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Introduction New onset stress urinary incontinence (SUI) is the second most common complication following a prostatectomy, significantly affecting an estimated 10-20% of patients. Severe cases of SUI are often managed surgically by artificial urinary sphincter (AUS) or urethral sling implantation, depending on patient preference and incontinence severity. However, despite a large portion of these patients requiring surgical revision, there is a lack of information regarding the risk factors associated with reoperation, particularly in diverse populations. Thus, in this study, we analyzed the impact of demographic and intraoperative characteristics on reoperation risk following sling and AUS device implantation. Objective To identify risk factors for reoperation following primary AUS and urethral sling implantation. Secondarily, we aim to see if there was a difference in reoperation rates between the two procedures. Methods We performed a retrospective review of primary AUS and urethral slings implanted at a single academic center from July 2015 to May 2022. Demographic data, SUI severity (measured in pads per day), intraoperative characteristics, and 30-day safety outcomes were collected. Baseline characteristics were analyzed using a two-sample t-test, chi-square, or Mann-Whitney U test depending on distribution normality. Reoperation risk factors were analyzed utilizing Cox proportional hazard models for univariate and multivariate analysis, and a Kaplan Meier curve was used to depict re-operation time between sling and AUS. Results A total of 116 patients were included, 72 (62.1%) of which underwent urethral sling placement and 44 (37.9%) AUS implantation. The reoperation rate was 19.4% for urethral slings and 34.1% for AUS (p=0.077). Baseline characteristics between slings and sphincters differed in mean age (64.0 [7.1] vs 67.2 [7.5], p=0.024), median preoperative pads per day (2 [1-3] vs 3 [2-5], p Conclusions A greater number of preoperative pads per day is associated with increased rates of reoperation following sling implantation, while age, CVD, and former smoking status are associated with AUS reoperation. Further research is warranted to identify patient-specific risk factors, particularly to clarify the effects of CVD and former smoking status on reoperation. Disclosure No

Introduction Stress urinary incontinence is the second-most common complication male patients face post-prostatectomy. Artificial urinary sphincters (AUS) and urethral slings are two effective surgical treatments recommended for patients with incontinence who have failed conservative therapy. Slings are often preferred in cases of mild to moderate SUI, whereas AUS is preferred in severe cases. Although prior studies have shown the AUS to be superior in restoring continence, few have compared them in a diverse patient population. We aim to determine the effectiveness of both devices both in the short-term and long-term postoperative setting. Objective To review the 1 and 3 year effectiveness of both AUS and urethral slings in post-prostatectomy patients, measured as the change in median pads per day. Methods This was a single-institution retrospective chart review study of 124 patients who received either an AUS or sling between the years 2015-2022. Patients were divided into one of two groups depending on if they underwent surgery for a urethral sling or AUS. Demographic, intra-operative, and post-operative characteristics were collected. Median pads used per day was the primary measure of outcome. A two-sample t-test, chi-square, or Mann-Whitney U test was used to compare baseline characteristics based on distribution normality. Wilcoxon signed-rank tests were used to compare 1 and 3 year pad usage to baseline. Results A total of 116 patients were included, of which 72 (62.1%) underwent sling placement while 44 (37.9) received an AUS. Patients receiving an AUS were older (67.2 [7.5] vs 64.0 [7.1], p=0.024), had a higher rate of prior radiation therapy (29.5% vs 11.1, p=0.012), and used more pads per day preoperatively (3 [2-5] vs 2 [1-3], p Conclusions Post-prostatectomy insertion of an AUS results in a significant improvement to continence at 1 and 3 years, while the urethral sling is only significantly effective at 1 year. Disclosure No

The flipped classroom is one the most popular teaching models in recent years. Domestic and international scholars have carried out many experimental and quasi-experimental studies to explore the impact of flipped classroom on students’ academic performance, but the results are mixed. To further explore the impact of flipped classroom on college students’ academic performance, this paper adopted the meta-analysis method to quantitatively analyze 20 domestic and international experimental studies of flipped classroom. We found that: i) The flipped classroom positively affected college students’ academic performance, and the overall combined effect size was 0.66; ii) Effect sizes vary somewhat by subject types. For example, effect sizes for science, liberal arts, and engineering were 0.75, 0.72, and 0.34, respectively; iii) The flipped classroom had the same effect on the learning effect of different knowledge types, but practical knowledge learning was better than theoretical knowledge; and iv) The flipped classroom had produced significant impact on different class sizes, particularly medium class size.

BACKGROUND: Aortic root evaluation is conventionally based on two-dimensional measurements at a single phase of the cardiac cycle. This work presents an image analysis method for assessing dynamic three-dimensional changes in the aortic root of minimally calcified bicuspid aortic valves (BAVs) with and without moderate to severe aortic regurgitation. METHODS: The aortic root was segmented over the full cardiac cycle in three-dimensional transesophageal echocardiographic images acquired from 19 patients with minimally calcified BAVs and from 16 patients with physiologically normal tricuspid aortic valves (TAVs). The size and dynamics of the aortic root were assessed using the following image-derived measurements: absolute mean root volume and mean area at the level of the ventriculoaortic junction, sinuses of Valsalva, and sinotubular junction, as well as normalized root volume change and normalized area change of the ventriculoaortic junction, sinuses of Valsalva, and sinotubular junction over the cardiac cycle. RESULTS: Normalized volume change over the cardiac cycle was significantly greater in BAV roots with moderate to severe regurgitation than in normal TAV roots and in BAV roots with no or mild regurgitation. Aortic root dynamics were most significantly different at the mid-level of the sinuses of Valsalva in BAVs with moderate to severe regurgitation than in competent TAVs and BAVs. CONCLUSIONS: Echocardiographic reconstruction of the aortic root demonstrates significant differences in dynamics of BAV roots with moderate to severe regurgitation relative to physiologically normal TAVs and competent BAVs. This finding may have implications for risk of future dilatation, dissection, or rupture, which warrant further investigation.

Even though the central role of mechanics in cardiovascular system is widely recognized, estimating mechanical deformation and strains in-vivo remains an ongoing practical challenge. Herein, we present a semi-automated framework to estimate strains from four-dimensional (4D) echocardiography images and apply it to the aortic roots of patients with normal trileaflet aortic valves (TAV) and congenital bicuspid aortic valves (BAV). The method is based on fully nonlinear shell-based kinematics, which divides the strains into in-plane (shear and dilatational) and out-of-plane components. The results indicate that, even for size-matched non-aneurysmal aortic roots, BAV patients experience larger regional shear strains in their aortic roots. This elevated strains might be a contributing factor to the higher risk of aneurysm development in BAV patients. The proposed framework is openly available and applicable to any tubular structures.

To evaluate the causes of miscarriage and subsequent pregnancy outcomes among different phenotypes of second trimester miscarriage.Retrospective analysis of 170 consecutive second trimester miscarriages between 14 + 0 and 23 + 6 weeks recorded in the Clinical Data Analysis and Reporting System from 2012 to 2021. Cases were excluded if miscarriages occurred before 14 + 0 weeks of gestation, data were incomplete, or passage of the fetus happened before the clinical assessment. Cases were classified with a stepwise approach into three phenotypic groups including silent miscarriages (ST-SM), rupture of membranes (ST-ROM), and inevitable miscarriages (ST-IM) depending on the fetal heart pulsation and leakage of liquor at presentation. Clinical investigation of the underlying causes and the outcome of the subsequent pregnancy was then reviewed.There were 97 cases of ST-SM, 21 cases of ST-ROM, and 52 cases of ST-IM. Placental histology and karyotype examination were more likely to yield significant results in the cases of ST-ROM and ST-SM (p 0.05). The phenotypic examination identified different underlying causes including fetal anomaly, suspected cervical insufficiency, diabetes mellitus, and unknown causes (p 0.001). Sixty-four cases achieved a subsequent pregnancy. Although women with history of ST-ROM and ST-IM received more cervical length monitoring and cervical cerclage than those with ST-SM (66.7% vs. 44.4% vs. 7.5%, p = 0.0002; and 16.7% vs. 22.2% vs. 2.5%, p = 0.031, respectively), the risk of recurrent second trimester miscarriage was higher in ST-ROM and ST-IM than in ST-SM (16.7% vs. 0%, p = 0.018).The classification can differentiate different second trimester miscarriage phenotypes, which offers essential information to guide investigation panels of the underlying cause of miscarriages, and the prognosis and management of subsequent pregnancy. Future researches focused on second trimester miscarriage should report their findings according to different phenotypes.

Gravitational-wave population studies have become more important in gravitational-wave astronomy because of the rapid growth of the observed catalog. In recent studies, emulators based on different machine learning techniques are used to emulate the outcomes of the population synthesis simulation with fast speed. In this study, we benchmark the performance of two emulators that learn the truncated power-law phenomenological model by using Gaussian process regression and normalizing flows techniques to see which one is a more capable likelihood emulator in the population inference. We benchmark the characteristic of the emulators by comparing their performance in the population inference to the phenomenological model using mock and real observation data. Our results suggest that the normalizing flows emulator can recover the posterior distribution by using the phenomenological model in the population inference with up to 300 mock injections. The normalizing flows emulator also underestimates the uncertainty for some posterior distributions in the population inference on real observation data. On the other hand, the Gaussian process regression emulator has poor performance on the same task and can only be used effectively in low-dimension cases., 13 pages, 7 figures

Activation of a telomere length maintenance mechanism (TMM), including telomerase and alternative lengthening of telomeres (ALT), is essential for replicative immortality of tumor cells, although its regulatory mechanisms are incompletely understood. We conducted a microRNA (miRNA) microarray analysis on isogenic telomerase positive (TEP) and ALT cancer cell lines. Amongst nine miRNAs that showed difference in their expression in TEP and ALT cancer cells in array analysis, miR-708 was selected for further analysis since it was consistently highly expressed in a large panel of ALT cells. miR-708 in TEP and ALT cancer cells was not correlated with C-circle levels, an established feature of ALT cells. Its overexpression induced suppression of cell migration, invasion, and angiogenesis in both TEP and ALT cells, although cell proliferation was inhibited only in TEP cells suggesting that ALT cells may have acquired the ability to escape inhibition of cell proliferation by sustained miR-708 overexpression. Further, cell proliferation regulation in TEP cells by miR708 appears to be through the CARF-p53 pathway. We demonstrate here that miR-708 (i) is the first miRNA shown to be differentially regulated in TEP and ALT cancer cells, (ii) possesses tumor suppressor function, and (iii) deregulates CARF and p21WAF1-mediated signaling to limit proliferation in TEP cells.

BackgroundZero-time Exercise (ZTEx), a simple strength- and stamina-enhancing physical activity (PA) requiring no extra equipment, can potentially increase PA and fitness. This pilot trial examined the feasibility and potential effectiveness of a smartphone ZTEx intervention to promote PA and fitness in patients with coronary heart disease (CHD).MethodsA parallel-group assessor-blinded pilot randomized controlled trial was conducted on Chinese patients with stable coronary heart disease (CHD) in three cardiology clinics. The experimental group received a 15-min brief individual face-to-face session and a 12-week ZTEx instant messaging with 28 picture e-messages and a smartphone ZTEx application (ZTExApp). The control group received the same duration of individual session and number and format of e-messages, but the content was healthy eating and breathing exercise. The feasibility was assessed based on: attrition rate, usage, response rate and perception of the intervention. The outcome evaluation included primary outcome (PA), fitness, exercise self-efficacy and intention, perceived happiness and health, and quality of life. A linear mixed model was used with intention-to-treat analysis adjusting for sex, age and baseline values. A semi-structured interview was conducted to collect feedback from the experiment group.ResultsOne hundred thirty-nine patients (mean age 59.8 ± 6.6; 71.2% male) were randomized to the experimental group (n = 70) or control group (n = 69), and 80% (56/70) and 82% (57/69) of patients completed the 12-week follow-up assessment, respectively. The attrition rate was 18.7%. The experimental group reported that ZTEx was feasible to integrate PA into their daily life and appreciated the picture e-messages, and 95% of them sent feedback to us, but only 19.6% (13/70) of the participants entered their PA information into the e-diary of the ZTExApp. The experimental group had a significantly greater increase in time spent walking [mean difference (95% CI): 155.3 (10.1, 300.4), P = 0.04, Cohen's d = 0.34] than the control group.ConclusionsThis pilot study showed using a brief ZTEx face-to-face session with picture e-messages empowered patients with CHD to integrate PA into daily life. Future definitive trials with a longer follow-up and a more user-friendly ZTExApp interface are necessary to determine the effectiveness of the smartphone ZTEx intervention in enhancing PA and related outcomes.Trial RegistrationThe research protocol was registered at the Hong Kong University Clinical Trials Registry (HKUCTR) on 22 Jul 2016 (Study identifier: HKUCTR-2165) and was also retrospectively registered at the National Institutes of Health (identifier number: NCT03464331) on 14 March 2018.

Copyright © Hammill Institute on Disabilities and The Author(s). Psychosocial adaptation to chronic illness and disability (CID) involves a complex interplay of the client’s background factors with resilience and coping. To date, there have been few studies on psychosocial adaptation to CID in the Chinese context. To examine the predictors of psychosocial adaptation, we surveyed people with CID from community-rehabilitation settings and self-help groups (N = 224). The research questionnaire collected information on demographics, health-related factors, social support, resilience, coping strategies, psychosocial adaptation, and mental well-being. Resilience, coping strategies, health-related factors, and sex were found to be important predictors of psychosocial adaptation. Using structural equation modeling (SEM), we tested a conceptual model on how social support and health-related factors predict adjustment variables (resilience and coping strategies), which further affect psychosocial adaptation and mental well-being. All the variables are closely linked and the path coefficients are all significant. An overall fair model fit (comparative fit index [CFI] = 0.89; root mean square error of approximation [RMSEA] = 0.089) was obtained. The results provide support for the conceptual model we proposed based on health-related coping and the phase model of psychosocial adaptation. The key predictors of psychosocial adaptation and mental well-being in Chinese people with CID in Hong Kong are similar to those identified in non-Chinese studies. Faculty of Health and Social Sciences, The Hong Kong Polytechnic University (Project Code ZVNB).

Expression of ATP‐binding cassette B5 (ABCB5) has been demonstrated to confer chemoresistance, enhance cancer stem cell properties and associate with poor prognosis in hepatocellular carcinoma (HCC). The aim of this study was to evaluate the genetic variations of ABCB5 in HCC patients with reference to healthy individuals and the clinicopathological significance. A pilot study has examined 20 out of 300 pairs HCC and paralleled blood samples using conventional sequencing method to cover all exons and exon/intron regions to investigate whether there will be novel variant sequence and mutation event. A total of 300 HCC and 300 healthy blood DNA samples were then examined by Sequenom MassARRAY genotyping and pyrosequencing for 38 SNP and 1 INDEL in ABCB5. Five novel SNPs were identified in ABCB5. Comparison of DNA from blood samples of HCC and healthy demonstrated that ABCB5 SNPs rs75494098, rs4721940 and rs10254317 were associated with HCC risk. Specific ABCB5 variants were associated with aggressive HCC features. SNP rs17143212 was significantly associated with ABCB5 expression level. Nonetheless, the paralleled blood and tumour DNA sequences from HCC patients indicated that ABCB5 mutation in tumours was not common and corroborated the TCGA data sets. In conclusion, ABCB5 genetic variants had significant association with HCC risk and aggressive tumour properties.

Despite the emergence of literature on gender differences in gambling problems, few empirical studies have explored how gender norms inform the gender dynamics involved in the development of gambling disorder. This study addresses this research gap by applying general strain theory to gambling disorder across genders. The objectives of this study are twofold. First, we examine the role of gender norms in the social strain-gambling disorder relationship across genders. Second, we explore the extent to which males and females who conform to traditional gender norms are likely to express strain-induced negative emotions that result in gambling disorder. These relationships are examined with data from a cross-sectional survey of 1,620 Chinese married couples in Hong Kong. Our results indicate that gender norms function differently between genders. Specifically, gender norms exacerbate the effect of social strain on gambling disorder in males but mitigate the effect of social strain on gambling disorder in females. In addition, gender norms amplify the effect of strain-induced negative emotions on gambling disorder in males only.

Mindfulness interventions have been shown to be effective in the treatment of anxiety for both adolescent and adult populations. However, little research has investigated and tested the use of mind...

There is limited knowledge on the possible pathways of victimization among rural dwellers during adolescence in developing contexts, such as rural China, where victimization may compound developmental disadvantages of rural adolescents. Guided by the lifestyle/routine activity theory, the goal of this study thus was to examine how far delinquent lifestyles (delinquent involvement and delinquent peer association); nondeviant routine activities (unstructured socializing with peers, structured activities, and solitary activities); and social guardianship within family, school, and neighborhood contribute to juvenile victimization in a rural setting. The outcomes of interest covered direct victimization (violent, property, and sexual) and indirect victimization (witnessing community violence). The study included 2,839 adolescents (51.2% male; mean age = 13.88 ± 0.90 years) from 30 middle schools in rural China. The delinquent peer influence as a risk factor of direct and indirect victimization appeared to be more profound than delinquent involvement. Solitary activities consistently put rural adolescents at greater risk of direct and indirect victimization, and their role was stronger than that of rural adolescents’ delinquent involvement. No victimization outcomes were predicted by unstructured socializing with peers and structured activities. Attachment to family caregivers and neighborhood cohesion were the strongest social guardianship predictors across all forms of victimization. These results suggest that alongside social guardianship and delinquent lifestyles, rural isolation should be addressed in managing juvenile victimization. The insignificant role of unstructured socializing with peers may raise the need to clarify its conceptual relevance to rural settings. The implications for improving the underdeveloped preventive measures against victimization of rural adolescent populations in developing societies are described.

BACKGROUND: The first UK guidelines for the management of hidradenitis suppurativa (HS) were published by the British Association of Dermatologists (BAD) in 2018. The guidelines contained a set of audit criteria. AIM: To evaluate current HS management against the audit standards in the BAD guidelines. METHODS: BAD members were invited to complete audit questionnaires between January and May 2020 for five consecutive patients with HS per department. RESULTS: In total, 88 centres participated, providing data for 406 patients. Disease staging using the Hurley system and disease severity using a validated tool during follow-ups was documented in 75% and 56% of cases, respectively, while quality of life and pain were documented in 49% and 50% of cases, respectively. Screening for cardiovascular disease risk factors was as follows: smoking 75%, body mass index 27% and others such as lipids and diabetes 57%. Screening for depression and anxiety was performed in 40% and 25% of cases, respectively. Support for smokers or obese patients was documented in 35% and 23% of cases. In total, 182 patients were on adalimumab, of whom 68% had documentation of baseline disease severity, and 76% were reported as having inadequate response or contraindications to systemic treatments; 44% of patients continued on adalimumab despite having < 25% improvement in lesion count. CONCLUSION: UK dermatologists performed well against several audit standards, including documenting disease staging at baseline and smoking status. However, improvements are needed, particularly with regard to screening and management of comorbidities that could reduce the long-term complications associated with HS. A re-audit is required to evaluate changes in practice in the future.

BACKGROUND: Self-efficacy is a key psychosocial factor influencing the outcome of vocational rehabilitation programs. There is lack of a validated job-seeking self-efficacy measure for Chinese persons with disabilities. OBJECTIVE: The aim of this study was to validate the Chinese version of the Job-Seeking Self-Efficacy Scale (C-JSS) developed by Barlow, Wright, and Cullen (2002) and to examine its psychometric properties using a Chinese sample of persons with disabilities. METHODS: JSS was first translated into Chinese and reviewed by vocational rehabilitation practitioners and persons with disabilities. Ninety-seven Chinese participants with disabilities were recruited to fill in the questionnaire of JSS and other questions. The internal consistency, structural and coverage validities of C-JSS were evaluated. RESULTS: C-JSS showed a high internal consistency (Cronbach’s alpha = 0.95) and unidimensional factorial structure. For concurrent validity, there were significant correlations between C-JSS with the score of WHODAS 2.0 (p = 0.001), educational level (p

Tumor hypoxia induces the large-scale adaptive reprogramming of cancer cells, promoting their transformation into highly invasive and metastatic species that lead to highly negative prognoses for cancer patients. We describe the synthesis and application of a hypoxia-responsive trigger derived from previously inaccessible enamine N-oxide structures. Hypoxia-dependent reduction of this motif by hemeproteins results in the concomitant activation of a caged molecule and a latent electrophile. We exploit the former in a hypoxia-activated prodrug application using a caged staurosporine molecule as a proof-of-principle. We demonstrate the latter in in vivo tumor labeling applications with enamine-N-oxide-modified near-infrared probes. Hypoxia-activated prodrug development has long been complicated by the heterogeneity of tumor hypoxia in patients. The dual drug release and imaging modalities of the highly versatile enamine N-oxide motif present an attractive opportunity for theranostic development that can address the need not only for new therapeutics but paired methods for patient stratification.