Sentinel lymph node identification using NIR-II ultrabright Raman nanotags on preclinical models.

Surface-enhanced Raman spectroscopy (SERS) nanotags have garnered much attention as promising bioimaging contrast agent with ultrahigh sensitivity, but their clinical translation faces challenges including biological and laser safety. As breast sentinel lymph node (SLN) imaging agents, SERS nanotags used by local injection and only accumulation in SLNs, which were removed during surgery, greatly reduce biological safety concerns. But their clinical translation lacks pilot demonstration on large animals close to humans. The laser safety requires irradiance below the maximum permissible exposure threshold, which is currently not achievable in most SERS applications. Here we report the invention of the core-shell SERS nanotags with ultrahigh brightness (1 pM limit of detection) at the second near-infrared (NIR-II) window for SLN identification on pre-clinical animal models including rabbits and non-human primate. We for the first time realize the intraoperative SERS-guided SLN navigation under a clinically safe laser (1.73 J/cm2) and identify multiple axillary SLNs on a non-human primate. No evidence of biosafety issues was observed in systematic examinations of these nanotags. Our study unveils the potential of NIR-II SERS nanotags as appropriate SLN tracers, making significant advances toward the accurate positioning of lesions using the SERS-based tracer technique.

Direct Oral Anticoagulant Use Early After Cardiac Surgery: A Retrospective Cohort Study.

Background: There is limited literature guiding the prescribing of direct oral anticoagulants (DOACs) early after cardiac surgery as this population has been excluded from landmark randomized controlled trials. This study aims to determine the rate of in-hospital DOAC use compared with warfarin early after cardiac surgery, evaluate factors associated with DOAC use, determine difference in postoperative length of stay, and characterize bleeding events. Methods: A retrospective cohort study was conducted in adult patients with indications for anticoagulation and receiving either a DOAC or warfarin after cardiac surgery during their index hospitalization. Patients were excluded if they had any contraindications to DOAC use. The primary outcome was the proportion of patients discharged on a DOAC compared with warfarin. Results: Of included 210 patients, 30% received DOACs and 70% received warfarin on discharge. The most common DOAC used was apixaban (74.6%), and median postoperative day of initiation was 5 days. Patients receiving DOACs were older (70.8 vs 68.0 years), had less valvular heart disease (38.1% vs 63.9%), were more likely to be on DOACs preoperatively (50.8% vs 31.3%), and were more likely to have undergone coronary artery bypass graft alone (54.0% vs 24.5%) compared with those on warfarin. Postoperative length of stay (7 vs 9 days; P = 0.59) and in-hospital bleeding (1.6% vs 2.0%; P = 1.00) did not differ between DOAC and warfarin groups. Conclusions: At a quaternary referral centre for cardiac surgery, DOACs were used in approximately one-third of patients with an indication for anticoagulation early after cardiac surgery.

Introduction: Il existe peu de documentation sur la prescription des anticoagulants oraux directs (AOC) peu de temps après la chirurgie cardiaque puisque cette population a été exclue des essais cliniques novateurs à répartition aléatoire. La présente étude vise à déterminer le taux d'utilisation des AOC à l'hôpital par rapport au taux d'utilisation de la warfarine peu de temps après la chirurgie cardiaque, à évaluer les facteurs associés à l'utilisation des AOC, à déterminer l'écart de la durée du séjour et à caractériser les événements hémorragiques. Méthodes: Nous avons réalisé une étude de cohorte rétrospective auprès de patients adultes qui avaient des indications d'anticoagulation et qui recevaient des AOC ou de la warfarine après la chirurgie cardiaque durant l'hospitalisation de référence. Les patients étaient exclus s'ils avaient des contre-indications à l'utilisation des AOC. Le critère d'évaluation principal était la proportion de patients sortis de l'hôpital sous AOC par rapport à celle des patients sortis de l'hôpital sous warfarine. Résultats: Parmi les 210 patients inclus, 30 % ont reçu des AOC et 70 % ont reçu de la warfarine à la sortie de l'hôpital. L'AOC le plus fréquemment utilisé était l'apixaban (74,6 %), et le nombre médian de jours après l'intervention chirurgicale du début du traitement était 5 jours. Les patients qui recevaient les AOC étaient plus âgés (70,8 vs 68,0 ans), avaient moins de cardiopathies valvulaires (38,1 % vs 63,9 %), étaient plus susceptibles de recevoir des AOC avant l'opération (50,8 % vs 31,3 %) et étaient plus susceptibles d'avoir seulement subi un pontage aorto-coronarien (54,0 % vs 24,5 %) que ceux sous warfarine. La durée du séjour postopératoire (7 vs 9 jours ; P = 0,59) et les événements hémorragiques à l'hôpital (1,6 % vs 2,0 % ; P = 1,00) ne différaient pas entre les groupes qui recevaient les AOC et les groupes qui recevaient la warfarine. Conclusions: Dans un centre d'aiguillage de soins quaternaires en chirurgie cardiaque, les AOC ont été utilisés chez environ un tiers des patients qui avaient une indication d'anticoagulation peu de temps après la chirurgie cardiaque.

Processing to improve the sustainability of chickpea as a functional food ingredient.

Chickpea is a field crop that is playing an emerging role in the provision of healthy and sustainable plant-based value-added ingredients for the food and nutraceutical industries. This paper reviews the characteristics of chickpea (composition, health properties and techno-functionality) of the chickpea grain which influence its use as a whole food or an ingredient in formulated food. It covers the exploitation of traditional and emerging food processes for conversion of chickpea into value-added differentiated food ingredients. The influence of processing on composition, health promoting properties and techno-functionality of chickpea are discussed. The opportunities for tailoring chickpea ingredients to facilitate their incorporation in traditional food applications and in the expanding plant-based meat alternative and dairy alternative markets are highlighted. The review includes an assessment of the possible uses of byproducts of chickpea processing, which is necessary for building a more sustainable future for chickpea. Recommendations for future research to build a sustainable chickpea value-added ingredient industry are provided. This article is protected by copyright. All rights reserved.

Antecedents and outcomes of cyberbullying among Chinese university students: verification of a behavioral pathway model.

Introduction: Cyberbullying is a commonly-seen and hotly-debated social topic around the globe. This negative behavior is the source of many disastrous events, and so leading government bodies, organizations, schools and social communities attach great importance to addressing this topic. However, there is still much work to do in order to be clear about the causes of cyberbullying. Methods: The previous research cases were mostly viewed from the victims' perspectives; however, there is no comprehensive understanding of the perpetrators' viewpoints. Therefore, based on Social Cognitive Theory (SCT) and analysis of discussion in the literature, the following six variables were chosen as the focus of this study: overconfidence, excessive moral sense, cyberbullying, perceived value, happiness, and continued cyberbullying intention. This study established a research model of continued cyberbullying intention, which was verified by Structural Equation Modeling. In order to achieve the aims of the study, Chinese university students with an average age of 20.29 (SD = 1.43) were recruited as participants, from whom 1,048 valid questionnaires were collected. Results: The research results are as follows: 1. Overconfidence and excessive moral sense positively predicted cyberbullying behaviors; 2. Overconfidence positively predicted excessive moral sense; 3. Cyberbullying positively predicted perceived value and sense of happiness; and 4. Perceived value and sense of happiness positively predicted continued cyberbullying intentions. Conclusion: Students' biased self-perception significantly predicts their cyberbullying behaviors and continued cyberbullying intention. What is more, it is interesting to learn that perpetrators will continue to exhibit cyberbullying behaviors when they believe that what they do (cyberbullying) is valuable or allows them to experience positive feelings; this requires our attention.

Digital colloid-enhanced Raman spectroscopy by single-molecule counting.

Quantitative detection of various molecules at very low concentrations in complex mixtures has been the main objective in many fields of science and engineering, from the detection of cancer-causing mutagens and early disease markers to environmental pollutants and bioterror agents1-5. Moreover, technologies that can detect these analytes without external labels or modifications are extremely valuable and often preferred6. In this regard, surface-enhanced Raman spectroscopy can detect molecular species in complex mixtures on the basis only of their intrinsic and unique vibrational signatures7. However, the development of surface-enhanced Raman spectroscopy for this purpose has been challenging so far because of uncontrollable signal heterogeneity and poor reproducibility at low analyte concentrations8. Here, as a proof of concept, we show that, using digital (nano)colloid-enhanced Raman spectroscopy, reproducible quantification of a broad range of target molecules at very low concentrations can be routinely achieved with single-molecule counting, limited only by the Poisson noise of the measurement process. As metallic colloidal nanoparticles that enhance these vibrational signatures, including hydroxylamine-reduced-silver colloids, can be fabricated at large scale under routine conditions, we anticipate that digital (nano)colloid-enhanced Raman spectroscopy will become the technology of choice for the reliable and ultrasensitive detection of various analytes, including those of great importance for human health.

Effect of astrocyte GPER on the optic nerve inflammatory response following optic nerve injury in mice.

Activated astrocytes are a primary source of inflammatory factors following traumatic optic neuropathy (TON). Accumulation of inflammatory factors in this context leads to increased axonal damage and loss of retinal ganglion cells (RGCs). Therefore, in the present study, we explored the role of the astrocyte G protein-coupled estrogen receptor (GPER) in regulating inflammatory factors following optic nerve crush (ONC), and analyzed its potential regulatory mechanisms. Overall, our results showed that GPER was abundantly expressed in the optic nerve, and co-localized with glial fibrillary acidic proteins (GFAP). Exogenous administration of G-1 led to a significant reduction in astrocyte activation and expression of inflammation-related factors (including IL-1ß, TNF-α, NFκB, and p-NFκB). Additionally, it dramatically increased the survival of RGCs. In contrast, astrocytes were activated to a greater extent by exogenous G15 administration; however, RGCs survival was significantly reduced. In vitro, GPER activation significantly reduced astrocyte activation and the release of inflammation-related factors. In conclusion, activation of astrocyte GPER significantly reduced ONC inflammation levels, and should be explored as a potential target pathway for protecting the optic nerve and RGCs after TON.

A global meta-analysis on the effects of organic and inorganic fertilization on grasslands and croplands.

A central role for nature-based solution is to identify optimal management practices to address environmental challenges, including carbon sequestration and biodiversity conservation. Inorganic fertilization increases plant aboveground biomass but often causes a tradeoff with plant diversity loss. It remains unclear, however, whether organic fertilization, as a potential nature-based solution, could alter this tradeoff by increasing aboveground biomass without plant diversity loss. Here we compile data from 537 experiments on organic and inorganic fertilization across grasslands and croplands worldwide to evaluate the responses of aboveground biomass, plant diversity, and soil organic carbon (SOC). Both organic and inorganic fertilization increase aboveground biomass by 56% and 42% relative to ambient, respectively. However, only inorganic fertilization decreases plant diversity, while organic fertilization increases plant diversity in grasslands with greater soil water content. Moreover, organic fertilization increases SOC in grasslands by 19% and 15% relative to ambient and inorganic fertilization, respectively. The positive effect of organic fertilization on SOC increases with increasing mean annual temperature in grasslands, a pattern not observed in croplands. Collectively, our findings highlight organic fertilization as a potential nature-based solution that can increase two ecosystem services of grasslands, forage production, and soil carbon storage, without a tradeoff in plant diversity loss.

A social network analysis of college students' online learning during the epidemic era: A triadic reciprocal determinism perspective.

The way in which college students learn online has dramatically altered due to the COVID-19 pandemic. Using the triadic reciprocal determinism (TRD) theory, this study aimed to identify the key factors influencing college students' online learning experience through sentiment analysis, text mining, and social network analysis (SNA). Macro- and micro-level parsing was conducted on the SNA model, which was divided into core, mantle, and shell layers to determine the most influential factors in the core layer. This study found that learners' personal factors, learning behaviors, and related elements in the online learning environment significantly influenced the learning outcomes of college students enrolled in online courses. Additionally, this study explored the distribution of SNA model elements in the mantle and peripheral shell layers, which also impact the online learning experience of college students. Overall, this study provides a comprehensive overview of the various factors affecting college students' online learning experience, and highlights the importance of considering these factors when designing online learning environments for college students.

Multi-path Fusion in SFCF-Net for Enhanced Multi-frequency Electrical Impedance Tomography.

Multi-frequency electrical impedance tomography (mfEIT) offers a nondestructive imaging technology that reconstructs the distribution of electrical characteristics within a subject based on the impedance spectral differences among biological tissues. However, the technology faces challenges in imaging multi-class lesion targets when the conductivity of background tissues is frequency-dependent. To address these issues, we propose a spatial-frequency cross-fusion network (SFCF-Net) imaging algorithm, built on a multi-path fusion structure. This algorithm uses multi-path structures and hyper-dense connections to capture both spatial and frequency correlations between multi-frequency conductivity images, which achieves differential imaging for lesion targets of multiple categories through cross-fusion of information. According to both simulation and physical experiment results, the proposed SFCF-Net algorithm shows an excellent performance in terms of lesion imaging and category discrimination compared to the weighted frequency-difference, U-Net, and MMV-Net algorithms. The proposed algorithm enhances the ability of mfEIT to simultaneously obtain both structural and spectral information from the tissue being examined and improves the accuracy and reliability of mfEIT, opening new avenues for its application in clinical diagnostics and treatment monitoring.

Spatial heterogeneity of neo- and paleo-endemism for plants in Madagascar.

Madagascar is a biogeographically unique island with a remarkably high level of endemism. However, endemic taxa in Madagascar are massively threatened due to unprecedented pressures from anthropogenic habitat modification and climate change. A comprehensive phylogeny-based biodiversity evaluation of the island remains lacking. Here, we identify hotspots of taxonomic and phylogenetic plant diversity and neo- and paleo-endemism by generating a novel dated tree of life for the island. The tree is based on unprecedented sampling of 3,950 species (33% of the total known species) and 1,621 genera (93% of the total known genera and 69% of endemic genera) of Malagasy vascular plants. We find that island-endemic genera are concentrated in multiple lineages combining high taxonomic and phylogenetic diversity. Integrating phylogenetic and geographic distribution data, our results reveal that taxon richness and endemism are concentrated in the northern, eastern, and southeastern humid forests. Paleo-endemism centers are concentrated in humid eastern and central regions, whereas neo-endemism centers are concentrated in the dry and spiny forests in western and southern Madagascar. Our statistical analysis of endemic genera in each vegetation region supports a higher proportion of ancient endemic genera in the east but a higher proportion of recent endemic genera in the south and west. Overlaying centers of phylogenetic endemism with protected areas, we identify conservation gaps concentrated in western and southern Madagascar. These gaps should be incorporated into conservation strategies to aid the protection of multiple facets of biodiversity and their benefits to the Malagasy people.

The HMGB1-RAGE axis in nucleus accumbens facilitates cocaine-induced conditioned place preference via modulating microglial activation.

INTRODUCTION: Repeated exposure to cocaine induces microglial activation. Cocaine exposure also induces a release of high mobility group box-1 (HMGB1) from neurons into the extracellular space in the nucleus accumbens (NAc). HMGB1 is an important late inflammatory mediator of microglial activation. However, whether the secretion of HMGB1 acts on microglia or contributes to cocaine addiction is largely unknown. METHODS: Rats were trained by intraperitoneal cocaine administration and cocaine-induced conditioned place preference (CPP). Expression of HMGB1 was regulated by viral vectors. Activation of microglia was inhibited by minocycline. Interaction of HMGB1 and the receptor for advanced glycation end products (RAGE) was disrupted by peptide. RESULTS: Cocaine injection facilitated HMGB1 signaling, together with the delayed activation of microglia concurrently in the NAc. Furthermore, the inhibition of HMGB1 or microglia activation attenuated cocaine-induced CPP. Box A, a specific antagonist to interrupt the interaction of HMGB1 and RAGE, abolished the expression of cocaine reward memory. Meanwhile, the inhibition of HMGB1-RAGE interaction suppressed cocaine-induced microglial activation, as well as the consolidation of cocaine-induced memory. CONCLUSION: All above results suggest that the neural HMGB1 induces activation of microglia through RAGE, which contributes to the consolidation of cocaine reward memory. These findings offer HMGB1-RAGE axis as a new target for the treatment of drug addiction.

Atropisomeric Carboxylic Acids Synthesis via Nickel-Catalyzed Enantioconvergent Carboxylation of Aza-Biaryl Triflates with CO2.

Upgrading CO2 to value-added chiral molecules via catalytic asymmetric C-C bond formation is a highly important yet challenging task. Although great progress on the formation of centrally chiral carboxylic acids has been achieved, catalytic construction of axially chiral carboxylic acids with CO2 has never been reported to date. Herein, we report the first catalytic asymmetric synthesis of axially chiral carboxylic acids with CO2, which is enabled by nickel-catalyzed dynamic kinetic asymmetric reductive carboxylation of racemic aza-biaryl triflates. A variety of important axially chiral carboxylic acids, which are valuable but difficult to obtain via catalysis, are generated in an enantioconvergent version. This new methodology features good functional group tolerance, easy to scale-up, facile transformation and avoids cumbersome steps, handling organometallic reagents and using stoichiometric chiral materials. Mechanistic investigations indicate a dynamic kinetic asymmetric transformation process induced by chiral nickel catalysis.

A rare Ewing-like small round cell tumor in prostate: a case report and literature review.

BACKGROUND: Small round cell tumor (SRCT) is a group of malignancy with similar optical microscopic morphology. Despite its low incidence, SRCT has a high malignant degree and poor prognosis. Besides, atypical clinical symptoms make it difficult in preoperative diagnosis. CASE REPORT: A 67-year-old man was presented to the outpatient service with dysuria and weak urine stream lasting for 3 months. After oral treatment with tamsulosin and finasteride for 2 months, the symptoms worsen. Transurethral prostate holmium laser enucleation was operated and postoperative pathology result revealed small blue round cell malignant tumor. Further immunohistochemistry and fluorescence in situ hybridization examination indicated Ewing-like SRCT. So a Da Vinci Robotic prostatectomy was performed further and whole-genome sequencing was conducted. Several gene mutations including RAF1, ARID1A, SMARCA4, and BCL2L11 were found but no FDA-approved drug could treat specifically. Then the patient received Ewing-type therapeutic regimens treatment and has been followed up to date (over 24 months). CONCLUSION: Because of its non-elevated serum PSA level, prostate SRCT is often ignored as a possibility of malignant tumor and regarded as benign prostatic hyperplasia (BPH). The possibility of prostate SRCT need to be considered if dysuria symptoms could not alleviate significantly after a period of oral treatment.

What do they Need?-The academic counseling needs of students majoring in art and design in a higher vocational college in China.

Students in higher vocational education are always encountering various challenges. The way they attempt to conquer these challenges influences their success in achieving their academic goals. With the development of the times, the needs of students in China's vocational colleges to cope with challenges are also changing. In order to understand the changing needs of these students to cope with the challenges, based on Trautwein and Bosse's academic counseling demand model and Knowles's demand theory, this study adopted semi-structured interviews, key event collection methods, and purposive sampling to select 12 students of different grades majoring in art and design in a higher vocational college in Guangzhou, China. With reference to related studies on the key academic needs of students, interview outlines were designed, interviews were conducted, and coding and analysis were performed. Students' experiences were categorized according to learning-related, individual, organization, and social constructs. The study results showed that the academic counseling needs of China's higher vocational art and design students mainly focused on the learning-related construct, such as understanding the courses and course systems they were majoring in, setting and realizing academic goals, coping with setbacks, pressure and other students' comprehensive evaluation. This was followed by dealing with personal and financial issues, building social circles and peer relationships, and so on. Therefore, for students to overcome challenges and achieve academic goals, it is helpful to strengthen the collaboration between professional teachers and counselors, the influence of peers, the focus on academic consulting work related to learning, and to explore and carry out guidance on students' individual needs in higher vocational colleges.

Using self-reported sexual positioning as an indicator for rectal chlamydia and gonorrhea screening among men who have sex with men in China: a missed opportunity.

BACKGROUND: Rectal chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) are escalating public health concerns. This study aimed to explore (1) the reliability of self-reported sexual positioning as an indicator for rectal CT and NG screening; and (2) factors associated with rectal CT and NG infections in Shenzhen, China. METHODS: A cross-sectional study was conducted in two settings in Shenzhen, China, from 1st April 2021 to 31st March 2022. Data on sociodemographic characteristics, sexual behaviors, and basic CT knowledge was collected. Urine and self-collected rectal swabs were collected for CT and NG testing. RESULTS: In total, 195 MSM participated in the study, and 5.1% tested positive for urogenital CT, 29.2% for rectal CT, 1.0% for urogenital NG, and 8.2% for rectal NG. Among those who reported exclusively insertive anal sex, 69.2% of CT infections and 85.7% of NG infections would have remained undetected with urine testing alone. Risk factors for rectal CT infection included engaging in both insertive and receptive anal sex, with a significant association found for co-infection with rectal NG. CONCLUSIONS: Self-reported sexual positioning was found to be an unreliable indicator for CT and NG screening, as a substantial proportion of infections would have remained undetected. The findings suggest that CT and NG screening in China should be offered to all MSM regardless of self-reported sexual positioning, and that the dual CT/NG testing is recommended.

Role of tea polyphenols in enhancing the performance, sustainability, and catalytic cleaning capability of membrane separation for water-soluble pollutant removal.

Tea polyphenols (TPs), like green tea polyphenol (GTP) and black tea polyphenol (BTP), with phenolic hydroxyl structures, form coordination and hydrogen bonds, making them effective for bridging inorganic catalysts and membranes. Here, TPs were employed as interface agents for the preparation of TPs-modified needle-clustered NiCo-layered double hydroxide/graphene oxide membranes (NiCo-LDH-TPs/GO). The incorporation of porous guest material, NiCo-LDH-TPs, facilitated water channel expansion, enhancing membrane permeability and resulting in the development of high-performance, sustainable catalytic cleaning membranes. The introduction of TPs through coordination weakened the surface electronegativity of NiCo-LDH, promoting a uniform mixed dispersion with GO and facilitating membrane self-assembly. NiCo-LDH-GTP/GO-5 and NiCo-LDH-BTP/GO-5 membranes demonstrated permeances of 85.98 and 90.76 L m-2 h-1 bar-1, respectively, with rejections of 98.73% and 99.54% for methylene blue (MB). Notably, the NiCo-LDH-BTP/GO-5 membrane maintained a high rejection of 97.11% even after 18 cycles in the catalytic cleaning process. Furthermore, the modification of GTP and BTP enhanced MB degradation through PMS activation, resulting in a 0.33% and 0.35% increase in the reaction rate constants of NiCo-LDH, respectively, while reducing metal ion spillover. These findings highlighted the potential of TPs in enhancing the efficiency and sustainability of catalytic cleaning GO membranes for water purification and separation processes.

The Causes, Counseling, and Prevention Strategies for Maladaptive and Deviant Behaviors in Schools.

Governments, organizations, and schools around the world are committed to creating a safe and friendly campus environment to ensure students' high-quality comprehensive development and to cultivate positive mental and physical health states [...].

A study on Taiwan's vocational senior high school teachers' teaching identity and teaching transformation when facing a new competency-based curriculum.

Introduction: The competency of education is advocated in the 2023 United Nations Sustainable Development Goals. UNESCO encourages countries to provide inclusive, equitable, competency education and lifelong learning opportunities for all. Starting from 2019, 12-Year-Basic-Education, a new curriculum, was fully implemented in Taiwan to conform to the competency education strategy. For the teachers on site, teachers' understanding of the new curriculum and teaching practice has a direct impact on the competency of the implementation of this new policy. The main purpose of this study was to explore the relationship between vocational senior high school teachers' competency-oriented teaching, teaching identity and teaching transformation regarding this new curriculum. Methods: In order to effectively expand teachers' understanding of competency-oriented teaching identity, this study put forward 6 hypothetical approaches based on the implicit theory of teaching transformation. The 747 valid questionnaires accounted for 97.1% of the total recovered questionnaires. The reliability and validity analyses, as well as overall model fitting analysis and research model validation were performed on these valid questionnaires. Results: The results of the study showed: (1) With the background of Competency-oriented teaching, teachers' teaching attitude and teaching willingness has a positive impact on teaching identity; (2) teachers' teaching identity has a positive impact on teaching preparation, teaching practice, further study, three types of teaching transformation. In summary, three conclusions from this study were concluded on the aspects of teaching preparation, teaching practice and further study on practical competency-oriented teaching, teaching identity and teaching transformation in the educational field. Conclusion: Three conclusions were derived for the relationships among these six constructs: (1) Teachers with a "good attitude" and "strong willingness" to teach, a "high sense of identification" acceptance and full implement of "teaching preparation" are considered as teachers with a "foresight and a visionary predictive style"; (2) Teachers with a high sense of self-awareness who can fully practice "teaching practice" are teachers with a "pragmatic teaching by example style"; (3) Teachers with a "good attitude," a "strong willingness" to teach, a "high sense of identification" acceptance and who are able to fully practice "advanced research" are considered as teachers with an "empowerment-enhancing coaching style".

Long-term outcome of isolated mitral valve repair versus replacement for degenerative mitral regurgitation in propensity-matched patients.

Objective: This study was performed to investigate the long-term outcomes in patients with degenerative mitral regurgitation (MR) undergoing mitral valve repair (MVr) versus mitral valve replacement (MVR) without concomitant surgeries. Methods: The study cohort comprised 1493 patients with degenerative MR who were treated with isolated mitral valve surgery between January 2000 and December 2017 in a large multicenter (5 hospitals) registry of the Province of British Columbia, Canada, including 991 with repair and 502 with replacement. A propensity-matched comparison and risk-adjusted model were used to analyze the outcomes. Results: After propensity matching (415 matched pairs), the 30-day mortalities were 2.4% and 3.6% in the MVr and MVR groups respectively (odds ratio [OR], 1.500; 95% confidence interval [CI], 0.674-3.339; P = .32). The MVR group had significantly greater rates of prolonged inotrope usage >24 hours (P = .024), prolonged ventilation (P = .039), and blood transfusion (P = .023). The respective 1-, 5-, 10-, and 15-year survival rates were 95.7%, 88.8%, 71.4%, and 53.3% in the MVr group, and 93.0%, 81.6%, 61.3%, and 46.0% in the MVR group (hazard ratio [HR], 1.355; 95% CI, 1.105-1.661; P = .004). A multivariable analysis revealed that MVR was an independent risk factor for 30-day mortality (OR, 2.270; 95% CI, 1.089-4.732; P = .029) and long-term mortality (HR, 1.417; 95% CI, 1.161-1.729; P < .001). The HR of MVR over MVr remained consistently greater than 1.0 across all ages. Conclusions: MVr is associated with lower postoperative morbidity and better long-term survival compared with MVR in patients undergoing isolated mitral valve surgery for degenerative MR. The benefit of MVr appears age-independent.

Tetracycline removal using NaIO4 activated by MnSO4: Design and optimization via response surface methodology.

The appearance of recalcitrant organic pollutants such as antibiotics in water bodies has gained a lot of attention owing to their adverse effects on organisms and humans. The current study aims to develop a novel approach to eliminate antibiotic tetracycline (TC) from a synthetic aqueous solution based on the advanced oxidation process triggered by MnSO4-catalyzed NaIO4. A single-factor experiment was performed to observe the impact of pH, NaIO4 concentration, and MnSO4 dosage on TC decomposition, and a three-factor, three-level response surface experiment with TC removal rate as the dependent variable was designed based on the range of factors determined from the single-factor experiment. The single-factor experiment revealed that the ranges of pH, NaIO4 concentration, and MnSO4 dosage need to be further optimized. ANOVA (analysis of variance) results showed that the data from the response surface experiment were consistent with the quadratic model with high R2 (0.9909), and the predicted values were very close to the actual values. After optimization by response surface methodology, the optimal condition obtained was pH = 6.7, [NaIO4] = 0.39 mM, and [MnSO4] = 0.12 mM, corresponding to a TC removal of 96.56%. This optimization condition was fully considered to save the dosage of the high-priced chemical NaIO4.