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To investigate the risk factors for major limb adverse events (MALE) in peripheral arterial disease (PAD) combined with frailty and to develop and validate a risk prediction model of MALE. This prospective study was performed in the vascular surgery department of patients in six hospitals in southwest China. Prospective collection of patients with PAD combined with frailty from February 1 to December 20, 2021, with MALE as the primary outcome, and followed for 1 year. The cohort was divided into a development cohort and a validation cohort. In the development cohort, a multivariate risk prediction model was developed to predict MALE using random forests for variable selection and multivariable Cox regression analysis. The model is represented by a visualized nomogram and a web-based calculator. The model performance was tested with the validation cohort and assessed using the C-statistic and calibration plots. A total of 1179 patients were prospectively enrolled from February 1 to December 20, 2021. Among 816 patients with PAD who were included in the analysis, the median follow-up period for this study was 9 ± 4.07 months, the mean age was 74.64 ± 9.43 years, and 249 (30.5%) were women. Within 1 year, 222 patients (27.2%) developed MALE. Target lesion revascularizations were performed in 99 patients (12.1%), and amputations were performed in 131 patients (16.1%). The mortality rate within the whole cohort was 108 patients (13.2%). After controlling for competing risk events (death), the cumulative risk of developing MALE was not statistically different. Prealbumin (hazard ratio [HR], 0.6; 95% confidence interval [CI], 0.41-0.89; P =.010), percutaneous coronary intervention (HR, 2.31; 95% CI, 1.26-4.21; P =.006), Rutherford classification (HR, 1.77; 95% CI, 1.36-2.31; P <.001), white blood cell (HR, 1.85; 95% CI, 1.20-2.87; P =.005), high altitude area (HR, 3.1; 95% CI, 1.43-6.75; P =.004), endovascular treatment (HR, 10.2; 95% CI, 1.44-72.50; P =.020), and length of stay (HR, 1.01; 95% CI, 1.00-1.03; P =.012) were risk factors for MALE. The MALE prediction model had a C-statistic of 0.76 (95% CI, 0.70-0.79). The C-statistic was 0.68 for internal validation and 0.66 for external validation for the MALE prediction model. The MALE prediction model for PAD presented an interactive nomogram and a web-based network calculator. In this study, the MALE prediction model has a discriminative ability to predict MALE among patients with PAD in frailty. The MALE model can optimize clinical decision-making for patients with PAD in frailty. [ABSTRACT FROM AUTHOR]

• Respect (73%, 1265/1727) was the most needed. Re-employment or part-time jobs (71%, 1230/1727) was the most unneeded • Five protection and safety items were the most unmet but needed factors. • Religion was the main influencing factor that were less unmet but needed. • Primary medical services, especially chronic disease management and emergency care, still need to be improved in China. • It is essential to build flexible retirement policies, such as raising the retirement age or returning to work. To investigate the needed, unneeded and unmet health care services among rural community-dwelling older adults in China and examine the influencing factors, aiming to facilitate the global development of the home care system for a healthier world. This cross-sectional study investigated rural areas in three provinces in Western China. A total of 1727 rural community-dwelling older adults were enrolled. The needed, unneeded and unmet health care services were assessed by the Supply and Demand of Health Care Services (SD-HCS) questionnaire for older adults. Respect (73%, 1265/1727) was the most needed. The other top 9 needed mainly belonged to the divisions of health monitoring and information regarding chronic diseases. Re-employment or part-time jobs (71%, 1230/1727) was the most unneeded. All five protection and safety items were the most unmet but needed. Religion was the main influencing factor of those health care services that were less unmet but needed. Respect was basic for older adults, and chronic disease management was in great demand among rural community-dwelling older adults. Due to low willingness and the crisis workforce, a more flexible retirement policy is needed in rural China. It is urgent to improve the emergency care system in rural areas. Last but not least, more research is needed to explore the association between religion and health. [ABSTRACT FROM AUTHOR]

When a disaster strikes, rescue workers are deployed to the disaster site to provide immediate rescue support to victims. Given the unpredictable and overwhelming nature of disasters, rescue workers are at risk of suffering from negative psychological consequences. The goal of this review is to explore the psychological impact of a disaster on rescue workers. In this paper, a total of 55 articles – one qualitative study, 53 quantitative studies, and one mixed-methods study – were eligible for inclusion. The rescue workers identified in the literature included fire fighters, police officers, military personnel/soldiers, healthcare professionals, and volunteers. The literature revealed that these rescue workers who were deployed to disaster sites might suffer from acute stress disorder (ASD), anxiety and depression, post-traumatic stress disorder (PTSD), and other psychological disorders. Generally, of all rescuers and nurses among the healthcare professionals, the unaffiliated volunteers were most susceptible to negative psychological consequences. The findings of this review indicated that rescue workers are at a high risk of experiencing psychological problems after a disaster deployment. Interventions are needed to mitigate negative psychological consequences and foster resilience in rescue workers. [ABSTRACT FROM AUTHOR]

Resilience plays an important role in the work of disaster rescue workers. When recruiting or training disaster workers or first responders, it is of paramount importance to have a reliable and valid instrument for measuring disaster resilience. The purpose of this scoping review is to identify the nature of existing instruments used to assess the resilience of adults and to draft a prototype of a tool specifically for measuring disaster resilience of disaster rescue workers. In this paper, a total of 26 studies were included and 20 existing resilience tools for adults were identified. A prototype tool, consisting of eight domains and 66 items, for assessing resilience was developed. The major domains of disaster resilience include optimism, altruism, preparation for disaster, social support, perceived control, self-efficacy, coping strategies, and positive meaning-making. The prototype resilience tool developed from this review will be validated and tested for reliability using the Delphi technique and a cross-sectional study to be conducted among disaster workers before it is used in recruitment or training programs. The findings of this scoping review and the development of a prototype tool for measuring disaster resilience will provide valuable information for researchers and scholars who plan to assess disaster resilience. [ABSTRACT FROM AUTHOR]

Background: Nurses in the intensive care unit have a high incidence of occupational burnout, which has a serious adverse impact on their physical and mental health. It is imperative, therefore, to explore interventions, especially those that may enhance individual coping resources. Mindfulness has been proven to be one such effective resource. The purpose of this study was to explore the effect of an eight-week mindfulness intervention on occupational burnout in ICU nurses.Methods: One hundred six nurses in two ICUs who met the inclusion criteria were recruited to the program, which consisted of an educational intervention related to burnout (EB, n = 53) or a mindfulness-based intervention (MBIB, n = 53), and the results compared. The Maslach Burnout Inventory (MBI), the Mindfulness Attention Awareness Scale (MAAS), and the Acceptance and Action Questionnaire II (AAQ-II) were administered at T0 (before the intervention), T1 (one week after the intervention), T2 (one month after the intervention), and T3 (three months after the intervention). A total of 91 nurses completed the study. Data were analysed by intention-to-treat analysis and repeated-measures ANOVA to observe the effects of the mindfulness-based intervention on occupational burnout.Results: Nurses' mindfulness, experiential avoidance, emotional exhaustion, depersonalization, and personal accomplishment were all affected by the intervention. The effect could be maintained to the third month post intervention.Conclusion: Mindfulness-based intervention can effectively improve the level of mindfulness and decrease the level of experiential avoidance among ICU nurses, alleviating occupational burnout. [ABSTRACT FROM AUTHOR]

To compare the risks of catheter-related complications between peripherally inserted central catheters placed via the upper and lower extremities in neonatal intensive care units. PUBMED, EMBASE, SCOPUS, and the Cochrane Library databases were searched from inception to 3 January 2019. All studies were of patients in neonatal intensive care units who underwent insertion of peripherally inserted central catheters and were published in English. Eight studies covering 4405 peripherally inserted central catheters were included. The upper extremity group was associated with a higher risk of non-elective removal (OR = 1.41; 95% 1.16–1.72; p = 0.0007) and malposition (OR = 4.52, 95% CI 2.16–9.47; p < 0.0001) and a lower risk of thrombosis (OR = 0.23, 95% CI 0.07–0.77; p = 0.02) compared with the lower extremity group. There was no significant difference in mechanical complications, catheter-related infection, or phlebitis. This meta-analysis showed that the lower extremity group was not associated with worse outcomes compared with the upper extremity group in the neonatal intensive care unit, with the exception of thrombosis. However, further prospective randomised controlled studies are needed to ensure the quality of the results. [ABSTRACT FROM AUTHOR]

Disaster healthcare rescuers are at risk of experiencing negative psychological effects. However, some are said to be resilient and to be protected from negative consequences. The purpose of this study was to explore and understand the characteristics of those disaster healthcare rescuers who were considered resilient in rescue work, and examine whether they experienced any positive changes in their life after being involved in rescue work. Focused group interviews were conducted with disaster healthcare rescuers from Sichuan, China. Purposive sampling was used to identify those disaster healthcare rescue workers who were deployed to conduct disaster work, who were able to continue doing their daily work, and who were considered to be resilient and to have suffered no obvious negative psychological consequences. Interviews were conducted until the point of data saturation. An inductive content analysis approach was adopted to analyze the data. A total of four focus group interviews were conducted with 21 disaster rescue workers who were considered to be resilient. The healthcare rescuers considered that the characteristics that contributed to resilience were: having personality strengths, utilizing appropriate coping strategies, having social support, and making adequate preparations for rescue work. The rescuers also reported that they experienced positive changes in their life after deployment. The characteristics of the resilience shown by disaster healthcare rescuers were identified. Adequate preparedness and training for disaster rescue work is essential for the resilience of rescue workers. The identified characteristics can be used for the development of a tool for the screening of disaster rescuers and the development of interventions to enhance resilience in rescue workers, with the ultimate aim of preventing disaster rescuers from experiencing negative psychological consequences. • Personality strengths, appropriate coping and social support, preparations for rescue work were the characteristics of disaster resilience of rescuers. • The rescuers also reported that they experienced positive changes in their life after deployment. • Interventions are needed to foster resilience, which may mitigate negative psychological consequences in rescue workers. [ABSTRACT FROM AUTHOR]

To delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. Most of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. This is an observational study conducted at West China Hospital, according to the STROBE guidelines. Cancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. Among the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P <.001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. PICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. The results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. Clinical Trials ChiCTR1900024890. • Sequential ultrasound scan can obtain date on PICC-related thrombosis in a dynamic pattern. • PICC-related thrombosis is very common and can occur early post-insertion. • Frequency and onset of PICC-related thrombosis are variable in different venous segments. • Clinical manifestations of PICC-related thrombosis are not parallel to ultrasonic assessment. [ABSTRACT FROM AUTHOR]

Na + doped WO 3 nanowire photocatalysts were prepared by using post-treatment (surface doping) and in situ (bulk doping) doping methods. Photocatalytic degradation of Methyl Blue was tested under visible light irradiation, the results showed that 1 wt.% Na + bulk-doped WO 3 performed better, with higher photoactivity than surface-doped WO 3 . Photoelectrochemical characterization revealed the differences in the photocatalytic process for surface doping and bulk doping. Uniform bulk doping could generate more electron–hole pairs, while minimizing the chance of electron–hole recombination. Some bulk properties such as the bandgap, Fermi level and band position could also be adjusted by bulk doping, but not by surface doping. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is the leading cause of death in cancer patients, second only to tumor progression. The Khorana score is recommended by clinical guidelines for identifying ambulatory cancer patients at high risk of venous thromboembolism during chemotherapy. However, its predictive performance is debated among cancer patients. To map the applicability of the Khorana score in cancer patients and to assess its predictive performance across various cancer types, providing guidance for clinicians and nurses to use it more appropriately. Systematic review and meta-analysis. A comprehensive literature search of the electronic database was first conducted on August 30, 2023, and updated on May 20, 2024. Studies examining the Khorana score's predictive performance (including but not limited to the areas under the curve, C-index, and calibration plot) in cancer patients were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was applied to evaluate the methodological quality of the included studies. Data synthesis was achieved via random-effects meta-analysis using the R studio software. The subgroup analysis was performed according to the study design, clinical setting, cancer type, anti-cancer treatment stage, and country. The review incorporated 67 studies, including 58 observational studies and nine randomized controlled trials. All included studies assessed the Khorana score's discrimination, with the C-index ranging from 0.40 to 0.84. The pooled C-index for randomized controlled trials was 0.61 (95 % CI 0.51–0.70), while observational studies showed a pooled C-index of 0.59 (95 % CI 0.57–0.60). Subgroup analyses revealed the pooled C-index for lung cancer, lymphoma, gastrointestinal cancer, and mixed cancer patients as 0.60 (95 % CI 0.53–0.67), 0.56 (95 % CI 0.51–0.61), 0.59 (95 % CI 0.39–0.76), and 0.60 (95 % CI 0.58–0.61), respectively. Inpatient and outpatient settings had the pooled C-index of 0.60 (95 % CI 0.58–0.63) and 0.58 (95 % CI 0.55–0.61), respectively. Calibration was assessed in only four studies. All included studies were identified to have a high risk of bias according to PROBAST. The Khorana score has been widely validated in various types of cancer patients; however, it exhibited poor capability (pooled C-index < 0.7) in accurately discriminating VTE risk among most types of cancer patients either in inpatient or outpatient settings. The Khorana score should be used with caution, and high-quality studies are needed to further validate its predictive performance. The protocol for this study is registered with PROSPERO (registration number: CRD42023470320). [ABSTRACT FROM AUTHOR]

Our previous studies have demonstrated that BML284 is a colchicine-site tubulin degradation agent. To improve its antiproliferative properties, 45 derivatives or analogs of BML284 were designed and synthesized based on the cocrystal structure of BML284 and tubulin. Among them, 5i was the most potent derivative, with IC 50 values ranging from 0.02 to 0.05 μM against the five tested tumor cell lines. Structure–activity relationship studies verified that the N1 atom of the pyrimidine ring was the key functional group for its tubulin degradation ability. The 5i –tubulin cocrystal complex revealed that the binding pattern of 5i to tubulin is similar to that of BML284. However, replacing the benzodioxole ring with an indole ring strengthened the hydrogen bond formed by the 2-amino group with E198, which improved the antiproliferative activity of 5i. Compound 5i effectively suppressed tumor growth at an intravenous dose of 40 mg/kg (every 2 days) in paclitaxel sensitive A2780S and paclitaxel resistant A2780T ovarian xenograft models, with tumor growth inhibition values of 79.4% and 82.0%, respectively, without apparent side effects, showing its potential to overcome multidrug resistance. This study provided a successful example of crystal structure–guided discovery of 5i as a colchicine-targeted tubulin degradation agent, expanding the scope of targeted protein degradation. [Display omitted] • A series of colchicine-binding site tubulin degradation agents were synthesized. • Compound 5i showed improved antiproliferative activity compared with BML284. • Compound 5i exerted certain in vivo antitumor activity and can overcome MDR. • These new derivatives expanded the scope of targeted protein degradation. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC), a tumor of the digestive system, is characterized by high malignancy and poor prognosis. Currently, targeted therapy of CRC is far away from satisfying. The molecular mechanisms of regulated cell death (RCD) have been clearly elucidated, which can be intervened by drug or genetic modification. Numerous studies have provided substantial evidence linking these mechanisms to the progression and treatment of CRC. The RCD includes apoptosis, autophagy-dependent cell death (ADCD), ferroptosis, necroptosis, and pyroptosis, and immunogenic cell death, etc, which provide potential targets for anti-cancer treatment. For the last several years, small-molecule compounds targeting RCD have been a well concerned therapeutic strategy for CRC. This present review aims to describe the function of small-molecule compounds in the targeted therapy of CRC via targeting apoptosis, ADCD, ferroptosis, necroptosis, immunogenic dell death and pyroptosis, and their mechanisms. In addition, we prospect the application of newly discovered cuproptosis and disulfidptosis in CRC. Our review may provide references for the targeted therapy of CRC using small-molecule compounds targeting RCD, including the potential targets and candidate compounds. This review aims to provide references for the targeted therapy of colorectal cancer using small-molecule compounds targeting regulated cell death, including the potential targets and candidate compounds. [Display omitted] • Integrating the biological mechanisms of RCD and its role in CRC. • Listing small molecule compounds based on RCD for the treatment of CRC. • Describing the newly discovered methods of cell death and their specific mechanisms. • Looking forward to the development of drugs for targeted therapy of CRC. [ABSTRACT FROM AUTHOR]

Objectives Continuous renal replacement therapy (CRRT) is a specialized type of dialysis. However, the characteristics and factors associated with nosocomial pneumonia in patients undergoing CRRT have received little attention to date. Therefore, this study investigated the characteristics of and factors contributing to nosocomial pneumonia in patients receiving CRRT. Methods The clinical data of 1160 patients undergoing CRRT during the period January 2008 to December 2015 were analyzed retrospectively. Of these 1160 cases, 145 (12.5%) were included in the nosocomial pneumonia group, while 1015 were included in the control group. Results The primary pathogen in the 145 cases of nosocomial pneumonia in the CRRT patients was Staphylococcus aureus (58.57%); the morbidity rate was 12.5%. Multivariate logistic regression analysis revealed that age (odds ratio (OR) 2.209), initial curative time (OR 1.960), underlying diseases (OR 1.820), consciousness disorder (OR 1.616), organ failure (OR 2.154), the Acute Physiology and Chronic Health Evaluation II score (APACHE II) (OR 1.186), and the Charlson Comorbidity Index score (CCI) (OR 1.278) were risk factors for nosocomial pneumonia (all p < 0.05). Conversely, the serum white blood cell count (OR 0.585), albumin (OR 0.673), and hemoglobin (OR 0.712) levels were protective factors (all p < 0.05). Conclusions Results from this study indicate that by modifying risk factors, such as providing adequate nutrition, earlier treatment of underlying diseases, and controlling organ failure, the risks associated with nosocomial pneumonia may be reduced. [ABSTRACT FROM AUTHOR]

Background Caregivers of patients with heart failure experience burden and negative health outcomes. Adequate support for family caregivers improves their well-being and the quality of care provided to the patients. However, little is known about the benefits of interventions for caregivers of patients with heart failure in China. Objectives To test the effects of a multidisciplinary supportive program for family caregivers on caregiver burden, quality of life, and depression. Design A randomized controlled design with repeated measures was used in this study. Methods A total of 118 participants were randomized into experimental ( n = 59) and control groups ( n = 59) from May to December 2014 in one hospital in Chengdu, People's Republic of China. Participants in the experimental group received a 3-month multidisciplinary supportive program, consisting of three 60-min sessions of group classes, three 30-min peer support groups, and regular telephone follow-ups and consultations, while participants in the control group received usual care only. Outcomes were caregiver burden, quality of life, and depression. Data were collected at baseline, post-test (3 months after discharge), and 3 months after post-test (6 months after discharge). The repeated measures analysis of variance was used to examine the effects of groups, changes over time, and time-group interaction on outcome variables. Results There were significant improvements in caregiver burden, mental health, and depression after post-test and 3 months after post-test in the experimental group. However, there was no significant improvement in caregivers’ physical health at either 3 or 6 months following discharge. Conclusions A multidisciplinary supportive program for caregivers of heart failure patients had positive effects and provides a unique perspective of an intervention considering Chinese culture and customs. [ABSTRACT FROM AUTHOR]

Tyrosinase is a copper-containing metalloenzyme that is responsible for the rate-limiting catalytic step in the melanin biosynthesis and enzymatic browning. As a promising target, tyrosinase inhibitors can be used as skin whitening agents and food preservatives, thus having broad potential in the fields of food, cosmetics, agriculture and medicine. From 2015 to 2020, numerous synthetic inhibitors of tyrosinase have been developed to overcome the challenges of low efficacy and side effects. This review summarizes the enzyme structure and biological functions of tyrosinase and demonstrates the recent advances of synthetic tyrosinase inhibitors from the perspective of medicinal chemistry, providing a better understanding of the catalytic mechanisms and more effective tyrosinase inhibitors. [Display omitted] • Tyrosinase is a type 3 copper-containing metalloenzyme. • Tyrosinase plays the key rate-limiting catalytic role in melanin biosynthesis. • Synthetic tyrosinase inhibitors and structure-activity relationships are discussed. • This review provides novel insights for designing efficient tyrosinase inhibitors. [ABSTRACT FROM AUTHOR]

The negative synergistic effect of cancer and a peripherally inserted central catheter could significantly increase the incidence of thrombosis. Rather than identifying risk factors for peripherally inserted central catheter–related thrombosis, exploring the effect of these risk factors might be a promising method to improve the outcomes of thrombosis. To analyze the effect of systemic and local risk factors on triggering peripherally inserted central catheter–related thrombosis in the first two weeks post–insertion in cancer patients. A prospective cohort study. The study was conducted at a 4500-bed university-affiliated medical center in China. One hundred seventy-three cancer patients with peripherally inserted central catheters were included. Peripherally inserted central catheter–related thrombosis was assessed using ultrasound at a series of timepoints, once every two days post–insertion. Data on age, body mass index, blood hypercoagulation, insertion attempts, catheter-to-vein ratio, and blood flow velocity were collected as risk factors. Descriptive statistics and structural equation modeling were used to describe the study samples and analyze the effects of systemic and local risk factors. Among the 173 cancer patients included, 126 (72.8%) patients were diagnosed with peripherally inserted central catheter–related thrombosis. Most thromboses (n = 118, 93.7%) were detected within five days, and 100% were detected within nine days post–insertion. Structural equation modeling analysis showed that local risk factors [catheter-to-vein ratio (standardized path coefficient = 0.32, p < 0.05) and blood flow velocity (standardized path coefficient = −0.35, p < 0.05)] had a greater effect than systemic factors [age (standardized path coefficient = 0.13, p < 0.05) and blood hypercoagulation (standardized path coefficient = 0.17, p < 0.05)] on triggering peripherally inserted central catheter–related thrombosis. Peripherally inserted central catheter–related thrombosis is quite common and can occur very early post–insertion in cancer patients. Among the common risk factors, local risk factors reflecting peripherally inserted central catheter technology itself had a greater effect than systemic risk factors reflecting predisposition to thrombosis. Clinical Registration: Clinical Trials ChiCTR1900024890. [ABSTRACT FROM AUTHOR]