Nomogram prediction of vessels encapsulating tumor clusters in small hepatocellular carcinoma ≤ 3 cm based on enhanced magnetic resonance imaging.

BACKGROUND: Vessels encapsulating tumor clusters (VETC) represent a recently discovered vascular pattern associated with novel metastasis mechanisms in hepatocellular carcinoma (HCC). However, it seems that no one have focused on predicting VETC status in small HCC (sHCC). This study aimed to develop a new nomogram for predicting VETC positivity using preoperative clinical data and image features in sHCC (≤ 3 cm) patients. AIM: To construct a nomogram that combines preoperative clinical parameters and image features to predict patterns of VETC and evaluate the prognosis of sHCC patients. METHODS: A total of 309 patients with sHCC, who underwent segmental resection and had their VETC status confirmed, were included in the study. These patients were recruited from three different hospitals: Hospital 1 contributed 177 patients for the training set, Hospital 2 provided 78 patients for the test set, and Hospital 3 provided 54 patients for the validation set. Independent predictors of VETC were identified through univariate and multivariate logistic analyses. These independent predictors were then used to construct a VETC prediction model for sHCC. The model's performance was evaluated using the area under the curve (AUC), calibration curve, and clinical decision curve. Additionally, Kaplan-Meier survival analysis was performed to confirm whether the predicted VETC status by the model is associated with early recurrence, just as it is with the actual VETC status and early recurrence. RESULTS: Alpha-fetoprotein_lg10, carbohydrate antigen 199, irregular shape, non-smooth margin, and arterial peritumoral enhancement were identified as independent predictors of VETC. The model incorporating these predictors demonstrated strong predictive performance. The AUC was 0.811 for the training set, 0.800 for the test set, and 0.791 for the validation set. The calibration curve indicated that the predicted probability was consistent with the actual VETC status in all three sets. Furthermore, the decision curve analysis demonstrated the clinical benefits of our model for patients with sHCC. Finally, early recurrence was more likely to occur in the VETC-positive group compared to the VETC-negative group, regardless of whether considering the actual or predicted VETC status. CONCLUSION: Our novel prediction model demonstrates strong performance in predicting VETC positivity in sHCC (≤ 3 cm) patients, and it holds potential for predicting early recurrence. This model equips clinicians with valuable information to make informed clinical treatment decisions.

Optimizing predictions: improved performance of preoperative gadobenate-enhanced MRI hepatobiliary phase features in predicting vessels encapsulating tumor clusters in hepatocellular carcinoma-a multicenter study.

BACKGROUND: Vessels Encapsulating Tumor Clusters (VETC) are now recognized as independent indicators of recurrence and overall survival in hepatocellular carcinoma (HCC) patients. However, there has been limited investigation into predicting the VETC pattern using hepatobiliary phase (HBP) features from preoperative gadobenate-enhanced MRI. METHODS: This study involved 252 HCC patients with confirmed VETC status from three different hospitals (Hospital 1: training set with 142 patients; Hospital 2: test set with 64 patients; Hospital 3: validation set with 46 patients). Independent predictive factors for VETC status were determined through univariate and multivariate logistic analyses. Subsequently, these factors were used to construct two distinct VETC prediction models. Model 1 included all independent predictive factors, while Model 2 excluded HBP features. The performance of both models was assessed using the Area Under the Curve (AUC), Decision Curve Analysis, and Calibration Curve. Prediction accuracy between the two models was compared using Net Reclassification Improvement (NRI) and Integrated Discriminant Improvement (IDI). RESULTS: CA199, IBIL, shape, peritumoral hyperintensity on HBP, and arterial peritumoral enhancement were independent predictors of VETC. Model 1 showed robust predictive performance, with AUCs of 0.836 (training), 0.811 (test), and 0.802 (validation). Model 2 exhibited moderate performance, with AUCs of 0.813, 0.773, and 0.783 in the respective sets. Calibration and decision curves for both models indicated consistent predictions between predicted and actual VETC, benefiting HCC patients. NRI showed Model 1 increased by 0.326, 0.389, and 0.478 in the training, test, and validation sets compared to Model 2. IDI indicated Model 1 increased by 0.036, 0.028, and 0.025 in the training, test, and validation sets compared to Model 2. CONCLUSION: HBP features from preoperative gadobenate-enhanced MRI can enhance the predictive performance of VETC in HCC.

Molecular dynamics simulations of the solubility and conformation change of chitosan grafted polyacrylamide: Impact of grafting rate.

Graft modification is an effective approach to improve the water solubility and molecular weight of chitosan. This work investigated the effect of grafting rate on water solubility of chitosan-grafted polyacrylamide (Chi-g-PAM) using molecular dynamics simulations. The intramolecular and intermolecular interaction between Chi-g-PAM with the grafting rate of 100%-250% and water together with the conformation change were analyzed by radial distribution function (RDF), radius of gyration, solvation free energy (ΔGSFE), mean square displacement, diffusion coefficient and shear viscosity. The results showed that the intramolecular hydrogen bonding of Chi-g-PAM was the dominant factor affecting its water solubility. While the grafting rate of Chi-g-PAM increased from 100% to 250%, the RDF of Chi-g-PAM decreased from 5.39 to 3.57 between O-H at 2.0 Å and 2.60 to 1.30 between N-H at 2.1 Å. The interaction between Chi-g-PAM and water increased with grafting rate as the absolute value of ΔGSFE for Chi-g-PAM increased from 432.917 kcal/mol to 858.749 kcal/mol. The solubility of Chi-g-PAM in acidic solution was much better than that of Chi-g-PAM in aqueous solution. Our work on the fundamental insights into the effect of grafted molecular structure of chitosan-based copolymer on its solubility will benefit the development of environmentally friendly chitosan-based flocculants.

Sorption enhancement of Cr(VI) from aqueous solution by polyaniline confined in three-dimensional network of composite porous hydrogel.

Hexavalent chromium Cr(VI) is a typical harmful pollutant, which is carcinogenic or mutagenic to aquatic animals and humans. In this study, sepiolite/humic acid/polyvinyl alcohol@ polyaniline (SC/HA/PVA@PANI) composite porous hydrogel adsorbent was synthesized by Pickering emulsion template in situ chemical oxidative polymerization for adsorption of Cr(VI) from aqueous solution. The in situ polymerization of aniline at the Pickering emulsion interface and the unique three-dimensional network structure of the hydrogel act as an effective "confinement" for the growth of the polymer. The porous structure of the material acts as a water channel, which effectively accelerates the binding of the adsorbate to the adsorption sites, and significantly improves the adsorption rate and adsorption capacity. The adsorption capacity of PANI for Cr(VI) confined in three-dimensional network of composite porous SC/HA/PVA@PANI hydrogel reached 1180.97 mg/g-PANI, which increased about 27-fold compared the adsorption capacity of pure PANI (43.48 mg/g). It is shown that the experimental design effectively avoids the agglomeration of PANI and improves its potential adsorption performance. In addition, the analysis of FESEM-EDX, FT-IR, and XPS spectra before and after adsorption confirmed that the main adsorption mechanisms of Cr(VI) on SC/HA/PVA@PANI included ion exchange, electrostatic attraction, and redox reaction. In conclusion, SC/HA/PVA@PANI has good stability and excellent adsorption performance, which is a new type of Cr(VI) ion adsorbent with great potential.

Circularly polarized near-infrared phosphorescence of chiral chromium(III) complexes.

Homoleptic Cr(III) complexes containing anionic tridentate 1,8-(bisoxazolyl)carbazolide ligands are phosphorescent in deaerated solutions with peak maxima in the range of 813-845 nm. The ligand carbon-centred chirality has been transferred to the helical chirality of the complexes and hence induced circularly polarized NIR-emissions with dissymmetry factor in the scale of 2.0 × 10-3.

Why breast cancer patients avoid communicating disease-related information to their dependent children: A qualitative study.

AIM AND OBJECTIVES: This qualitative study explores why breast cancer patients do not share disease-related information with their dependent children. BACKGROUND: 'Open' communication between breast cancer patients and their children is beneficial to both. However, some still try to avoid discussing their diagnosis and related information with their children. Some worries lie in communicating with dependent children, but the underlying cause remains unclear. DESIGN: Qualitative descriptive study. METHODS: Semi-structured interview was used in this study. Twenty breast cancer patients with children (aged 8-18 years) were recruited at two urban tertiary hospitals in mainland China. Qualitative content analysis was conducted to analyse and identify themes and subthemes. This study followed the COREQ checklist for qualitative studies. RESULTS: Three main themes were identified: (1) Uncertainty about the future: Their struggles with cancer remain a sensitive subject with their children. They described the uncertainty surrounding their disease prognosis and their children's response. They were also unsure whether, when and how to inform their children of their conditions; (2) Useless and risky for their children to know the truth: They considered it useless because their children can neither understand nor change the existing facts. They were concerned that it could affect their children's emotional state, character and academic performance; and (3) All for their children's sake: They were willing to take care of their affairs without troubling their dependent children as much as possible. CONCLUSION: Most mothers delayed communicating disease-related information to their dependent children. However, they often underestimated children's abilities and ignored their thoughts and wishes. Motherhood leads to avoidance and concealment in discussing health issues with their children. RELEVANCE TO CLINICAL PRACTICE: Mothers should try to understand their children's views towards cancer earlier. Healthcare professionals, especially nurses, should provide further consultation and intervention services to assist mothers and their children.

China's industrial green development and its influencing factors under the background of carbon neutrality.

To measure and analyze the evolution characteristics and influencing factors of China's industrial green development level is of great significance in achieving carbon neutrality goal. Based on the panel data from 2000 to 2018 of 30 provinces in China, this research uses the super slack-based measuring model and the Malmquist-Luenberger index to calculates China's industrial green total factor productivity and to describe its evolution characteristics using the kernel density function and moreover uses the Spatial Durbin model and the partial differential method to explores its main influencing factors. This study finds that China's overall industrial green development level is not high but shows an upward trend year by year; carbon emissions, fiscal decentralization, and urbanization are not conducive to improving the national industrial green development level, whereas economic development, foreign direct investment, industrial structure, and technological progress are positive contributors. At the same time, the level of economic development and technological progress have significant direct and spatial spillover effect. Our findings also provide some policy implications for improving China's industrial green development.

The energy gap law for NIR-phosphorescent Cr(III) complexes.

A series of homoleptic Cr(III) complexes containing substituted anionic 1,3-bis(pyridin-2-ylimino)isoindolin-2-ide ligands are phosphorescent with λmax in the 777-970 nm range in degassed fluid solutions. The energy gap law has been successfully applied to the doublet excited states of Cr(III) complexes.

Efficiency measurement and spatial spillover effect of provincial health systems in China: Based on the two-stage network DEA model.

The effectiveness of a health care system is an important factor for improving people's health and quality of life. The purpose of this research is to analyze the efficiency and spatial spillover effects of provincial health systems in China using panel data from 2009 to 2020. We employ the two-stage network DEA model to evaluate their efficiencies and use a spatial econometric model for empirical estimation. The results suggest that the overall efficiency, resource allocation efficiency, and service operation efficiency of health systems in different regions of China generally have fluctuating upward trends, with large differences in efficiency among the various regions. Further analysis reveals that the efficiency of China's health system has a significant spatial spillover effect. The level of economic development, fiscal decentralization and old-age dependency ratio are important factors affecting the health system efficiency. Our findings help to identify the efficiency and internal operating mechanisms of China's health system at different stages, and are expected to contribute to policymakers' efforts to build a high-quality health service system.

Effect of hospital-based case management on psychosocial wellbeing and treatment outcomes in colorectal cancer patients: A quasi-experimental study.

BACKGROUND: Case management has been regarded as the front line of necessary change for fragmented healthcare system. AIM: This study proposed a case management intervention that is suitable for Chinese colorectal cancer patients and explored its effectiveness over a 12-month follow-up. METHODS: A quasi-experimental study was conducted in an oncology hospital in China. A total of 188 patients were recruited from May 2015 to February 2017; 85 patients in the control group and 80 patients in the intervention group were included in data analysis. The intervention group was managed for 1 year by a case manager who organized the multidisciplinary team, provided regular assessment, a consulting service and referrals. Quality of life, anxiety and depression, symptom distress, treatment adherence and unplanned readmission rates were measured. RESULTS: Repeated measurement ANOVA showed significant intervention and time effects in global quality of life, anxiety and depression, symptom distress and oral chemotherapy adherence. The intervention group showed statistically significantly better overall treatment adherence and lower unplanned readmission rate. CONCLUSION: Nurse-led case management was effective in improving psychosocial outcomes, treatment adherence and unplanned readmission rate of colorectal cancer patients. A case management model is feasible and effective in colorectal cancer patients and in hospital-dominated healthcare systems where primary care is underutilized.

Factors associated with psychosocial adjustment in working-age colorectal cancer survivors: A cross-sectional study.

Objective: This study aimed to describe the level of psychosocial adjustment and identify factors associated with psychosocial adjustment in working-age colorectal cancer survivors. Methods: This cross-sectional study involved 212 colorectal cancer survivors visiting a cancer clinic at a specialized oncology hospital in China. Socio-demographic characteristics, disease-related characteristics, status of returning to work, Work Ability Index scores, M. D. Anderson Symptom Inventory for Gastrointestinal Cancer scores, and self-reported Psychological Adjustment to Illness Scale scores were collected from all participants. Data analyses included descriptive statistics, independent t-test, one-way analysis of variance, correlation analysis, and multiple linear regression analysis, which were performed using the Statistical Package for the Social Sciences version 25.0 (IBM Corporation, Armonk, NY, USA). Results: Participants reported a medium level of psychosocial maladjustment (35.73 â€‹± â€‹19.68), with 19.3% of participants experiencing severe maladjustment, 29.7% experiencing moderate maladjustment, and 50.9% experiencing mild maladjustment, respectively. Age, gender, marital status, having a child, education level, having a stoma, comorbidities, return to work, work ability, and symptom distress were entered into a multiple linear regression analysis. The strongest factor influencing the level of psychosocial adjustment was work ability (ߠ​= â€‹-0.393, P â€‹< â€‹0.001), followed by symptom distress (ߠ​= â€‹0.380, P â€‹< â€‹0.001) and an education level of college or above (ߠ​= â€‹0.150, P â€‹= â€‹0.027). These variables accounted for 46.1% of the variance in psychosocial adjustment. Conclusions: Colorectal cancer survivors with low work ability, high symptom distress, and an education level of college or above are at a high risk for psychosocial maladjustment. Nursing interventions for psychosocial adjustment should attach increased importance to the work status and symptom distress of colorectal cancer survivors.

Spatial and Temporal Differences in the Health Expenditure Efficiency of China: Reflections Based on the Background of the COVID-19 Pandemic.

The outbreak of the COVID-19 pandemic has brought several challenges to China's national health services, causing great risks and uncertainties to people's lives. Considering China's huge population and relatively small medical investment and its good performance in the COVID-19 pandemic, this research utilizes the hybrid meta-frontier model to analyze health expenditure efficiencies of 30 provinces in China from 1999 to 2018 and compares spatial and temporal differences of the efficiencies in regards to regional forward position and national common frontier. The results show an obvious difference in health expenditure efficiency in different provinces along the regional frontier, in which the efficiency gap in the eastern region is the largest. Moreover, the room for improvement in health expenditure efficiency varies from region to region. For the national common frontier, Beijing is the most efficient, while Guizhou is the least. The eastern region owns the most efficient technical level of health expenditure efficiency, and there is a large efficiency distance between it and the western region. The findings offer effective guidance for elevating the expenditure structure and spatial resource allocation of public health and for promoting the equalization of high quality basic medical services.

Psychometric properties of a simplified Chinese version of the cancer predisposition perception scale.

Objective: Cancer predisposition perception refers to the subjective estimation of the likelihood of being diagnosed with cancer in the future. It affects people's behavior concerning cancer screening and prevention. At present, there is no available tool to evaluate cancer predisposition perception. The aim of this study was to translate the cancer predisposition perception scale into simplified Chinese (C-CPPS), and then test its psychometric properties among Chinese patients. Methods: In phase I, the CPPS was translated into Chinese, and validated by an expert panel. In phase II, data on reliability and validity was evaluated in terms of construct validity, criterion validity, internal consistency, test-retest reliability, and item-total correlations, with a convenience sample of 208 patients recruited from the colorectal cancer surgical ward. Results: The C-CPPS had desirable validity and reliability. The scale-level content validity index was 0.96. Exploratory factor analysis indicated that the six-factor structure of the C-CPPS was good fit to the data. Correlation between the C-CPPS and the Brief Illness Perception Questionnaire was statistically significant. Cronbach's α for the entire scale was 0.90 and 0.71-0.95 for five of the six subscales. Item-total correlations ranged from 0.309 to 0.775, and the intraclass correlation coefficient was 0.97. Conclusions: The C-CPPS appears to be culturally appropriate, reliable, and valid for assessing cancer predisposition perception among patients with colorectal cancer in China.

Capital misallocation, technological innovation, and green development efficiency: empirical analysis based on China provincial panel data.

The study aims to analyze the impacts of capital misallocation and technological innovation on green development efficiency in China by using the panel data from 2000 to 2018. We employ the Super-SBM model to evaluate green development efficiency and use the system generalized method of moments (GMM) for empirical estimation. The results suggest that capital misallocation has a significant inhibitory effect on green development efficiency. Moreover, capital misallocation restrains technological innovation, which plays an important role in improving green development efficiency. Further research on the effect of regional heterogeneity indicates that the negative impact of capital misallocation on green development efficiency is more significant in the central and western regions, while the effect is not significant in the eastern region. Our findings provide useful policy implications for improving green development efficiency in China.

Obstacles to access to community care in urban senior-only households: a qualitative study.

BACKGROUND: The increased number of older adults living alone has created a substantial care need. However, the utilization rate of services and facilities to meet these needs are surprisingly low. Many of older adults experience difficulties accessing these services, although it remains unclear how these obstacles impede access to services. This study explored the obstacles and difficulties experienced by urban older adults in seeking community care. METHODS: A phenomenological study was carried out and participatory observation and in-depth interviews were employed to investigate the process of seeking care of older adults in urban communities. A total of 18 urban community-dwelling older adults aged 75 years and over were included. Data collected were analysed by content analysis. RESULTS: We identified the pathways by which senior-only households sought community care and encountered obstacles. (1) lack of community care information: older adults did not know where and how to get services, even though the care institutions scattered throughout the community; (2) limited mobility: older adults often suffered from various chronic diseases, which physically hindered their access to care resources; (3) complex process of achieving care: the functional fragmentation and geographical dispersion of care institutions made the care-seeking process challenging and confusing for older adults; (4) incomprehension of needs expression: limited interaction time and communication barriers between staff of institutions and the older adults were the final obstacle. Only by surmounting these obstacles one by one can older adults access the care resources effectively. CONCLUSIONS: When older adults in the community initiated calls for help, they encountered several obstacles. Their physiological and social disadvantages limited their ability to seek care physically. Lack of integration and clear guidance in the process of providing community care exacerbated these difficulties. Reform of care services should focus on the visibility and accessibility of services for older adults.

Intelligent colorimetric film incorporated with anthocyanins-loaded ovalbumin-propylene glycol alginate nanocomplexes as a stable pH indicator of monitoring pork freshness.

Protein-polysaccharide nanocomplexes system could improve the low stability of ACNs, making ACNs become a potential and stable pH indicator. In this study, intelligent colorimetric film was designed to monitor pork freshness by incorporating ACNs-loaded ovalbumin-propylene glycol alginate nanocomplexes (ACNs-loaded OVA-PGA) into polyvinyl alcohol/ glycerol (PG) matrix. The intelligent film (PG/ACNs-loaded OVA-PGA film) presented well barrier performance (lower water vapor permeability and light transmittance at 200-600 nm). Fourier transform infrared spectroscopy further confirmed the hydrogen bonds among film-forming components. Moreover, Scanning electron microscope and X-ray diffraction showed that ACNs-loaded OVA-PGA was uniformly distributed in film matrix but decreased the crystallinity of polyvinyl alcohol. PG/ACNs-loaded OVA-PGA film had distinguishable colorimetric response to pH 2.0-11.0 buffers and volatile ammonia. In the test, PG/ACNs-loaded OVA-PGA film displayed visible color alterations from purplish-red to dark-blue as pork freshness decreased, suggesting it can be used in intelligent packaging for real-time monitoring freshness of meat products.

Adsorption and interaction mechanisms of Chi-g-P(AM-DMDAAC) assisted settling of kaolinite in a two-step flocculation process.

Flocculation has been widely employed in treatment of mineral tailings and water management. In this study, a chitosan-graft-poly(acrylamide-dimethyl diallyl ammonium chloride) (Chi-g-P(AM-DMDAAC)) was synthesized in-house. The adsorption and interaction mechanisms of Chi-g-P(AM-DMDAAC) and an anionic polyacrylamide (APAM) in a two-step flocculation process of kaolinite were explored using settlement tests, zeta potential measurement, quartz crystal micro-balance with dissipation (QCM-D) and atomic force microscopy (AFM) technique. The type of primary flocculant was critical for the two-step flocculation process. The treatment of the kaolinite suspension using 1 mg/L of Chi-g-P(AM-DMDAAC) followed by adding 2 mg/L of APAM displayed more efficient flocculation performance. QCM-D results showed that three dissipative layers were assembled on model kaolinite surface after sequentially injecting 3.5 mg/L of Chi-g-P(AM-DMDAAC), 0.05 wt% kaolinite suspension and 2.5 mg/L of APAM. The above total adsorption amount (Δf of -64.9 Hz) was much higher than that of using the two flocculants in reverse order (Δf of -23.1 Hz). This result indicated that the adsorption layer of the positively charged Chi-g-P(AM-DMDAAC) on kaolinite surface provided active adsorption sites for APAM. Further AFM measurement confirmed that the average adhesion between the silicon tip adsorbed Chi-g-P(AM-DMDAAC) and model kaolinite surface in 2.5 mg/L APAM solution increased from 0.25 ± 0.1 nN to 4.2 ± 0.3 nN with the effective interaction range of 700 nm, which was stronger than that measured between a bare silicon tip and silica substrate in single-component-flocculant solutions. The highly efficient two-step flocculation process could be ascribed to the strong electrostatic attraction between the kaolinite and the oppositely charged Chi-g-P(AM-DMDAAC) and APAM. Findings in this study will benefit the development of environmentally friendly flocculant for mineral tailings and water treatment.

Nucleus accumbens shell modulates seizure propagation in a mouse temporal lobe epilepsy model.

Temporal lobe epilepsy (TLE) is the most common form of epilepsy with focal seizures which in some conditions can develop into secondarily generalized tonic-clonic seizures by the propagation of epileptic activities in the temporal lobe to other brain areas. The nucleus accumbens (NAc) has been suggested as a treatment target for TLE as accumulating evidence indicates that the NAc, especially its shell, participates in the process of epileptic seizures of patients and animal models with TLE. The majority of neurons in the NAc are GABAergic medium spiny neurons (MSNs) expressing dopamine receptor D1 (D1R) or dopamine receptor D2 (D2R). However, the direct evidence of the NAc shell participating in the propagation of TLE seizures is missing, and its cell type-specific modulatory roles in TLE seizures are unknown. In this study, we microinjected kainic acid into basolateral amygdala (BLA) to make a mouse model of TLE with initial focal seizures and secondarily generalized seizures (SGSs). We found that TLE seizures caused robust c-fos expression in the NAc shell and increased neuronal excitability of D1R-expressing MSN (D1R-MSN) and D2R-expressing MSN (D2R-MSN). Pharmacological inhibition of the NAc shell alleviated TLE seizures by reducing the number of SGSs and seizure stages. Cell-type-specific chemogenetic inhibition of either D1R-MSN or D2R-MSN showed similar effects with pharmacological inhibition of the NAc shell. Both pharmacological and cell-type-specific chemogenetic inhibition of the NAc shell did not alter the onset time of focal seizures. Collectively, these findings indicate that the NAc shell and its D1R-MSN or D2R-MSN mainly participate in the propagation and generalization of the TLE seizures.