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Abstract Background The aging of the population is a social problem faced by many countries in the world. With the increase in the elderly population, the number of patients with Kummell’s disease is also gradually increasing. No study has demonstrated that Kummell’s disease has a clear correlation with the foramen of a vertebrobasilar vein. Objectives The research was conducted to describe and evaluate the morphological characteristics of a basivertebral foramen in patients with osteoporosis and Kummell’s disease by CT; to infer whether the specific morphological characteristics of basivertebral foramen may be one of the risk factors of Kummell’s disease; to provide clinical suggestions for the treatment of Kummell’s disease. Design Retrospective analysis from January 2020 to December 2021 on 83 patients with 83 vertebral bodies (T8-L5) diagnosed with senile osteoporosis and Kummell’s disease hospitalized in our hospital due to chronic low back pain, including 57 women and 23 men. Group A was assigned for the following patients: the age ranged from 59 to 86 years old, with the average age of 67.30 ± 7.32 years old; the body mass index ranged from 20.01 to 29.46 kg/m2, with the average body mass index of 23.51 ± 3.03 kg/m2.Group B was assigned for the following patients: 83 patients diagnosed with senile osteoporosis in our outpatient department from January 2020 to December 2021, including 41 males and 42 females; the age ranged from 60 to 85 years, with an average age of 68.52 ± 4.68 years old; the height to weight ratio met the normal reference standard (except 20% above or 10% below the standard weight). Through the lanwon PACS imaging system, the related parameters of the vertebrobasilar foramen in patients with osteoporosis and Kummell’s disease were measured to evaluate and analyze the correlation between the morphological characteristics of the vertebrobasilar foramen in patients with osteoporosis and Kummell’s disease. Results In patients with osteoporosis, the distribution of incidence rate of Kummell’s disease in the spine was consistent with that of osteoporotic compression fractures. Sagittal view of the vertebral body on CT scan and the triangular-shaped, trapezoidal-shaped, and irregular-shaped basivertebral foramen in group A accounted for 18%,57%,and 36%,respectively. In group B, triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen accounted for 51%,17%,and 26%,respectively.The distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen was compared between groups A and B, and the difference was recorded as statistically significant (P 0.05).On a horizontal CT scan of the vertebra of group A, triangles, trapezoids, and irregularities accounted for 28%, 26%, and 47%, respectively. In group B, triangles,trapezoids,and irregularities accounted for 31%, 37%, and 30%, respectively. The difference in the distribution of the triangular-shaped and trapezoidal-shaped foramen in groups A and B was statistically insignificant (P > 0.05), while that of irregular-shaped was statistically significant (P 0.05) in the difference in the morphological distribution of triangular-shaped and trapezoidal-shaped foramen in group A, while that of irregular-shaped was found to be statistically significant (P 0.05).In general, about 8% of the vertebral body of BF has an osseous septum. In group A, 97% are single-holed while the remaining 3% are porous; in group B, those with single holes accounted for 76%, while the remaining 24% are porous. In groups A and B, the difference in the morphological distribution of single-holed and multi-holed T8, T11, T12, L1, L2, L4, and L5 vertebral bodies was statistically significant (P

Background: The imbalance between the increasing demand of highly specialized service and the reduction of specialists able to release this service is a global challenge for Pathology. This situation applies also to the setting of intra-operatory diagnostic: here the broad presence of Surgical divisions contrasts with the contraction of Pathology departments, progressively concentrated in few hospitals. The use of e-pathology device, such as remote-control microscopes, offers a possible solution to this imbalance.Aim: To prove the non-inferiority of function of a remote-control, real-time microscope named Nano-Eye Device (NED) with the optical microscope (OM) for intra-operatory histological diagnosis.Methods: The study was designed into two phases: discovery and validation. During the discovery phase features influencing the process of adaptation to NED were investigated in detail, focusing on the turnaround time (TAT). Validation phase investigated the diagnostic concordance between NED and OM; as well as sensitivity, specificity, and accuracy of NED in intra-operatory histological diagnosis.Results: During the discovery phase 250 cases were examined. TAT of NED was longer than that of OM (112 ± 89.8 vs. 36 ± 37.9 s) and influenced by the difficulty of the specimen, age of pathologist and the type of the specimen. In the validation phase (185 cases) TAT of NED reduced significantly to 92 ± 86.3 s (p: 0.01). NED showed a concordance rate of 98% with OM; the sensitivity (95.65%), specificity (100%), and diagnostic accuracy (98.87%) of NED were equal to that of OM. NED failed to work in 6% during the discovery phase and 4% in the validation.Conclusions: Taken as a whole, the functionality of NED is comparable to OM. It can be the alternative choice for hospital lacking on-site pathology services and one of the tool of e-pathology.

Abstract Background Previous studies have shown that the Gaming Disorder Test (GDT) and Gaming Disorder Scale for Adolescents (GADIS-A) have promising validity and reliability when assessing symptoms of gaming disorder among young adults. However, validity and reliability properties of the two scales have not been established among a Vietnamese population. Objective The present study translated the GDT and GADIS-A into Vietnamese and examined their factor structures, measurement invariance, convergent validity, concurrent validity, and divergent validity among university students. Methods A total of 610 young adults (mean age = 21.09 years; 63.4% females) were recruited using convenience sampling and who completed a paper-and-pencil survey between April and June 2023. All participants completed a demographic questionnaire, GDT, GADIS-A, and six standardized scales related to gaming disorder, social media addiction, smartphone addiction, and psychological distress. Confirmatory factor analysis (CFA), internal consistency testing, and Pearson’s correlations were performed. Results CFA showed that the GDT had a one-factor structure and the GADIS-A had a two-factor structure. The internal consistency was excellent for both scales among this population. Moreover, both GDT and GADIS-A showed convergent, concurrent, and divergent validity with other standardized scales. Conclusion The Vietnamese versions of the GDT and GADIS-A have good psychometrics, which may be utilized in future research regarding gaming disorder among Vietnamese populations.

OBJECTIVES: Laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) has been well known for its advantages in the past 10 years, but little is known regarding its oncologic outcomes while the technique is being developed at an institution. This study aimed to evaluate the safety and effectiveness of LH for patients with primary HCC at favorable locations, focusing on postoperative short- and long-term outcomes during the development period. MATERIALS AND METHODS: We retrospectively reviewed patients diagnosed with primary HCC who underwent hepatectomy between January 2013 and December 2019 at Hualien Tzu Chi Hospital. Patients with HCC at favorable locations (anterolateral segments) were collected and divided into laparoscopic and open hepatectomy (OH) groups. The data for long-term outcomes, as the primary endpoint, and postoperative outcomes, as the secondary endpoint, were collected. Results: The review included 159 patients, among which 42 and 44 patients in favorable locations underwent open and laparoscopic hepatectomies, respectively. There were no significant differences in intraoperative blood loss, major complication rate, and 90-day mortality rate between the two groups. The laparoscopic group had a lower transfusion rate, shorter postoperative hospital stay, and lower 90-day readmission rate. There were no significant differences in 12-, 36-, and 60-month overall survival and disease-free survival. Conclusion: LH for favorably located HCC is the preferred surgical approach compared to OH due to the decreased transfusion rate, shorter postoperative hospital stay, and lower 90-day readmission rate. LH did not compromise the 90-day mortality rate with sustained long-term overall and disease-free survival. LH for favorably located HCC is a safe and effective surgical approach even during the development period.

Abstract Direct copper-to-copper (Cu-Cu) bonding is a promising technology for advanced electronic packaging. Nanocrystalline (NC) Cu receives increasing attention due to its unique ability to promote grain growth across the bonding interface. However, achieving sufficient grain growth still requires a high thermal budget. This study explores how reducing grain size and controlling impurity concentration in NC Cu leads to substantial grain growth at low temperatures. The fabricated NC Cu has a uniform nanograin size of around 50 nm and a low impurity level of 300 ppm. To prevent ungrown NC and void formation caused by impurity aggregation, we propose a double-layer (DL) structure comprising a normal coarse-grained (CG) layer underneath the NC layer. The CG layer, with a grain size of 1 μm and an impurity level of 3 ppm, acts as a sink, facilitating impurity diffusion from the NC layer to the CG layer. Thanks to sufficient grain growth throughout the entire NC layer, cross-interface Cu-Cu bonding becomes possible under a low thermal budget, either at 100 °C for 60 min or at 200 °C for only 5 min.

The goal of archival appraisal is to assist archives in selecting and preserving information of permanent value in accordance with established principles, to efficiently enhance archival management and maximize the value of archives. Archival appraisal is an important procedure for the construction of archives collections. This study utilizes content analysis. First, it constructs an indicator classification framework based on research papers related to archival value issues. Subsequently, it examines the archival appraisal policies of six countries, namely the United States, Canada, the United Kingdom, the Netherlands, Australia, and New Zealand. It analyzes the emphasis on archival value and policy characteristics in these six countries and summarizes core indicators used in archival appraisal. These findings serve as a reference for the archival practice field to improve archival appraisal operations and archival selection competencies for administrative agencies.

ObjectiveTo evaluate the safety and efficacy of partial splenic embolization (PSE) in treating chemotherapy-induced thrombocytopenia (CIT) in patients with colorectal cancer who failed to respond to platelet growth factor therapy.Methods56 patients who underwent PSE were retrospectively analyzed. Based on the inclusion and the exclusion criteria, 29 patients were eligible for the study, of whom one underwent twice PSE procedures due to recurrent thrombocytopenia. The clinical characteristics were retrospectively analyzed with respect to efficacy, safety and outcome.Results60.0% of patients restarted antineoplastic therapy after PSE. There was a positive correlation between difference value of platelet count and embolization material size (Eta Squared = 0.252, p < 0.05). The correlation between the absolute volume of spleen embolized and postoperative complications was analyzed, with a statistically significant result (p < 0.001). The mean preoperative spleen volume, the preoperative platelet count, postoperative platelet count and difference value of platelet count in the non-cirrhotic group were larger than those in the cirrhotic group (p < 0.001). The mean overall survival was 47.7 ± 7.7 months.ConclusionPSE is safe and effective in the treatment of CIT patients with colorectal cancer. The larger the embolized particle, the more platelets grew. The severity of complication was also positively correlated with the absolute volume of spleen embolized. Therefore, large particle embolization materials can be used to improve the efficacy of PSE and reduce complications. For CIT patients with cirrhosis, PSE was less effective in improving platelet count than those without cirrhosis.

Cardiovascular disease (CVD) has now become the leading cause of death worldwide, and its high morbidity and mortality rates pose a great threat to society. Although numerous studies have reported the pathophysiology of CVD, the exact pathogenesis of all types of CVD is not fully understood. Therefore, much more research is still needed to explore the pathogenesis of CVD. With the development of proteomics, many studies have successfully identified the role of posttranslational modifications in the pathogenesis of CVD, including key processes such as apoptosis, cell metabolism, and oxidative stress. In this review, we summarize the progress in the understanding of posttranslational modifications in cardiovascular diseases, including novel protein posttranslational modifications such as succinylation and nitrosylation. Furthermore, we summarize the currently identified histone deacetylase (HDAC) inhibitors used to treat CVD, providing new perspectives on CVD treatment modalities. We critically analyze the roles of posttranslational modifications in the pathogenesis of CVD-related diseases and explore future research directions related to posttranslational modifications in cardiovascular diseases.

Background: Problematic use of the internet (PUI) is prevalent, particularly among adolescents and young adults. Given the limited measures to assess specific types of PUI, which encompasses a broad spectrum of activities such as online gaming, social media use, pornography use, shopping, gambling, and web-streaming, Muller et al. (2022) developed the Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) to comprehensively assess different types of PUI (i.e., gaming, shopping, social media use, gambling, and pornography use). The present study aimed to validate the Chinese ACSID-11 among adolescents incorporating cross-cultural adaptations. Methods: Using forward-backward translation method, a culturally adapted version of the ACSID-11 was prepared. Then, a cross-sectional online survey was administered between September 8 and September 26, 2023. Adolescents, using a convenience sample (N = 11,492; mean age = 16.42 years [SD ± 0.91]; 59.1% male), were recruited from six schools to complete the translated ACSID-11, Internet Gaming Disorder Scale-Short Form (IGDS9-SF), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application Based Addiction Scale (SABAS) via an online platform. Pearson correlation coefficients assessed convergent/discriminant validity. Factor structure and measurement invariance were examined through confirmatory factor analysis (CFA) and multi-group CFA. Cronbach's alpha and McDonald's omega tested internal consistency. Results: Associations between the ACSID-11 components and other scales supported convergent validity (i.e., ACSID-11 gaming scale with IGDS9-SF [0.37 ≤ r ≤ 0.41]; social networks use scale with BSMAS [0.24 ≤ r ≤ 0.31]) and discriminant validity (i.e., online gambling scale with BSMAS [0.16 ≤ r ≤ 0.19] and with SABAS [0.11 ≤ r ≤ 0.13]). A four-factor solution indicated good fit with comparative fit index (CFI) ranging from 0.982 to 0.958. The ACSID-11 was measurement invariant across sexes (∆CFI = -0.001 to 0.000) and different levels of related addictive behaviors (∆CFI = -0.001 to 0.000). Both Cronbach's alpha and McDonald's omega (0.63 to 0.97) were acceptable for both frequency and intensity of responses. Conclusions: The ACSID-11 is an appropriate scale to assess different kinds of PUI among Chinese adolescents and students. Psychometric assessment of the measure in other cultures and among clinical samples is recommended.

Abstract The anticonvulsant valproic acid (VPA) despite complex pharmacokinetics has been in clinical use for nearly 6 decades. Previous reports indicated neonates, infants, and toddlers/preschoolers had higher risk of valproate hepatotoxicity than adults. However, dosing recommendations for those less than 10 years of age are lacking. To decipher clinical puzzles, physiologically‐based pharmacokinetic (PBPK) models of VPA and its hepatotoxic metabolite 4‐ene‐VPA were constructed and simulated with particularly integrated information of drug‐metabolizing enzyme ontogeny. Adult and pediatric PK data of VPA (n = 143 subjects) and 4‐ene‐VPA (n = 8 subjects) collected from previous reports were used for model development and validation. Sensitivity analyses were performed to characterize ontogeny impacts of CYP2C9 and UGT2B7 on dispositions of VPA and 4‐ene‐VPA across age groups. Optimal VPA dosing for each pediatric age group was also predicted and objectively judged by ensuring VPA efficacy and avoiding 4‐ene‐VPA hepatotoxicity. The study revealed UGT2B7 ontogeny was quite influential on VPA clearance even in neonates and small children. Intrinsic clearance of CYP2C9 was the most prominent determinant for areas under the concentration‐time curve of VPA and 4‐ene‐VPA in infants, and toddlers/preschoolers, reflecting higher hepatotoxicity risk due to noxious 4‐ene‐VPA accumulation in these groups. The ontogeny‐based PBPK approach complements conventional allometric methods in dosing estimation for the young by providing more mechanistic insight of the processes changing with age. The established ontogeny‐based PBPK approach for VPA therapy deserves further corroboration by real‐world therapeutic data to affirm its clinical applicability.

BackgroundHemorrhagic transformation (HT) is a serious complication after endovascular thrombectomy (EVT) for patients with acute ischemic stroke (AIS). We analyzed the plasma levels of MMP-9 before and after EVT and assessed the temporal changes of MMP-9 that may be associated with, and therefore predict, HT after EVT.MethodsWe enrolled 30 AIS patients who received EVT, and 16 (53.3%) developed HT. The levels of MMP-9 in plasma collected from the arteries of AIS patients before and immediately after EVT were measured using ELISA. The percent change in MMP-9 after EVT (after/before) was calculated and compared between patients with and without HT.ResultsThe median age of the AIS patients was 70 years, and 13 patients (43.3%) were men. The median National Institutes of Health Stroke Scale (NIHSS) scores of patients with HT were 18 on admission and 18 after EVT. The median NIHSS scores of patients without HT were 17 on admission and 11 after EVT. Patients with HT demonstrated significantly greater percentage increases in arterial MMP-9 levels after EVT.ConclusionPatients with AIS who developed HT had significantly increased arterial MMP-9 levels after EVT, suggesting that the upregulation of MMP-9 following EVT could serve as a predictive biomarker for HT.

A common adverse effect of Parkinson's disease (PD) treatment is L-dopa-induced dyskinesia (LID). This condition results from both dopamine (DA)-dependent and DA-independent mechanisms, as glutamate inputs from corticostriatal projection neurons impact DA-responsive medium spiny neurons in the striatum to cause the dyskinetic behaviors. In this study, we explored whether suppression of presynaptic corticostriatal glutamate inputs might affect the behavioral and biochemical outcomes associated with LID. We first established an animal model in which 6-hydroxydopamine (6-OHDA)-lesioned mice were treated daily with L-dopa (10 mg/kg, i.p.) for 2 weeks; these mice developed stereotypical abnormal involuntary movements (AIMs). When the mice were pretreated with the NMDA antagonist, amantadine, we observed suppression of AIMs and reductions of phosphorylated ERK1/2 and NR2B in the striatum. We then took an optogenetic approach to manipulate glutamatergic activity. Slc17a6 (vGluT2)-Cre mice were injected with pAAV5-Ef1a-DIO-eNpHR3.0-mCherry and received optic fiber implants in either the M1 motor cortex or dorsolateral striatum. Optogenetic inactivation at either optic fiber implant location could successfully reduce the intensity of AIMs after 6-OHDA lesioning and L-dopa treatment. Both optical manipulation strategies also suppressed phospho-ERK1/2 and phospho-NR2B signals in the striatum. Finally, we performed intrastriatal injections of LDN 212320 in the dyskenesic mice to enhance expression of glutamate uptake transporter GLT-1. Sixteen hours after the LDN 212320 treatment, L-dopa-induced AIMs were reduced along with the levels of striatal phospho-ERK1/2 and phospho-NR2B. Together, our results affirm a critical role of corticostriatal glutamate neurons in LID and strongly suggest that diminishing synaptic glutamate, either by suppression of neuronal activity or by upregulation of GLT-1, could be an effective approach for managing LID.

The development of severe multidrug-resistant bacterial infections has recently intensified because of the COVID-19 pandemic. According to the guidelines issued by the World Health Organization (WHO), routine antibiotic administration is not recommended for patients with supposed or confirmed mild SARS-CoV-2 infection or pneumonia, unless bacterial infection is clinically suspected. However, recent studies have pointed out that the proportion of non-essential antibiotic use in patients infected with SARS-CoV-2 remains high. Therefore, the silent pandemic of antibiotic resistance remains a pressing issue regardless of the present threats presented by the COVID-19 pandemic. To prevent or delay entry into the postulated post-antibiotic era, the long-term advocacy for the rational use of antibiotics, the optimization of infection control procedures, and the development of new antibacterial agents and vaccines should be underscored as vital practices of the antibacterial toolbox. Recently, the development of vaccines and monoclonal antibodies has gradually received attention following the advancement of biotechnology as well as enhanced drug discovery and development in cancer research. Although decent progress has been made in laboratory-based research and promising results have been obtained following clinical trials of some of these products, challenges still exist in their widespread clinical applications. This article describes the current advantages of antibacterial monoclonal antibodies, the development of associated clinical trials, and some perceived future perspectives and challenges. Further, we anticipate the development of more therapeutic agents to combat drug-resistant bacterial infections as well as to increase the resilience of current or novel agents/strategies.

An innovative strategy has been developed to activate the basal planes in molybdenum disulfide (MoS2) to improve their electrocatalytic activity by controlling surface electron accumulation (SEA) through aging, annealing, and nitrogen-plasma treatments. The optimal hydrogen evolution reaction (HER) performance was obtained on the surface treated with nitrogen-plasma for 120 s. An overpotential of 0.20 V and a Tafel slope of 120 mV dec−1 were achieved for the optimized condition. The angle-resolved photoemission spectroscopy measurement confirmed the HER efficiency enhanced by the SEA conjugated with the sulfur vacancy active sites in the MoS2 basal planes. This study provides new insight into optimizing MoS2 catalysts for energy applications.

Abstract The development of optical organic nanoparticles (NPs) is desirable and widely studied. However, most organic dyes are water-insoluble such that the derivatization and modification of these dyes are difficult. Herein, we demonstrated a simple platform for the fabrication of organic NPs designed with emissive properties by loading ten different organic dyes (molar masses of 479.1–1081.7 g/mol) into water-soluble polymer nanosponges composed of poly(styrene-alt-maleic acid) (PSMA). The result showed a substantial improvement over the loading of commercial dyes (3.7–50% loading) while preventing their spontaneous aggregation in aqueous solutions. This packaging strategy includes our newly synthesized organic dyes (> 85% loading) designed for OPVs (242), DSSCs (YI-1, YI-3, YI-8), and OLEDs (ADF-1–3, and DTDPTID) applications. These low-cytotoxicity organic NPs exhibited tunable fluorescence from visible to near-infrared (NIR) emission for cellular imaging and biological tracking in vivo. Moreover, PSMA NPs loaded with designed NIR-dyes were fabricated, and photodynamic therapy with these dye-loaded PSMA NPs for the photolysis of cancer cells was achieved when coupled with 808 nm laser excitation. Indeed, our work demonstrates a facile approach for increasing the biocompatibility and stability of organic dyes by loading them into water-soluble polymer-based carriers, providing a new perspective of organic optoelectronic materials in biomedical theranostic applications.

Abstract Background The outbreak of coronavirus disease 2019 (COVID-19) is rapidly changed medical habits, and dental clinics have been forced to adapt. This study explored the pandemic-induced changes in patient utilization of dental services to assist practitioners in responding efficiently to similar public crises as references in the future. Methods We retrospectively analyzed the correlation between patient profiles and dental visits attendance within 2 months before and during the outbreak. Results A total of 332 patients, 210 women and 122 men (total number of visits: 1068) were enrolled in this study. A significantly lower attendance rate was noted during the COVID-19 period (70.3%) than prior to the pandemic (83.4%). The rate of return visits for patients with a high education level during the COVID-19 period was significantly reduced from 96.5 to 93.1%. In addition, the number of days between two visits significantly increased during the pandemic. Conclusions Our results indicate that, during the pandemic period, the attendance rates of return dental appointments decreased, and the rate of missed appointments for patients with a high educational levels was higher than that of patients with a low educational level. Clinical relevance Preventive management of these patients who are easy to miss dental appointments may enable more effective use of medical resources.

Objective To identify factors and assess to what extent they impact the magnitude of the treatment effect of acupuncture therapies across therapeutic areas.Data source Medline, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc, between 2015 and 2019.Study selection The inclusion criteria were trials with a total number of randomised patients larger than 100, at least one patient-important outcome and one of two sets of comparisons.Data analysis The potential independent variables were identified by reviewing relevant literature and consulting with experts. We conducted meta-regression analyses with standardised mean difference (SMD) as effect estimate for the dependent variable. The analyses included univariable meta-regression and multivariable meta-regression using a three-level robust mixed model.Results 1304 effect estimates from 584 acupuncture randomised controlled trials (RCTs) were analysed. The multivariable analyses contained 15 independent variables . In the multivariable analysis, the following produced larger treatment effects of large magnitude (>0.4): quality of life (difference of adjusted SMDs 0.51, 95% CI 0.24 to 0.77), or pain (0.48, 95% CI 0.27 to 0.69), or function (0.41, 95% CI 0.21 to 0.61) vs major events. The following produced larger treatment effects of moderate magnitude (0.2–0.4): single-centred vs multicentred RCTs (0.38, 95% CI 0.10 to 0.66); penetration acupuncture vs non-penetration types of acupuncture (0.34, 95% CI 0.15 to 0.53); non-pain symptoms vs major events (0.32, 95% CI 0.12 to 0.52). The following produced larger treatment effects of small magnitude (

Background: Critically ill neonates receive care in the neonatal intensive care unit (NICU). Unfortunately, some neonates pass away in the NICU. Providing comprehensive neonatal palliative care and hospice services is crucial in supporting parents through the loss of their offspring. In our NICU, we identified that only 74.5% of nurses are able to properly recognize the need for palliative care and only 55% are able to implement the necessary procedures. Purpose: A project was designed and implemented to enhance the ability of nursing staff to recognize the need for and properly implement palliative care to improve the quality of this care in the NICU. Resolutions: We organized an on-the-job education and training program within our NICU with the goals of heightening awareness among nursing staff. In addition, a specialist palliative care operation flow chart, process preparation checklist, and palliative-care-related tools were created to facilitate the care process. Results: After program implementation, among nursing staff in our NICU, the palliative care recognition accuracy rate rose to 100% (from 74.5%) and the implementation rate rose to 94.8% (from 55%). The quality of provided neonatal palliative care and hospice services was significantly improved. Conclusion: The developed program was shown to significantly improve nursing staff recognition and implementation of neonatal palliative care in our NICU. This experience provides a reference for improving palliative care quality and for helping families effectively manage end-of-life challenges. [ABSTRACT FROM AUTHOR]

Objectives Emotion-related hyperarousal is an important core pathology of poor sleep. Studies investigating the interplay of alexithymia and affective experiences in determining sleep quality have yielded mixed results. To disentangle the inconsistency, this study examined the concurrent predictive power of alexithymia, and negative and positive affect, while incorporating interoceptive sensibility (IS) as a possible moderator. Methods A sample of 224 (70.10% were female) participants completed the Toronto Alexithymia Scale, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Interoceptive Awareness (MAIA), and Marlowe‐Crowne Social Desirability Scale (for controlling response bias) using paper and pencil. A two-stage cluster analysis of the MAIA was used to capture IS characteristics. Stepwise regression was conducted separately for each IS cluster. Results A three-group structure for IS characteristics was found. Higher alexithymia was predictive of poor sleep quality in the low IS group, while higher negative affect predicted poor sleep quality in the moderate and high IS groups. Additionally, alexithymia and positive affect were significantly different in the three IS groups, while negative affect and sleep quality were not. Conclusions Emotion and cognitive arousal may impact sleep quality differently in individuals with different levels of internal focusing ability, depending on physiological versus emotional self-conceptualization. The implications on pathological research, clinical intervention, study limitations and future directions are discussed.

An RNA polymerase ribozyme that has been the subject of extensive directed evolution efforts has attained the ability to synthesize complex functional RNAs, including a full-length copy of its own evolutionary ancestor. During the course of evolution, the catalytic core of the ribozyme has undergone a major structural rearrangement, resulting in a novel tertiary structural element that lies in close proximity to the active site. Through a combination of site-directed mutagenesis, structural probing, and deep sequencing analysis, the trajectory of evolution was seen to involve the progressive stabilization of the new structure, which provides the basis for improved catalytic activity of the ribozyme. Multiple paths to the new structure were explored by the evolving population, converging upon a common solution. Tertiary structural remodeling of RNA is known to occur in nature, as evidenced by the phylogenetic analysis of extant organisms, but this type of structural innovation had not previously been observed in an experimental setting. Despite prior speculation that the catalytic core of the ribozyme had become trapped in a narrow local fitness optimum, the evolving population has broken through to a new fitness locale, raising the possibility that further improvement of polymerase activity may be achievable.

Doxorubicin (Dox) is a commonly used anthracycline chemotherapy with a side effect of cardiotoxicity, which may increase the risk of heart failure for cancer patients. Although various studies have demonstrated the cardioprotective property of dapagliflozin (DAPA), a sodium-glucose cotransporter 2 inhibitor, the detailed mechanism underlying its effect on Dox-induced cardiomyopathy is still limited. In this study, we showed that DAPA induced the activation of AKT/PI3K signaling in cardiac myoblast H9c2 cells following Dox treatment, leading to the upregulation of antioxidant HO-1, NQO1, and SOD, as well as an improved mitochondrial dysfunction via Nrf2. In addition, the reduced oxidative stress resulted in the downregulation of hypertrophy (ANP and BNP) and fibrosis (phospho-Smad3, collagen I, fibronectin, and α-SMA) markers. Furthermore, the inflammatory IL-8 concentration was inhibited after DAPA, possibly through PI3K/AKT/Nrf2/p38/NF-κB signaling. Moreover, our results were validated in vivo, and echocardiography results suggested an improved cardiac function in DAPA-receiving rats. In summary, we demonstrated that the administration of DAPA could mitigate the Dox-elicited cardiotoxicity by reducing oxidative stress, mitochondrial dysfunction, fibrosis, hypertrophy, and inflammation via PI3K/AKT/Nrf2 signaling.

Abstract Diabetic nephropathy is the leading cause of end‐stage renal disease. Although dysfunction of podocytes, also termed glomerular visceral epithelial cells, is critically associated with diabetic nephropathy, the mechanism underlying podocyte dysfunction still remains obscure. Here, we identify that KDM6A, a histone lysine demethylase, reinforces diabetic podocyte dysfunction by creating a positive feedback loop through up‐regulation of its downstream target KLF10. Overexpression of KLF10 in podocytes not only represses multiple podocyte‐specific markers including nephrin, but also conversely increases KDM6A expression. We further show that KLF10 inhibits nephrin expression by directly binding to the gene promoter together with the recruitment of methyltransferase Dnmt1. Importantly, inactivation or knockout of either KDM6A or KLF10 in mice significantly suppresses diabetes‐induced proteinuria and kidney injury. Consistent with the notion, we also show that levels of both KDM6A and KLF10 proteins or mRNAs are substantially elevated in kidney tissues or in urinary exosomes of human diabetic nephropathy patients as compared with control subjects. Our findings therefore suggest that targeting the KDM6A–KLF10 feedback loop may be beneficial to attenuate diabetes‐induced kidney injury.

Brain computed tomography (CT) is commonly used for evaluating the cerebral condition, but immediately and accurately interpreting emergent brain CT images is tedious, even for skilled neuroradiologists. Deep learning networks are commonly employed for medical image analysis because they enable efficient computer-aided diagnosis. This study proposed the use of convolutional neural network (CNN)-based deep learning models for efficient classification of strokes based on unenhanced brain CT image findings into normal, hemorrhage, infarction, and other categories. The included CNN models were CNN-2, VGG-16, and ResNet-50, all of which were pretrained through transfer learning with various data sizes, mini-batch sizes, and optimizers. Their performance in classifying unenhanced brain CT images was tested thereafter. This performance was then compared with the outcomes in other studies on deep learning–based hemorrhagic or ischemic stroke diagnoses. The results revealed that among our CNN-2, VGG-16, and ResNet-50 analyzed by considering several hyperparameters and environments, the CNN-2 and ResNet-50 outperformed the VGG-16, with an accuracy of 0.9872; however, ResNet-50 required a longer time to present the outcome than did the other networks. Moreover, our models performed much better than those reported previously. In conclusion, after appropriate hyperparameter optimization, our deep learning–based models can be applied to clinical scenarios where neurologist or radiologist may need to verify whether their patients have a hemorrhage stroke, an infarction, and any other symptom.

We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms. A total of 21 patients with diagnosed adnexal masses between 2014 and 2017 were divided into malignant (four serous cystadenocarcinomas, four endometrioid carcinomas, three clear cell carcinomas, and one carcinosarcoma) and benign (four cystadenomas, two teratomas, one fibroma, one endometrioma, and one corpus luteal cyst) groups. An apparent diffusion coefficient (ADC) value of 1.27 × 10−3 mm2/s was considered as the optimal threshold in distinguishing malignant from benign ovarian tumors (sensitivity and specificity: 100% and 77.8%, respectively). Choline peaks were detected in six of seven O-RADS (Ovarian-Adnexal Imaging-Reporting Data System) 4 lesions and corrected all of the DWI false-negative clear cell carcinoma. Based on the presence of the choline peaks, the diagnostic performance of MRS showed a sensitivity of 77.8%, a specificity of 100%, and an accuracy of 85.7%, respectively. In conclusion, MRS could potentially play a complementary role for DWI in tumor characterization, particularly for O-RADS 4 tumors or clear cell carcinomas.