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Funding Acknowledgements Type of funding sources: None. Background Frailty is emerging as an important prognostic indicator for patients undergoing cardiac surgeries or procedures. Purposes We sought to evaluate the prognostic and differential impacts of frailty on patients undergoing coronary artery or valvular surgical procedures of different levels of invasiveness, as well as to explore the differential predictability of various frailty measurement models. Methods Nine databases were searched for prospective cohort studies that have adopted validated measure(s) of frailty and reported clinical, healthcare service utilisation, or patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures. Meta-analysis was conducted using random-effects model. Results Sixty-two articles were included (N = 16,679). Frailty significantly predicted mortality (short-term [≤ 30 days]: odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.28–4.26; mid-term [1 year]: OR: 3.93, 95% CI: 2.65–5.83; long-term [>1 year]: HR: 2.23, 95% CI: 1.60–3.11), postoperative complications (ORs: 2.54–3.57), discharge to care facilities (OR: 5.52, 95% CI: 3.84–7.94), hospital readmissions (OR: 2.00, 95% CI: 1.15–3.50), and reduced health-related quality of life (HRQoL; SMD: −0.74, 95% CI: −1.30 to −0.18) (Figure 1 and 2). Subgroup analyses showed that frailty exerted a greater impact on short-term mortality in patients undergoing open-heart surgeries than those receiving transcatheter procedures (Figure 1A), but no significant difference was observed for mid- and long-term mortality between these two groups of patients (Figure 1B and C). Multidimensional and physical-aspect-focused frailty measurements equally predicted mortality and complications, but multidimensional measurements were more predictive of hospital readmissions than physical-aspect-focused measurements (Figure 2B). Conclusion Frailty was predictive of postoperative mortality, complications, increased healthcare service utilisation, and reduced HRQoL. The impact of frailty on short-term mortality was more prominent in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional measures of frailty enhanced prognostic risk estimation, especially for hospital readmissions, demonstrating a need to incorporate a formal frailty assessment into routine preoperative risk evaluation to inform therapeutic decision-making.

患儿8月龄起病以脾脏、淋巴结和腮腺肿大为突出表现，伴反复发热、窦肺感染、贫血和血小板减少，外周血多克隆性B细胞增殖。基因检出半胱天冬酶募集结构域11基因第5外显子新发杂合变异（c.368CT，p.G123D），父母为野生型，诊断NF-κB相关B细胞增殖和T细胞失能性疾病。经10年利妥昔单抗治疗，淋巴增殖控制良好。.

Aims Patients with atrial fibrillation (AF) play passive roles in disease management. This study aimed to examine the feasibility and preliminary effects of an empowerment-based care model, titled ‘the nurse-led multi-component behavioural activation (N-MBA) programme’, on health-related quality of life, AF knowledge, psychological outcomes, medication adherence, and treatment decision-making in patients with AF. Methods and results This mixed-methods study comprised a pilot randomized controlled trial and a qualitative study. Patients with AF who had a moderate-to-high risk of stroke but were not prescribed oral anticoagulants were recruited. Forty participants were recruited and randomized in a 1:1 ratio to receive either the N-MBA programme or standard care. The 13-week programme comprised care components that prepared patients for shared decision-making, an empowerment-based educational module on AF self-care, and continuous support through telephone calls. The programme was feasible, and the overall attendance rate was 82.5%. The participants gave excellent ratings in the satisfaction survey. The N-MBA group showed greater improvements in health-related quality of life (HRQoL) and AF knowledge than the standard care group at the immediate post intervention and 6-month follow-up time points. No significant between-group changes in medication adherence, anxiety, and depression were detected. Participants in the N-MBA group actively raised concerns about AF and its treatment with their attending doctors. The qualitative data were consistent with the quantitative data, indicating that the programme built a comprehensive knowledge base of AF and self-care behaviours. Conclusion The N-MBA programme is feasible and acceptable to patients with AF. It improved patients’ AF knowledge, treatment-related decision-making, and HRQoL. Registration ClinicalTrials.gov NCT03924739

Background motivating older people with cognitive impairment to remain physically active is challenging. Objective this study aimed to examine the effects of a peer-supported exercise intervention on the cognitive function and health-related quality of life (HRQoL) of persons with mild cognitive impairment (MCI). Design a two-arm randomised controlled trial. Setting and participants community-dwelling persons with MCI were recruited from community centres for older adults in Hong Kong. Methods participants randomised to the intervention group received an 8-week group-based peer-supported multicomponent exercise intervention, while the waitlist control group received usual care. A battery of neuropsychological tests and the Short Form-36 were administered at baseline, immediately post-intervention and 3 months post-intervention. Results two hundred and twenty-nine participants were randomised to the intervention (n = 116) or control (n = 113) group. Compared with the control group, participants in the intervention group showed significantly greater improvements in processing speed and attention measured by the Colour Trails Test 1 (β = 7.213, 95% confidence interval [CI] = 2.870–11.557, P = 0.001) and working memory measured by the Digit Span Backward Test (β = 0.540, 95% CI = 0.199–0.881, P = 0.002) immediately post-intervention. The effects were sustained at 3 months post-intervention. Similarly, significantly greater improvements in sequencing and mental flexibility measured by the Colour Trails Test 2 were observed in the intervention group 3 months post-intervention (β = 6.979, 95% CI = 3.375–10.584, P Conclusion the peer-supported exercise intervention was effective at sustaining improvements in executive function, attention and working memory in persons with MCI.

The rotating magnetocaloric effect has been researched in double perovskite Tb $$_{2}$$ CoMnO $$_{6}$$ by Monte Carlo simulation. The magnetization, specific heat and isothermal entropy change are presented for magnetic fields in different directions ( $$h\parallel c$$ and $$h\perp c$$ ). The rotating magnetic entropy, transition temperature and relative cooling power are given as well. Due to the different magnetic anisotropy, the spin of Co $$^{2+}$$ /Mn $$^{4+}$$ is parallel to c axis and the spin of Tb $$^{3+}$$ is perpendicular to c axis. The corresponding A-type antiferromagnetic order appears at $$T_{C} = 94$$ K, and at $$T_{N} = 15$$ K, ferromagnetic state appears. Different orientations of spins result in a big negative and positive rotating magnetic entropy appeared in different temperature. Those findings may provide a wider temperature range for magnetic refrigeration applications.

Crambus duospineus Li, sp. n. is described from Jiangxi Province, China. The new species can be diagnosed by the sacculus of male genitalia with a strongly sclerotized apex, ending with two spine-like projections, and the well-developed apical spine of the phallus is approximate half as long as the phallus. Images of the head, habitus, and male genitalia of Crambus bipartellus South, 1901 are provided for comparison.

Background: Preoperative evaluation of the number of lymph node metastasis (LNM) is the basis of individual treatment of locally advanced gastric cancer (LAGC). However, the routinely used preoperative determination method is not accurate enough. Patients and methods: We enrolled 730 LAGC patients from five centers in China and one center in Italy, and divided them into one primary cohort, three external validation cohorts, and one international validation cohort. A deep learning radiomic nomogram (DLRN) was built based on the images from multiphase computed tomography (CT) for preoperatively determining the number of LNM in LAGC. We comprehensively tested the DLRN and compared it with three state-of-the-art methods. Moreover, we investigated the value of the DLRN in survival analysis. Results: The DLRN showed good discrimination of the number of LNM on all cohorts [overall C-indexes (95% confidence interval): 0.821 (0.785–0.858) in the primary cohort, 0.797 (0.771–0.823) in the external validation cohorts, and 0.822 (0.756–0.887) in the international validation cohort]. The nomogram performed significantly better than the routinely used clinical N stages, tumor size, and clinical model (P < 0.05). Besides, DLRN was significantly associated with the overall survival of LAGC patients (n = 271). Conclusion: A deep learning-based radiomic nomogram had good predictive value for LNM in LAGC. In staging-oriented treatment of gastric cancer, this preoperative nomogram could provide baseline information for individual treatment of LAGC.

Magnetic frustration can induce interesting magnetic phases including skyrmion state in centrosymmetric materials. By means of Monte Carlo simulations, we theoretically study the frustrated J 1–J 2 classical Heisenberg model on the triangular lattice. Both h 1–J 2 and h–T phase diagrams show rich magnetic phases, and skyrmion state can be stabilized by J 2. These results can be qualitatively explained by energy competitions, and indicate that skyrmion can be driven by the competition of short-range interactions in absence of DM interaction. This may help us to design and apply the skyrmion devices more easily in the future.

Purpose This study aimed to assess the health-related quality of life (HRQoL) and identify the important correlates of HRQoL in older Chinese adults with mild cognitive impairment (MCI). Patients and methods A cross-sectional study design was adopted. A total of 204 older adults with MCI were enrolled in this study. HRQoL was evaluated by the Quality of Life-Alzheimer's disease. Hierarchical regression analysis was conducted to investigate the sociodemographic, disease-related, psychological, and behavioral factors associated with the HRQoL of individuals with MCI. Results Hierarchical regression analysis indicated that old age (Beta = -0.131, p =0.024), low income (Beta = 0.128, p = 0.032), depressive symptoms (Beta = -0.564, p < 0.001), and poor sleep quality (Beta = -0.169, p =0.004) were significantly associated with the HRQoL of individuals with MCI. Conclusion Caring for older Chinese adults with MCI should focus on sociodemographically disadvantaged groups with advanced age and low income. Rehabilitation programs that effectively alleviate depressive symptoms and improve sleep quality should be applied to older adults with MCI to enhance their HRQoL.

胆囊神经内分泌肿瘤相对罕见，而同时含有多种不同上皮性及肉瘤成分的混合性神经内分泌肿瘤在胆囊则更为罕见。胆囊混合性神经内分泌肿瘤患者早期缺乏特异性症状往往导致延期诊断，其预后也比单纯性肿瘤更差，因此正确的病理诊断对临床评估患者预后及选择治疗方案具有重要意义。该文报道1例发生在胆囊同时含有大细胞神经内分泌癌、腺癌和肉瘤成分的混合性肿瘤，探讨其临床病理特征、诊断及鉴别诊断，并进行讨论。.

ImportanceDespite decades of educational efforts, patients’ prolonged delays in seeking care for symptoms of acute myocardial infarction (AMI) remain the greatest obstacle to successful management of the condition.ObjectiveTo compare the effects of a narrative-based psychoeducational intervention with a didactic educative approach on AMI survivors’ intention to seek care for AMI symptoms and on AMI knowledge.Design, Setting, and ParticipantsA multisite randomized clinical trial recruited community-dwelling patients aged 18 years or older with a history of AMI from 4 hospitals in Hong Kong from January 1, 2018, to January 22, 2021, and followed up participants for 1 year.InterventionsAn 8-week narrative-based psychoeducational intervention aimed to create a vivid cognitive experience of complex decision-making and modeled desirable behavioral changes through nurse-led, interactive video sessions using model patients. The control group received 4 nurse-led sessions comprising education about AMI and care seeking delivered using a didactic approach.Main Outcomes and MeasuresThe primary outcome was the behavioral intention between the 2 groups, reflected by participants’ attitudes and beliefs about care seeking for AMI measured using the Acute Coronary Syndrome Response Index—Chinese version. The secondary outcome was AMI knowledge.ResultsSix hundred and eight participants (mean [SD] age, 67.2 [8.3] years; 469 [77.1%] male) were randomized to either the narrative-based psychoeducation group (n = 304) or the didactic education group (n = 304). The psychoeducational intervention group reported greater positive changes than the control group in their attitudes (β = −1.053 [95% CI, −1.714 to −0.391]; P P = .04) toward care seeking at the 3-month follow-up, and the difference was sustained at 12 months for both attitudes (β = −0.797 [95% CI, −1.477 to −0.117]; P = .02) and beliefs (β = −0.692 [95% CI, −1.309 to −0.012]; P = .047). There were no significant differences in AMI knowledge between the 2 study groups at the 3-month and 12-month time points.Conclusions and RelevanceThe results of this randomized clinical trial found that a novel approach of narrative-based psychoeducation was effective in improving patients’ behavioral intention to seek care for AMI symptoms. Longer-term follow-up to evaluate actual care-seeking behavior and clinical outcomes in patients with AMI is warranted to determine the sustained effects of this intervention.Trial RegistrationChiCTR Identifier: ChiCTR-IIC-17010576

淋巴瘤种类繁多，分类复杂，一直是病理诊断工作中的难点。近几年，随着新的分子检测技术的出现及应用，人们对淋巴瘤的认识逐渐深入，特别是在淋巴瘤的组织学分类和分子遗传学方面有了较大的进展。新的分类、关键的分子改变及分子分型的提出，有助于淋巴瘤的精准诊断、风险分层、预后评估及精准治疗。.

In this work, the effect of uniaxial stress on the stability of magnetic skyrmion is studied by use of Monte Carlo simulations. The classical Heisenberg model with anisotropic exchanges and Dzyaloshinskii-Moriya interactions is applied to correlate the stress behavior. We calculate magnetization M and skyrmion number Q to estimate the phase transition points, use the spin configurations and their Fourier transform to determine the region of skyrmion state. The h − T phase diagram show the area of skyrmion state is larger with stress than without stress. These results are interpreted qualitatively by the energy competitions between Zeeman, exchanges and Dzyaloshinskii-Moriya interactions. The simulated results suggest that anisotropy induced by uniaxial stress can stabilize the skyrmion phase.

IntroductionIn early 2020, our hospital responded with high alertness when novel coronavirus SARS-CoV-2 appeared. A hospital-based training programme was rapidly arranged to prepare staff for the imminent threat.ObjectiveWe developed a hospital-wide multidisciplinary infection control training programme on endotracheal intubation for healthcare workers to minimise nosocomial spread of COVID-19 during this high-stress and time-sensitive risky procedure.MethodologyMajor stakeholders (Quality & Safety Department, Infection Control Team, Central Nursing Division, high-risk clinical departments and hospital training centre) formed a training programme task group. This group was tasked with developing high-fidelity scenario-based simulation training curriculum for COVID-19 endotracheal intubation with standard workflow and infection control practice. This group then implemented and evaluated the training programme for its effectiveness.Results101 training classes of 2-hour session were conducted from 5 February to 18 March 2020, involving 1415 hospital staff (~81% of target participants with training needs) either inside the hospital training centre or as in situ simulation training (intensive care unit or accident and emergency department). Learners’ satisfaction was reflected by overall positive response percentage at 90%. Opinions of participating staff were incorporated into the standard airway management and infection control practice for endotracheal intubation of adult patients with COVID-19. Thirty-five patients with COVID-19 were intubated with the current workflow and guideline without any nosocomial transmission.ConclusionAn early planned and well-structured multidisciplinary hospital-wide simulation training programme was organised expeditiously to provide extensive staff coverage. The insight and experience gained from this project is valuable for future infectious disease challenges.

幼年型复发性腮腺炎是一种儿童期少见的腮腺非阻塞性炎症性疾病，选择性IgA缺陷是一种抗体缺陷的原发性免疫缺陷病。本文报告1例幼年型复发性腮腺炎合并选择性IgA缺陷病例。.

Senescence of nucleus pulposus (NP) cells is involved in the pathological process of intervertebral disc degeneration (IVDD). HMG-box transcription factor 1 (HBP1) is a transcriptional inhibitor that prevents proliferation and regulates premature senescence of cells. The aim of this study was to confirm whether HBP1 deficiency could protect stress-induced NP cells premature senescence.Firstly, HBP1 protein level in human degenerated intervertebral disc tissues was detected. Then, NP cells were isolated from disc samples and transfected with plasmid to upregulate HBP1expression. H2O2 and interleukin-1b (IL-1b) were used to induce NP cells premature senescence in a different manner. Thereafter, cell viability, proliferation, and apoptosis were measured, and the protein expressions of collagen II, HBP1, and p16, were determined by Western blot or immunofluorescence. Finally, the mRNA levels of aggrecan, collagen I, IL-6, Transforming Growth Factor-α (TNF-α), and matrix metalloproteinase-3 (MMP-3) were determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR).The data indicated that HBP1 was upregulated in degenerated NP tissues. HBP1 gene overexpression increased p16 expression, affected NP cell proliferation, and caused cell apoptosis. In addition, HBP1 also decreased the collagen II and aggrecan expressions but increased collagen I, IL-6, TNF-α, and MMP-3 levels. Moreover, the silencing of HBP1 markedly reversed the H2O2 and IL-1b induced NP cell senescence by reducing p16 expression, apoptotic cell population, and inflammatory response and by promoting cell proliferation.In summary, HBP1 accumulation contributes to the senescence of NP cells, and HBP1 deficiency protects stress-induced NP cells premature senescence.

Plant height and lodging resistance can affect rice yield significantly, but these traits have always conflicted in crop cultivation and breeding. The current study aimed to establish a rapid and accurate plant type evaluation mechanism to provide a basis for breeding tall but lodging-resistant super rice varieties. A comprehensive approach integrating plant anatomy and histochemistry was used to investigate variations in flexural strength (a material property, defined as the stress in a material just before it yields in a flexure test) of the rice stem and the lodging index of 15 rice accessions at different growth stages to understand trends in these parameters and the potential factors influencing them. Rice stem anatomical structure was observed and the lignin content the cell wall was determined at different developmental stages. Three rice lodging evaluation models were established using correlation analysis, multivariate regression and artificial radial basis function (RBF) neural network analysis, and the results were compared to identify the most suitable model for predicting optimal rice plant types. Among the three evaluation methods, the mean residual and relative prediction errors were lowest using the RBF network, indicating that it was highly accurate and robust and could be used to establish a mathematical model of the morphological characteristics and lodging resistance of rice to identify optimal varieties.

Basalt discriminant diagrams have been used to identify the tectonic setting of basaltic magmatism since the 1970s and have played an important role in reconstructing paleotectonic environments. Ho...

To investigate the prevalence and molecular features ofA total 832 and 781 fresh fecal samples were collected from seven large-scale sheep farms and ten large-scale goat farms in Anhui Province and neighboring provinces of Henan, Jiangsu and Shandong. The prevalence and species ofThe overall prevalence ofThe identification of zoonotic