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Abstract Background This study assessed the effect of standardized efficacy markers on prognosis in patients with newly diagnosed multiple myeloma (MM) during the induction phase of treatment with bortezomib, cyclophosphamide, and dexamethasone (BCD). Methods We retrospectively analyzed clinical data in 197 newly diagnosed MM patients treated with BCD as front‐line regimen at Peking Union Medical College Hospital from January 1, 2013 to December 31, 2018. Results There were 107 patients with International Staging System (ISS) III and 51 with paraprotein of light chain. Of these, 77 completed nine cycles of the BCD regimen. As the number of treatment cycles increased, the proportions of serum and urine immunofixation electrophoresis (IFE) tests elevated from 40.39% to 62.22% and 16.75% to 37.78%, respectively. More than 90% of intact immunoglobulin chain MM patients were evaluated for blood M protein per cycle, but that of urinary M protein was less than 60%. The detection rate of urinary M protein in light chain MM was more than 70% per cycle. Patients with a very good partial response (VGPR) had longer progression‐free survival (PFS) than those with uncertain VGPR (32 vs. 26 months, p = 0.0336). Of the 141 patients who completed at least four cycles without undergoing autologous hematopoietic stem cell transplantation, those who were regularly assessed at every other cycle showed more favorable PFS than those who visited irregularly (27 vs. 22 months, p = 0.059). Conclusion Urinary M protein detection rate is significantly lower than that in serum, leading to an overestimation of efficacy, premature reduction of treatment intensity, and shortened PFS. Precise response assessments are critical to treatment decisions and clinical diagnoses.

In order to enhance the toughness of mining polymer foam, polyethylene glycol (PEG), an organic material, was added to modify the toughening effect of foam. The effect of PEG modification with different molecular weight was studied by scanning electron microscope, thermogravimetric test, oxygen index test, cone calorimetric test, compressive strength test, foaming and curing time test. The results show that: PEG with different molecular weight can effectively increase the compressive strength of phenolic resin foam and reduce its pulverization rate. When the molecular weight of PEG is 1 000, the addition of 6% has the best toughening effect, the compressive strength reaches 0.155 MPa, and the pulverization rate decreases to 1.3%. Adding a certain amount of PEG can effectively increase the foaming ratio of phenolic resin, but at the same time, it will increase the shrinkage and curing time of its foam. The pore structure of PEG modified phenolic resin foam is more uniform, and the pore size of foam is also more uniform, mainly because the PEG that does not react with the phenolic resin plays the role of surfactant, and can better mix the curing agent with the resin. Compared with the thermal stability of phenolic resin foam with different PEG molecular weight, the larger the molecular weight, the worse the thermal stability of phenolic resin foam with more PEG molecular weight.

Abstract Objective The doctor-patient relationship (DPR) plays a crucial role in the Chinese healthcare system, functioning to improve medical quality and reduce medical costs. This study examined the psychometric properties of the Chinese version of the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) among general hospital inpatients in China. Methods The research recruited 38 resident doctors responsible for 120 participants, and factor analyses were used to assess the construct validity of the scale. Convergent validity was evaluated by examining the correlation between DDPRQ-10 and depressive symptoms, burnout, and self-efficacy, using the Patient Health Questionnaire Depression Scale-9 item (PHQ-9), and the Maslach Burnout Inventory (MBI). Both multidimensional item response theory (MIRT) and unidimensional item response theory (IRT) frameworks were used to estimate the parameters of each item. Results The Chinese version of DDPRQ-10 showed satisfactory internal consistency (Cronbach's alpha = 0.931), and fitted in a modified two-factor model of positive feelings and negative feelings (χ2/df = 1.494, GFI = 0.925, RMSEA = 0.071, SRMR = 0.008, CFI = 0.985, NFI = 0.958, NNFI = 0.980, TLI = 0.980, IFI = 0.986). Significant correlations with PHQ-9 with DDPRQ-10 and both subscales were revealed (r = 0.293 ~ 0.333, p

Abstract Background For better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus. Methods The cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach’s alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity. Results The WHO-5-C presented satisfactory reliability (Cronbach’s alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75. Conclusion The WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.

Extreme precipitation events induced by tropical cyclones have increased frequency and intensity, significantly impacting human socioeconomic activities and ecological environments. This study systematically examines the spatiotemporal characteristics of these events across Hainan Island and their influencing factors using GsMAP satellite precipitation data and tropical cyclone track data. The results indicate that while the frequency of typhoon events in Hainan decreased by 0.3 events decade−1 from 1949 to 2020, extreme precipitation events have increased significantly since 2000, especially in the eastern and central regions. Different typhoon tracks have distinct impacts on the island, with Track 1 (Northeastern track) and Track 2 (Central track) primarily affecting the western and central regions and Track 3 (Southern track) impacting the western region. The impact of typhoon precipitation on extreme events increased over time, being the greatest in the eastern region, followed by the central and western regions. Incorporating typhoon precipitation data shortened the recurrence interval of extreme precipitation in the central and eastern regions. Diurnal peaks occur in the early morning and late evening, primarily affecting coastal areas. Typhoon duration (CC_max = 0.850) and wind speed (CC_max = 0.369) positively correlated with extreme precipitation, while the pressure was negatively correlated. High sea surface temperature areas were closely associated with extreme precipitation events. The atmospheric circulation indices showed a significant negative correlation with extreme precipitation, particularly in the western and central regions. ENSO events, especially sea surface temperature changes in the Niño 1 + 2 region (−0.340 to −0.406), have significantly influenced typhoon precipitation characteristics. These findings can inform region-specific disaster prevention and mitigation strategies for Hainan Island.

This paper starts with the application of hyper-convergence technology, builds the framework of a university smart campus based on it, and gives the framework description of the smart campus. In order to analyze the network security for the smart campus, the Markov model is used as the basis combined with the reinforced Q learning algorithm for network node security detection, and a specific simulation analysis is given. The encryption performance and defense performance of the elliptic curve cryptosystem are analyzed through the elliptic curve cryptosystem to formulate the encryption scheme for students’ private data in the smart campus. The results indicate that the Markov model node detection combined with reinforcement Q-learning in this paper takes a maximum time of about 5.75s when the network node size reaches 150. When the number of nodes in the smart campus network is 30, under brute force attack, the whole network is captured only when the number of malicious nodes increases to more than 22, while under random attack, it takes as many as 30 malicious nodes to join before the network completely falls. This illustrates that the use of the Markov model can be realized to analyze the network security of the smart campus and that student privacy protection needs to further improve the awareness of student data privacy protection and develop the habit of assessing the privacy risk beforehand in their daily network behavior.

ObjectivesA general expectation measurement of inpatients across wards is needed in the patient safety management systems of general hospitals. This study developed and psychometrically validated a new scale fulfilling the requirements above: the Hospitalized Patients’ Expectations for Treatment Scale-Patient version (HOPE-P). MethodsA total of 35 experts and ten inpatients were interviewed during the formulation of the HOPE-P scale, which was initially designed with three dimensions: doctor–patient communication expectations, treatment outcome expectations, and disease management expectancy. We recruited 210 inpatients from a general hospital in China and explored the reliability, validity, and psychometric characteristics of the questionnaire. Item analysis, construct validity, internal consistency and 7-day test–retest reliability analysis were applied.ResultsExploratory and confirmatory analyses supported a 2-dimension (doctor–patient communication expectation and treatment outcome expectation) structure with satisfactory model fit parameters (root mean square residual (RMR) = 0.035, a root-mean-square-error of approximation (RMSEA) = 0.072, comparative fit index (CFI) = 0.984, Tucker-Lewis index (TLI) = 0.970). Item analysis revealed an appropriate item design (r = 0.573–0.820). The scale exhibited good internal consistency, with Cronbach’s α of 0.893, 0.761, and 0.919 for the overall scale, the doctor–patient communication expectation subscale, and the treatment outcome expectation subscale, respectively. The 7-day test–retest reliability was 0.782 (p < .001).ConclusionOur results indicated that the HOPE-P is a reliable and valid assessment tool to measure the expectations of general hospital inpatients, with a strong capacity to recognize patients’ expectations regarding doctor–patient communication and treatment outcomes.

ObjectiveThe patient-doctor relationship has been considered as a crucial concept in primary healthcare, while the medical reform launched by the Chinese government in 2009 has brought significant changes to the healthcare system, which made it urgent to introduce reliable measurement instruments for assessing today’s doctor-patient relationship in China. This study examined the psychometric properties of the Chinese version of the Patient-Doctor-Relationship Questionnaire-9 item (PDRQ-9) scale among general hospital inpatients in China.Materials and methodsA total of 203 participants responded to the survey, of which 39 completed retest after 7 days. Factor analyses were used to test the construct validity of the scale. Convergent validity was evaluated by the correlation between PDRQ-9 and depressive symptoms measured using PHQ-9 (Patient Health Questionnaire Depression Scale-9 item). Both multidimensional item response theory (MIRT) and unidimensional item response theory (IRT) framework were used to estimate the parameters of each item.ResultsThe two-factor model of relationship quality and treatment quality was supported (χ2/df = 1.494, GFI = 0.925, RMSEA = 0.071, RMR = 0.008, CFI = 0.985, NFI = 0.958, NNFI = 0.980, TLI = 0.980, IFI = 0.986). The PDRQ-9 and both subscales showed significant correlation with PHQ-9 (r = −0.196∼−0.309) and good internal consistency (Cronbach’s alpha = 0.865∼0.933). ANCOVA analysis adjusted with age revealed significant difference in PDRQ-9 ratings between patients with or without significant depressive symptoms (P = 0.019). The 7-day test-retest reliability of the scale was 0.730. The MIRT model of full scale and IRT models of both subscales showed high discrimination of all items (a = 2.46∼38.46), and the test information within the range of low-quality relationship was relatively high.ConclusionThe Chinese version of PDRQ-9 is a valid and reliable rating scale, which can measure the doctor-patient relationship among Chinese patients.

Treatment of multiple myeloma (MM) has advanced dramatically in the past two decades. However, under the conditions of the COVID-19 pandemic, treatment strategies have been modified accordingly. Numerous novel agents, updated trials, and major advances in myeloma have been reported in the American Society of Hematology 2020 annual meeting, either for transplant-eligible or ineligible patients. Hot topics such as the significance of autologous stem cell transplantation (ASCT), development of novel agents, and chimeric antigen receptor-T (CAR-T) cells have been widely discussed. The triplet regimen bortezomib, lenalidomide, and dexamethasone (VRd) is recommended as the standard first-line treatment, and the addition of a fourth drug improves efficacy and survival. The value of ASCT remains undoubtful, even in the era of quadruplet induction. Dual-drug maintenance, including proteasome inhibitors and immunomodulatory drugs, overcomes unfavorable outcomes in high-risk patients. For relapsed/refractory myeloma (RRMM) patients, novel agents such as selinexor and venetoclax are superior. CAR-T cells and other cell-surface-targeted therapies also appear promising.

Abstract The optimal method of tumor burden evaluation in newly diagnosed multiple myeloma (NDMM) is yet to be determined. This study aimed to compare the value of 11C-acetate positron-emission tomography (PET)/computed tomography (CT) (AC-PET and 18F-fluorodeoxyglucose PET/CT (FDG-PET) in the assessment of tumor burden in NDMM. This study evaluated 64 NDMM patients between February 2015 and July 2018. AC-PET and FDG-PET were used to assess myeloma lesions. The clinical data, imaging results, and their correlations were analyzed. Diffuse bone marrow uptake in AC-PET was significantly correlated with biomarkers for tumor burden, including serum hemoglobin (P = 0.020), M protein (P = 0.054), the percentage of bone marrow plasma cells (P 6.0 in AC-PET, but not in FDG-PET, predicted a higher probability of disease progression and shorter progression-free survival (P

Owing to the specific topological states in nodal-line semimetals, novel topological superconductivity is expected to emerge in these systems. In this Letter, we demonstrate that La_{3}Pt_{3}Bi_{4} is a topologically nontrivial nodal-ring semimetal protected by the gliding-mirror symmetry using first-principles calculations. Meanwhile, we discover bulk superconductivity with a transition temperature of ∼1.1 K and an upper critical field of ∼0.41 T by means of resistivity, susceptibility, and specific heat measurements. These findings demonstrate that La_{3}Pt_{3}Bi_{4} provides a material platform for studying novel superconductivity in the nodal-ring system.

Fire activity in China and its associations with climate are not well quantified at a local scale. Here, the authors present a detailed fire occurrence dataset for China and find a dipole fire pattern between southwestern and southeastern China that is modulated by the El Niño-Southern Oscillation (ENSO).

Abstract Background Realistic, portable, and scalable lectures, cadaveric models, 2D atlases and computer simulations are being combined more frequently for teaching anatomy, which result in major increases in user satisfaction. However, although digital simulations may be more portable, interesting, or motivating than traditional teaching tools, whether they are superior in terms of student learning remain unclear. This paper presents a study in which the educational effectiveness of a virtual reality (VR) skull model is compared with that of cadaveric skulls and atlases. The aim of this study was to compare the results of teaching with VR to results of teaching with traditional teaching methods by administering objective questionnaires and perception surveys. Methods A mixed-methods study with 73 medical students was conducted with three different groups, namely, the VR group (N = 25), cadaver group (N = 25) and atlas group (N = 23). Anatomical structures were taught through an introductory lecture and model-based learning. All students completed the pre- and post-intervention tests, which comprised a theory test and an identification test. The theory test consisted of 18 multiple-choice questions, and the identification test consisted of 25 fill-in-the-blank questions. Results The participants in all three groups had significantly higher total scores on the post-intervention test than on the pre-intervention test; the post-intervention test score in the VR group was not statistically significantly higher than the post-intervention test score of the other groups (VR: 30 [IQR: 22–33.5], cadaver: 26 [IQR: 20–31.5], atlas: 28[IQR: 20–33]; p > 0.05). The participants in the VR and cadaver groups provided more positive feedback on their learning models than the atlas group (VR: 26 [IQR: 19–30], cadaver: 25 [IQR: 19.5–29.5], atlas: 12 [IQR: 9–20]; p

Abstract Immune checkpoint inhibitors (ICIs) are able to reactivate the immune system, thereby enhancing the anti‐tumor effects. However, over‐activated T cells may induce immune‐related adverse events (irAEs). Hematological irAEs are rarely reported which mainly represent monolineage cytopenia or pancytopenia, including autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), neutropenia and aplastic anemia, sometimes even life‐threatening diseases such as hemophagocytic lymphohistiocytosis. Here, the clinical manifestations of hematological irAEs are summarized and recommendations for diagnosis and treatment proposed. Key points Significant findings of the study • Hematological immune‐related adverse events (irAEs) caused by checkpoint inhibitors are rare and may sometimes be life‐threatening. This study summarizes the manifestations of hematological irAEs and proposes preliminary recommendations for diagnosis and treatment. What this study adds • Much still remains unknown regarding hematological irAEs caused by checkpoint inhibitors. This study delineates the overview of hematological irAEs, and provides practical treatment suggestions, in particular addressing the issue of rechallenge.

Background: Acute ischemic stroke (AIS) caused by tandem intracranial and extracranial occlusions is not rare. However, optimal strategy between antegrade (extracranial first) or retrograde (intracranial first) approaches still remains elusive. This systematic review and meta-analysis aim to compare the two approaches to provide updated clinical evidence of strategy selection.Methods: PubMed, Ovid, Web of Science, and the Cochrane Library were searched for literature comparing antegrade and retrograde approaches for patients with AIS with concomitant tandem occlusions. Outcomes including successful reperfusion [Throbolysis in Cerebral Infarction (TICI) 2b−3] and 90-day favorable outcome [modified Rankin Scale (mRS) 0–2], any intracerebral hemorrhage, symptomatic intracerebral hemorrhage, procedural complications, and mortality were evaluated. The risk of bias was assessed using the Newcastle–Ottawa Scale and illustrated in the Funnel plot. Heterogeneity was assessed by I2 statistic. Subgroup and sensitivity analyses were also performed.Results: A total of 11 studies accounting 1,517 patients were included. 831 (55%) patients were treated with an antegrade approach and 686 (45%) patients were treated with the retrograde approach. A higher successful reperfusion rate was achieved in retrograde group than that of antegrade group [83.8 vs. 78.0%; odds ratio (OR): 0.63, 95% CI: 0.40–0.99, p = 0.04]. 90-day favorable outcome (mRS 0–2 at 90 days) also showed significantly higher in retrograde group compared with antegrade group (47.3 vs. 40.2%; OR: 0.72, 95% CI: 0.58–0.89, p = 0.002). The incidence of any intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage, 90-day mortality, and other complications did not differ between two groups.Conclusion: In AIS with tandem occlusions, the retrograde approach might achieve a higher successful reperfusion rate and better functional outcome with a comparable safety profile when compared with an antegrade approach. Further prospective controlled studies with more meticulous design and a higher level of evidence are needed to confirm these results.Systematic Review Registration: “PROSPERO” database (CRD 42020199093), https://www.crd.york.ac.uk/PROSPERO/.

Abstract The so-called Dirac materials such as graphene and topological insulators are a new class of matter different from conventional metals and (doped) semiconductors. Superconductivity induced by doing or applying pressure in these systems may be unconventional, or host mysterious Majorana fermions. Here, we report a successfully observation of pressure-induced superconductivity in an antiferromagnetic Dirac material BaMnBi2 with T c of ~4 K at 2.6 GPa. Both the higher upper critical field, μ 0 H c2(0) ~ 7 Tesla, and the measured current independent of T c precludes that superconductivity is ascribed to the Bi impurity. The similarity in ρ ab (B) linear behavior at high magnetic fields measured at 2 K both at ambient pressure (non-superconductivity) and 2.6 GPa (superconductivity, but at the normal state), as well as the smooth and similar change of resistivity with pressure measured at 7 K and 300 K in zero field, suggests that there may be no structure transition occurred below 2.6 GPa, and superconductivity observed here may emerge in the same phase with Dirac fermions. Our findings imply that BaMnBi2 may provide another platform for studying SC mechanism in the system with Dirac fermions.

In order to improve the recovery effect of oily wastewater, the chemical oxygen demand of oily wastewater treatment by Ti/CeO2 is studied in this paper. At first, thin film electrodes with photo catalytic activity are prepared to discuss the mechanism of catalytic oxidation organics of electrodes, proposing a method of photo catalytic oxidation degradation and anodic treatment. Then, this paper measures the current in the process of oxidizing organics to carry out more analysis.It is found that the decolorization rate of methylene blue solution is 97.3% and 88.8% after electrocatalytic degradation of methylene blue solution by electrodes.The depth mineralization selection coefficients of organics are 97.5% and 76.6%, respectively.It can be seen that the electrode prepared by anodizing-laser forging not only has stronger ability of photocatalytic oxidation, but also has higher selectivity for depth mineralization.

Quasiparticle interference (QPI) of the electronic states has been widely applied in scanning tunneling microscopy to analyze the electronic band structure of materials. Single-defect-induced QPI reveals defect-dependent interaction between a single atomic defect and electronic states, which deserves special attention. Due to the weak signal of single-defect-induced QPI, the signal-to-noise ratio is relatively low in a standard two-dimensional QPI measurement. In this paper, we introduce a projective quasiparticle interference (PQPI) method in which a one-dimensional measurement is taken along high-symmetry directions centered on a specified defect. We apply the PQPI method to the topological nodal-line semimetal ZrSiS. We focus on two special types of atomic defects that scatter the surface and bulk electronic bands. With an enhanced signal-to-noise ratio in PQPI, the energy dispersions are clearly resolved along high-symmetry directions. We discuss the defect-dependent scattering of bulk bands with the nonsymmorphic symmetry-enforced selection rules. Furthermore, an energy shift of the surface floating band is observed, and a branch of energy dispersion (q_{6}) is resolved. This PQPI method can be applied to other complex materials to explore defect-dependent interactions in the future.

The Western Pacific Warm Pool (WP), with the highest sea surface temperature (SST) in the world, has strong impacts on the drought variations in Eurasia. However, since the little ice age (1250–1850, LIA), the co-climatic drought pattern due to WP warming in Eurasia remains unclear. This is a long-term warming background for the current warming period (CWP). In this paper, we use both instrumental data and 1625 tree-ring width records from Eurasia to investigate the drought patterns in both modern and historical periods. This study revealed two seesaw precipitation patterns, namely the Central Asia–Mongolia (CAMO) and Northern Europe–Southern Europe (NESE) patterns. When the Western Pacific Warm Pool sea surface temperature (WPSST) is high, precipitation increases in Central Asia and Northern Europe, and decreases in Mongolia and southern Europe. When the positive (negative) phase event of the El Niño–Southern Oscillation (ENSO) occurs, the WPSST is reduced (increased), and the decreases (increases) of precipitation in Central Asia and Northern Europe and the increases (decreases) in precipitation in Mongolia and southern Europe are more obvious. The CAMO dipole has been strengthened since the LIA. The CAMO dipole is positively correlated with solar radiation and Northern Hemisphere temperature, and negatively correlated with Pacific decadal oscillations (PDO).

Humid subtropical China is an “oasis” relative to other dry subtropics of the world due to the prevailing of the East Asian summer monsoon (EASM). Although many long climate sensitive tree-rings have been published to understand the historical climate change over various regions in China, long tree-ring chronologies in humid subtropical China are rare due to the difficulty to find old growth trees. This study established a tree-ring chronology spanning from 1776 to 2016 from Cryptomeria fortunei Hooibrenk ex Otto et Dietr in Liancheng area of humid subtropical China, which is also currently the longest chronology in Fujian province. Similar to the climate-growth relationships in neighboring regions, our tree-ring chronology is limited by cold temperature in winter and spring and drought in summer. In addition, a drought stress before the growing season also played a role in limiting the growth of our tree rings. Our climate sensitive tree rings showed different correlations with the Pacific Decadal Oscillation (PDO) in different periods, possibly via modulation of the EASM.