An efficient method for the preparative isolation and purification of alkaloids from Gelsemium by using high speed counter-current chromatography and preparative HPLC.

We established an efficient method using high-speed countercurrent chromatography (HSCCC) combined with preparative high-performance liquid chromatography (prep-HPLC) for isolating and purifying Gelsemium elegans (G. elegans) alkaloids. First, the two-phase solvent system composed of 1% triethylamine aqueous solution/n-hexane/ethyl acetate/ethanol (volume ratio 4:2:3:2) was employed to separate the crude extract (350 mg) using HSCCC. Subsequently, the mixture that resulted from HSCCC was further separated by Prep-HPLC, resulting in seven pure compounds including: 14-hydroxygelsenicine (1, 12.1 mg), sempervirine (2, 20.8 mg), 19-(R)-hydroxydihydrogelelsevirine (3, 10.1 mg), koumine (4, 50.5 mg), gelsemine (5, 32.2 mg), gelselvirine (6, 50.5 mg), and 11-hydroxyhumanmantenine (7, 12.5 mg). The purity of these seven compounds were 97.4, 98.9, 98.5, 99, 99.5, 96.8, and 85.5%, as determined by HPLC. The chemical structures of the seven compounds were analyzed and confirmed by electrospray ionization mass spectrometry (ESI-MS), 1H-nuclear magnetic resonance (1H NMR), and 13 C-nuclear magnetic resonance (13 C NMR) spectra. The results indicate that the HSCCC-prep-HPLC method can effectively separate the major alkaloids from the purified G. elegans, holding promising prospects for potential applications in the separation and identification of other traditional Chinese medicines.

The Guiding Significance of Ocular Biometry in Evaluating the Refractive Status of Preschool Children.

INTRODUCTIONS: This study aimed to analyze the correlation between refractive status and ocular biological parameters in preschool-age children (3-6 years old), establish a regression curve, guide the clinical judgment of children's refractive status, and improve the accuracy of refractive screening for this age group. METHODS: A total of 508 children, aged 3-6 years, were admitted to the hospital, exhibiting symptoms of ametropia and a need for dilation optometry. Among these, 326 children were included in the statistics group, having been examined between August 2021 and October 2022, and 182 children were included in the validation group, having been examined between November 2022 and March 2023. Using IOL Master700, ocular biometry parameters were measured for all participants, including axial length (AL), keratometry readings (K1 and K2), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT). One percent atropine sulfate eye gel was administered, and then the spherical equivalent (SE) was calculated by Bennett's formula. The correlation between SE and other ocular biometrics was analyzed, followed by the establishment of an SE prediction equation. The SE prediction equation was used to calculate the spherical equivalent (SE#) using ocular biometry data from the validation group, and the consistency between SE and SE# was evaluated. RESULTS: SE showed a negative correlation with AL/CR (r = -0.936), AL (r = -0.811), ACD (r = -0.500), age (r = -0.396), and Km (r = -0.213) (p < 0.001), and positive correlation with LT (r = 0.301), LP (r = 0.176) (p < 0.001). A multiple linear regression equation was established for SE using the stepwise selection method, SE = 49.232 - 23.583 × AL/CR + 1.703 × ACD + 0.589 × Km - 0.609 × LP + 1.103 × LT (R2 = 0.997). Based on the regression equation, the predicted SE# highly correlated with SE after cycloplegia in the validation group (r = 0.998, p < 0.001). CONCLUSION: The main ocular biological factors of ocular diopter in children aged 3-6 years are AL/CR, ACD, Km, LP, and LT, which are jointly influenced by multiple factors. Ocular biometry is a reliable predictor of real refraction among children aged 3-6.

Induction of zincophore pseudopaline secretion by Cr(VI) and intracellular formation of granules from nanocrystal aggregation by Cr(III) in Pseudomonas aeruginosa.

When microorganisms are challenged with toxic metals, intracellular granules are commonly observed, however, the exact nature of these granules is poorly understood. Here we show that when Pseudomonas aeruginosa CCTCC AB93066 were exposed to Cr(VI), Cr can enter the cell in the form of both Cr(VI) and Cr(III), and intracellular granules of several hundred nanometers were formed in the nucleoid region and were built up by aggregation of nanocrystals. We suggested that these nanocrystals are organic crystals. Transcriptomic profiles and liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis indicated that pseudopaline (a metallophore that can complex with Zn2+) production and pseudopaline-Zn2+ import into bacterial cells were enhanced upon Cr(VI) exposure. It was proposed that pseudopaline can scavenge Zn2+ which is essential for transcription alteration and DNA repair. Excessive pseudopaline might precipitate as nanospheres in the nuclear region that are further agglomerated by Cr(III) to form larger granules. During this process, Cr(III) is sequestered and immobilized. Hence we revealed pseudopaline production and zinc acquisition is crucial for alleviation of Cr(VI) toxicity and intracellular granules are composed of organic nanospheres which are aggregated by Cr(III).

Superlattice in a Ru Superstructure for Enhancing Hydrogen Evolution.

Superlattices are attracting extensive attention due to their unique properties. Nevertheless, the observations of superlattices are limited to those layered structures with weak interlayered interactions, and the effect of the superlattice in metal-based nanostructures on catalysis is unexplored yet. We here report a facile wet-chemical method for synthesizing two-dimensional Ru multilayered nanosheets (Ru MNSs) with a superlattice. Characterizations reveal that the superlattice is formed by stacking Ru layers with twisted angles from 2° to 30°. Owing to the strong synergy between the adjacent layers, Ru MNSs can serve as an efficient catalyst for the alkaline hydrogen evolution reaction (HER). Theoretical calculations reveal that the superlattice can induce the strain effect, which leads to lattice contraction and weak *H adsorption ability, as a result of improved HER performance. This work sheds new light on the utilization of the superlattice on enhancing catalysis in metal-based materials.

Comparison of the Performance of 24 Early Warning Scores with the Updated National Early Warning Score (NEWS2) for Predicting Unplanned Intensive Care Unit (ICU) Admission in Postoperative Brain Tumor Patients: A Retrospective Study at a Single Center.

BACKGROUND There have been few studies to evaluate early warning score (EWS) systems, or track and trigger systems (TTS), to identify early clinical deterioration in patients following brain tumor surgery who are admitted to the Intensive Care Unit (ICU). The National Early Warning Score (NEWS2) is an established method used in the U.K. National Health Service to improve care for in-hospital patients. This retrospective study from a single center aimed to compare the performance of NEWS2 with 24 other types of EWS to evaluate unplanned ICU admissions within 72 h after brain tumor surgery. MATERIAL AND METHODS A total of 326 patients with brain tumors were included in the study. Patients who experienced unplanned ICU transfer after surgery (69 cases) were diagnostically matched with patients who did not require intensive care (257 controls). We collected the physiological variables to calculate the area under the receiver operator characteristic curve (AUROC), sensitivity, specificity, Youden index values, cutoff values, positive predictive values, and negative predictive values. RESULTS The NEWS2 identified postoperative brain tumor patients with AUROC (0.860, p=0.000). The Patient-At-Risk (PAR) score was higher than NEWS2 in terms of AUROC value (0.870, P=0.000), Youden index (0.589 vs 0.542). CONCLUSIONS The findings showed that although the NEWS 2 performed well when used to evaluate unplanned ICU admissions within 72 h of postoperative brain tumor patients, the PAR score was also an accurate EWS.

A paper-based colorimetric assay system for sensitive cysteine detection using a fluorescent probe.

A fluorescent probe for the colorimetric detection of cysteine (Cys) was synthesized by combining resorufin with 7-nitrobenzofurazan. The resultant probe was characterized by FT-IR spectroscopy, fluorescence detection, mass spectrometry and NMR spectroscopy. After reacting with Cys, resorufin is released and the color changes from light yellow to red on paper-based analytical devices. The results were recorded using a common cell phone and subsequently analyzed using Photoshop software. The color intensity of the RGB channel increased linearly in the 0.04 to 70.04 µM Cys concentration range when the probe concentration was 2.6 mM (R = 0.9965), and the limit of detection was 16 nM. The effects of detection conditions have been investigated and are discussed. The interference deviations of 13 substances to Cys were in the range of -2% to +2%. The Cys concentration was determined as 270.8 ± 19.3 µM in human plasma, and the recovery was from 99.7% to 100.4%. The work demonstrates the potential of the method to detect Cys in real samples with low cost and high sensitivity.

Counterion-Controlled Formation of Layered Honeycomb and Polythreading Uranyl Networks and the Highly Sensitive and Selective Detection of Fe3+ in Aqueous Media.

Under hydrothermal conditions, six uranium coordination polymers were obtained by employing the ligand of tris(2-carboxyethyl) isocyanurate (H3tci) and different combinations of d-block metal ions (Mn2+, Co2+, Zn2+, Ni2+) or N-donors (triethylamine (Et3N), 2,2'-bipyridine (2,2'-bipy)). Three uranium polymers [(UO2)2(tci)2]1/2-·[Mn2(µ2-O)(H2O)8]1/2+·2H2O (1), [(UO2)2(tci)2]1/2-·[Co2(µ2-O)(H2O)8]1/2+ (2), and [(UO2)2(tci)2]1/2-·[Zn2(µ2-O)(H2O)8]1/2+·2H2O (3) containing transition metal hydrated ions, crystallized as two-dimensional coordination polymers with the common (6, 3) net topology. X-ray crystal structures of 1-3 display that they have similar honeycomb-like frameworks with all ligands bis-chelating. [UO2(tci)]-3·[Ni(H2O)6]2+(H3O)+·2H2O (4) and [UO2(tci)]-·[NH(CH2CH3)3]1/3+·(2H3O+)1/3 (5) are made up of four interlocked sets and exhibit the 4-fold-interpenetrated frameworks. [UO2(tci)]-·(C10H9N2)+·H2O (6) comprises the 2,2'-bipy cation as counterion and represents a 2D grid layered structure. Additional metals and the N-donors are all free in the complexes, acting as the templates and compensation of the charge equilibrium. The solid-state emission spectra indicate that all of the synthesized compounds own fluorescence emissions. Furthermore, the results of the quenching ability of Fe3+ for complexes 5 and 6 exhibit their highly sensitive and selective detection for Fe3+ ions. Moreover, the uranium complexes can be used as a potential probe for Fe3+ in aqueous solutions.

A novel functional variant in Wilms' Tumor 1 (WT1) is associated with idiopathic non-obstructive azoospermia.

Idiopathic nonobstructive azoospermia (INOA) is one of the most severe forms of male infertility, yet its pathophysiology remains unclear. WT1 (Wilms' tumor 1) regulates the polarity of Sertoli cells, thereby playing a critical, indirect role in spermatogenesis. Here, we evaluated WT1 gene variation associates with INOA by assessing its promoter and coding regions in 200 patients diagnosed with INOA and 200 proven-fertile men. Three novel variants in the WT1 coding region were detected only in INOA patients, including two synonymous variants and one missense variant, p.Phe435Leu (p.F435L), which was predicted to be deleterious to protein function. The results of dual luciferase reporter showed that the WT1 p.F435L variant decreases transcription of COL4A1 and WNT4 promoters through a dominant-negative effect. Furthermore, chromatin immunoprecipitation assays revealed that COL4A1 and WNT4 promoter is directly bound by wild-type WT1 protein, but not the p.F435L WT1 variant. Thus, we identified a novel functional variant of WT1 functionally associated with INOA. Mol. Reprod. Dev. 84: 222-228, 2017. © 2017 Wiley Periodicals, Inc.

Damage to the macula associated with LED-derived blue laser exposure: A case report.

BACKGROUND: Light emitting diodes laser is emerging as an important source of light replacing conventional lights. It is widely used for illumination in the bar where young people love to go. But not everyone knows about the light damage to the eye especially to the macula. In this article, we report the case of a macular damage induced by LED-derived blue laser in a bar, studied with optical coherence tomography (OCT) to evaluate the retinal lesion and multifocal electroretinography (mfERG) to evaluate functional damage. CASE PRESENTATION: Four days after the photo injury to the right eye, the visual acuity was 0.5. Funduscopy revealed a round red lesion in the macula of the right eye. Fluorescein angiography (FA) revealed no leakage. OCT revealed a deficiency in the center of the fovea. MfERG revealed a reduction of the peak value in the right eye compared to the left eye. One month later, although the vision was 1.0 in the right eye, OCT revealed a hyporeflectivity of the ellipsoid zone. MfERG still showed a reduction of the peak value in the right eye compared to the left eye. CONCLUSION: We believe that general knowledge about laser injuries to the eye should be realized widely. We also think in cases of macular laser damage, the recovery of vision can not demonstrate the recovery of the function of photoreceptors.

In vivo confocal microscopy of pre-Descemet corneal dystrophy associated with X-linked ichthyosis: a case report.

BACKGROUND: Pre-Descemet corneal dystrophy (PDCD) is characterized by the presence of numerous, tiny, polymorphic opacities immediately anterior to Descemet membrane, which is a rare form of corneal stromal dystrophy and hard to be diagnosed. In vivo confocal microscopy (IVCM) is a useful tool to examine the minimal lesions of the cornea at the cellular level. In this article, we report a rare case of PDCD associated with X-linked ichthyosis and evaluate IVCM findings. CASE PRESENTATION: We present a 34-year-old male Chinese patient with PDCD associated with X-linked ichthyosis. Slit-lamp biomicroscopy showed the presence of tiny and pleomorphic opacities in the posterior stroma immediately anterior to Descemet membrane bilaterally. IVCM revealed regular distributed hyperreflective particles inside the enlarged and activated keratocytes in the posterior stroma. Hyperreflective particles were also observed dispersedly outside the keratocytes in the anterior stroma. Dermatological examination revealed that the skin over the patient's entire body was dry and coarse, with thickening and scaling of the skin in the extensor side of the extremities. PCR results demonstrated that all ten exons and part flanking sequences of STS gene failed to produce any amplicons in the patient. CONCLUSIONS: IVCM is useful for analyzing the living corneal structural changes in rare corneal dystrophies. We first reported the IVCM characteristics of PDCD associated with X-linked ichthyosis, which was caused by a deletion of the steroid sulfatase (STS) gene, confirmed by gene analysis.

Central retinal artery occlusion associated with persistent truncus arteriosus and single atrium: a case report.

BACKGROUND: Central retinal artery occlusion (CRAO) is an ocular emergency and most of the cases present with painless sudden persistent loss of vision in the range of counting fingers to perception of light. The presentation of CRAO is associated with a variety of medical conditions. We report a rare case of CRAO associated with persistent truncus arteriosus (PTA) and single atrium in a female patient. CASE PRESENTATION: A 23-year-old woman was admitted due to sudden painless visual loss in the left eye. On examination visual acuity of light-perception was noted in the left eye with a left relative afferent pupillary defect. Fundoscopic examination revealed retinal ischemic whitening, constriction of the arteriole and venule with segmentation and typical "cherry-red spot" suggesting CRAO. The patient was treated with ocular massage and anterior chamber paracentesis. She was commenced on 150 mg of aspirin and also received hyperbaric oxygen therapy. An echocardiogram revealed PTA and single atrium. A diagnosis of CRAO associated with PTA and single atrium was made. CONCLUSION: The ophthalmologist should enquire about congenital and acquired cardiac abnormalities in patients with CRAO and consider such abnormalities to be possible sources of emboli.

Low Content Ga2O3 Enables the Direct Methane Conversion.

The direct conversion of methane (CH4), a main greenhouse gas, to value-added chemicals has attracted increasing attention in order to alleviate the current energy crisis and environmental concern. Nevertheless, the oriented conversion of CH4 to target product is formidably challenging due to the inertness of CH4. In this work, we demonstrate that zeolite modified by a low amount of Ga2O3 (GS-1) can serve as a highly active and stable catalyst for direct conversion to hydrogen (H2) and solid carbon. The optimal GS-1 with 0.62 wt % of Ga displays a CH4 conversion rate of 70.6 mol/gGa/h with a H2 productivity of 134 mol/gGa/h at 800 °C. Analysis on NH3 temperature-programmed desorption (TPD) and in situ diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) suggests that the introduction of Ga2O3 can poison the acidic site of zeolite and promote the dehydrogenation of CH4. This work reports a highly active and stable catalyst for direct methane conversion, which may provide a feasible strategy for the sustainable utilization of CH4.

AC125611.3 promotes the progression of colon cancer by recruiting DKC1 to stabilize CTNNB1.

BACKGROUND AND STUDY AIMS: Previous studies have suggested that lncRNAs impact cancer progression. The lncRNA AC125611.3 (also referred to as RP11-161H23.5) is highly expressed in colon cancer but rarely studied; understanding its regulation may provide novel insights on treating colon cancer. MATERIALS AND METHODS: qRT-PCR was performed to quantify RNAs. CCK-8 and EdU assays were performed to assess cell proliferation. Western blot analysis was used to detect levels of proteins related to cell apoptosis and EMT. Wound healing assay and Transwell invasion assay were conducted to evaluate cell migratory and invasive capabilities, respectively. Luciferase reporter assay, RIP assay, and pull-down assay were used to verify RNA-RNA and RNA-protein interactions. RESULTS: AC125611.3 was highly overexpressed in colon cancer cells. AC125611.3 depletion curbed cell proliferative, invasive, migratory, and EMT processes while enhancing apoptosis. Furthermore, AC125611.3 activated the Wnt signaling pathway in colon cancer cells by regulating catenin beta-1 (CTNNB1). Moreover, AC125611.3 recruited dyskeratosis congenita 1 (DKC1) to stabilize CTNNB1. CONCLUSION: AC125611.3 recruits DKC1 to stabilize CTNNB1 and activate Wnt signaling, thereby promoting the progression of colon cancer.

Reductive Hydrodehalogenation of Halogenated Carboxylic Acid Derivatives Using a DMSO/HCOONa·2H2O System.

A practical and operationally simple hydrodehalogenation of halogenated carboxylic acid derivatives using a DMSO/HCOONa·2H2O system is developed. This protocol avoids the involvement of light irradiation, electrochemical apparatus, transition metals, radical initiators, strong bases, and other additional additives. Control experiments suggest that HCOONa might function as a hydride donor in the reduction process via nucleophilic substitution or addition to achieve the hydrodehalogenation.

Protocol to characterize target components of Gelsemium using an in-house herb database and high-performance liquid chromatography/quadrupole time-of-flight mass spectrometry.

Currently, the identification of herb metabolites is challenging due to a lack of clear standards. Here, using Gelsemium as an example, we present a protocol for characterizing target components of herbs. This approach utilizes high-performance liquid chromatography/quadrupole time-of-flight mass spectrometry guided by an in-house herb metabolite database based on reported studies and mass spectrometry. We describe steps for creating an in-house database, preparing and detecting samples, processing data, and characterizing compounds. This approach offers a reference for future research on the identification of herb metabolites. For complete details on the use and execution of this protocol, please refer to Liu et al. (2017).1.

Comparison of 0.02% atropine eye drops, peripheral myopia defocus design spectacle lenses, and orthokeratology for myopia control.

CLINICAL RELEVANCE: There are many methods to control the progression of myopia. However, it is currently unknown which method could better control myopia progression: 0.02% atropine eye drops, peripheral myopic defocus design spectacle lenses (PMDSL), or orthokeratology (OK). BACKGROUND: To compare the efficacy of 0.02% atropine, PMDSL, and OK to control axial length (AL) elongation in children with myopia. METHODS: This study was analysed based on a previous cohort study (0.02% atropine group) and retrospective data (PMDSL and OK group). Overall, 387 children aged 6-14 years with myopia - 1.00D to - 6.00D in the three groups were divided into four subgroups according to age and spherical equivalent refraction (SER). The primary outcome was changed in AL over 1-year. RESULTS: The mean axial elongation was 0.30 ± 0.21 mm, 0.23 ± 0.16 mm, and 0.17 ± 0.19 mm in the 0.02% atropine, PMDSL, and OK groups, respectively. Multivariate linear regression analyses showed significant differences in axial elongation among the three groups, especially in children aged 6-10, but not in children aged 10.1-14; the corresponding axial elongation was 0.35 ± 0.21 mm, 0.23 ± 0.17 mm, and 0.21 ± 0.20 mm (P < 0.05 between any two groups, except between PMDSL and OK groups at P > 0.05) and 0.22 ± 0.20 mm, 0.21 ± 0.13 mm, and 0.13 ± 0.18 mm (P < 0.05 between any two groups, except between 0.02% atropine and PMDSL groups at P > 0.05) in children with SER from - 1.00D to - 3.00D and from - 3.01D to - 6.00D, respectively. CONCLUSIONS: Within the limits of this study design and using only the current brand of PMDSL, OK appeared to be the best method, followed by PMDSL and then 0.02% atropine, for controlling AL elongation over one year. However, different effects were found in the various age and SER subgroups.

Effect of 0.02% and 0.01% atropine on ocular biometrics: A two-year clinical trial.

Background: Several studies have shown that various concentrations of low-concentration atropine can reduce myopia progression and control axial elongation safely and efficiently in children. The aim of this study was to evaluate the effects of 0.02% and 0.01% atropine on ocular biometrics. Methods: Cohort study. 138 and 142 children were randomized to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine applied to both eyes nightly. Controls (N = 120) wore only SV spectacles. Ocular and corneal astigmatism were calculated using Thibos vector analysis and split into J0 and J45. Results: The changes in cycloplegic spherical equivalent refraction (SER) and axial length (AL) were -0.81 ± 0.52D, -0.94 ± 0.59D, and -1.33 ± 0.72D; and 0.62 ± 0.29 mm, 0.72 ± 0.31 mm, and 0.89 ± 0.35 mm in the 0.02% and 0.01% atropine and control groups, respectively (all P < 0.05). Both anterior chamber depth (ACD) and ocular astigmatism (including J0) increased, and lens power decreased in the three groups (all P < 0.05). However, there were no differences in the changes in ACD, ocular astigmatism, and lens power among the three groups (all P > 0.05). Intraocular pressure (IOP), corneal curvature, ocular astigmatism J45, and corneal astigmatism (including J0 and J45) remained stable over time in the three groups (all P > 0.05). The contributions to SER progression from the changes in AL, lens and corneal power of the three groups were similar (P > 0.05). The contribution of AL change alone to the change in SER was 56.3%, 63.4% and 78.2% in the above corresponding three groups. Conclusions: After 2 years, 0.02% and 0.01% atropine had no clinical effects on corneal and lens power, ocular and corneal astigmatism, ACD or IOP compared to the control group. 0.02% and 0.01% atropine helped to control myopia progression mainly by reducing AL elongation.

Comparison of Low Molecular Weight Heparin Used alone or Combined with Aspirin in the Treatment of Fetal Growth Restriction.

The objective of the study was to compare the efficacy of low-molecular weight heparin (LMWH) alone and use in the combination with aspirin in the treatment of fetal growth restriction (FGR) patients. Ninety-six FGR patients were divided into the LMWH group (n=48) and the combined group (n=48), according to the different treatments. This research showed after treatment, values of PI, RI and S/D, serum IL-6 and TNF-α in the combined group were lower than those in the LMWH group (all p <0.001). The frequency of pregnancy complications and adverse neonatal outcomes in the combined group were 2 (4.2%) lower than the LMWH group (p=0.045, 0.025). Combination of LMWH with aspirin in FGR patients effectively reduced levels of IL-6 and TNF-α within the mother, improved fetal developmental parameters, and reduced the frequency of pregnancy complications and adverse neonatal outcomes compared with LMWH treatment alone. Key Words: Fetal growth restriction (FGR), Low-molecular weight heparin (LMWH), Aspirin, Pregnancy, Newborn.

Physician awareness and attitudes regarding early warning score systems in mainland China: a cross-sectional study.

INTRODUCTION: The purpose of this study was to assess the application of the early warning score system (EWS-S) and gauge physician awareness, perceptions of necessity and attitudes regarding these tools based on previously experienced unnoticed clinical deterioration (CDET). METHODS: A cross-sectional survey was carried out via an online questionnaire at a large 3,500-bed Class 3A general hospital in China. A total of 299 physicians of adult general wards were asked to answer a translated questionnaire that was localised from the original version. Demographic profiles of patients were included as well as three other sections assessing awareness of CDET/EWS-S and gauging attitudes towards and perceptions of the necessity of EWS-S at our hospital. RESULTS: A high level of physician awareness of the CDET problem was observed. Most physicians knew about the existence of a systematic assessment tool for clinical application. Physicians with previous experience in reanimation, unplanned transfer to intensive care unit (UTICU) and/or death tended to consider EWS-S necessary in attentive and well-trained staff (p < 0.05). Physicians who had previous experience with UTICU were more likely to recommend implementing EWS-S in their wards compared with those without such experience (p < 0.05). CONCLUSION: Most physicians have positive attitudes towards EWS-S. However, their awareness should be further heightened. Physicians who had previous experience with CDET/UTICU were more likely to employ EWS-S in their clinical practices. To better facilitate the implementation of EWS-S in Chinese hospitals, existing facilities, policy supports, standardised managements and the development of information systems should be strengthened.

Application Value of Real-Time Ultrasonic Elastograph with Serum Human Epididymis Protein 4, Interleukin-33, and Carbohydrate Antigen 153 in Diagnosis of Early Cervical Cancer.

Objective: To explore the application value of real-time ultrasonic elastograph (USE) with serum human epididymis protein 4 HE4, interleukin-33 (IL-33), and carbohydrate antigen 153 (CA153) in the diagnosis of early cervical cancer. Methods: A total of 120 cervical cancer patients treated in our hospital (06, 2019-06, 2021) and meeting the study criteria were screened and divided into the benign group (BG, n = 70) and malignant group (MG, n = 50) according to their final diagnostic results, and healthy females who received physical examination in our hospital in the same period were selected as the control group (CG, n = 60). Patients in the three groups received real-time USE and detection of serum HE4, IL-33, and CA153 so as to analyze the diagnostic value of single examination and combined examination in diagnosing early cervical cancer. Results: The patients' real-time USE score, E max, E mean, and elastic fibers were significantly higher in the MG than those in the BG (P < 0.05), and the patients' real-time USE E min, stroma ratio and collagen fibers were significantly lower in the MG than those in the BG (P < 0.05); the HE4, IL-33, and CA153 levels were obviously higher in the MG than those in the BG (P < 0.05) and were significantly higher in the BG than those in the CG (P < 0.05); the positive detection rate of combining real-time USE with serum HE4, IL-33, and CA153 was higher than that of single examination, and the diagnostic accuracy rate, sensitivity, specificity, positive predictive value, and negative predictive value of the combined examination were significantly higher than those of single examination (P < 0.05); according to the diagnostic efficacy of single examination and combined examination in diagnosing early cervical cancer by ROC curve, it was combined diagnosis > real-time USE > HE4 > CA153 > IL-33. Conclusion: Combined examination of real-time USE and serum HE4, IL-33, and CA153 has higher diagnostic value in diagnosing early cervical cancer, which can obviously improve the diagnostic accuracy rate of cervical cancer.