From phenotype to mechanism: Prenatal spectrum of NKAP mutation-related disorder and its pathogenesis inducing congenital heart disease.

NKAP mutations are associated with Hackmann-Di Donato-type X-linked syndromic intellectual developmental disorder (MRXSHD, MIM: #301039). Here, we elucidate the potential prenatal manifestation of NKAP mutation-associated disorder for the first time, alongside revealing the relationship between NKAP mutations and congenital heart defect (CHD) in the Chinese population. An NKAP mutation (NM_024528.4: c.988C>T, p.Arg330Cys) was identified in two foetuses presenting with CHD. Subsequent mechanistic exploration revealed a marked downregulation of NKAP transcription within HEK293T cells transfected with NKAP p.R330C. However, no significant change was observed at the protein level. Moreover, the mutation led to a dysregulation in the transcription of genes associated with cardiac morphogenesis, such as DHRS3, DNAH11 and JAG1. Additionally, our research determined that NKAP p.R330C affected Nkap protein intra-nuclear distribution, and binding with Hdac3. Summarily, our study strengthens NKAP mutations as a cause of CHD and prompts the reclassification of NKAP p.R330C as likely pathogenic, thereby establishing a prospective prenatal phenotypic spectrum that provides new insight into the prenatal diagnosis of CHD. Our findings also provide evidence of NKAP p.R330C pathogenicity and demonstrate the potential mechanism by which p.R330C dysregulates cardiac developmental gene transcription by altering Nkap intra-nuclear distribution and obstructing the interaction between Nkap and Hdac3, thereby leading to CHD.

[Status of outcome measures in randomized controlled trials of kidney-tonifying and blood-activating method in treatment of knee osteoarthritis].

This study assesses the status of outcome measures in the randomized controlled trial(RCT) involving the kidney-tonif-ying and blood-activating method for treating knee osteoarthritis(KOA), aiming to establish a theoretical foundation for the development of a core set of outcome measures in traditional Chinese medicine(TCM) treatment of KOA. The relevant articles were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, in addition to ClinicalTrials.gov and the China Clinical Trial Registration Center, with the time interval from inception to August 2023. The RCT of treating KOA with the kidney-tonifying and blood-activating method was included. Two assessors independently conducted literature screening, data collection, and qualitative analysis to compile the outcome measure results. A total of 350 RCTs were included, involving 165 outcome measures with the total frequency of 1 462. These outcome measures were categorized into six domains: symptom and sign measures(23) with the frequency of 718(49.1%), TCM symptom and syndrome measures(3) with the frequency of 53(3.6%), physical examination measures(130) with the frequency of 506(34.6%), quality of life measures(4) with the frequency of 20(1.3%), long-term efficacy measures(2) with the frequency of 6(0.4%), and safety measures(3) with the frequency of 159(10.9%). Additionally, 53 studies used TCM syndrome and symptom scores as indicators of efficacy, employing eight distinct measurement tools. The RCTs involving the kidney-tonifying and blood-activating method for treating KOA had a variety of problems, such as unclear prio-ritization of outcome measures, diversity in measurement tools, absence of standardized assessment criteria for specific measures, and non-standardized usage. These problems affected the research quality and reliability. Hence, it is advisable to draw upon international expertise, improve research design, and merge TCM efficacy characteristics with clinical research to establish a core set of KOA outcome measures aligned with TCM principles.

Broadband beam collimation metasurface for full-color micro-LED displays.

Near-eye displays are widely recognized as a groundbreaking technological advancement with the potential to significantly impact daily life. Within the realm of near-eye displays, micro-LEDs have emerged as a highly promising technology owing to their exceptional optical performance, compact form factor, and low power consumption. However, a notable challenge in integrating micro-LEDs into near-eye displays is the efficient light collimation across a wide spectrum range. In this paper, we propose what we believe to be a novel design of a broadband beam collimation metasurface for full-color micro-LEDs by harnessing wavefront phase modulation based on Huygens' principle. Our results demonstrate a substantial reduction in the full width at half maximum (FWHM) angles, achieving a reduction to 1/10, 1/10, and 1/20 for red, green, and blue micro-LEDs compared to those without the metasurface, which is the best collimation result as far as we know. The central light intensity increases by 24.60, 36.49, and 42.15 times. Furthermore, the significant enhancement in the light energy within ±10° is achieved, with the respective multiplication factors of 14.16, 15.60, and 13.00. This metasurface has the potential to revolutionize the field by enabling high-performance, compact, and lightweight micro-LED displays, with applications in near-eye displays, micro-projectors, and beyond.

A Reaction-based Ratiometric Fluorescent Probe with Large STOKES Shift for Cu2+ in Neat Aqueous Solution.

A novel reaction-based ratiometric fluorescent probe 1 for Cu2+ using picolinate as the reaction site and hemicyanine as the fluorophore was developed. 1 displayed maximum absorption peak at 355 nm and fluorescence emission peak at 500 nm, with large Stokes shift of 145 nm. Upon reaction with Cu2+, the maximum absorption and fluorescence emission peaks red-shifted to 390 nm and 570 nm respectively, owing to Cu2+-induced hydrolysis of the picolinate moiety in 1. Meanwhile, the solution of 1 turned from green to orange under a 365 nm UV lamp. 1 not only could detect Cu2+ ratiometrically by the ratios of both absorbance (A390 nm/A355 nm) and fluorescence intensity (F570 nm/F500 nm), but also displayed large Stokes shift, fast response, high sensitivity and excellent selectivity over other metal ions in neat aqueous solution.

Epidemiology of myasthenia gravis in the United States.

Introduction: Global studies of epidemiology of myasthenia gravis (MG) have pointed to increasing prevalence of this rare autoimmune disorder affecting the neuromuscular synapse; however, no new data for the USA were available for decades. We aimed to estimate the incidence rate and prevalence of MG in a large-scale insured US population. Methods: We conducted a population-based retrospective cohort study to estimate the annual incidence and prevalence of MG cases in the USA during 2017. Using a previously validated algorithm, we identified cases of MG in two Truven Health MarketScan databases, which during 2017 included a sample of approximately 20 million commercially insured and Medicare recipients, plus 10 million Medicaid recipients. We report crude incidence and prevalence and calculated age-and sex-standardized estimates for the USA based on the 2017 American Community Survey. We estimated the number of adult cases during 2021 by extrapolating from the stratified estimates to the population size from the 2021 American Community Survey. Results: From the US commercially/Medicare-insured cohort, we calculated an age-and sex-standardized incidence of 68.5 new cases per million person-years with an adjusted prevalence of 316.4 per million. Within the Medicaid-insured population, similar yet slightly lower numbers emerged: the adjusted incidence was 49.7 new cases per million person-years, and the adjusted prevalence rate was 203.7 cases per million. Given our results, we were able to estimate that there were approximately 82,715 US adults living with MG in 2021 (or an estimated 320.2 cases per million adults in the USA). We observed a strong effect of age and sex when stratifying the identified incidence rate and prevalence, with a pattern of female preponderance among the younger age brackets, a male preponderance for older cases in the commercially/Medicare-insured cohort, and the disease incidence and prevalence steadily increasing with age. Discussion: Our updated US population-based estimates of MG epidemiology demonstrate an increase in the previously reported incidence and prevalence from over 20 years ago, in keeping with developments in westernized, industrialized countries. Notable findings of steadily increasing prevalence with age, driven by robust increases in elderly males, prompts questions for basic-translational research, therapeutics, and public health.

Optimization of Chinese land spatial pattern in the transformation process of resource-based cities: a case study in Tongling City, China.

Optimizing the spatial layout of the national territory is crucial for realizing the transformation and development of resource-oriented cities in the context of high-quality development in the new period. This paper takes Tongling City as a case study, based on the analysis of the historical development foundation, then uses the SD-FLUS comprehensive model to carry out a systematic analysis of the transformation in five dimensions of economy, society, population, science and technology, resources and environment, and discusses the optimization of spatial pattern under the contextual simulation. The conclusions are as follows: ① The hierarchical framework of "system-indicator-element" is not only internally interconnected, but also inextricably linked with the relationship between the various categories of the land use system. ② Decrease of cropland, forest, water, grassland, and barren decreases from the economic development, social progress, and comprehensive development, and there is a small increase in the area under the scenario of resource and environmental protection, and the direction of the change of the impervious is in the opposite direction. ③ Cultivated land is retained in situ and concentrated to a small extent, forested land is reduced to a small extent while the status quo is maintained, and the Yangtze River water system will be retained and protected to a large extent, but part of the waters of Zongyang County will give way to the expansion of construction land under the development objectives of the new county. Building land will be expanded and extended to the northeast in the original site area, while the southwest corner of the original county center will be expanded to some extent in Zongyang County to promote the county's economic development.

Comprehensive prognostic assessment in kidney cancer: A multidimensional approach analyzing Fufang Sanling granules, genetic variants, and immune infiltration.

This study delves into the potential therapeutic benefits of Fufang Sanling Granules for kidney cancer, focusing on their active components and the underlying mechanisms of their interaction with cancer-related targets. By constructing a drug-active component-target network based on eight herbs, key active compounds such as kaempferol, quercetin, and linolenic acid were identified, suggesting their pivotal roles in modulating immune responses and cellular signaling pathways relevant to cancer progression. The research further identified 51 central drug-disease genes through comprehensive bioinformatics analyses, implicating their involvement in crucial biological processes and pathways. A novel risk score model, encompassing six genes with significant prognostic value for renal cancer, was established and validated, showcasing its effectiveness in predicting patient outcomes through mutation analysis and survival studies. The model's predictive power was further confirmed by its ability to stratify patients into distinct risk groups with significant survival differences, highlighting its potential as a prognostic tool. Additionally, the study explored the relationship between gene expression within the identified black module and the risk score, uncovering significant associations with the extracellular matrix and immune infiltration patterns. This reveals the complex interplay between the tumor microenvironment and cancer progression. The integration of the risk score with clinical parameters through a nomogram significantly improved the model's predictive accuracy, offering a more comprehensive tool for predicting kidney cancer prognosis. In summary, by combining detailed molecular analyses with clinical insights, this study presents a robust framework for understanding the therapeutic potential of Fufang Sanling Granules in kidney cancer. It not only sheds light on the active components and their interactions with cancer-related genes but also introduces a reliable risk score model, paving the way for personalized treatment strategies and improved patient management in the future.

Minimally invasive surgical approaches for spontaneous intracranial hemorrhage in neonates aged 0-3 months.

OBJECTIVE: The aim of this study is to assess the clinical efficacy of minimally invasive surgical interventions in addressing spontaneous intracranial hemorrhage among neonates aged 0-3 months. METHODS: A retrospective analysis was conducted on a cohort of 30 neonates diagnosed with spontaneous intracranial hemorrhage, who underwent minimally invasive cranial trepanation and drainage procedures at our department between 2011 and 2015. RESULTS: A comprehensive follow-up, spanning a duration of 1-5 years, was conducted for all 30 neonates, revealing a 100% survival rate among the pediatric cohort. CONCLUSION: The findings suggest that minimally invasive cranial trepanation and drainage exhibit efficacy in neonates aged 0-3 months experiencing spontaneous intracranial hemorrhage, leading to a reduction in both mortality and disability rates. It is recommended that surgery be promptly performed upon definitive diagnosis and identification of operation indications to prevent severe brain damage resulting from prolonged intracranial hypertension and potential fatal outcomes in neonates. Furthermore, the surgical procedure is characterized by its simplicity, involving minimal trauma.

Effect of polymethyl methacrylate on in situ patterning of perovskite quantum dots by inkjet printing.

The preparation of perovskite quantum dots (PQDs) using an in situ inkjet printing method is beneficial for improving the problems of aggregation and photoluminescence (PL) quenching during long-term storage. However, the stability of PQDs prepared using this method is still not ideal, and the morphology of in situ-printed patterns needs to be optimized. To address these problems, this study introduced polymethyl methacrylate (PMMA) into the process of in situ inkjet printing of PQDs and explored the effect of PMMA on the in situ patterning effect of PQDs. The results showed that using a mixed precursor solution containing a small amount of PMMA as the printing ink can slow down the shrinkage process of ink droplets and improve the uniformity of film formation. As the printing substrate, PMMA provided a suitable high-viscosity environment for the in situ growth of PQDs. This could effectively suppress the coffee ring effect. In addition, the interaction between the C=O=C group in PMMA and metal ion Pb2+ in the CsPbBr3 precursor molecules was favourable to enhancing the density of PQDs. The prepared PMMA-coated CsPbBr3 quantum dots (QDs) pattern had high stability and could maintain at 90.08% PL intensity after 1 week of exposure to air.

Novel Bidirectional Output Ytterbium-Doped High Power Fiber Lasers: From Continuous to Quasi-Continuous.

Traditional ytterbium-doped high-power fiber lasers generally use a unidirectional output structure. To reduce the cost and improve the efficiency of the fiber laser, we propose a bidirectional output fiber laser (BOFL). The BOFL has many advantages over that of the traditional unidirectional output fiber laser (UOFL) and has a wide application in the industrial field. In theory, the model of the BOFL is established, and a comparison of the nonlinear effect in the traditional UOFL and the BOFL is studied. Experimentally, high-power continuous wave (CW) and quasi-continuous wave (QCW) BOFLs are demonstrated. In the continuous laser, we first combine the BOFL with the oscillating amplifying integrated structure, and a near-single-mode bidirectional 2 × 4 kW output with a total power of above 8 kW is demonstrated. Then, with the simple BOFL, a CW bidirectional 2 × 5 kW output with a total power of above 10 kW is demonstrated. By means of pump source modulation, a QCW BOFL is developed, and the output of a near-single mode QCW laser with a peak output of 2 × 4.5 kW with a total peak power of more than 9 kW is realized. Both CW and QCW output BOFL are the highest powers reported at present.

Functional Composite Dual-Phase In Situ Self-Reconstruction Design for High-Energy-Density Li-Rich Cathodes.

The unique anionic redox mechanism provides, high-capacity, irreversible oxygen release and voltage/capacity degradation to Li-rich cathode materials (LRO, Li1.2 Mn0.54 Co0.13 Ni0.13 O2 ). In this study, an integrated stabilized carbon-rock salt/spinel composite heterostructured layers (C@spinel/MO) is constructed by in situ self-reconstruction, and the generation mechanism of the in situ reconstructed surface is elucidated. The formation of atomic-level connections between the surface-protected phase and bulk-layered phase contributes to electrochemical performance. The best-performing sample shows a high increase (63%) of capacity retention compared to that of the pristine sample after 100 cycles at 1C, with an 86.7% reduction in surface oxygen release shown by differential electrochemical mass spectrometry. Soft X-ray results show that Co3+ and Mn4+ are mainly reduce in the carbothermal reduction reaction and participate in the formation of the spinel/MO rock-salt phase. The results of oxygen release characterized by Differential electrochemical mass spectrometry (DEMS) strongly prove the effectiveness of surface reconstruction.

Long-term outcomes of pelvic exenterations for gynecological malignancies: a single-center retrospective cohort study.

BACKGROUND: Recently, with the advancement of medical technology, the postoperative morbidity of pelvic exenteration (PE) has gradually decreased, and it has become a curative treatment option for some patients with recurrent gynecological malignancies. However, more evidence is still needed to support its efficacy. This study aimed to explore the safety and long-term survival outcome of PE and the feasibility of umbilical single-port laparoscopic PE for gynecologic malignancies in a single medical center in China. PATIENTS AND METHODS: PE for gynecological cancers except for ovarian cancer conducted by a single surgical team in Sun Yat-sen University Cancer Center between July 2014 and December 2019 were included and the data were retrospectively analyzed. RESULTS: Forty-one cases were included and median age at diagnosis was 53 years. Cervical cancer accounted for 87.8% of all cases, and most of them received prior treatment (95.1%). Sixteen procedures were performed in 2016 and before, and 25 after 2016. Three anterior PE were performed by umbilical single-site laparoscopy. The median operation time was 460 min, and the median estimated blood loss was 600 ml. There was no perioperative death. The years of the operations was significantly associated with the length of the operation time (P = 0.0018). The overall morbidity was 52.4%, while the severe complications rate was 19.0%. The most common complication was pelvic and abdominal infection. The years of surgery was also significantly associated with the occurrence of severe complication (P = 0.040). The median follow-up time was 55.8 months. The median disease-free survival (DFS) was 17.9 months, and the median overall survival (OS) was 25.3 months. The 5-year DFS was 28.5%, and the 5-year OS was 30.8%. CONCLUSION: PE is safe for patient who is selected by a multi-disciplinary treatment, and can be a curative treatment for some patients. PE demands a high level of experience from the surgical team. Umbilical single-port laparoscopy was a technically feasible approach for APE, meriting further investigation.

Dysfunction of DMT1 and miR-135b in the gut-testis axis in high-fat diet male mice.

BACKGROUND: Obese patients have been found to be susceptible to iron deficiency, and malabsorption of dietary iron is the cause of obesity-related iron deficiency (ORID). Divalent metal transporter 1 (DMT1) and ferroportin (FPN), are two transmembrane transporter proteins expressed in the duodenum that are closely associated with iron absorption. However, there have been few studies on the association between these two proteins and the increased susceptibility to iron deficiency in obese patients. Chronic inflammation is also thought to be a cause of obesity-related iron deficiency, and both conditions can have an impact on spermatogenesis and impair male reproductive function. Based on previous studies, transgenerational epigenetic inheritance through gametes was observed in obesity. RESULTS: Our results  showed that obese mice had decreased blood iron levels (p < 0.01), lower protein and mRNA expression for duodenal DMT1 (p < 0.05), but no statistically significant variation in mRNA expression for duodenal FPN (p > 0.05); there was an increase in sperm miR-135b expression (p < 0.05). Bioinformatics revealed ninety overlapping genes and further analysis showed that they were primarily responsible for epithelial cilium movement, fatty acid beta-oxidation, protein dephosphorylation, fertilization, and glutamine transport, which are closely related to spermatogenesis, sperm development, and sperm viability in mice. CONCLUSIONS: In obese mice, we observed downregulation of DMT1 in the duodenum and upregulation of miR-135b in the spermatozoa.

A Bibliometric Analysis: Current Perspectives and Potential Trends of Enzyme Thermostability from 1991-2022.

Thermostability is considered a crucial parameter to evaluate the viability of enzymes in industrial applications. Over the past 31 years, many studies have been reported on the thermostability of enzymes. However, there is no systematic bibliometric analysis of publications on the thermostability of enzymes. In this study, 16,035 publications related to the thermostability of enzymes were searched and collected, showing an increasing annual trend. China contributed the most publications, while the United States had the highest citation count. International Journal of Biological Macromolecules is the most productive journal in the research field. Moreover, Chinese acad sci and Khosro Khajeh are the most active institutions and prolific authors in the field, respectively. Analysis of references with the strongest citation bursts and keyword co-occurrences, magnetic nanoparticles, metal-organic frameworks, molecular dynamics, and rational design are current hot spots and significant future research directions. This study is the first comprehensive bibliometric analysis summarizing trends and developments in enzyme thermostability research. Our findings could provide scholars with an understanding of the fundamental knowledge framework of the field and identify recent potential hotspots and research trends that could facilitate the discovery of collaboration opportunities.

Quercetin-loaded PLGA nanoparticles coating with macrophage membranes for targeted delivery in acute liver injury.

Quercetin (QU), a natural flavonoid with potent anti-inflammatory and antioxidant properties, holds promise in treating acute liver injury (ALI). Nonetheless, its limited solubility hampers its efficacy, and its systemic distribution lacks targeting, leading to off-target effects. To address these challenges, we developed macrophage membrane-coated quercetin-loaded PLGA nanoparticles (MVs-QU-NPs) for active ALI targeting. The resulting MVs-QU-NPs exhibited a spherical morphology with a clear core-shell structure. The average size and zeta potential were assessed as 141.70 ± 0.89 nm and -31.83 ± 0.76 mV, respectively. Further studies revealed sustained drug release characteristics from MVs-QU-NPs over a continuous period of 24 h. Moreover, these MVs-QU-NPs demonstrated excellent biocompatibility when tested on normal liver cells. The results of biodistribution analysis in ALI mice displayed the remarkable ALI-targeting ability of MVs-DiD-NPs, with the highest fluorescence intensity observed in liver tissue. This biomimetic approach combining macrophage membranes with nanoparticle delivery, holds great potential for targeted ALI treatment.

Uniformity improvement of a mini-LED backlight by a quantum-dot color conversion film with nonuniform thickness.

Mini-LED backlights energized by quantum-dot color conversion (QDCC) hold great potential for technological breakthroughs of liquid crystal displays. However, luminance uniformity issues should still be urgently solved owing to the large interval of direct-lit mini-LEDs, especially when covering with a QDCC film (QDCCF) with uniform thickness. Herein, we propose a uniformity improvement approach of mini-LED backlights by employing a QDCCF with nonuniform thickness based on the Lambertian distribution of mini-LEDs, which is demonstrated by screen-printing preparation and ray-tracing simulation. Experimental results show that the luminance uniformity of the nonuniform QDCCF can reach 89.91%, which is 24.92% higher than the uniform one. Ray-tracing simulation further elaborates the mechanism of this significant improvement. Finally, by employing this nonuniform QDCCF, a mini-LED backlight prototype is assembled and achieves high uniformity of 92.15%, good white balance with color coordinates of (0.3482, 0.3137), and high color gamut of 109% NTSC. This work should shed some new light on mini-LED-based display technology.

Optimal interval timing between transurethral resection of bladder tumors and Bacillus Calmette-Guerin perfusion.

OBJECTIVE: There is no consensus regarding the best interval time between transurethral resection of a bladder tumor and Bacillus Calmette-Guerin (BCG) perfusion. This study was to explore whether the interval time has an impact on the prognosis and adverse effects. METHODS: We retrospectively reviewed the clinical data of patients who received BCG intravesical perfusion at Sun Yat-sen University Cancer Center (SYSUCC) from September 2015 to October 2021. Recurrence-free survival (RFS) and progression-free survival were the primary endpoints. Cox regression was used to explore independent predictors. The association between interval time and adverse effect grade was detected by logistic regression. Propensity score matching (PSM) was performed. RESULTS: A total of 403 patients were enrolled, the median interval time was 24 days (6-163 days), and the follow-up was 28 months (7-82 months). Eighty-eight (20.9%) patients relapsed, and 40 patients (10.0%) suffered progression. The multivariate Cox regression analysis confirmed that interval time was an independent predictor of RFS (p = 0.017). Notably, when the interval time was less than or equal to 26 days, there was a trend toward better RFS, PSM resulted in 65 matched pairs in each group, and Kaplan-Meier analysis showed that there was a significant difference in RFS between groups (p = 0.009). The logistic regression analysis showed that there was no correlation between interval time and adverse effects and their grades (p > 0.05). CONCLUSIONS: We considered that the first BCG perfusion could be performed within 2-4 weeks after surgery.

Investigation of the Functional Requirements and Influencing Factors of Self-management App Use in Patients with Diabetes Mellitus.

Objective: Diabetes self-management apps can provide convenient and personalized health information and reduce glycosylated haemoglobin, weight, the occurrence of severe hypoglycaemia and disease burden. This study aims to describe the attitudes towards and needs of self-management apps among diabetic patients in China. Methods: A self-administered cross-sectional survey was offered to patients in Changzhou from March to December 2021. Participants were included if they were≥ 18 years old, had the ability to read and write, and completed the questionnaire independently. Responses were summarized using descriptive statistics. Multiple logistic regression analysis was used to identify factors associated with attitudes towards the use of self-management apps. Results: We surveyed 615 diabetes patients and found that 60% of the patients were willing to use self-management applications. The scores indicating importance of functional needs were sequentially ordered as follows: contact and interaction with medical practitioners (4.16), reminder to assess blood glucose levels (4.07), alert indicating abnormal blood glucose levels (4.06), medication reminder (3.93), documentation of intake per meal (3.91), calculation of carbohydrate intake (3.85), graphic presentation of blood glucose levels (3.84), setting of personal goals (3.82), reminder to exercise (3.80), and providing diabetes knowledge (3.77). Factors influencing the usage of mobile applications included age (OR:0.956, 95%CI:0.935-0.977, P < .01), employed (OR:2.822, 95%CI:1.373-5.802, P < .05), medical insurance (OR:2.084, 95%CI:1.073-4.047, P < .05) and the eHealth Literacy Scale score (OR:1.128, 95%CI:1.088-1.169, P < .01). The main reason for unwillingness to use self-management applications was a lack of experience using it. Conclusions: The functional needs of patients using diabetes self-management apps include contacting and interacting with medical staff, recording and alarming blood glucose, reminding medicine, recording and calculating intake, providing graphic representation of blood glucose, setting health goals, recording exercise and sending diabetes knowledge. Age, employed, medical insurance and the eHealth Literacy Scale score were the factors influencing willingness to use self-management applications. The main reason for reluctance to use self-management applications was lack of experience.

Regular gastroscopy and colonoscopy during the evaluation of urachal cancer: do we really need them?

PURPOSE: Urachal cancer is similar to gastrointestinal adenocarcinoma in histology, and gastroscopy/colonoscopy is often administered during perioperative evaluation. However, gastroscopy and colonoscopy have corresponding disadvantages. This study discusses whether gastroscopy/colonoscopy is truly necessary for patients with urachal cancer. PATIENTS AND METHODS: A total of 166 bladder adenocarcinoma cases diagnosed at Sun Yat-sen University Cancer Center were retrospectively reviewed and divided into two groups (urachal cancer and nonurachal cancer), and perioperative evaluations were retrieved. RESULTS: There were 78 patients with urachal cancer, the median age was 48 years, and 59 were male. Perioperative gastroscopy/colonoscopy revealed 5 intestinal polyps and 1 adenoma during these evaluations, and no primary gastrointestinal cancer was found. Meanwhile, preoperative imaging evaluation did not detect significant gastrointestinal lesions. For 88 patients with nonurachal cancer, including primary bladder adenocarcinoma and metastatic tumors from gastrointestinal cancer, the median age was 56 years, and 64 were male. Preoperative imaging evaluation demonstrated 36 cases of gastrointestinal lesions, and 32 were confirmed by gastroscopy/colonoscopy; the other 4 were negative. Another 4 cases of colon cancer were detected by regular colonoscopy for suspected primary bladder adenocarcinoma. In all, 35 cases of colon cancer and 1 case of gastric cancer were identified by endoscopic examination. The diagnostic consistency of imaging and gastrointestinal endoscopy was favorable (P < 0.001), and the negative predictive value and diagnostic efficiency of imaging were 96.9% and 94.6%, respectively. CONCLUSIONS: The vast majority of gastrointestinal cancer cases can be identified by assessment of the patient's clinical symptoms, meticulous physical examination, and imaging evaluation. We recommend that gastroscopy/colonoscopy only be applied to patients with urachal cancer when the above examinations are positive.