Using a Clinical Decision Support System to Improve Anticoagulation in Patients with Nonvalve Atrial Fibrillation in China's Primary Care Settings: A Feasibility Study.

Background: To primarily investigate the effect of using a clinical decision support system (CDSS) in community health centers in Shanghai, China, on the proportion of patients prescribed guideline-directed antithrombotic therapy. This study also gauged the general practitioner (GP)'s acceptance of the CDSS who worked in the atrial fibrillation (AF) special consulting room of the CDSS group. Methods: This was a prospective cohort study that included a semistructured interview and a feasibility study for a cluster-randomized controlled trial. Eligible patients who sought medical care in the AF special consulting rooms in two community health centers in Shanghai, China, between April 1, 2020, and October 1, 2020, were enrolled, and their medical records from the enrollment date, up to October 1, 2021, were extracted. Based on whether the GPs in the AF special consulting rooms of the two sites used the CDSS or not, we classified the two sites as a software group and a control group. The CDSS could automatically assess the risks of stroke and bleeding and provide suggestions on treatment, follow-up, adjustment of anticoagulants or dosage, and other items. The primary outcome was the proportion of patients prescribed guideline-directed antithrombotic therapy. We also conducted a semistructured interview with the GP in the AF special consulting rooms of the software group regarding the acceptance of the CDSS and suggestions on the optimization of the CDSS and the study protocol of the cluster-randomized controlled trial in the future. Results: Eighty-four patients completed the follow-up. The mean age of these subjects was 75.71 years, the median time of clinical visits was six times per person, and the follow-up duration was 15 months. The basic demographics were similar between the two groups, except for age (t = 2.109, p = 0.038) and the HAS-BLED score (χ 2 = 4.363, p = 0.037). The primary outcome in the software group was 8.071 times higher than that in the control group (adjusted odds ratio (OR) = 8.071, 95% confidence interval (2.570-25.344), p < 0.001). The frequency of consultation between groups was not significantly different (p = 0.981). It seemed that the incidence of adverse clinical events in the software group was lower than that in the control group. The main reason for dropouts in both groups was "following up in other hospitals." The GP in the AF special consulting rooms of the software group accepted the CDSS well. Conclusions: The findings indicated that it was feasible to further promote the CDSS in the study among community health centers in China. The use of the CDSS might improve the proportion of patients prescribed guideline-directed antithrombotic therapy. The GP in the AF special consulting room of the software group showed a positive attitude toward the CDSS.

Current Status of Hedgehog Signaling Inhibitors.

The Hedgehog (Hh) signaling pathway plays a crucial role in diverse biological processes such as cell differentiation, proliferation, senescence, tumorigenesis, malignant transformation, and drug resistance. Aberrant Hh signaling, resulting from mutations and excessive activation, can contribute to the development of various diseases during different stages of biogenesis and development. Moreover, it has been linked to unfavorable outcomes in several human cancers, including basal cell carcinoma (BCC), multiple myeloma (MM), melanoma, and breast cancer. Hence, the presence of mutations and excessive activation of the Hh pathway presents obstacles and constraints in the realm of cancer treatment. Extant research has demonstrated that small molecule inhibitors are regarded as the most effective therapeutic approaches for targeting the Hh pathway in contrast to traditional chemotherapy and radiotherapy. Consequently, this review focuses on the present repertoire of small molecule inhibitors that target various components of the Hh pathway, including Hh ligands, Ptch receptors, Smo transmembrane proteins, and Gli nuclear transcription factors. This study provides a comprehensive analysis of small molecules' structural and functional aspects in the preclinical and clinical management of cancer. Additionally, it elucidates the obstacles encountered in targeting the Hh pathway for human cancer therapy and proposes potential therapeutic approaches.

Radiomics analysis of R2* maps to predict early recurrence of single hepatocellular carcinoma after hepatectomy.

Objectives: This study aimed to evaluate the effectiveness of radiomics analysis with R2* maps in predicting early recurrence (ER) in single hepatocellular carcinoma (HCC) following partial hepatectomy. Methods: We conducted a retrospective analysis involving 202 patients with surgically confirmed single HCC having undergone preoperative magnetic resonance imaging between 2018 and 2021 at two different institutions. 126 patients from Institution 1 were assigned to the training set, and 76 patients from Institution 2 were assigned to the validation set. A least absolute shrinkage and selection operator (LASSO) regularization was conducted to operate a logistic regression, then features were identified to construct a radiomic score (Rad-score). Uni- and multi-variable tests were used to assess the correlations of clinicopathological features and Rad-score with ER. We then established a combined model encompassing the optimal Rad-score and clinical-pathological risk factors. Additionally, we formulated and validated a predictive nomogram for predicting ER in HCC. The nomogram's discrimination, calibration, and clinical utility were thoroughly evaluated. Results: Multivariable logistic regression revealed the Rad-score, microvascular invasion (MVI), and α fetoprotein (AFP) level > 400 ng/mL as significant independent predictors of ER in HCC. We constructed a nomogram based on these significant factors. The areas under the receiver operator characteristic curve of the nomogram and precision-recall curve were 0.901 and 0.753, respectively, with an F1 score of 0.831 in the training set. These values in the validation set were 0.827, 0.659, and 0.808. Conclusion: The nomogram that integrates the radiomic score, MVI, and AFP demonstrates high predictive efficacy for estimating the risk of ER in HCC. It facilitates personalized risk classification and therapeutic decision-making for HCC patients.

miR-504 knockout regulates tumor cell proliferation and immune cell infiltration to accelerate oral cancer development.

miR-504 plays a pivotal role in the progression of oral cancer. However, the underlying mechanism remains elusive in vivo. Here, we find that miR-504 is significantly down-regulated in oral cancer patients. We generate miR-504 knockout mice (miR-504-/-) using CRISPR/Cas9 technology to investigate its impact on the malignant progression of oral cancer under exposure to 4-Nitroquinoline N-oxide (4NQO). We show that the deletion of miR-504 does not affect phenotypic characteristics, body weight, reproductive performance, or survival in mice, but results in changes in the blood physiological and biochemical indexes of the mice. Moreover, with 4NQO treatment, miR-504-/- mice exhibit more pronounced pathological changes characteristic of oral cancer. RNA-seq shows that the differentially expressed genes observed in samples from miR-504-/- mice with oral cancer are involved in regulating cell metabolism, cytokine activation, and lipid metabolism-related pathways. Additionally, these differentially expressed genes are significantly enriched in lipid metabolism pathways that influence immune cell infiltration within the tumor microenvironment, thereby accelerating tumor development progression. Collectively, our results suggest that knockout of miR-504 accelerates malignant progression in 4NQO-induced oral cancer by regulating tumor cell proliferation and lipid metabolism affecting immune cell infiltration.

Understory fuel loads and the impact factors of Quercus mongolica natural secondary forest in Hebei Pro-vince, China.

We investigated understory fuel loads of Quercus mongolica natural secondary forests in Hebei Province, China. We analyzed the effects of stand factors, topographic factors, and ground cover factors on the quantity and composition of fuel, established the dynamic models of understory fuel loads, and proposed management measures. The results showed that the understory total fuel load in Q. mongolica natural secondary forests was 11.68 t·hm-2, which exceeded the forest fire potential threshold (10 t·hm-2). The understory dead fuel load was mainly humus, and the understory living fuel load was mainly shrubs. The 1 h time-lag fuel load increased significantly with increasing canopy density, stand density, stand age, and litter thickness. The 10 h time-lag fuel load increased signi-ficantly with increasing stand density, average tree height, and litter thickness. Humus load decreased significantly with increasing altitude and increased significantly with increasing humus thickness. Herb load increased significantly with increasing sunny slope orientation and herbal coverage. Shrub load increased significantly with increasing slope degree, shrub coverage, and humus thickness. Understory total fuel load decreased significantly with increasing altitude, and increased significantly with increasing stand density, humus thickness, and litter thickness. The results of stepwise regression analysis indicated that stand density, humus thickness, and altitude could better predict the understory total fuel load (Radj2=0.775). Therefore, more attention should be paid on the control of stand density of Q. mongolica natural secondary forest in Hebei Province. Cleaning of litters and humus on the ground would help prevent forest fires scientifically and effectively.

Effect of an artificial intelligence-assisted tool on non-valvular atrial fibrillation anticoagulation management in primary care: protocol for a cluster randomized controlled trial.

BACKGROUND: Atrial fibrillation (AF) is one of the most common cardiac arrhythmia diseases. Thromboembolic prophylaxis plays an essential role in AF therapy, but at present, general practitioners (GPs) are presumed to lack the knowledge and enthusiasm for AF management. Clinical decision support systems (CDSS), assisted by artificial intelligence, help primary care providers (PCPs) make quick, individualized, and correct clinical decisions. This primary aim of the study is to identify whether the promotion of the CDSS would improve the primary care provided to patients with AF. The secondary objectives are mainly to assess the health-economic and clinical benefits from using the CDSS, and the improvement of GPs' AF management capability. METHODS: This study will be a prospective cluster randomized controlled trial, conducted among 14 community health centers in Shanghai which were randomized as the intervention group and control group in a ratio of 1:1. The intervention group will use the CDSS in the consultation of patients with AF and the control group will maintain their usual care. The trial will include 498 patients with AF and the follow-up period will be 12 months. The primary outcome is set as the proportion of antithrombotic treatment prescriptions in agreement with recommendations in the latest China's AF-related guidelines. The secondary outcomes are the frequency of consultation, the compliance rate of international normalized ratio (INR) in patients with warfarin, stroke morbidity, treatment compliance, medication satisfaction, and the cost-benefit analysis. Per-protocol (PP) analysis and the intention-to-treat (ITT) analysis will be conducted. DISCUSSION: This study aims to identify whether the application of CDSS to manage patients with AF in China's community health centers would bring benefits for patients, physicians, and health economics. TRIAL REGISTRATION: Registry name: AI (Development and promotion of an AI-assisted tool for NVAF management in primary care); registry number: ChiCTR2100052307; registration date: Nov. 22nd, 2021; http://www.chictr.org.cn/showproj.aspx?proj=133849 .

Risk factors for acute kidney injury in patients with acute myocardial infarction.

BACKGROUND: Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI). It has high short- and long-term mortality rates and a poor prognosis but is potentially preventable. However, the current incidence, risk factors, and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care. METHODS: The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed. AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria. All the patients were divided into either the AKI group or the non-AKI group. A univariate comparison analysis was performed to identify possible risk factors associated with AKI. A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI. RESULTS: Overall, the incidence of AKI was 26.0%. The mortality rate of the AKI group was 20.5%, and the mortality rate of the non-AKI group was 0.6% (P < 0.001). Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included: age (>60 years old) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.05, P = 0.000), hypertension (OR 2.51, 95% CI 1.62-3.87, P = 0.000), chronic kidney disease (OR 3.52, 95% CI 2.01-6.16, P = 0.000), Killip class ≥3 (OR 5.22, 95% CI 3.07-8.87, P = 0.000), extensive anterior myocardial infarction (OR 3.02, 95% CI 1.85-4.93, P = 0.000), use of furosemide (OR 1.02, 95% CI 1.02-1.03, P = 0.000), non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58, 95% CI 1.04-2.40, P = 0.032). These factors provided an accurate tool to identify patients at high risk of developing AKI. CONCLUSIONS: Approximately 26.0% of patients undergoing AMI developed AKI, and the development of AKI was strongly correlated with in-hospital mortality. The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.

Comparison of acupuncture and other drugs for chronic constipation: A network meta-analysis.

The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture and drugs in the treatment of chronic constipation. Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs for chronic constipation were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database and CBM) up to December 2017. Additional references were obtained from review articles. With quality evaluations and data extraction, a network meta-analysis (NMA) was performed using a random-effects model under a frequentist framework. A total of 40 studies (n = 11032) were included: 39 were high-quality studies and 1 was a low-quality study. NMA showed that (1) acupuncture improved the symptoms of chronic constipation more effectively than drugs; (2) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome was acupuncture, polyethylene glycol, lactulose, linaclotide, lubiprostone, bisacodyl, prucalopride, sham acupuncture, tegaserod, and placebo; (3) the ranking of side effects were as follows: lactulose, lubiprostone, bisacodyl, polyethylene glycol, prucalopride, linaclotide, placebo and tegaserod; and (4) the most commonly used acupuncture point for chronic constipation was ST25. Acupuncture is more effective than drugs in improving chronic constipation and has the least side effects. In the future, large-scale randomized controlled trials are needed to prove this. Sham acupuncture may have curative effects that are greater than the placebo effect. In the future, it is necessary to perform high-quality studies to support this finding. Polyethylene glycol also has acceptable curative effects with fewer side effects than other drugs.

Acupuncture for Diarrhoea-Predominant Irritable Bowel Syndrome: A Network Meta-Analysis.

BACKGROUND: The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture, and drugs in the treatment of diarrhoea-predominant irritable bowel syndrome. METHODS: Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database, and CBM) up to December 2017. Additional references were obtained from review articles. With document quality evaluations and data extraction, Network Meta-Analysis was performed using a random-effects model under a frequentist framework. RESULTS: A total of 29 studies (n = 9369) were included; 19 were high-quality studies, and 10 were low-quality studies. NMA showed the following: (1) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome is acupuncture, sham acupuncture, pinaverium bromide, alosetron = eluxadoline, ramosetron, and rifaximin; (2) the ranking of treatments in terms of severity of side effects in diarrhoea-predominant irritable bowel syndrome is rifaximin, alosetron, ramosetron = pinaverium bromide, sham acupuncture, and acupuncture; and (3) the treatment of diarrhoea-predominant irritable bowel syndrome includes common acupoints such as ST25, ST36, ST37, SP6, GV20, and EX-HN3. CONCLUSION: Acupuncture may improve diarrhoea-predominant irritable bowel syndrome better than drugs and has the fewest side effects. Sham acupuncture may have curative effect except for placebo effect. In the future, it is necessary to perform highly qualified research to prove this result. Pinaverium bromide also has good curative effects with fewer side effects than other drugs.

The effects of different levels of superoxide dismutase in Modena on boar semen quality during liquid preservation at 17°C.

This study was conducted to investigate the influence of superoxide dismutase (SOD) on the quality of boar semen during liquid preservation at 17°C. Semen samples from 10 Duroc boars were collected and pooled, divided into five equal parts and diluted with Modena containing different concentrations (0, 100, 200, 300 and 400 U/mL) of SOD. During the process of liquid preservation at 17°C, sperm motility, acrosome integrity, membrane integrity, total antioxidant capacity (T-AOC) activity, malondialdehyde (MDA) content and hydrogen peroxide (H2 O2 ) content were measured and analyzed every 24 h. Meanwhile, effective survival time of boar semen during preservation was evaluated and analyzed. The results indicated that different concentrations of SOD in Modena showed different protective effects on boar sperm quality. Modena supplemented with SOD decreased the effects on reactive oxygen species on boar sperm quality during liquid preservation compared with that of the control group. The added 200 U/mL SOD group showed higher sperm motility, membrane integrity, acrosome integrity, effective survival time and T-AOC activity. Meanwhile, the added 200 U/mL SOD group showed lower MDA content and H2 O2 content. In conclusion, addition of SOD to Modena improved the boar sperm quality by reducing oxidative stress during liquid preservation at 17°C and the optimum concentration was 200 U/mL.

A novel method for preparation of MNP@CS-tethered coenzyme for coupled oxidoreductase system.

The immobilized cofactor NAD(H) is easily recovered from the reaction bulk, which is essential for repeated use of NAD(H) in the bioprocess catalyzed by NAD(H)-dependent oxidoreductase. Here, a magnetic nanoparticle platform was designed to immobilize both of the NADH and the NAD(+). The design was based on chitosan-coated magnetic nanoparticles (MNP@CS) which was activated by the EDC/NHS with the aid of azelaic acid as spacer. Interestingly, the succinimide group at the end of spacer arm catalyzed direct coupling of a carboxyl-terminal to the 6-amino group of the adenine residue of NAD(H). Our results indicated that 150 µmol NADH and 50 µmol NAD(+) was effectively attached to 1g MNP@CS at 25°C in 120 min and the prepared MNP@CS-NAD(H) showed good activity according to the coupling reaction of benzyl alcohol and acetaldehyde catalyzed by alcohol dehydrogenase.