were analyzed using Colaizzi's analysis method. Lincoln and Guba's criteria was used to evaluate the trustworthiness of the data. Results: Four main themes emerged from the interviews: (a) reactions to encounters with death; (b) adjustment strategies; (c) personal growth induced by the death experiences; and (d) professional reflections for preparing nurse role. Conclusions: Although the death of a loved one makes nursing students suffer from grief and emotional distress, we show that the experience promotes the personal growth and professional competencies of nursing students and thereby, developing their overall aptitude towards the profession. Death experiences of nursing students have shown to allow them to reflect on both life and death, to consider the demands of the nursing profession, and to provide foundation for nursing students to be more empathetic and compassionate when facing death in the future. Exploring death experiences of nursing students is vital in better providing better quality education and personal support for nursing students.