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Soluble extracellular metabolites (SEM) produced by microorganisms might significantly change during sludge bulking, which is a major operational problem caused by the excessive growth of filamentous bacteria. However, knowledge remains limited about the dynamics and potential role of SEM in the bulking of sludge. In this study, filamentous bulking was simulated in a laboratory-scale reactor and changes to SEM characteristics during the bulking process were investigated using excitation-emission matrix spectroscopy and ultrahigh-performance liquid chromatography-mass spectrometry. SEM components changed significantly at different phases of sludge bulking. Changes in SEM were closely correlated with the structure of the bacterial community. Based on the EEM profiles, significant increases in fulvic acid-like and humic acid-like substances in SEM were observed with the development of filamentous bulking. The degree of humification in SEM showed a clear increasing trend. Untargeted extracellular metabolomic analysis showed that the intensity of berberine and isorhamnetin in SEM increased significantly during the bulking phase, which might synergistically facilitate the development of filamentous bulking., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To investigate if a Family-Clinician Shared Decision-Making (FCSDM) intervention benefits patients, families and intensive care units (ICUs) clinicians., Methods: Six ICUs in China were allocated to intervention or usual care. 548 patients with critical illness, 548 family members and 387 ICU clinicians were included into the study. Structured FCSDM family meetings were held in the intervention group. Scales of SSDM, HADS, QoL2 and CSACD were used to assess families' satisfaction and distress, patients' quality of life, and clinicians' collaboration respectively., Results: Comparing the intervention group with the control group at post-intervention, there were significant differences in the families' satisfaction (P = 0.0001), depression level (P = 0.005), and patients' quality of life (P = 0.0007). The clinicians' mean CSCAD score was more positive in the intervention group than controls (P < 0.05). There was no significant between-group differences on ICU daily medical cost, but the intervention group demonstrated shorter number of days' stay in ICU (P = 0.0004)., Conclusion: The FCSDM intervention improved families' satisfaction and depression, shortened patients' duration of ICU stay, and enhanced ICU clinicians' collaboration., Practice Implications: Further improvement and promotion of the FCSDM model are needed to provide more evidence to this field in China., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To investigate physicians' responses to negative emotions in high-risk preoperative conversations; and to explore the influencing factors of these responses., Methods: One hundred and sixty-two audio recordings were coded using the Chinese Verona Coding Definition of Emotional Sequences (VR-CoDES). Big Five Personality Inventory Brief Version and Emotional Intelligence Scale were administered to explore the influencing factors of physicians' responses. SPSS 24.0 and R 3.6.3 LME4 Package were used for data analysis., Results: Reduce Space (83%), referring to physicians' responses reducing the opportunities of patients to disclose emotions, was physicians' most frequent response to patients or families' emotions. The main responses were Information-advice (ERIa) and Ignoring (NRIa). Younger age, female, Agreeableness and Openness were factors positively associated with Explicit Provide Space (EP); Neuroticism was negatively correlated with EP. Extroversion was negatively correlated with Explicit Reduce Space (ER); Conscientiousness was negatively correlated with both EP and ER responses. Emotional intelligence had no significant influence on physicians' responses., Conclusion: The majority of physicians were inclined to reduce space by providing information advice or ignoring. Physicians' responses were correlated with their gender, age and personality traits., Practice Implications: The trainees' gender, age and personality should be considered when conducting doctor-patient communication skills training., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To test the reliability of the Chinese version of the OPTION 12 (OPTION 12 -C) scale; and to evaluate the level of shared decision-making (SDM) in the preoperative conversations for high-risk procedures by using the OPTION 12 -C., Methods: Two hundred and ninety-seven conversations were rated. Cronbach's alpha, Pearson's correlation coefficient and intraclass correlation coefficient (ICC) were used to assess the reliability of the OPTION 12 -C. Mean and median were applied to evaluate the scores., Results: The Cronbach's alpha was 0.603. The Pearson's correlation coefficient of the sub-items ranged from 0.002 to 0.595; the inter-rater ICC was 0.992. The mean and median of the total scores were 9.61 ( ± 3.583) and 9 respectively. 430 family members appeared in the conversations., Conclusion: The reliability of the OPTION 12 -C was acceptable. The SDM behaviors of doctors were only scored at or close to the minimal skill level. High level of family involvement demonstrated the Chinese culture of family- centeredness., Practice Implications: The OPTION 12 -C was proved to be applicable for testing the extent of SDM. The low level of SDM indicates a need to improve Chinese doctors' communication skills., Competing Interests: Declaration of competing interests The authors declare they have no competing interests., (Copyright © 2021. Published by Elsevier B.V.)

Bacillary dysentery is a common foodborne disease with an exaggerated mortality rate because of Shigella infection. With the increasing severity of Shigella infection, lyase has been considered as the most promising alternative to antimicrobial agents, owing to the emergence of resistant bacteria and the difficulty in disrupting and eliminating bacterial biofilms. In this study, we cloned and characterised HolSSE1 and LysSSE1, holin, and lysozyme from the S. dysenteriae phage SSE1 with extended bacterial host range against common gram-negative and gram-positive bacteria. In addition, the efficacy of HolSSE1 and LysSSE1 in removing bacterial biofilms was observed on polystyrene surfaces. Moreover, synergistic bacteriostasis was observed when they were used together. Alignment and structural model analysis showed that both HolSSE1 and LysSSE1 are T4 phage proteins that have not yet been identified. Therefore, HolSSE1 and LysSSE1 can be promising biocontrol agents for the prevention and treatment of various pathogenic infections., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Soluble iron from atmospheric aerosol particles has toxicological effects on ambient environment due to their oxidative potential. However, the dissolution process and factors affecting this process are poorly understood. In this study, by solid phase characterization and aqueous dissolution experiments, we investigated the influence of acids, including HCl, H 2 SO 4 and HNO 3 , and H + concentration on iron dissolution rate, solubility and speciation of iron in chlorite, illite, kaolinite and pyrite. The dissolution of iron-bearing clay minerals, i.e. chlorite, illite and kaolinite, was a multi-stage process with a rapid rate in the initial stage and then decreasing rate in the following stages. In contrast, the regularly crystallized pyrite proceeded with an extremely rapid dissolution rate at very beginning and then remained almost constant. In all acid solutions, the dissolution rate was in the order of pyrite > illite > chlorite > kaolinite. H 2 SO 4 was stronger than HCl and HNO 3 in the destruction of mineral structures to release iron, while HNO 3 dissolved more iron in pyrite (FeS 2 ). High H + concentration easily destroyed the mineral structures to release the structural or interlayer iron, whereas low H + concentration increased the proportion of Fe (II) in clay minerals. Non-linear fitting of continuous dissolution models showed that the iron dissolution rates and iron redox speciation as functions of time were well predicted, with r 2  > 0.99 for chlorite and illite, and r 2  > 0.96 for kaolinite. Oxidative potential analysis proved that the dissolved iron possessed a considerable potential to generate reactive oxygen species., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Apply Chinese VR-CoDES in ophthalmic setting and describe patients' worries and the doctor's responses. Explore cultural differences in coding., Methods: 102 audio-taped consultations of 84 patients were coded by Chinese version of VR-CoDES. The intra-class correlation coefficient (ICC) was used to test inter/intra-rater reliability, and inductive content analysis was conducted., Results: The ICCs of inter-rater reliability for cues/concerns and responses were 0.78 and 0.81, and intra-rater reliability were 0.87 and 0.99, respectively. Cues were more frequent than concerns and elicited often by patients. Explicit Reduce Space (ER) was the most frequent response. Interruptions and the doctor's repetitions were evident. Some expressions were not specified in the coding manual. Patients concerned about treatment effect (22 %), expenses (18 %), risk of operation (14 %), and pain (10 %)., Conclusion: The Chinese VR-CoDES can be applied to clinical consultations in China. Ophthalmic patients often expressed cues which were frequently elicited by themselves. The ophthalmologist preferred to give ER response. Interruptions and the ophthalmologist's repetitions were difficult to code. More Chinese expressions should be collected to reduce cultural difference when coding., Practice Implication: VR-CoDES will be helpful in doctor-patient communication and medical education. VR-CoDES should undergo cultural adaptions in China., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: There are few reports on the robot-assisted percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF), and we aimed to explore the learning curve of the robot-assisted PKP for treating OVCF., Methods: A total of 44 patients (71 vertebral fractures) with OVCF treated with robot-assisted PKP were divided into 4 groups, namely groups 1, 2, 3, and 4, according to the date of operation, with 11 cases in each group. Another 11 patients (18 vertebral fractures) treated with PKP without robot assistance were included in group 5. The success rate of robot-assisted puncture, total operation time, robot-assisted operation time, PKP operation time, and complications were analyzed., Results: All patients underwent operation successfully. The success rates of puncture in the robot-assisted groups were 92.9%, 94.4%, 94.7%, and 100%, respectively, with no statistical difference (P > 0.05). The success rate of puncture in group 5 was 63.2%, with a statistical difference (P < 0.05) compared with groups 1-4. The total operation time and robotic operation time reduced significantly and remained relatively stable since the third group, and groups 1 and 2 showed a statistical significance compared with groups 3 and 4 (P < 0.05), but there was no difference among groups 3, 4, and 5 (P > 0.05). The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space, with an incidence of 8.5% in the robot-assisted groups and 26.3% in group 5., Conclusions: The puncture accuracy of robot-assisted PKP for treating OVCF does not change with the increase in the number of operations. The total operation time and robotic-assisted operation time decreases with the increase in the number of cases., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Despite of technical advancements in design and development of new biomaterials, device-related infections continue to occur and can be life-threatening. Differing from existing research work pertaining to introducing antibacterial function upon device surface, this study attempts to address such germ-infection issues through controlled release of antibacterial species from bulk gallium (Ga) and strontium (Sr) containing magnesium (Mg) alloys. To validate such a conceptual framework, Mg alloys containing micro-level concentrations of Ga and/or Sr (0.1 wt%) are employed as model materials, along with commercially pure Mg and titanium (Ti) as control groups. Biodegradation progress of such metal specimens is examined through pH and mass loss measurements, and inductively coupled plasma - atomic emission spectrometry (ICP-AES) as a function of immersion time in Trypticase Soy Broth (TSB) solution under physiological conditions. In vitro biocompatibility and antibacterial performance are characterised through MTT proliferation assay with human mesenchymal stem cells (hMSCs) and the spread plate method with three representative bacterial strains, i.e. S. aureus (ATCC 43300), E. coli (ATCC 25922), and S. epidermidis (ATCC 35984). Animal tests are performed through implanting target metal rods into femurs of Sprague Dawley rats, accompanied with injection of S. aureus to build a model of osteomyelitis. Results demonstrate that such lean additions of Ga and/or Sr reduce the degradation kinetics of Mg matrix, and the release of Ga 3+ ions plays a crucial role in disabling the viability of all selected bacterial strains. The histological tests confirm that the growth of fibrous tissue has been accelerated in the vicinity of Mg-based implants, in comparison to that of blank and c.p. Ti controls. It is also striking that the smallest number density of S. aureus bacteria on the surface of the retrieved Ga-containing Mg rod implants. Such a proof-of-concept study provides a new and feasible strategy to address the notorious device-infection issues associated with biomedical implants for bone fracture management., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: To investigate the reliability and validity of the Chinese version of VR-CoDES., Methods: The VR-CoDES was translated into Chinese, and a focus group was held to discuss its cultural adaptation. Video consultations between 75 fourth-year medical students and 2 standardized patients (SPs) were coded by two raters with the Chinese VR-CoDES. Inter-rater reliability was tested by using ICC. To obtain validity, the SPs reviewed the video consultations to confirm the cues and concerns., Results: ICC was 0.79. Specificity and sensitivity were 0.99 and 0.96 respectively. The SPs expressed considerably more cues (mean = 7.00) than concerns (mean = 0.32). Half of the responses of medical students were explicit reducing space. Focus group participants raised some cultural considerations, and some interactions were difficult to code due to cultural differences., Conclusion: The Chinese VR-CoDES obtained good reliability and validity. Due to differences in the expression of emotions and other differences such as different medical systems between China and Western countries, the Chinese VR-CoDES needs further cultural adaptation., Practice Implication: More consultations in real clinical settings need to be gathered to further support the Chinese VR-CoDES both on validation and cultural adaptation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This multi-centered study was designed to evaluate the biological effects of exposure to antineoplastic drugs (ADs) at PIVAS (Pharmacy Intravenous Admixture Service) across ten Chinese hospitals. 8-hydroxy-2-deoxyguanosine (8-OHdG) was used as a biomarker of DNA oxidative damage and lymphocyte apoptosis assays using peripheral lymphocyte cells were used to detect primary DNA damage. The mutagenicity activity was estimated with the Ames fluctuation test. 158 exposed and 143 unexposed workers participated in this study. The urinary 8-OHdG/Cr concentrations of the exposed group was 22.05±17.89ng/mg Cr, which was significantly higher than controls of 17.36±13.50ng/mg Cr (P<0.05). The rate of early lymphocyte apoptosis was slightly increased in exposed group than that of the control group (P=0.087). The mutagenic activity was significantly higher in the exposed group relative to the control group (P<0.05). Moreover, while no statistically significant difference was observed, higher concentrations of 8-OHdG/Cr in urine and an early lymphocyte apoptosis rate were found in exposed group II as compared to exposed group I. In addition, a significant correlation between early lymphocyte apoptosis and exposure time to ADs was also observed (P<0.05). In conclusion, our study identified elevated biomarkers in PIVAS workers exposed to ADs. However whether these findings could lead to increased incidence of genotoxic responses remains to be further investigated., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Two acute toxicity tests (luminescent bacteria assay and cladoceran assay) and one genotoxicity test (broad bean assay) were used to evaluate whole effluent toxicity during the standard anion exchange resin-based pilot-scale sewage tertiary treatment that stably achieved significant dissolved organic carbon and inorganic ions reduction. The effect of six representative inorganic ions (i.e., Cl(-), SO4(2-), NO3(-)-N, NO2(-)-N, NH4(+)-N and PO4(3-)-P) on the acute toxicity and genotoxicity was further investigated. Significant whole effluent genotoxicity reduction was observed as an ∼ 57% micronucleated cell frequency reduction and ∼ 46% mitotic index increment during the pilot-scale periods, which should be attributed to significant organic removal since no significant (p ≥ 0.116) increase in genotoxicity was observed with the increase in these ionic concentrations. However, no significant (p ≥ 0.14) reductions were observed for whole effluent acute toxicity using two acute toxicity assays during the pilot-scale periods, and these inorganic ions, especially NH4(+)-N, contributed considerably to the acute toxicity. Based on Pearson correlation coefficients, whole effluent acute toxicity showed significant positive (p < 0.001, r ≥ 0.758) correlations with the NH4(+)-N concentration. Two optimal models were finally developed using step-wise multiple linear regression to predict the whole effluent acute toxicity via NH4(+)-N concentrations., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: Laminoplasty (LP) and laminectomy with fusion (LCF) are acceptable surgical options for cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). This study focused on evaluating cervical range of motion (ROM) on a three-dimensional basis as well as neurological outcomes after LP and LCF., Methods: This prospective cohort study consisted of 38 patients undergoing LP (n=20) or LCF (n=18) from December 2010 to December 2012. Before surgery and at the 3rd, 6th, 12th month follow-up, patients were assessed with three-dimensional cervical ROM, Japanese Orthopaedic Association (JOA) scores, Visual Analogue Scale (VAS) and complications., Results: The patients in both groups had significant ROM loss after surgery in six directions of motion. At the 12th month follow-up, the LP group preserved more ROM than LCF in all directions except bilateral rotations. Major reduction was observed in extension, as with only 59.8% and 54.3% ROM preserved in LP and LCF groups. However, the most preserved ROM was witnessed in rotation, especially in the LP group (90.8%). For JOA and VAS, both groups showed significant improvements postoperatively, and the difference between the two groups was not statistically significant., Conclusions: Patients with OPLL had an obvious reduction in active cervical ROM following LP and LCF. Major reduction was observed in extension, and less impact was detected on rotation. Compared with LCF, LP had better ROM preserved. Both LP and LCF provided patients with significant neurological improvement., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objectives: To conduct a systematic review of studies on doctor-patient communication skills training (CST) for medical students and physicians in mainland China., Methods: We retrieved articles from six electronic databases, and searched additional eligible papers by checking reference lists. Chinese or English-language studies focused on CST and implemented in mainland China were applied to the pre-determined criteria. Articles included were further reviewed under the following categories: participant; training strategy; assessment; and outcome., Results: 20 studies met the inclusion criteria. 90% of the CST improved trainees' communication skills using a strategy which included a didactic component combined with practical rehearsal and feedback. The duration of training varied substantially. A lack of enhancement in empathy, and the use of open-ended questions were reported. 83% of the assessment instruments were self-designed and most lacked reliability and validity testing. Only two of the included studies evaluated patient satisfaction., Conclusions: The majority of included studies attained statistically significant improvements. Chinese doctors and medical students' communication skills can be enhanced through CST., Practice Implications: Future studies in China should place stronger emphasis on the development of training strategies, validation of the assessment instruments, and evaluation of patient satisfaction affected by CST., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)