Utility of immunocytochemistry in diagnosing abdominopelvic washings from patients undergoing radical surgery for endometrial cancer.

Objective: This study aimed to explore the efficacy of immunocytochemistry in diagnosing abdominopelvic washings (APWs) and evaluate the superiority of cytology combined with immunocytochemistry over cytology alone. Material and Methods: Data on APW cytology and available cell blocks from patients who underwent radical surgery for endometrial cancer between January 2021 and December 2022 were reviewed. Cytology was re-evaluated according to a five-tier system. Immunocytochemistry analysis for targets such as Sry box transcription factor 1(SOX17), Paired box gene 2 (Pax-2) protein, Phosphatase and tensin (PTEN), and ß-catenin was performed on each case with non-negative cytology. Mismatch repair (MMR) protein and P53 immunocytochemistry analyses were performed using cell blocks from cases with abnormal MMR or P53 expression in their primary lesion. The accuracies of cytology combined with immunocytochemistry and cytology alone were calculated. Results: Overall, 126 patients were included in this study, 18 of whom demonstrated non-negative cytology of APW. Cell blocks were successfully prepared for 16 cases. SOX17 positivity was observed in 16 cases, including 1 of serous carcinoma, 1 of clear cell carcinoma, and 14 of endometrioid carcinoma (EC). Loss of Pax-2 and PTEN expression was observed in the APWs of the 14 patients with EC. MMR deficiency was noted in two patients with EC, and P53 mutation was noted in another two patients with EC. Compared with 10 metastatic carcinomas (10/18, 55.56%) diagnosed by cytology alone, 15 malignant APWs (15/18, 83.33%) were confirmed through combination cytology and immunocytochemistry. APWs were more likely to be observed in cases with more than half myometrial invasion than those with no or less than half myometrial invasion (P = 0.0067). The probability of malignant APW occurrence was slightly elevated in cases of EC exhibiting microcystic, elongated, and fragmented(MELF) infiltrative growth (P = 0.039). Conclusion: SOX17 is a useful Müllerian marker for distinguishing endometrial epithelium in APW. Loss of Pax-2 and PTEN expression offers evidence of metastatic endometrial carcinoma. Furthermore, positive APWs retained molecular features similar to primary lesions. The use of multiple immunocytochemical markers can effectively enhance the diagnostic efficiency of APWs.

Human brain proteome-wide association study provides insights into the genetic components of protein abundance in obesity.

BACKGROUNDS: Genome-wide association studies have identified multiple genetic variants associated with obesity. However, most obesity-associated loci were waiting to be translated into new biological insights. Given the critical role of brain in obesity development, we sought to explore whether obesity-associated genetic variants could be mapped to brain protein abundances. METHODS: We performed proteome-wide association studies (PWAS) and colocalization analyses to identify genes whose cis-regulated brain protein abundances were associated with obesity-related traits, including body fat percentage, trunk fat percentage, body mass index, visceral adipose tissue, waist circumference, and waist-to-hip ratio. We then assessed the druggability of the identified genes and conducted pathway enrichment analysis to explore their functional relevance. Finally, we evaluated the effects of the significant PWAS genes at the brain transcriptional level. RESULTS: By integrating human brain proteomes from discovery (ROSMAP, N = 376) and validation datasets (BANNER, N = 198) with genome-wide summary statistics of obesity-related phenotypes (N ranged from 325,153 to 806,834), we identified 51 genes whose cis-regulated brain protein abundance was associated with obesity. These 51 genes were enriched in 11 metabolic processes, e.g., small molecule metabolic process and metabolic pathways. Fourteen of the 51 genes had high drug repurposing value. Ten of the 51 genes were also associated with obesity at the transcriptome level, suggesting that genetic variants likely confer risk of obesity by regulating mRNA expression and protein abundance of these genes. CONCLUSIONS: Our study provides new insights into the genetic component of human brain protein abundance in obesity. The identified proteins represent promising therapeutic targets for future drug development.

The concept, technical architecture, applications and impacts of satellite internet: A systematic literature review.

To conduct a comprehensive review of international publications, this study focuses on discussing the development status and future trends of Satellite Internet. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all peer-reviewed publications in English from journals indexed with the SSCI and SCIE categories of the Web of Science are reviewed, with an emphasis on studies that focused only on the architecture, functions, technologies, and applications of Satellite Internet across the entire period. A total of 2085 records were identified, of which 69 met the inclusion criteria. Through a systematic literature review, the results show that three main research perspectives were summarised and a unified Satellite Internet definition and technical architecture were innovatively provided. Additionally, Satellite Internet application industries and scenarios were comprehensively sorted, and four types of potential impacts were categorised and discussed. This study provides an insightful analysis of recent trends in Satellite Internet research, which may provide guidance for planning and supporting the forthcoming wave of information infrastructure growth. Future research should broaden the scope of theoretical studies when assessing the strategic importance of Satellite Internet. Further quantitative research is needed to provide a more scientific and comprehensive perspective.

Trends and prospects in nursing care for diabetic foot: A bibliometric analysis from 2003 to 2023.

BACKGROUNDS: Diabetic foot (DF) is a globally significant concern, with complications like diabetic foot ulcers (DFUs) posing major challenges despite medical advancements. Effective nursing strategies are crucial to preventing DF progression and reducing disability risk. However, nursing research in DF care is fragmented, necessitating a comprehensive bibliometric analysis to identify key trends, influential contributors, and critical research areas. PURPOSE: This study explored current trends in nursing methods for DF care and their impact on patient outcomes, utilizing CiteSpace, VOSviewer, and Bibliometrix to identify key contributors, influential countries, and noteworthy topics, aiming to provide valuable insights for healthcare professionals and researchers in the field. METHODS: Relevant publications from the Web of Science (WOS) Core Collection Science Citation Index Expanded were retrieved for the period between 2003 and 2023. We included peer-reviewed original articles or reviews related to diabetic foot (DF) and nursing. The following criteria were used for exclusion: ① conference abstracts or corrigendum documents, ② unpublished articles, ③ repeated publications, ④ unrelated articles, ⑤ case reports, and ⑥ qualitative studies. CiteSpace was employed to identify top authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends. VOSviewer was used to generate a network of authors, journals, and references. Bibliometrix was utilized to create maps of cooperating countries and keyword frequency charts, as well as a Sankey diagram illustrating the relationship between authors, keywords, and countries. RESULTS: A total of 305 relevant articles were included in this study. The research pertaining to nursing aspects of diabetic foot care exhibited a noticeable upward trend. The analysis in this study revealed that "amputation" held the highest centrality, indicating a critical area of focus in nursing interventions to prevent severe outcomes. "Diabetic foot ulcer" ranked first in terms of citation rate, emphasizing the ongoing challenges in managing DFUs through nursing care. In recent years, there was a shift in focus towards keywords such as "pressure ulcers", "burden", and "chronic wound" highlighting the evolving priorities in nursing research to address complex wound care, patient burden, and long-term management strategies. CONCLUSIONS: The current primary research focuses in nursing care for diabetic foot (DF) include wound management, offloading techniques, sensory protection, anti-infective treatment, education and self-management, and multidisciplinary teamwork. Future research should prioritize developing innovative nursing interventions tailored to individual patient needs, integrating advanced technologies like telemedicine and wearable devices for continuous monitoring, and exploring the psychological aspects of DFU management to improve patient adherence and outcomes. Additionally, more longitudinal studies are needed to assess the long-term effectiveness of various nursing strategies on patient quality of life.

Genome- and Toxicology-Based Safety Assessment of Probiotic Akkermansia muciniphila ONE Isolated from Humans.

In this study, the genome of Akkermansia muciniphila ONE (designated AKK ONE) was sequenced, assembled, and analyzed. In addition, the safety of this strain was further evaluated by toxicological studies. The results showed that the AKK ONE genome is contained on a single chromosome with a total length of 2,817,524 bp and an average GC content of 55.48%. In total, 2411, 1131, 1168, 1745, and 1402 genes were annotated to the NR, GO, KEGG, COG, and SwissProt database, respectively. Potential resistance genes, adeF, tetW, ANT(3″)-IIa, and aadA1 were detected. AKK ONE was sensitive to ampicillin, ceftriaxone, cefotaxime, meropenem, tetracycline, and chloramphenicol and resistant to moxifloxacin. No potential virulence-related genes were detected. The PathogenFinder database analysis showed that AKK ONE was a non-potential human pathogen. This strain had good gastroenteric fluid tolerance and a weak ability to colonize the gut. No test item-related adverse effects were observed in the acute and subchronic toxicity test. AKK ONE did not display mutagenic activity either. This strain did not change the hematological and clinical biochemical parameters of mice. The weights of the organs were not affected by AKK ONE treatment. These results support that AKK ONE is safe for use as a probiotic at a dose of 8.28 × 109 CFU/kg bw/day.

Hysteretic and asynchronous regime shifts of bacterial and micro-eukaryotic communities driven by nutrient loading.

Nutrient pollution is pervasive in many urban rivers, while restoration measures that reduce nutrient loading but fail to improve biological communities often lack effectiveness due to the indispensable role of biota, especially multi-taxa, in enhancing ecosystem stability and function. The investigation of the response patterns of multi-taxa to the nutrient loading in urban rivers is important for the recovery of biota structure and thus ecosystem function. However, little is known about the response patterns of multi-taxa and their impact on ecosystem structure and function in urban rivers. Here, the study, from the perspective of alternative stable states theory, showed the hysteretic response of both bacterial and micro-eukaryotic communities to nutrient loading based on the field investigation and environmental DNA metabarcoding. Bistability was shown to exist in both bacterial and micro-eukaryotic communities, demonstrating that the response of microbiota to nutrient loading was a regime shifts with hysteresis. Potential analysis then indicated that the increased nutrient loading drove regime shifts in the bacterial community and the micro-eukaryotic community towards a state dominated by anaerobic bacteria and benthic Bacillariophyta, respectively. High nutrient loading was found to reduce the relative abundance of metazoan, but increase that of eukaryotic algae, which made the trophic pyramid top-lighter and bottom-heavier, probably exacerbating the degradation of ecosystem function. It should be noted that, in response to the reduced nutrient loading, the recovery threshold of micro-eukaryotic communities (nutrient loading = ∼0.5) was lower than that of bacterial communities (nutrient loading = ∼1.2), demonstrating longer hysteresis of micro-eukaryotic communities. In addition, the markedly positive correlation between the status of microbial communities and N-related enzyme activities suggested the recovery of microbial communities probably will benefit the improvement of N-cycling functionality. The obtained results provide a deep insight into the collapse and recovery trajectories of multi-trophic microbiota to the nutrient loading gradient and their impact on the N transformation potential, therefore benefiting the restoration and management of urban rivers.

Quantitative analysis of sagittal curvatures of the tibial plafond by computed tomography.

Background: Although the talar morphology has been well understood, studies on the corresponding tibial plafond are still lacking. Based on computed tomography (CT) data, this quantitative study divided the tibial plafond into anterior and posterior regions on five sagittal sections. The objectives of this study were (I) to determine whether the sagittal curvatures of the tibial plafond can be quantitatively and accurately described using the double-diameter method; (II) to compare the difference between the anterior and posterior diameters on five sagittal sections. Methods: In this study, CT data were collected from 100 adult ankles, and the three-dimensional (3D) ankle joint model was reconstructed using CT images. An anatomical coordinate system of the 3D ankle joint model was created to establish the standard coronal and sagittal planes. The measurement outcomes of sagittal curvatures included: the anterior and posterior diameters, the distal tibial arc length (TiAL) and the distal tibial mortise depth (TMD) on five sagittal sections (the most medial, medial 1/4, middle, lateral 1/4 and the most lateral section). Subgroup analysis was performed to compare the differences between males and females. Results: Analysis of the sagittal curvatures showed that the anterior diameter of tibial plafond was significantly smaller than the posterior diameter on five sagittal sections with a mean difference ranging from 3.9 to 6.8 mm (P<0.001). For the anterior diameters, the anteromedial curve had the smallest diameter (35.3±5.3 mm), and the anterolateral curve had the largest diameter (38.0±5.8 mm). For the posterior diameter, the posteromedial curve had the smallest diameter (39.2±6.4 mm), and the posterolateral 1/4 curve had the largest diameter (43.5±6.9 mm). One-way analysis of variance (ANOVA) revealed significant differences in the anterior and posterior diameters among five groups (P<0.012). Subgroup analysis showed that gender partly affected the results of sagittal curvature measurements. Conclusions: The sagittal curvatures of the tibial plafond can be described quantitatively and accurately using anterior and posterior diameters. Our study showed that there were significant differences between the anterior and posterior diameters, and gender was an important factor influencing the sagittal curvatures of the tibial plafond.

An Atlas on Multitudinous Risk Factors Associated with Incident Hypertension: Comprehensive Exposome-Wide Association and Wide-angled Genetic Analyses.

BACKGROUND: Despite numerous risk factors being associated with hypertension, the breadth of research remains constrained, with a notable absence of systematic, data-driven exploration into established and novel factors across a broad spectrum of exposures. This study aims to construct an atlas on known and emerging factors for hypertension through comprehensive epidemiological and genetic analyses. METHODS: We conducted exposome-wide association studies (ExWAS) via Cox regression models on two equally sized datasets for discovery and replication in UK Biobank, a large prospective cohort study. A maximum of 10,806 exposome variables were included in ExWAS and were grouped into 13 categories: genomics, sociodemographic, lifestyle, physical measure, biomarkers, medical history, imaging markers, sex-specific factors, psychosocial factors, cognitive function indicators, local environment, family history, and early life factors. The credibility of epidemiological associations was assessed through meta-analyses. The genetic underpinnings were explored through linkage-disequilibrium score regression (LDSC), quantifying global genetic correlation. Two-sample Mendelian randomization (MR) studies were conducted to investigate the causal effects of each exposure on hypertension, with co-analyses undertaken to identify associations supported by both epidemiological and genetic evidence. RESULTS: This study included 214,957 UK Biobank participants, hypertension-free at baseline. In our ExWAS analyses, 964 significant exposome variables were replicated. In meta-analyses, 462 were backed by convincing and highly suggestive evidence. Among 10,765 exposures in LDSC, 1923 had global genetic correlations with hypertension. The MR analyses yielded robust evidence for a causal relationship with 125 phenotypes, probable evidence for 270 phenotypes, and suggestive evidence for 718 phenotypes. Co-analyses identified 146 associations supported by strong epidemiological and genetic evidence. These primarily encompassed traits like anthropometry, lung function, lipids, and factors such as urate and walking pace. This coverage further extended from well-studied factors (like BMI and physical activity) to less explored exposures (including high light scatter reticulocyte count and age at first live). All study results are compiled in a webserver for user-friendly exploration of exposure-hypertension associations. CONCLUSION: This study provides an atlas on established and novel risk factors for hypertension, underpinned by epidemiological and causal evidence. Our findings present a multiple perspective to prioritize hypertension prevention strategies, encompassing modifiable risk factors like television watching time and walking pace. The study also emphasized the roles of urate in hypertension pathogenesis. Consequently, our study may serve as a critical guide for hypertension prevention and bear significant clinical implications.

Researchers have created a comprehensive map that identifies and analyses a wide array of risk factors linked to the development of high blood pressure, using extensive data from the UK Biobank. The study revealed 964 significant factors related to lifestyle, environment, and genetics that could influence the risk of developing hypertension, with 462 of these factors showing strong evidence of a link.Key lifestyle-related findings include the impact of behaviors such as television watching and walking pace on hypertension risk, suggesting that modifiable habits can be targeted for prevention strategies.

Decreased nitrogen deposition in Beijing over the recent decade and its implications.

Atmospheric reactive nitrogen (Nr) deposition has been modified significantly by human activities such as agriculture and fossil fuel combustion. Understanding the changes in Nr deposition is essential for maintaining the functionality and sustainability of ecosystems. Taking Beijing as a case study, we report long-term measurements of wet Nr deposition from 1999 to 2022 and dry Nr deposition from 2010 to 2022 and their relationship with China's air pollution control. Total Nr deposition to Beijing decreased by 34 % during 2010-2022, mainly caused by a decrease in dry N deposition by 54.27 %, from 47.86 kg N ha-1 yr-1 in 2010-2014 to 21.89 kg N ha-1 yr-1 in 2018-2022; reduced and oxidized N in dry deposition decreased by 29.93 % and 72.05 %, respectively. This was a result of the "Action Plan for Prevention and Control of Air Pollution (APCP)" and the implementation of the "Zero Growth in Fertilizer Use by 2020" in 2015. Our ground-based measurements provide evidence to support recent achievements in air pollution control and a reference and guidance for other regions of China and other countries for abating Nr pollution.

The Association Between Surgery and Mild Cognitive Impairment: Insight from a Case-Control Study.

Background: Surgery may be associated with postoperative cognitive impairment in elder participants, yet the extent of its association with mild cognitive impairment (MCI) remains undetermined. Objective: To determine the relationship between surgery and MCI. Methods: The data of participants from the Alzheimer's Disease Neuroimaging Initiative were analyzed, including individuals with MCI or normal cognition. We focused on surgeries conducted after the age of 45, categorized by the number of surgeries, surgical risk, and the age at which surgeries occurred. Multivariable logistic regression was employed to determine the association between surgery and the development of MCI. Results: The study is comprised of 387 individuals with MCI and 578 cognitively normal individuals. The overall surgery exposure (adjusted OR = 1.14, [95% CI 0.83, 1.56], p = 0.43) and the number of surgeries (adjusted OR = 0.92  [0.62, 1.36], p = 0.67 for single exposure, adjusted OR = 1.12 [0.71, 1.78], p = 0.63 for two exposures, adjusted OR = 1.38 [0.95, 2.01], p = 0.09 for three or more exposures compared to no exposure as the reference) were not associated with the development of MCI. However, high-risk surgeries (adjusted OR = 1.79 [1.00, 3.21], p = 0.049) or surgeries occurring after the age of 75 (adjusted OR = 2.01 [1.03, 3.90], p = 0.041) were associated with a greater risk of developing MCI. Conclusions: High risk surgeries occurring at an older age contribute to the development of MCI, indicating a complex of mechanistic insights for the development of postoperative cognitive impairment.

Catalase immobilization: Current knowledge, key insights, applications, and future prospects - A review.

Catalase (CAT), a ubiquitous enzyme in all oxygen-exposed organisms, effectively decomposes hydrogen peroxide (H2O2), a harmful by-product, into water and oxygen, mitigating oxidative stress and cellular damage, safeguarding cellular organelles and tissues. Therefore, CAT plays a crucial role in maintaining cellular homeostasis and function. Owing to its pivotal role, CAT has garnered considerable interest. However, many challenges arise when used, especially in multiple practical processes. "Immobilization", a widely-used technique, can help improve enzyme properties. CAT immobilization offers numerous advantages, including enhanced stability, reusability, and facilitated downstream processing. This review presents a comprehensive overview of CAT immobilization. It starts with discussing various immobilization mechanisms, support materials, advantages, drawbacks, and factors influencing the performance of immobilized CAT. Moreover, the review explores the application of the immobilized CAT in various industries and its prospects, highlighting its essential role in diverse fields and stimulating further research and investigation. Furthermore, the review highlights some of the world's leading companies in the field of the CAT industry and their substantial potential for economic contribution. This review aims to serve as a discerning, comprehensive source of information for researchers seeking a comprehensive cutting-edge overview of this rapidly evolving field and have been overwhelmed by the size of publications.

Astragaloside IV mediates radiation-induced neuronal damage through activation of BDNF-TrkB signaling.

BACKGROUND: Electromagnetic radiation is relevant to human life, and radiation can trigger neurodegenerative diseases by altering the function of the central nervous system through oxidative stress, mitochondrial dysfunction, and protein degradation. Astragaloside IV (AS-IV) is anti-oxidative, anti-apoptotic, activates the BDNF-TrkB pathway and enhances synaptic plasticity in radiated mice, which can exert its neuroprotection. However, the exact molecular mechanisms are still unclear. PURPOSE: This study investigated whether AS-IV could play a neuroprotective role by regulating BDNF-TrkB pathway in radiation damage and its underlying molecular mechanisms. METHODS: Transgenic mice (Thy1-YFP line H) were injected with AS-IV (40 mg/kg/day body weight) by intraperitoneal injection daily for 4 weeks, followed by X-rays. PC12 cells and primary cortical neurons were also exposed to UVA after 24 h of AS-IV treatment (25 µg/ml and 50 µg/ml) in vitro. The impact of radiation on learning and cognitive functions was visualized in the Morris water maze assay. Subsequently, Immunofluorescence and Golgi-Cox staining analyses were utilized to investigate the structural damage of neuronal dendrites and the density of dendritic spines. Transmission electron microscopy was performed to examine how the radiation affected the ultrastructure of neurons. Finally, western blotting analysis and Quantitative RT-PCR were used to evaluate the expression levels and locations of proteins in vitro and in vivo. RESULTS: Radiation induced BDNF-TrkB signaling dysregulation and decreased the levels of neuron-related functional genes (Ngf, Bdnf, Gap-43, Ras, Psd-95, Arc, Creb, c-Fos), PSD-95 and F-actin, which subsequently led to damage of neuronal ultrastructure and dendrites, loss of dendritic spines, and decreased dendritic complexity index, contributing to spatial learning and memory deficits. These abnormalities were prevented by AS-IV treatment. In addition, TrkB receptor antagonists antagonized these neuroprotective actions of AS-IV. 7,8-dihydroxyflavone and AS-IV had neuroprotective effects after radiation. CONCLUSION: AS-IV inhibits morphological damage of neurons and cognitive dysfunction in mice after radiation exposure, resulting in a neuroprotective effect, which were mediated by activating the BDNF-TrkB pathway.

Combined short-term and long-term emission controls improve air quality sustainably in China.

The effectiveness of national policies for air pollution control has been demonstrated, but the relative effectiveness of short-term emission reduction measures in comparison with national policies has not. Here we show that short-term abatement measures during important international events substantially reduced PM2.5 concentrations, but air quality rebounded to pre-event levels after the measures ceased. Long-term adherence to strict emission reduction policies led to successful decreases of 54% in PM2.5 concentrations in Beijing, and 23% in atmospheric nitrogen deposition in China from 2012 to 2020. Incentivized by "blue skies" type campaigns, economic development and reactive nitrogen pollution are quickly decoupled, showing that a combination of inspiring but aggressive short-term measures and effective but durable long-term policies delivers sustainable air quality improvement. However, increased ammonia concentrations, transboundary pollutant flows, and the complexity to achieving reduction targets under climate change scenarios, underscore the need for the synergistic control of multiple pollutants and inter-regional action.

Utility of SHOX2 and RASSF1A gene methylation detection on the residual cytology material from endobronchial ultrasound-guided transbronchial needle aspiration.

Objective: This study aims to assess the effectiveness of Short Stature Homeobox 2 (SHOX2) and RAS Association Domain Family 1 Isoform A (RASSF1A) gene methylation detection in residual liquid-based cytology (LBC) materials from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) and investigate the diagnostic accuracy of a comprehensive diagnostic approach. Material and Methods: Between June 2022 and May 2023, a total of 110 cases that underwent EBUS-TBNA were enrolled in the study. SHOX2 and RASSF1A genes methylation detection using the residual cytological material, LBC, and cell block (CB) were conducted for each EBUS-TBNA case. The sensitivity and specificity of cytology, CB histopathology, SHOX2, and RASSF1A methylation in diagnosing EBUS-TBNA samples were determined based on follow-up data. Results: Among the 72 cases confirmed as pulmonary carcinomas, the methylation test yielded positive results in 24 adenocarcinoma cases, 10 squamous cell carcinoma cases, and 14 small cell carcinoma cases. The sensitivity of the comprehensive diagnosis (combining LBC, CB, and methylation detection) in distinguishing metastatic pulmonary epithelial malignancies in mediastinal and hilar lymph nodes or masses from benign lesions was higher (97.22%, 70/72) than that of morphological diagnosis alone (LBC and CB) (88.89%, 64/72; P < 0.05). Conclusion: SHOX2 and RASSF1A methylation detection demonstrates a high sensitivity and negative predictive value in the identification of pulmonary epithelial malignancies and holds promise as a valuable ancillary approach to enhance morphological diagnosis of EBUS-TBNA.

Diagnostic efficiency of conventional ultrasound, shear wave elastography, and superb microvascular imaging in evaluating ulnar neuropathy at the elbow.

INTRODUCTION/AIMS: The current diagnosis of ulnar neuropathy at the elbow (UNE) relies mainly on the clinical presentation and nerve electrodiagnostic (EDX) testing, which can be uncomfortable and yield false negatives. The aim of this study was to investigate the diagnostic value of conventional ultrasound, shear wave elastography (SWE), and superb microvascular imaging (SMI) in diagnosing UNE. METHODS: We enrolled 40 patients (48 elbows) with UNE and 48 healthy volunteers (48 elbows). The patients were categorized as having mild, moderate or severe UNE based on the findings of EDX testing. The cross-sectional area (CSA) was measured using conventional ultrasound. Ulnar nerve (UN) shear wave velocity (SWV) and SMI were performed in a longitudinal plane. RESULTS: Based on the EDX findings, UNE severity was graded as mild in 4, moderate in 10, and severe in 34. The patient group showed increased ulnar nerve CSA and stiffness at the site of maximal enlargement (CSA mean at the site of max enlargement [CSAmax] and SWV mean at the site of max enlargement [SWVmax]), ulnar nerve CSA ratio, and stiffness ratio (elbow-to-upper arm), compared with the control group (p < .001). Furthermore, the severe UNE group showed higher ulnar nerve CSAmax and SWVmax compared with the mild and moderate UNE groups (p < .001). The cutoff values for diagnosis of UNE were 9.5 mm2 for CSAmax, 3.06 m/s for SWVmax, 2.00 for CSA ratio, 1.36 for stiffness ratio, and grade 1 for SMI. DISCUSSION: Our findings suggest that SWE and SMI are valuable diagnostic tools for the diagnosis and assessment of severity of UNE.

Dynamic Microcirculation Characteristics of Plantar Skin Under Metatarsal Head of Human Foot in Response to Life-Like Pressure Stimulus.

OBJECTIVE: Diabetic foot ulcer (DFU) is a severe complication with high mortality. High plantar pressure and poor microcirculation are considered main causes of DFU. The specific aims were to provide a novel technique for real-time measurement of plantar skin blood flow (SBF) under walking-like pressure stimulus and delineate the first plantar metatarsal head dynamic microcirculation characteristics because of life-like loading conditions in healthy individuals. METHODS: Twenty young healthy participants (14 male and 6 female) were recruited. The baseline (i.e., unloaded) SBF of soft tissue under the first metatarsal head were measured using laser Doppler flowmetry (LDF). A custom-made machine was utilized to replicate daily walking pressure exertion for 5 min. The exerted plantar force was adjusted from 10 N (127.3 kPa) to 40 N (509.3 kPa) at an increase of 5 N (63.7 kPa). Real-time SBF was acquired using the LDF. After each pressure exertion, postload SBF was measured for comparative purposes. Statistical analysis was performed using the R software. RESULTS: All levels of immediate-load and postload SBF increased significantly compared with baseline values. As the exerted load increased, the postload and immediate-load SBF tended to increase until the exerted load reached 35 N (445.6 kPa). However, in immediate-load data, the increasing trend tended to level off as the exerted pressure increased from 15 N (191.0 kPa) to 25 N (318.3 kPa). For postload and immediate-load SBF, they both peaked at 35 N (445.6 kPa). However, when the exerted force exceeds 35 N (445.6 kPa), both the immediate-load and postload SBF values started to decrease. CONCLUSIONS: Our study offered a novel real-time plantar soft tissue microcirculation measurement technique under dynamic conditions. For the first metatarsal head of healthy people, 20 N (254.6 kPa)-plantar pressure has a fair microcirculation stimulus compared with higher pressure. There might be a pressure threshold at 35 N (445.6 kPa) for the first metatarsal head, and soft tissue microcirculation may decrease when local pressure exceeds it.

Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins.

Importance: Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts. Objective: To investigate the association of current PTSD symptoms and PTSD diagnosis with OSA. Design, Setting, and Participants: This cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023. Exposure: Symptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure. Main Outcomes and Measures: Obstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis. Results: A total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found. Conclusions and Relevance: This cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.

Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study.

BACKGROUND: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. OBJECTIVE: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. METHODS: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. RESULTS: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7% vs 8.8%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for "ease of task completion" (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), "satisfaction with completion time" (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and "satisfaction with support" (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3% vs 93.3%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. CONCLUSIONS: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED.

Spatial lipidomics maps brain alterations associated with mild traumatic brain injury.

Traumatic brain injury (TBI) is a global public health problem with 50-60 million incidents per year, most of which are considered mild (mTBI) and many of these repetitive (rmTBI). Despite their massive implications, the pathologies of mTBI and rmTBI are not fully understood, with a paucity of information on brain lipid dysregulation following mild injury event(s). To gain more insight on mTBI and rmTBI pathology, a non-targeted spatial lipidomics workflow utilizing high resolution mass spectrometry imaging was developed to map brain region-specific lipid alterations in rats following injury. Discriminant multivariate models were created for regions of interest including the hippocampus, cortex, and corpus callosum to pinpoint lipid species that differentiated between injured and sham animals. A multivariate model focused on the hippocampus region differentiated injured brain tissues with an area under the curve of 0.99 using only four lipid species. Lipid classes that were consistently discriminant included polyunsaturated fatty acid-containing phosphatidylcholines (PC), lysophosphatidylcholines (LPC), LPC-plasmalogens (LPC-P) and PC potassium adducts. Many of the polyunsaturated fatty acid-containing PC and LPC-P selected have never been previously reported as altered in mTBI. The observed lipid alterations indicate that neuroinflammation and oxidative stress are important pathologies that could serve to explain cognitive deficits associated with rmTBI. Therapeutics which target or attenuate these pathologies may be beneficial to limit persistent damage following a mild brain injury event.