Search

Background Primary care physicians in community settings face numerous challenges when making medication decisions for patients with multimorbidity. Enhancing their decision-making capabilities through training is an important way to address these challenges. However, there is a dearth of in-depth research on the training needs of primary care physicians in the context of medication decision-making for multimorbidity. Objective This study aims to explore the challenge physicians encountered in medication decision-making for patients with multimorbidity and their needs for training content and modalities, providing a reference for designing the training courses for the abilities enhancement. Methods From October 5th to December 21st in 2023, physicians from community health care centers in Hangzhou, Ningbo, Jiaxing, Shenzhen, and Shanghai were recruited for in-depth interviews following the principle of purposive sampling and maximum variation, which focus on the content and formats of training to enhance medication decision-making abilities. Two researchers transcribed and coded the interviews independently, and content analysis was performed on the interview data. Results A total of 20 Physicians completed the interviews and 15 were females, mean age were (38.5±3.0) years. Based on the challenges faced by primary care physicians in the medication decision-making for multimorbidity, the training should cover four aspects: evaluation of medication therapy, rational selection of medication, doctor-patient communication and shared decision-making, medication education and follow-up. In terms of training form, primary care physicians are willing to accept flexible and multiple teaching approaches, and prefer case-based training that aligns with community health needs. Conclusion Primary care physicians have clear training needs of medication decision-making for patients with multimorbidity. The results of this study provide a theoretical reference for the development of training courses, which adapt to the working environment and actual requirements of primary care physicians.

With the transformation of the role of pharmacists, the model and content of pharmacy services in primary care delivered by them have changed significantly, and they may play a greater role in the collaboration with general practitioner teams. This paper elaborated the content and model of collaboration between primary care pharmacists and general practitioner teams globally, analyzed the current effects of collaboration on improving clinical outcomes of patients, saving medical expenses and standardizing rational use of medicines, and summarized the challenges and barriers to collaboration, including general practitioners' low willingness to collaborate, patients' lack of confidence in the professional competence of primary pharmacists, barriers to role conversion of primary care pharmacists, additional medical costs, and imperfect infrastructure, etc. In view of the above barriers, this paper proposed five coping strategies, including clearly defining the responsibility of pharmacists in general practitioner teams, developing the incentive system and improving the management of fund, enhancing the training for community pharmacists and constructing the position-specific competencies evaluation system, strengthening the communication and mutual trust between general practitioners and pharmacists, and optimizing the pattern of collaboration. All of these provide theoretical reference and strategic support for the development of the collaboration between primary care pharmacists and general practitioners teams in China.

Metal foam composite is a kind of lightweight composite with low density, high strength, high shielding performance, high damping performance and other characteristics. It has a wide range of application prospects in aerospace, drilling trap floats, artificial bone and other fields, which has attracted people's attention. In this paper, based on the research of the existing literature, the fabrication methods of metal foam composites were introduced, the effect of microstructure on the properties of metal foam composites was analyzed, the progress of mechanical properties, damping properties, shielding properties and heat insulation and their mechanisms of metal foam composites and their applications in relevant fields were reviewed, which provides a theoretical basis for the development of metal foam composites in the future, and the new fabrication technology, modeling research, sandwich structure of metal foam composites and the fabrication of high performance foam hollow sphere composite were also prospected.

Ti-6Al-4V(TC4) titanium alloy is a kind of α+β type two-phase titanium alloy widely used. However, due to the microscopic defects in additive manufacturing titanium alloy, its mechanical properties are lower than the forging level, and post-treatment is usually required. Therefore, it is necessary to further study the additive manufacturing process and post-treatment of TC4 titanium alloy. In this paper, the microstructure and comprehensive properties of titanium alloy were analyzed by the changes of common process parameters such as energy input power and scanning strategy in the additive manufacturing process, and the influence of other process parameters such as protective gas type, substrate thickness, powder size and other factors in the additive manufacturing process was introduced. The influence of common heat treatment methods after additive manufacturing on its microstructure and mechanical properties was also comprehensively analyzed, and the influence of new post-heat treatment methods, such as vacuum heat treatment and cyclic heat treatment, as well as the influence of multiple post-treatment and comprehensive use of heat treatment were summarized. Generally speaking that the reasonable selection of additive manufacturing process parameters and the application of post-heat treatment method are the basis for obtaining titanium alloy components with excellent performance. The comprehensive use of various heat treatment methods or other post-treatment methods and heat treatment are the effective ways to further improve the performance of titanium alloy components in additive manufacturing. To establish a uniform selection standard for additive manufacturing process parameters and post-processing process is the key to the future development of additive manufacturing.

The study status on the joining of titanium alloy/steel dissimilar joint technology was summarized and reviewed, the microstructure characteristics of titanium alloy/steel direct joining and interlayer joining interface were analyzed.The formation and evolution process of titanium alloy/steel joint interface products with different interlayers (copper, copper-based alloy and others) were emphatically described, and the mechanical properties of titanium alloy/steel with different interlayers and preparation processes were also summarized.Finally, the methods and design ideas that can be adopted for the preparation of good titanium alloy/steel joints were summarized, and it was pointed out that the future development of this field can be combined with simulation in addition to using traditional methods to further the existing research, so as to achieve deeper understanding and experimental prediction.

Background: Concerns have been raised regarding the effects of perfluoroalkyl substance (PFAS) exposure on cardiovascular diseases (CVD), but clear evidence linking PFAS exposure to CVD is lacking, and the mechanism remains unclear. Objectives: To study the association between PFASs and CVD in U.S. population, and to reveal the mechanism of PFASs' effects on CVD. Methods: To assess the relationships between individual blood serum PFAS levels and the risk of total CVD or its subtypes, multivariable logistic regression analysis and partial least squares discriminant analysis (PLS-DA) were conducted on all participants or subgroups among 3391 adults from the National Health and Nutrition Examination Survey (NHANES). The SuperPred and GeneCards databases were utilized to identify potential targets related to PFAS and CVD, respectively. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of intersection genes were performed using Metascape. Protein interaction networks were generated, and core targets were identified with STRING. Molecular docking was achieved using Autodock Vina 1.1.2. Results: There was a positive association between Me-PFOSA-AcOH and CVD (OR = 1.28, p = 0.022), especially coronary heart disease (CHD) (OR = 1.47, p = 0.007) and heart attack (OR = 1.58, p < 0.001) after adjusting for all potential covariates. Me-PFOSA-AcOH contributed the most to distinguishing between individuals in terms of CVD and non-CVD. Significant moderating effects for Me-PFOSA-AcOH were observed in the subgroup analysis stratified by sex, ethnicity, education level, PIR, BMI, smoking status, physical activity, and hypertension (p < 0.05). The potential intersection targets were mainly enriched in CVD-related pathways, including the inflammatory response, neuroactive ligand–receptor interaction, MAPK signaling pathway, and arachidonic acid metabolism. TLR4 was identified as the core target for the effects of Me-PFOSA-AcOH on CVD. Molecular docking results revealed that the binding energy of Me-PFOSA-AcOH to the TLR4-MD-2 complex was −7.2 kcal/mol, suggesting that Me-PFOSA-AcOH binds well to the TLR4-MD-2 complex. Conclusions: Me-PFOSA-AcOH exposure was significantly associated with CVD. Network toxicology and molecular docking uncovered novel molecular targets, such as TLR4, and identified the inflammatory and metabolic mechanisms underlying Me-PFOSA-AcOH-induced CVD. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) is a highly heterogeneous disease. To identify potential clinically actionable therapeutic targets that may inform individualized treatment strategies, we performed whole-exome sequencing on 78 GCs of differing histologies and anatomic locations, as well as whole-genome sequencing on two GC cases, each with three primary tumors and two matching lymph node metastases. The data showed two distinct GC subtypes with either high-clonality (HiC) or low-clonality (LoC). The HiC subtype of intratumoral heterogeneity was associated with older age, TP53 (tumor protein P53) mutation, enriched C > G transition, and significantly shorter survival, whereas the LoC subtype was associated with younger age, ARID1A (AT rich interactive domain 1A) mutation, and significantly longer survival. Phylogenetic tree analysis of whole-genome sequencing data from multiple samples of two patients supported the clonal evolution of GC metastasis and revealed the accumulation of genetic defects that necessitate combination therapeutics. The most recurrently mutated genes, which were validated in a separate cohort of 216 cases by targeted sequencing, were members of the homologous recombination DNA repair, Wnt, and PI3K-ERBB pathways. Notably, the drugable NRG1 (neuregulin-1) and ERBB4 (V-Erb-B2 avian erythroblastic leukemia viral oncogene homolog 4) ligand-receptor pair were mutated in 10% of GC cases. Mutations of the BRCA2 (breast cancer 2, early onset) gene, found in 8% of our cohort and validated in The Cancer Genome Atlas GC cohort, were associated with significantly longer survivals. These data define distinct clinicogenetic forms of GC in the Chinese population that are characterized by specific mutation sets that can be investigated for efficacy of single and combination therapies.