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New carbon nanomaterials include carbon dots, graphene, and carbon nanotubes.

[EN] Rabbit coccidiosis is a very serious disease caused by protozoan parasites of the genus Eimeria, which increases the production rate of free radicals, especially reactive oxygen species. When the generation of free radicals exceeds the scavenging capacity of the body s antioxidant system, the oxidant-antioxidant balance is broken, resulting in oxidative stress. This study was designed to investigate the effect on the oxidant-antioxidant status of rabbits infected with E. intestinalis and E. magna. To this end, eighteen 30-d-old weaned rabbits were randomly allocated into three groups as follows: the E. intestinalis infection group with 3×103 sporulated oocysts of E. intestinalis, the E. magna infection group with 20×103 sporulated oocysts of E. magna, and the uninfected control group. We measured the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and total antioxidant capacity (T-AOC) and the contents of malondialdehyde (MDA) in rabbits small intestinal tissues (duodenum, jejunum and ileum) of the three groupson day 8. The results showed that CAT activity and MDA levels significantly increased, while the activities of SOD, GSH-Px and T-AOC decreased after E. intestinalis and E. magna infection. Besides, the jejunum and ileum were particularly damaged in the rabbits. It is concluded that the pathological oxidative stress occurs during the E. intestinalis and E. magna infection process and the body s oxidant-antioxidant balance is disrupted., This experiment was supported by the National Natural Science Foundation Project of China (nos. 31960688 and 31360592) and the Natural Science Foundation Project of Jiangxi Province (no. 20181BAB204016).

Vanadium-dependent haloperoxidases (VHPOs) from

Background Accurate and thorough surgical ward round documentation is crucial for maintaining quality clinical care. Accordingly, checklists have been proposed to improve ward round documentation. This systematic review aimed to evaluate the literature investigating the use of checklists to improve surgical ward round documentation. Methods MEDLINE, EMBASE, and PsycINFO were searched on August 16, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of checklists during ward rounds in various surgical subspecialties compared to routine care, where the rates of documentation were reported as outcomes. We excluded studies that used checklists in outpatient, non-surgical, or pediatric settings. Due to heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (ID: CRD42021273735) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) reporting guidelines. Results A total of 206 studies were identified, only 9 were suitable for inclusion. All included studies were single-center observational studies, spanning across seven surgical specialties. Rates of documentation on 4–23 parameters were reported. Documentation for all measured outcomes improved in 8/9 studies; however, statistical analyses were not included. There was a high risk of bias due to the nature of observational studies. Conclusion Ward round checklists can serve as a useful tool to improve inpatient care and safety. Currently, there is no high-level evidence showing the effectiveness of checklists on ward round documentation. The synthesis of results indicates that further high-quality research is imperative.

One-third of Australia's population reside in rural and remote areas. This audit aims to describe all-causes of mortality in rural general surgical patients, and identify areas of improvement.This is a retrospective multi-centre study involving four South Australian hospitals (Mt Gambier, Whyalla, Port Augusta, and Port Lincoln). All general surgical inpatients admitted from June 2014 to September 2019 were analysed to identify all-cause of mortality.A total of 80 mortalities were recorded out of 26 996 admissions. The overall mortality rate of 0.3% was the same as the 2020 Victorian state-wide Audit of Surgical Mortality. No mortality was secondary to trauma. Mean age was 79 ± 11 years and ASA was 3.9 ± 1. Malignancy was associated in over a third of cases (41.2%), mostly colorectal and pancreatic. Most cases were related to general surgical subspecialties: colorectal (51.3%), upper gastrointestinal (21.3%), hepatopancreaticobiliary (13.8%); however, there were also vascular (6.3%) and urology (3.8%) cases. The most common causes of mortality were large bowel obstruction (13.4%), ischemic bowel (10.4%), and small bowel obstruction (7.5%). Majority of mortality were beyond the surgeon's control (73.8%). Of the 21 potentially preventable mortalities, 42.9% were attributed to aspiration pneumonia and decompensated heart failure. Only one (1.3%) mortality case was due to pulmonary embolism.Rural general surgical mortalities occur in older, comorbid patients. Rural surgeons should be equipped to manage basic subspeciality conditions. To further reduce mortalities, clear protocols to prevent aspiration pneumonia and resuscitation associated fluid overload are needed.

Days of Abandonment, Ferrante’s most frequently read novel in English world before My Brilliant Friend, witnesses the establishment of Ferrante’s unique voice. It relates the psychological and physical turmoil of its female protagonist Olga who has been abandoned by her husband. By drawing on Freud’s theory of mourning and loss, as well as Judith Butler’s theorization of ungrievable loss, this paper seeks to lay bare the process of the reconstruction of female subjectivity in Days of Abandonment. It is argued that, by conducting a proper mourning process for the loss of her boundedness with the patriarchal order as represented by her husband Mario, Olga has managed to step out of the patriarchal order and reestablish her connection not only with other human subjects, but also with nonhuman actors as well. And in this posthuman intra-action with materiality of the world, she has rebuilt her identity that initiates her into a more rewarding life.

Cyclic arginine noncanonical amino acids (ncAAs) are found in several actinobacterial peptide natural products with therapeutically useful antibacterial properties. The preparation of ncAAs like enduracididine and capreomycidine currently takes multiple biosynthetic or chemosynthetic steps, thus limiting the commercial availability and applicability of these cyclic guanidine-containing amino acids. We recently discovered and characterized the biosynthetic pathway of guanitoxin, a potent freshwater cya-nobacterial neurotoxin, that contains an arginine-derived cyclic guanidine phosphate within its highly polar structure. The ncAA L-enduracididine is an early intermediate in guanitoxin biosynthesis and is produced by GntC, a unique pyridoxal-5’-phosphate (PLP)-dependent enzyme. GntC catalyzes a cyclodehydration from a stereoselectively γ-hydroxylated L-arginine precursor via a reaction that functionally and mechanistically diverges from previously established actinobacterial cyclic arginine ncAA pathways. Herein, we interrogate L-enduracididine biosynthesis from the cyanobacteriumSphaerospermopsis torques-reginaeITEP-024 using spectroscopic, stable isotope labeling techniques, and X-ray crystal structure-guided site-directed mutagenesis. GntC initially facilitates the reversible deprotonations of the α- and β-positions of its substrate prior to catalyzing an irreversible diastereoselective dehydration and subsequent intramolecular cyclization. The comparison ofholo-and substrate bound GntC structures and activity assays on sitespecific mutants further identified amino acid residues that contribute to the overall catalytic mechanism. These interdisciplinary efforts at structurally and functionally characterizing GntC enables an improved understanding of how Nature divergently produces cyclic arginine ncAAs and generates additional tools for their biocatalytic production and downstream biological applications.

NanoSIMS has been widely used for in-situ sulfur isotopic analysis (32S and 34S) of micron-sized grains or complex zoning in sulfide in terrestrial and extraterrestrial samples. However, the conventional spot mode analysis is restricted by depth effects at the spatial resolution < 0.5–1 μm. Thus sufficient signal amount cannot be achieved due to limited analytical depths, resulting in low analytical precision (1.5‰). Here we report a new method that simultaneously improves spatial resolution and precision of sulfur isotopic analysis based on the NanoSIMS imaging mode. This method uses a long acquisition time (e.g., 3 h) for each analytical area to obtain sufficient signal amount, rastered with the Cs+ primary beam of ∼100 nm in diameter. Due to the high acquisition time, primary ion beam (FCP) intensity drifting and quasi-simultaneous arrival (QSA) significantly affects the sulfur isotopic measurement of secondary ion images. Therefore, the interpolation correction was used to eliminate the effect of FCP intensity variation, and the coefficients for the QSA correction were determined with sulfide isotopic standards. Then, the sulfur isotopic composition was acquired by the segmentation and calculation of the calibrated isotopic images. The optimal spatial resolution of ∼ 100 nm (Sampling volume of 5 nm × 1.5 μm2) for sulfur isotopic analysis can be implemented with an analytical precision of ∼1‰ (1SD). Our study demonstrates that imaging analysis is superior to spot-mode analysis in irregular analytical areas where relatively high spatial resolution and precision are required and may be widely applied to other isotopic analyses.

We present a comparison of the measured cosmic ray (CR) muon fluxes from two identical detectors at different geolocations and their sensitivity to space weather events in real time. The first detector is installed at Mount Wilson Observatory, CA, USA (geomagnetic cutoff rigidity Rc $\sim$ 4.88 GV), and the second detector is running on the downtown campus of Georgia State University in Atlanta, GA, USA (Rc $\sim$3.65 GV). The variation of the detected muon fluxes is compared to the changes of the interplanetary solar wind parameters at L1 Lagrange point and geomagnetic indexes. We have also investigated the muon flux behavior during major interplanetary shock events and geomagnetic disturbances. To validate the interpretation of the measured muon signals, the muon fluxes are compared to the neutron flux measurement from the Oulu neutron monitor (NM) in northern Finland (Rc $\sim$0.8 GV). The results of this analysis show that the cosmic ray flux percentage changes from all stations are significantly correlated with each other and with solar wind parameters at L1, and the decreases of the muon fluxes can sometimes be observed several hours ahead of the onsets of the interplanetary shock arrivals at L1 and geomagnetic disturbances. Although this is yet an initial effort of building a global network of cosmic ray muon detectors for monitoring the space and earth weather in real time, the study provides evidence that muon network detection efficiency can be a diagnostic and forecasting tool for geomagnetic storms hours before they hit the Earth.

Patient centred communication ensures patients are well informed and educated, which is vital to providing the best care possible. By asking questions, patients can better understand their disease and make informed decisions regarding their health journey. We aimed to investigate factors that affect question asking behaviours in surgical outpatient consultations and to determine the typical question-asking by doctors, patients, and their companions.This is an observational cross-sectional study, where 182 video recordings of surgical consultations in the surgical outpatient setting at The Queen Elizabeth Hospital, Adelaide, South Australia were reviewed.A total of 3472 questions were asked. Most questions were asked by the surgeon, followed by the patient, and if present, their companion. Pre-surgical consultations resulted in the most questions asked by the patients, compared to post-surgical or follow-up consultations. When companions were present, patients asked more questions in consultants regarding malignant conditions. Interruptions increased the number of questions asked by the patient and their companion. Questions were commonly asked to clarify information given by the surgeon and often regarded the cause of the illness and the timing of the next step in disease management.Patients are generally interested in their health and ask questions during consultations. Companions have a positive effect on patient question asking behaviour and their presence in surgical consultations should be encouraged. Surgeons should develop strategies to encourage question asking and could review their own behaviours via surgical coaching and video review.

The marine microbial natural product salinosporamide A (marizomib) is a potent proteasome inhibitor currently in clinical trials for the treatment of brain cancer. Salinosporamide A is characterized by a complex and densely functionalized γ-lactam-β-lactone bicyclic warhead, the assembly of which has long remained a biosynthetic mystery. Here, we report an enzymatic route to the salinosporamide core catalyzed by a standalone ketosynthase (KS), SalC. Chemoenzymatic synthesis of carrier protein-tethered substrates, as well as intact proteomics, allowed us to probe the reactivity of SalC and understand its role as an intramolecular aldolase/β-lactone synthase with roles in both transacylation and bond-forming reactions. Additionally, we present the 2.85-Å SalC crystal structure that, combined with site-directed mutagenesis, allowed us to propose a bicyclization reaction mechanism. This work challenges our current understanding of the role of KS enzymes and establishes a basis for future efforts toward streamlined production of a clinically relevant chemotherapeutic.

A series of new aromatic fluorinated copoly(ether amide)s containing 4-(4-trifluoromethylphenyl)-2,6-diphenylpyridyl moiety with high molecular weight were prepared by a low-temperature solution polycondensation of terephthaloyl chloride with 4-(4-trifluoromethylphenyl)-2,6-bis(4-aminophenyl)pyridine and 1,4-bis(4-amino-2-trifluoromethylphenoxy)benzene with various mole ratios of the two monomers ranged from 20/80 to 80/20. All polymers were amorphous and soluble in common organic solvents such as N-methyl-2-pyrrolidone, N,N-dimethylacetamide and tetrahydrofuran at room temperature or upon heating at 70oC, and could be solution cast into transparent, tough, and flexible films with tensile strengths of 66.9–80.2 MPa, tensile moduli of 1.84–2.03 GPa, and elongations at break of 11.8–20.7%. These new polyamides displayed good thermal stability with gradually increasing of glass temperatures of 259–285oC as an increase of the 4-(4-trifluoromethylphenyl)-2,6-diphenylpyridyl component, the temperature at 10% weight loss of 476–505oC, and the residue of 55–61% at 750oC in nitrogen. They also exhibited low dielectric constants of 3.11–3.38 (1 MHz), low moisture absorption in the range of 1.43–1.75%, and high transparency with an UV–vis absorption cut-off wavelength in the 350–368 nm range.

Purpose Excellent metabolic improvement following one anastomosis gastric bypass (OAGB) remains compromised by the risk of esophageal bile reflux and theoretical carcinogenic potential. No ‘gold standard’ investigation exists for esophageal bile reflux, with diverse methods employed in the few studies evaluating it post-obesity surgery. As such, data on the incidence and severity of esophageal bile reflux is limited, with comparative studies lacking. This study aims to use specifically tailored biliary scintigraphy and upper gastrointestinal endoscopy protocols to evaluate esophageal bile reflux after OAGB, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods Fifty-eight participants underwent OAGB (20), SG (15) or RYGB (23) between November 2018 and July 2020. Pre-operative reflux symptom assessment and gastroscopy were performed and repeated post-operatively at 6 months along with biliary scintigraphy. Results Gastric reflux of bile was identified by biliary scintigraphy in 14 OAGB (70%), one RYGB (5%) and four SG participants (31%), with a mean of 2.9% (SD 1.5) reflux (% of total radioactivity). One participant (OAGB) demonstrated esophageal bile reflux. De novo macro- or microscopic gastroesophagitis occurred in 11 OAGB (58%), 8 SG (57%) and 7 RYGB (30%) participants. Thirteen participants had worsened reflux symptoms post-operatively (OAGB, 4; SG, 7; RYGB, 2). Scintigraphic esophageal bile reflux bore no statistical association with de novo gastroesophagitis or reflux symptoms. Conclusion Despite high incidence of gastric bile reflux post-OAGB, esophageal bile reflux is rare. With scarce literature of tumour development post-OAGB, frequent low-volume gastric bile reflux likely bears little clinical consequence; however, longer-term studies are needed. Clinical Trial Registry Australian New Zealand Clinical Trials Registry number ACTRN12618000806268. Graphical abstract

BackgroundCalcaneal fracture is common and carries high morbidity and disability. Its treatment is therefore of vital concern. Many topics concerning calcaneal fracture remain controversial, and the subject has not yet been well-researched. We aim to analyze and illustrate the trends in development, overall knowledge structure, “hotspots,” and research frontiers on the topic of calcaneal fracture.MethodsLiterature relating to calcaneal fracture published between 2000 and 2021 was retrieved from Science Citation Index Expanded (SCIE) database of the Web of Science. Three bibliometric tools (Bibliometrix, CiteSpace, and VOSviewer software) were used for analysis and the generation of knowledge maps. Annual trends in publication counts and the relative contributions of different countries, regions, institutions, authors, and journals, as well as keyword clusters, “hot topics,” and research frontiers, were analyzed.ResultsA total of 1,687 publications were included in the analysis. The number of calcaneal fracture articles published worldwide each year was highest in 2019, with a total of 128 articles. The United States has made the greatest contribution to the field, with the largest number of publications and the highest H-index. Foot & Ankle International was the most productive journal, publishing a total of 167 articles on calcaneal fracture during the study period. Hebei Medical University of China and the University of California, San Francisco were the most prolific institutions. Professors T. Schepers, S. Rammelt, H. Zwipp, and Y. Z. Zhang have made remarkable contributions to the field. However, the degree of collaboration between researchers and among institutions was relatively low, and took place mainly in Europe and the Americas. All relevant keywords could be categorized into three clusters: studies of internal fixation, studies of fractures, and studies of osteoporosis. A trend of balanced and diversified development could be seen within these clusters. Keywords with ongoing “citation bursts,” such as sinus tarsi approach, wound complications, minimally invasive technique, extensile lateral approach, surgical treatment, and plate, may continue to be research “hotspots” in the near future.ConclusionBased on current global trends, the number of publications on calcaneal fracture will continue to increase. Topics such as minimally invasive techniques and complications have become important hotspots of research. We recommend enhancing international communication and collaboration for future research in this field.

Additional file 1.

Supplemental material, sj-docx-1-tah-10.1177_20406207231168215 for Cost-effectiveness analysis of axicabtagene ciloleucel as a second-line treatment for diffuse large B-cell lymphoma in China and the United States by Na Li, Jianying Lei, Jiahao Zhang, Hongfu Cai, Bin Zheng, Ting Yang, Maobai Liu and Jianda Hu in Therapeutic Advances in Hematology

Supplemental material, sj-docx-1-tar-10.1177_17534666231178692 for REALizing and improving management of stable COPD in China: results of a multicentre, prospective, observational study (REAL) by Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian and Chen Wang in Therapeutic Advances in Respiratory Disease

We outline the physics opportunities provided by the Electron Ion Collider (EIC). These include the study of the parton structure of the nucleon and nuclei, the onset of gluon saturation, the production of jets and heavy flavor, hadron spectroscopy and tests of fundamental symmetries. We review the present status and future challenges in EIC theory that have to be addressed in order to realize this ambitious and impactful physics program, including how to engage a diverse and inclusive workforce. In order to address these many-fold challenges, we propose a coordinated effort involving theory groups with differing expertise is needed. We discuss the scientific goals and scope of such an EIC Theory Alliance., Comment: 44 pages, ReVTeX, White Paper on EIC Theory Alliance

Supplemental material, sj-docx-1-tar-10.1177_17534666231158283 for Treatment patterns in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL) by Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian and Chen Wang in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-docx-1-tar-10.1177_17534666231167353 for Exacerbation in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL) by Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian and Chen Wang in Therapeutic Advances in Respiratory Disease

Topological insulators (TI) can apply highly efficient spin-orbit torque (SOT) and manipulate the magnetization with their unique topological surface states, and their magnetic counterparts, magnetic topological insulators (MTI) offer magnetization without shunting and are one of the highest in SOT efficiency. Here, we demonstrate efficient SOT switching of a hard MTI, V-doped (Bi,Sb)2Te3 (VBST) with a large coercive field that can prevent the influence of an external magnetic field and a small magnetization to minimize stray field. A giant switched anomalous Hall resistance of 9.2 $k\Omega$ is realized, among the largest of all SOT systems. The SOT switching current density can be reduced to $2.8\times10^5 A/cm^2$, and the switching ratio can be enhanced to 60%. Moreover, as the Fermi level is moved away from the Dirac point by both gate and composition tuning, VBST exhibits a transition from edge-state-mediated to surface-state-mediated transport, thus enhancing the SOT effective field to $1.56\pm 0.12 T/ (10^6 A/cm^2)$ and the spin Hall angle to $23.2\pm 1.8$ at 5 K. The findings establish VBST as an extraordinary candidate for energy-efficient magnetic memory devices.

Supplemental material, sj-docx-1-tar-10.1177_17534666231167353 for Exacerbation in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL) by Ting Yang, Baiqiang Cai, Bin Cao, Jian Kang, Fuqiang Wen, Yahong Chen, Wenhua Jian and Chen Wang in Therapeutic Advances in Respiratory Disease

The efficient total synthesis of anti-tumor natural product pongaflavone (1) was described starting from commercially available 2,4-dihydroxyacetophenone (9) via seven steps and in 16% overall yield. Its two natural analogues pongachromene (2) and 7,8-(2”,2”-dimethylpyrano)-5,3’,4’-trihydroxy-3-methoxyflavone (3) were also synthesized following the similar procedure with the yields of 11% and 18%, respectively. Their preliminary anti-tumor activities were evaluated by the inhibition effect on A549 cells. The result showed that this kind of natural products exhibited different levels of anti-tumor activity. Among them, pongachromene (2) displayed the best anti-tumor activity.

Supplemental material, sj-docx-1-tah-10.1177_20406207231168215 for Cost-effectiveness analysis of axicabtagene ciloleucel as a second-line treatment for diffuse large B-cell lymphoma in China and the United States by Na Li, Jianying Lei, Jiahao Zhang, Hongfu Cai, Bin Zheng, Ting Yang, Maobai Liu and Jianda Hu in Therapeutic Advances in Hematology

Thiopurine dose optimization by thiopurine-S-methyltransferase (TPMT) or nudix hydrolase-15 (NUDT15) significantly reduced early leucopenia in Asia. However, it fails to avoid the late incidence (> 2 months). Although laboratory monitoring of 6-thioguanine nucleotides (6TGN) to optimize thiopurine dose was suggested in White patients the exact association between leucopenia and 6TGN was controversial in Asian patients. In the present study, we aimed to explore whether DNA-thioguanine nucleotides (DNA-TGs) in leukocytes, compared with 6TGN in erythrocytes, can be a better biomarker for late leucopenia. This was a prospective, observational study. Patients with inflammatory bowel disease (IBD) prescribed thiopurine from February 2019 to December 2019 were recruited. Thiopurine dose was optimized by NUDT15 C415T (rs116855232). DNA-TG and 6TGN levels were determined at the time of late leucopenia or 2 months after the stable dose was obtained. A total of 308 patients were included. Thiopurine induced late leucopenia (white blood cells

Objective To select the value evaluation index system of large-scale medical equipment in public hospitals in China, to provide an evidence-based decision-making basis for the introduction and management of large-scale medical equipment. Methods Based on the theory of value medical and whole life cycle, literature analysis was used to establish the original indicator library of value evaluation of large-scale medical equipment. We used a 2-round Delphi technique to conduct expert consultation on the alternative value evaluation indicators of large-scale medical equipment, and further select indicators to build a value evaluation index system to determine its weight. Results A total of 17 experts were selected in this study to participate in the consultation, with an average professional period of 19.15. The positive coefficients of the two rounds of consultation were 88% and 100% respectively. The expert authority coefficient of the first round and the second round was 0.83. In the second round of consultation, the expert consistency coefficient (Kendall's W) of the first-level indicators and the second-level indicators were 0.305 and 0.387 (P

In visible light positioning(VLP) system, in the moving process of photodiode(PD), PD will rotate a small angle to a certain extent, although the rotation angle is small, it will still cause a large positioning error, thus, in order to alleviate the error caused by the rotation of PD, a high-precision 3D indoor VLP method based on the improved adaptive cuckoo search (VLP-IACS) algorithm is proposed in this paper. Firstly, the rotation angles of the photodiode (PD) are introduced into the optical channel transmission model instead of assuming that the PD and the light-emitting diode (LED) are parallel to each other. Secondly, two adaptive strategies are applied to update the detection probability $$p_{a}$$ and step factor $$\alpha_{0}$$ in the traditional cuckoo search (CS) algorithm, and the convergence speed of the cuckoo search algorithm is significantly enhanced. Finally, the IACS algorithm is successfully applied to solve the 3D indoor positioning problem in an indoor space with dimensions of 5 m $$\times$$ 5 m $$\times$$ 6 m. Simulation results for fixed positioning show that in the case of no PD rotation, the average 3D positioning error is 2.20 cm, and in the case of PD rotation, the average 3D positioning errors under different rotation angle ranges are 9.04 cm, 14.45 cm and 16.22 cm. The results of kinematic positioning show that in the case of no PD rotation, the average 3D positioning error is 1.54 cm, and in the case of PD rotation, the average 3D positioning error is 16.48 cm. The proposed method can effectively reduce the degradation caused by PD rotation in the positioning system and can potentially be used in various indoor positioning scenarios.

Introduction The lack of an effective continuing professional development programme for qualified surgeons, specifically one that enhances non-technical skills (NTS), is an issue receiving increased attention. Peer-based coaching, used in multiple professions, is a proposed method to deliver this. The aim of this study was to undertake a systematic review of the literature to summarize the quantity and quality of studies involving surgical coaching of NTS in qualified surgeons. Methods A systematic search of the literature was performed through MEDLINE, EMBASE, Cochrane Collaboration and PsychINFO. Studies were selected based on predefined inclusion and exclusion criteria. Data for the included studies was independently extracted by two reviewers and the quality of the studies evaluated using the Medical Education and Research Study Quality Instrument (MERSQI). Results Some 4319 articles were screened from which 19 met the inclusion criteria. Ten studies involved coaching of individual surgeons and nine looked at group coaching of surgeons as part of a team. Group coaching studies used non-surgeons as coaches, included objective assessment of NTS, and were of a higher quality (average MERSQI 13.58). Individual coaching studies focused on learner perception, used experienced surgeons as coaches and were of a lower quality (average MERSQI 11.58). Individual coaching did not show an objective improvement in NTS for qualified surgeons in any study. Conclusion Surgical coaching of qualified surgeons’ NTS in a group setting was found to be effective. Coaching of individual surgeons revealed an overall positive learner perception but did not show an objective improvement in NTS for qualified surgeons.

Background Surgical outpatient consultations are demanding for the surgeon and patients without a definite formula for success. Various factors have been identified regarding factors that influence patient satisfaction and engagement. We aimed to examine the modern-day surgical outpatient consultation and report on these factors. Methods An observational cross-sectional study was performed by reviewing video recordings of 182 surgical consultations by 12 surgeons at The Queen Elizabeth Hospital, South Australia, Australia. Results The mean consultation time was 12.3 min, with pre-surgical consultations being the longest. There were 107 consultations for benign conditions (58%). Proportionally, the consultant spoke most (51.9% of total consultation time), followed by the patient (19.5%) and then companion (8.2%). Forty-eight (26.4%) patients brought a companion to the clinic but monopolisation of the consultation by the companion was rare. When a companion was present, there was more mutual eye gaze between the consultant and the patient. Interruptions were present in 23.6% of consultations and were associated with a significant increase of the length of the consultation. Table positioning did not seem to affect the dynamics of the outpatient consultation. Conclusion Companions are highly valuable for promoting patient engagement and their presence should be encouraged in surgical outpatients. Interruptions should be kept to a minimum to avoid unnecessary delays. Further studies should be conducted to investigate the effect of companions, interruptions and table positioning during a consultation on patient outcomes.

DIS2022 conference presentation

Background: Smoking behavior is a continuous and gradual behavior, and most of the addiction of adult smokers comes from their childhood and adolescence.Once they start trying smoking, if no timely intervention measures are taken, the vast majority of smokers will become lifelong smokers.Adolescent is the most effective group in implementing tobacco control and smoking bans.The study aims to effectively evaluate the characteristics of trying smoking behavior of adolescents in rural western China and identify the key psychosocial factors to provide a scientific basis for preventing and reducing the occurrence of smoking behaviors of adolescents. Methods: A total of 2671 students from rural middle schools in western China were surveyed using the Adolescent Health Questionnaire including Global Youth Tobacco Survey (GYTS). Structural Equation Model (SEM) was used to analyze the direct or indirect relationship between adolescent's try smoking behavior and psychosocial influencing factors. Results: (1)Tobacco use: 28.3% of adolescents have tried tobacco products, boys are higher than girls,senior is higher than junior,and the tobacco use rate increases with the increase in monthly living expenses (PPPConclusions: Findings of this study highlight that adolescents smoking behavior is a complex psychosocial behavior. Reducing mental health problemsand promoting life satisfaction should be considered as the key target for interventions aiming to the prevalence of adolescents’ smoking behavior.

Non-technical skills complement technical skills in surgeons to provide best possible care for patients. The former is essential to promote patient engagement. Coaching has been introduced to surgeons as a method to improve non-technical skills. We aimed to investigate the impact of coaching for surgeons on patient engagement in the outpatient consultation setting.This was a single-centre cohort study conducted in South Australia. Consultant surgeons, suitable coaches, and patients were recruited. Coaches underwent further training by a human factors psychologist on being an effective coach. Outpatient consultations were recorded in an audio-visual format and analysed by investigators. Patient talking time, mutual eye gaze between surgeon and patient, and number of questions asked by the patient were measured as outcomes for patient engagement.182 patients, 12 surgeons, and 4 coaches participated in the study. Each surgeon underwent 3 coaching sessions, 5 to 6 weeks apart. There were 62 pre-coaching patient consultations, 63 patient consultations after one coaching session, and 57 patient consultations after two coaching sessions. The mean talking time of the patient increased significantly after a single coaching session (P 0.05) without making significant difference to the total consultation time (p = 0.76). Coaching sessions did not have a significant effect on mutual eye gaze or mean number of questions asked by the patient.Coaching of non-technical skills for surgeons appears to objectively improve patient engagement during the outpatient consultation. This would suggest that tailored coaching programs should be developed and delivered to surgeons to improve care delivery.

GRAS proteins are plant-specific transcription factors and play important roles in plant growth, development, and stress responses. In this study, a total of 48 GRAS genes in the eggplant (S. melongena) genome were identified. These genes were distributed on 11 chromosomes unevenly, with amino acid lengths ranging from 417 to 841 aa. A total of 48 GRAS proteins were divided into 13 subgroups based on the maximum likelihood (ML) model. The gene structure showed that 60.42% (29/48) of SmGRASs did not contain any introns. Nine pairs of SmGRAS appeared to have a collinear relationship, and all of them belonged to segmental duplication. Four types of cis-acting elements, namely, light response, growth and development, hormone response, and stress response, were identified by a cis-acting element predictive analysis. The expression pattern analysis based on the RNA-seq data of eggplant indicated that SmGRASs were expressed differently in various tissues and responded specifically to cold stress. In addition, five out of ten selected SmGRASs (SmGRAS2/28/32/41/44) were upregulated under cold stress. These results provided a theoretical basis for further functional study of GRAS genes in eggplant.

Linseed oil, an important source of dietary α-linolenic acid, is used to provide meat enriched in n-3 PUFA. We investigated the effects of dietary linseed oil (0, 0.5, 1, and 2%) on growth performance, meat quality, tissue fatty acid (FA), and transcriptome profiles in ducks. The result showed that dietary linseed oil had no effect on growth performance. Increasing dietary linseed oil enrichment raised n-3 PUFA and linoleic acid (LA) levels in both the liver and breast muscle, but decreased dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (ARA) levels in the liver. The liver n-3 PUFA content was negatively correlated with duck body weight. Transcriptome analysis showed that dietary linseed oil caused hepatic changes in genes (SCD, FADS1, FADS2, and ACOT6) related to the biosynthesis of unsaturated fatty acids. Besides, dietary linseed oil also affected the expression of genes related to PUFAs and downstream metabolites (such as linoleic acid, steroid hormone, progesterone, etc.) metabolic pathways in both liver and breast muscle. Key genes involved in PUFA synthesis and transport pathways were examined by RT-qPCR, and the results verified that hepatic expression levels of FADS1 and FADS2 decreased, and those of FABP4 and FABP5 increased when 2% linseed oil was added. CD36 expression level increased in breast muscle when 2% linseed oil was added. Thus, 2% dietary linseed oil supplementation produces n-3 PUFA-enriched duck products by regulating the PUFA metabolic pathways, which could be advantageous for health-conscious consumers.

The cover image is based on the Research Article PDGFA‐associated protein 1 is a novel target of c‐Myc and contributes to colorectal cancer initiation and progression by Hong‐Yong Cui et al., https://doi.org/10.1002/cac2.12322. [Image: see text]

BACKGROUND At present, the value of lipid indicators in evaluating the prognosis of colorectal cancer is still relatively limited. AIM To evaluate the value of a novel parameter for colorectal cancer (CRC) prognosis scoring based on preoperative serum lipid levels. METHODS Four key serum lipid factors, namely, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB), were detected. Two representative ratios, HDL-C-LDL-C ratio (HLR) and ApoA1-ApoB ratio (ABR) were calculated. The relationship of these parameters with the prognosis of CRC patients including progression-free survival (PFS) and overall survival (OS) was analyzed by Kaplan-Meier plot and Cox proportional hazards regression. A novel lipoprotein cholesterol-apolipoprotein (LA) score based on HLR and ABR was established and its value in prognosis evaluation for CRC patients was explored. RESULTS Multivariate Cox proportional hazards regression analysis of PFS and OS showed that HDL-C, ApoA1, HLR, and ABR were positively associated with the prognosis of CRC patients. LA score was independently associated with a good prognosis in resectable CRC patients. Data processing of a dummy variable showed that the prognosis of patients with higher LA scores is better than that with lower LA scores. CONCLUSION The newly established LA score might serve as a better predictor of the prognosis of resectable CRC patients.

With the enhancement of environmental protection awareness, research on the bioremediation of petroleum hydrocarbon environmental pollution has intensified. Bioremediation has received more attention due to its high efficiency, environmentally friendly by-products, and low cost compared with the commonly used physical and chemical restoration methods. In recent years, bacterium engineered by systems biology strategies have achieved biodegrading of many types of petroleum pollutants. Those successful cases show that systems biology has great potential in strengthening petroleum pollutant degradation bacterium and accelerating bioremediation. Systems biology represented by metabolic engineering, enzyme engineering, omics technology, etc., developed rapidly in the twentieth century. Optimizing the metabolic network of petroleum hydrocarbon degrading bacterium could achieve more concise and precise bioremediation by metabolic engineering strategies; biocatalysts with more stable and excellent catalytic activity could accelerate the process of biodegradation by enzyme engineering; omics technology not only could provide more optional components for constructions of engineered bacterium, but also could obtain the structure and composition of the microbial community in polluted environments. Comprehensive microbial community information lays a certain theoretical foundation for the construction of artificial mixed microbial communities for bioremediation of petroleum pollution. This article reviews the application of systems biology in the enforce of petroleum hydrocarbon degradation bacteria and the construction of a hybrid-microbial degradation system. Then the challenges encountered in the process and the application prospects of bioremediation are discussed. Finally, we provide certain guidance for the bioremediation of petroleum hydrocarbon-polluted environment.

Rhodomentosones A and B (1 and 2), two pairs of novel enantiomeric phloroglucinol trimers featuring a unique 6/5/5/6/5/5/6-fused ring system were isolated from Rhodomyrtus tomentosa. Their structures with absolute configurations were elucidated by NMR spectroscopy, X-ray crystallography, and ECD calculation. The bioinspired syntheses of 1 and 2 were achieved in six steps featuring an organocatalytic asymmetric dehydroxylation/Michael addition/Kornblum-DeLaMare rearrangement/ketalization cascade reaction. Compounds 1 and 2 exhibited promising antiviral activities against respiratory syncytial virus (RSV).

Sexual transmission is currently the main mode of transmission of the human immunodeficiency virus (HIV). In this study, 181 HIV-infected female cross-border travelers entering Yunnan province were recruited between 2003 and 2012. HIV RNAs were extracted from their frozen serum and gag-pol gene sequences were obtained for phylogenetic and recombination analyses. In total, 131 gag-pol gene sequences were obtained successfully, at a rate of 72.4%. The most prevalent subtypes were CRF01_AE, followed by CRF08_BC, subtypes B and C. The other 4 subjects were classified as undefined subtypes and other recombinants. The subtype distribution of intravenous drug users (IDUs) was significantly different from that of sexually transmitted infections (STIs) and unknown groups. The genetic distances of subtype B, C, and CRF01_AE strains were all close to the reference sequences from Yunnan province and Southeast Asian countries. Gene diversity and co-circulation of multiple subtypes were observed in female cross-border travelers, and CRF01_AE was the dominant epidemic subtype. The advantages of these subtype preferences for sexual transmission were obvious in HIV infection and transmission among this population. Our findings also suggest that close attention should be given to the HIV infection status of the female migrant population. In addition, description of their epidemic characteristics is significant for the surveillance and prevention of AIDS (acquired immunodeficiency syndrome) in the Yunnan province. This article is protected by copyright. All rights reserved.

Accurate and thorough surgical ward round documentation is crucial for maintaining quality clinical care. Accordingly, checklists have been proposed to improve ward round documentation. This systematic review aimed to evaluate the literature investigating the use of checklists to improve surgical ward round documentation.MEDLINE, EMBASE, and PsycINFO were searched on August 16, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of checklists during ward rounds in various surgical subspecialties compared to routine care, where the rates of documentation were reported as outcomes. We excluded studies that used checklists in outpatient, non-surgical, or pediatric settings. Due to heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (ID: CRD42021273735) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) reporting guidelines.A total of 206 studies were identified, only 9 were suitable for inclusion. All included studies were single-center observational studies, spanning across seven surgical specialties. Rates of documentation on 4-23 parameters were reported. Documentation for all measured outcomes improved in 8/9 studies; however, statistical analyses were not included. There was a high risk of bias due to the nature of observational studies.Ward round checklists can serve as a useful tool to improve inpatient care and safety. Currently, there is no high-level evidence showing the effectiveness of checklists on ward round documentation. The synthesis of results indicates that further high-quality research is imperative.

BackgroundSepsis and septic shock, a subset of sepsis with higher risk stratification, are hallmarked by high mortality rates and necessitated early and accurate biomarkers.MethodsUntargeted metabolomic analysis was performed to compare the metabolic features between the sepsis and control systemic inflammatory response syndrome (SIRS) groups in discovery cohort, and potential metabolic biomarkers were selected and quantified using multiple reaction monitoring based target metabolite detection method.ResultsDifferentially expressed metabolites including 46 metabolites in positive electrospray ionization (ESI) ion mode, 22 metabolites in negative ESI ion mode, and 4 metabolites with dual mode between sepsis and SIRS were identified and revealed. Metabolites 5-Oxoproline, L-Kynurenine and Leukotriene D4 were selected based on least absolute shrinkage and selection operator regularization logistic regression and differential expressed between sepsis and septic shock group in the training and test cohorts. Respective risk scores for sepsis and septic shock based on a 3-metabolite fingerprint classifier were established to distinguish sepsis from SIRS, septic shock from sepsis. Significant relationship between developed sepsis risk scores, septic shock risk scores and Sequential (sepsis-related) Organ Failure Assessment (SOFA), procalcitonin (PCT) and lactic acid were observed.ConclusionsCollectively, our findings demonstrated that the characteristics of plasma metabolites not only manifest phenotypic variation in sepsis onset and risk stratification of sepsis but also enable individualized treatment and improve current therapeutic strategies.