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Abstract Background The aim of this study is to explore the mediation effect of family support on the relationship between SES and postpartum depressive symptoms. Methods A total of 1887 mothers of newborn babies under 6 months of age in selected community health service centers in Shanghai were included in the analysis. A multi-stage probability sampling method was applied to select the sample. We generated a composite index for measuring each sample household’s SES using a categorical principal component analysis approach. The mothers’ perceived family support scale was used to reflect family functioning status. Regression models were used to verify the research hypotheses and assess the impact of intermediating variables. Results 8.90% of participants had postpartum depressive status. The data showed that there was variability in the SES index, ranging from -4.18 to 0.81 (with lower SES being a low index value). According to the findings, the SES index was negative associated with depressive symptoms, the lower the SES level of the household, the higher the probability of the mother being at risk for depressive symptoms. (β = -0. 115, P

Background: Observational data have suggested that patients with moderate to severe ischemia benefit from revascularization. However, this was not confirmed in a large, randomized trial. Objectives: Using a contemporary, multicenter registry, the authors evaluated differences in the association between quantitative ischemia, revascularization, and outcomes across important subgroups. Methods: Patients who underwent myocardial perfusion imaging in 12 centers were included in this retrospective analysis. The population was divided into original (2009-2014) and recent (2014-2021) registry sites. Early revascularization was defined as any revascularization within 90 days of myocardial perfusion imaging. A propensity score was developed to adjust for nonrandomization. Propensity score-adjusted survival analyses were used to evaluate the associations between quantitative ischemia, early revascularization, and death or myocardial infarction (MI) to identify at what severity of ischemia the HR for early revascularization crosses 1 (threshold for potential benefit). Results: Overall, 40,449 patients were included with a median follow-up of 3.5 (IQR: 2.4-4.6) years, during which death or MI occurred in 2,797 (6.9%). Early revascularization was associated with reduced death or MI in patients with >9.0% myocardial ischemia (95% upper CI: 11.2%, interaction P 10.0%) and male patients (>8.6%). Conclusions: Early revascularization was associated with reduced risk in patients with a higher burden of quantitative ischemia in more recent populations. These findings suggest that methods integrating more factors than just ischemia are needed to improve patient selection for revascularization.

Abstract Background Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives. A complex immunization schedule, however, may be burdensome to parents and lead to reduced vaccine compliance and completion. Thus, it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule. This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B conjugate (DTaP-IPV/Hib) vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations. Methods A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023. The study employed a stratified multistage cluster random sampling method. Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire. Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations. Results Of the 4818 valid responses, 95.3% of children were aged 3–4 years, and 2856 (59.3%) held rural hukou. Coverage rates of the DTaP-IPV/Hib vaccine, from 1 to 4 doses, were 24.4%, 20.7%, 18.5%, and 16.0%, respectively. Caregivers who are concerned about vaccine efficacy [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI): 1.30–1.79], the manufacturer (aOR = 2.05, 95% CI: 1.69–2.49), and a simple immunization schedule (aOR = 1.26, 95% CI: 1.04–1.54) are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib. In addition, caregivers in urban areas showed more concern about the vaccine price (P = 0.010) and immunization schedule (P = 0.022) in regard to vaccinating children. Conclusions The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low. Factors such as lower socioeconomic status, cultural beliefs, concerns about vaccine safety, and cost may hinder caregivers from vaccinating their children. Further measures, such as health education campaigns to raise knowledge and awareness, and encouragement of domestic vaccine innovation, which would reduce out-of-pocket costs, could be implemented to improve the coverage of DTap-IPV/Hib vaccination. Graphical Abstract

Background: Emerging data in the general population and those with coronary artery disease demonstrate higher risk of adverse outcomes with high (>70 mg/dL) HDL-C levels. There are limited data on the risk of adverse outcomes in women with suspected ischemic heart disease. Objective: To investigate relationships between high (>70 mg/dL), average (50–70 mg/dL), and low (

Resumo Fundamento A fibrilação atrial (FA) e a insuficiência cardíaca (IC) coexistem frequentemente, resultando em desfechos adversos. No entanto, permanecem controvérsias quanto à eficácia da ablação por cateter (AC) em pacientes com FA com disfunção ventricular esquerda grave. Objetivos O objetivo deste estudo foi realizar uma metanálise de ensaios prospectivos randomizados e controlados para avaliar a eficácia da AC versus terapia médica (TM) em pacientes com FA com fração de ejeção do ventrículo esquerdo (FEVE) ≤45%. Métodos Procuramos na literatura estudos que comparassem AC com TM em pacientes com FA com FEVE ≤45%. Foi realizada uma metanálise de 7 ensaios clínicos, incluindo 1.163 pacientes com FA e IC. A análise de subgrupo foi realizada com base na FEVE basal. Todos os testes foram bilaterais; apenas o valor p

Abstract Diabetic nephropathy (DN) is one of the serious chronic microvascular complications of diabetes, and leads to the increased morbidity and mortality in diabetic patients. Gasdermin E (GSDME)-dependent pyroptosis signaling pathway plays important roles in a variety of physiological and pathological processes. However, its role and mechanism in DN are still unclear. In this study, we established a rat DN model by intraperitoneal injection of streptozotocin (STZ) successfully. Structural and functional disorders in the kidney were exhibited on the 12th week after STZ injection; the expressions of caspase-3 and GSDME at protein level in renal cortex were significantly up-regulated. At the 20th week, GSDME-N increased significantly, accompanied by the upregulation of caspase-1 in renal cortex and the release of mature IL-1β (mIL-1β) in serum. Furthermore, we found the protein levels of GSDME, caspase-3, caspase-1 and IL-1β were all increased in HK2 and HBZY-1 cells under high-glucose conditions. We also found that the expression of GSDME-N significantly decreased when caspase-3 was knockdown. In contrast, knockdown of GSDME has no effect on caspase-3. Interestingly, either caspase-3, caspase-1 or GSDME knockdown reduced the release of mIL-1β. Finally, injection of adeno-associated virus (AAV) 9-shGSDME into the rat kidney reduced kidney damage and renal cell pyroptosis in comparison with wild-type diabetic rats. These results indicated that the activation of caspase-1 induced IL-1β maturation, and the activation of caspase-3 mediated cleavage of GSDME responsible for the formation of plasma membrane pore, followed by cytoplasmic release of mIL-1β. Overall, we identified a pro-pyroptosis role for GSDME in DN, which does provide an important basis for clinical therapeutic studies.

Abstract Due to their atomically dispersed active centers, single‐atom nanozymes (SAzymes) have unparalleled advantages in cancer catalytic therapy. Here, loaded with chlorin e6 (Ce6), a hydrothermally mass‐produced bimetallic silicate‐based nanoplatforms with atomically dispersed manganese/gadolinium (Mn/Gd) dual sites and oxygen vacancies (OVs) (PMnSAGMSNs‐V@Ce6) is constructed for tumor glutathione (GSH)‐triggered chemodynamic therapy (CDT) and O2‐alleviated photodynamic therapy. The band gaps of silica are significantly reduced from 2.78 to 1.88 eV by doping with metal ions, which enables it to be excited by a 650 nm laser to produce electron‐hole pairs, thereby facilitating the generation of reactive oxygen species. The Gd sites can modulate the local electrons of the atom‐catalyzed Mn sites, which contribute to the generation of superoxide and hydroxyl radicals (•OH). Tumor GSH‐triggered Mn2+ release can convert endogenous H2O2 to •OH and realize GSH‐depletion‐enhanced CDT. Significantly, the hydrothermally generated OVs can not only capture Mn and Gd atoms to form atomic sites but also can elongate and weaken the O‐O bonds of H2O2, thereby improving the efficacy of Fenton reactions. The degraded Mn2+/Gd3+ ions can be used as tumor‐specific magnetic resonance imaging contrast agents. All the experimental results demonstrate the great potential of PMnSAGMSNs‐V@Ce6 as cancer theranostic agent.

The inconsistencies regarding the fundamental correlation between Gd content and slip (twinning) activities of Mg alloys appeal further investigations. However, the traditional slip dislocations analysis by TEM is time-consuming, and that by SEM/EBSD cannot recognize the partial slip modes. These urge a more efficient and comprehensive approach to easily distinguish all potential slip modes occurred concurrently in alloy matrix. Here we report a modified lattice rotation analysis that can distinguish all slip systems and provide statistical results for slip activities in Mg alloy matrix. Using this method, the high ductility of Mg-Gd alloy ascribed to the enhanced non-basal slips, cross-slip, and postponed twinning activities by Gd addition is quantitatively clarified.

Abstract Background The association between social distress and child health is important and attracts research interest. This study aims to examine the trend of inequality in the mortality rate for children under five (U5MR) over time and decompose the population mental health (PMH)-gradient in U5MR into different drivers at the national level. Methods Data from 1990 to 2019 on the U5MR, PMH, and potential risk factors, such as socioeconomic status, environmental exposures at the national level, health behavior, basic water and sanitation services, urbanization, healthcare level, and HIV prevalence, were collected from online databases. We described the trend of U5MR and broke down U5MR based on the countries’ risk factor status and PMH. We constructed regression models and decomposed the drivers of change in U5MR disparity based on PMH-gradient. Results The difference in U5MR between countries with different levels of air pollution and income status was narrowed since 1990 for the high PMH groups. Countries with a higher level of PMH had less significant differences in U5MR between low- and middle-income groups than those with a lower level of PMH. The development of PMH-related gradient in child health is not consistent thoroughly. Before 2000, boys experienced a sharper decline in PMH-related gradient in health than girls did. The decomposition shows that the changes in PMH-gradient in child health were mainly caused by changes in the return to risk factors. The mental health of female population matters more in child health outcomes. Conclusion Although the U5MR converges across countries, the reason varies. The PMH gradient in child mortality is mainly explained by the change in the return to risk factors. The PMH-gradient health disparity in boys is larger than that in girls in 2019, which indicates that boys’ health may be more vulnerable to the development of PMH recently. The findings remind us that we need to pay attention to the hidden reasons for the growth of disparity. It also suggests that improving PMH has a great impact on reducing PMH-related health disparity, especially for boys. Our research contributes to the understanding of the transition of PMH-related health disparity in U5MR and provides policy implications for reducing gender disparity in child health.

Twinning-detwinning (TDT) behavior in a strongly basal-textured Mg-Li alloy during two-step compression (RD)-compression (ND) process was investigated using quasi-in-situ EBSD. TDT behavior and TDT variants selection were statistically discussed with the loading path for the first time. Non-Schmid twinning behavior was observed in the first step compression, owing to the local stress fluctuations by neighboring twins; in contrast, Schmid's law well predicted the detwinning variants selection. This asymmetrical TDT behavior was first investigated to date related with the strong basal texture and loading path. Besides, with the progress of compression, Schmid factors for twinning demonstrated a decreasing tendency; however, those for detwinning during the second step displayed an abnormally increasing trend, fundamentally stemming from prior twinning behavior.

Objective: Cervical squamous cell carcinoma (CESC) is a cancer with high mortality caused by human papillomavirus. The aim of this study was to uncover potential CESC biomarkers to help early diagnosis and treatment. Materials and methods: The mRNA transcriptome data and DNA methylation data were downloaded from database for the identification of differentially expressed mRNAs (DEmRNAs) and DNA methylation analysis. Functional analysis was used to reveal the molecular functions. Then, the association between differential methylation and DEmRNA was analyzed. Protein–protein interaction (PPI) network analysis was performed on the selected differentially methylated genes (DEGs). Subsequently, we analyzed the prognosis and constructed a prognostic risk model. We also performed diagnostic analyses of risk model genes. In addition, we verified the protein expression level of identified DEGs. Results: 1438 DEmRNAs, 1669 differentially methylated sites (DMSs), 46 differentially methylated CpG islands and 53 differential methylation genes (DMGs) were obtained. In PPI, the highest interaction scores were MX2 and IRF8, and their interaction score was 0.928. Interestingly, 5 DMGs were found to be associated with CESC prognosis. In addition, our results demonstrated that high risk score was associated with poor prognosis of CESC. Furthermore, it was found that ZIK1, ZNRF2, HHEX, VCAM1 could be diagnostic molecular markers for CESC. Conclusion: Analysis of methylated-differentially expressed genes may contribute to the identification of early diagnosis and therapeutic targets of CESC. In addition, a prognostic model based on 5 DMGs can be used to predict the prognosis of CESC.

Resumo Fundamento A influência do volume do apêndice atrial esquerdo (VAAE) na recorrência de fibrilação atrial (FA) após ablação por cateter de radiofrequência permanece obscura. Objetivos Realizamos uma metanálise para avaliar se o VAAE é um preditor independente de recorrência de FA após ablação por cateter de radiofrequência. Métodos Os bancos de dados PubMed e Cochrane Library foram pesquisados até março de 2022 para identificar publicações avaliando o VAAE em associação com a recorrência de FA após ablação por cateter por radiofrequência. Foram encontrados 7 estudos que preencheram os critérios especificados de nossa análise. Usamos a Escala de Newcastle-Ottawa para avaliar a qualidade dos estudos. Os efeitos agrupados foram avaliados dependendo das diferenças médias padronizadas (DMPs) ou hazard ratios (HRs) com intervalos de confiança (ICs) de 95%. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Um total de 1.017 pacientes de 7 estudos de coorte com um seguimento médio de 16,3 meses foram incluídos na metanálise. Dados de 6 estudos (943 indivíduos) comparando VAAE mostraram que o VAAE basal foi significativamente maior em pacientes com recorrência de FA em comparação com aqueles sem FA (DMP: −0,63; IC de 95%: −0,89 a −0,37; todos os valores de p < 0,05; I 2 = 62,6%). Além disso, maior VAAE foi independentemente associado a um risco significativamente maior de recorrência de FA após ablação por cateter de radiofrequência (HR: 1,10; IC de 95%: 1,02 a 1,18). Conclusões A metanálise mostrou que existe uma correlação significativa entre o VAAE e a recorrência de FA após ablação por cateter de radiofrequência, e o papel do VAAE em pacientes com FA não deve ser ignorado na prática clínica.

Objective To investigate the clinical significance of changes in platelet parameters in patients with secondary failure of platelet recovery (SFPR) and cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT). Methods In this retrospective study, 79 patients who had undergone allogeneic HSCT (allo-HSCT), including 40 patients with SFPR and 39 patients without SFPR, were recruited. The evaluated parameters were platelet count (PLT), plateletcrit (PCT), platelet-large cell ratio (P-LCR), mean platelet volume (MPV), platelet distribution width (PDW), the incidence of CMV infection after allo-HSCT, and the correlation of SFPR and CMV infection in patients who had undergone allo-HSCT. The control group included 107 healthy donors. Results The SFPR group had significantly lower megakaryocyte counts, PLT, and PCT and significantly higher P-LCR, MPV, and PDW than the healthy donor and non-SFPR groups. The incidence of CMV infection was higher in SFPR patients than in non-SFPR patients. Among the patients with SFPR, P-LCR, MPV, and PDW were lower in those with CMV DNA >8000 copies/mL than in those with CMV DNA

Solid solution phases dominate the thermodynamic competition with intermetallic phases in high-entropy alloys (HEAs), known as the high-entropy effect. However, owing to inevitable local substitutions in multi-component intermetallics (MCIMs), imposed thermodynamic changes are often overlooked. This study investigated a partially disordered MCIM, C14 Laves phase, in a dual-phase CrHfNbTaTi refractory HEA. The chemical formula and site preferences were determined based on the observation of spatial atomic arrangement. Furthermore, a parameter kdis was proposed to describe the disorder degree of MCIMs. As kdis increased from 0 to 0.2 due to local substitutions, the formation enthalpy of the C14 Laves phase significantly increased, resulting in higher energy and lower stability. Therefore, when feasible composition regulation and site occupancy design are adopted to manipulate the kdis of the potential MCIM, the high-entropy solid solution is able to be superior to the MCIM even at intermediate temperatures. The study provides insights into the high-entropy effect by considering MCIM enthalpies, providing a valuable phase-regulation strategy for future design of HEAs.

Surveys are widely used to assess hospital management with the aim of understanding differences in management practices. However, survey measures with prior notice can make hospitals change their routine practices and are unable to reflect the actual hospital management level. The World Management Survey (WMS) methodology has been developed to ameliorate these issues. It uses a double-blinded method and open-ended question design. The Chinese Hospital Management Survey (CHMS) project is the first to adapt the WMS methodology in China, which it uses to measure hospital management level in 510 hospitals. This paper provides an instrument to better measure actual management practices, which makes it possible to compare the management level of hospitals in China and other countries.

IntroductionPreoperative evaluation of the mitotic index (MI) of gastrointestinal stromal tumors (GISTs) represents the basis of individualized treatment of patients. However, the accuracy of conventional preoperative imaging methods is limited. The aim of this study was to develop a predictive model based on multiparametric MRI for preoperative MI prediction.MethodsA total of 112 patients who were pathologically diagnosed with GIST were enrolled in this study. The dataset was subdivided into the development (n = 81) and test (n = 31) sets based on the time of diagnosis. With the use of T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) map, a convolutional neural network (CNN)-based classifier was developed for MI prediction, which used a hybrid approach based on 2D tumor images and radiomics features from 3D tumor shape. The trained model was tested on an internal test set. Then, the hybrid model was comprehensively tested and compared with the conventional ResNet, shape radiomics classifier, and age plus diameter classifier.ResultsThe hybrid model showed good MI prediction ability at the image level; the area under the receiver operating characteristic curve (AUROC), area under the precision–recall curve (AUPRC), and accuracy in the test set were 0.947 (95% confidence interval [CI]: 0.927–0.968), 0.964 (95% CI: 0.930–0.978), and 90.8 (95% CI: 88.0–93.0), respectively. With the average probabilities from multiple samples per patient, good performance was also achieved at the patient level, with AUROC, AUPRC, and accuracy of 0.930 (95% CI: 0.828–1.000), 0.941 (95% CI: 0.792–1.000), and 93.6% (95% CI: 79.3–98.2) in the test set, respectively.DiscussionThe deep learning-based hybrid model demonstrated the potential to be a good tool for the operative and non-invasive prediction of MI in GIST patients.

Motor imagery (MI) electroencephalography (EEG) is natural and comfortable for controllers, and has become a research hotspot in the field of the brain–computer interface (BCI). Exploring the inter-subject MI-BCI performance variation is one of the fundamental problems in MI-BCI application. EEG microstates with high spatiotemporal resolution and multichannel information can represent brain cognitive function. In this paper, four EEG microstates (MS1, MS2, MS3, MS4) were used in the analysis of the differences in the subjects’ MI-BCI performance, and the four microstate feature parameters (the mean duration, the occurrences per second, the time coverage ratio, and the transition probability) were calculated. The correlation between the resting-state EEG microstate feature parameters and the subjects’ MI-BCI performance was measured. Based on the negative correlation of the occurrence of MS1 and the positive correlation of the mean duration of MS3, a resting-state microstate predictor was proposed. Twenty-eight subjects were recruited to participate in our MI experiments to assess the performance of our resting-state microstate predictor. The experimental results show that the average area under curve (AUC) value of our resting-state microstate predictor was 0.83, and increased by 17.9% compared with the spectral entropy predictor, representing that the microstate feature parameters can better fit the subjects’ MI-BCI performance than spectral entropy predictor. Moreover, the AUC of microstate predictor is higher than that of spectral entropy predictor at both the single-session level and average level. Overall, our resting-state microstate predictor can help MI-BCI researchers better select subjects, save time, and promote MI-BCI development.

BackgroundRapid serial visual presentation (RSVP) has become a popular target detection method by decoding electroencephalography (EEG) signals, owing to its sensitivity and effectiveness. Most current research on EEG-based RSVP tasks focused on feature extraction algorithms developed to deal with the non-stationarity and low signal-to-noise ratio (SNR) of EEG signals. However, these algorithms cannot handle the problem of no event-related potentials (ERP) component or miniature ERP components caused by the attention lapses of human vision in abnormal conditions. The fusion of human-computer vision can obtain complementary information, making it a promising way to become an efficient and general way to detect objects, especially in attention lapses.MethodsDynamic probability integration (DPI) was proposed in this study to fuse human vision and computer vision. A novel basic probability assignment (BPA) method was included, which can fully consider the classification capabilities of different heterogeneous information sources for targets and non-targets and constructs the detection performance model for the weight generation based on classification capabilities. Furthermore, a spatial-temporal hybrid common spatial pattern-principal component analysis (STHCP) algorithm was designed to decode EEG signals in the RSVP task. It is a simple and effective method of distinguishing target and non-target using spatial-temporal features.ResultsA nighttime vehicle detection based on the RSVP task was performed to evaluate the performance of DPI and STHCP, which is one of the conditions of attention lapses because of its decrease in visual information. The average AUC of DPI was 0.912 ± 0.041 and increased by 11.5, 5.2, 3.4, and 1.7% compared with human vision, computer vision, naive Bayesian fusion, and dynamic belief fusion (DBF), respectively. A higher average balanced accuracy of 0.845 ± 0.052 was also achieved using DPI, representing that DPI has the balanced detection capacity of target and non-target. Moreover, STHCP obtained the highest AUC of 0.818 ± 0.06 compared with the other two baseline methods and increased by 15.4 and 23.4%.ConclusionExperimental results indicated that the average AUC and balanced accuracy of the proposed fusion method were higher than individual detection methods used for fusion, as well as two excellent fusion methods. It is a promising way to improve detection performance in RSVP tasks, even in abnormal conditions.

We utilized electron backscatter diffraction to investigate the microstructure evolutions of a newly developed magnesium-rare earth alloy (Mg–9.80Gd–3.78Y–1.12Sm–0.48Zr) during instantaneous hot indirect extrusion. An equiaxed fine-grained (average grain size of 3.4 ± 0.2 µm) microstructure with a weak texture was obtained. The grain refinement was mainly attributed to the discontinuous dynamic recrystallization (DDRX) and continuous DRX (CDRX) processes during the hot indirect extrusion process. The twin boundaries formed during the initial deformation stage effectively increased the number of high angle grain boundaries (HAGBs), which provided sites for new grain nuclei, and hence, resulted in an improved DDRX process. Along with DDRX, CDRX processes characterized by low angle grain boundary (LAGB) networks were also observed in the grain interior due to effective dynamic recovery (DRV) at a relatively high temperature of 773 K and high strain rates. Thereafter, LAGB networks were transformed into HAGB networks by the progressive rotation of subgrains during the CDRX process.

Abstract In recent years, spherical powders with no or minimal internal pores fabricated by the plasma rotating electrode process (PREP) have been highly recommended for powder-type additive manufacturing. Most research on PREP is aimed at establishing relationship between PREP parameters and powder size. However, almost no dedicated research on granulation behavior has been conducted so far. In the present study, PREP experiments of Ti64 and SUS316 alloys were carried out. Numerical modeling based on computational thermo-fluid dynamics was developed to analyze the granulation behavior. In particular, the roles of the additionally introduced gas blast and the morphology of the electrode end surface in fluid granulation were preliminarily investigated. The study showed that in addition to the electrode's rotating speed and diameter, manipulating the plasma arc current (i.e., the melting rate) could also be an effective way to control the PREP-powder size. According to the simulation, there were competing actions of the gas blast affecting the powder size. The gas blast created disturbance on the fluid and deepened the depression of the electrode end surface, which facilitated powder refinement. However, the cooling effect enhanced the fluid stability and hindered fluid granulation. The conclusions indicated the possibility of using various methods to manipulate PREP-powder size.

Abstract Background Medical litigation represents a growing cost to healthcare systems. Mediation, arbitration, and other alternative dispute resolution (ADR) methods are increasingly used to help solve the disputes and improve healthcare satisfaction. In China, the increasing number of medical disputes has contributed to concern for the safety of physicians and mistrust between physician and patients resulting in ADR processes being established in several provinces in recent years. Our aim was to describe and explain the impact of this new mediation process in the Chinese healthcare system. Methods Our study investigated mediation practices in China using case-level data from 5614 mediation records in Guangdong Province between 2013 and 2015. We investigated how the resolution success as well as the compensations are associated with the case characteristics using regression analysis. Results Among the cases analyzed, 1995 (41%) were solved with agreement through mediation, 1030 were closed by reconciliation, 559 were closed by referring to court and 1017 cases were withdrawn after mediation. Five hundred five Yinao cases were solved with the help of mediators on the spot. We find that mediation solved about 90% of medical disputes under present mechanisms, while more police support is needed to cope with Yinao. The average compensation of mediation is CNY60,200 and average length of mediation is 87 days. Longer time taken to reach resolution and more money claimed by patients are associated with lower resolution success rate (p

Summary: Background: COH04S1, a synthetic attenuated modified vaccinia virus Ankara vector co-expressing SARS-CoV-2 spike and nucleocapsid antigens, was tested for safety and immunogenicity in healthy adults. Methods: This combined open-label and randomised, phase 1 trial was done at the City of Hope Comprehensive Cancer Center (Duarte, CA, USA). We included participants aged 18–54 years with a negative SARS-CoV-2 antibody and PCR test, normal haematology and chemistry panels, a normal electrocardiogram and troponin concentration, negative pregnancy test if female, body-mass index of 30 kg/m2 or less, and no modified vaccinia virus Ankara or poxvirus vaccine in the past 12 months. In the open-label cohort, 1·0 × 107 plaque-forming units (PFU; low dose), 1·0 × 108 PFU (medium dose), and 2·5 × 108 PFU (high dose) of COH04S1 were administered by intramuscular injection on day 0 and 28 to sentinel participants using a queue-based statistical design to limit risk. In a randomised dose expansion cohort, additional participants were randomly assigned (3:3:1), using block size of seven, to receive two placebo vaccines (placebo group), one low-dose COH04S1 and one placebo vaccine (low-dose COH04S1 plus placebo group), or two low-dose COH04S1 vaccines (low-dose COH04S1 group). The primary outcome was safety and tolerability, with secondary objectives assessing vaccine-specific immunogenicity. The primary immunological outcome was a four times increase (seroconversion) from baseline in spike-specific or nucleocapsid-specific IgG titres within 28 days of the last injection, and seroconversion rates were compared with participants who received placebo using Fisher's exact test. Additional secondary outcomes included assessment of viral neutralisation and cellular responses. This trial is registered with ClinicalTrials.gov, NCT046339466. Findings: Between Dec 13, 2020, and May 24, 2021, 56 participants initiated vaccination. On day 0 and 28, 17 participants received low-dose COH04S1, eight received medium-dose COH04S1, nine received high-dose COH04S1, five received placebo, 13 received low-dose COH04S1 followed by placebo, and four discontinued early. Grade 3 fever was observed in one participant who received low-dose COH04S1 and placebo, and grade 2 anxiety or fatigue was seen in one participant who received medium-dose COH04S1. No severe adverse events were reported. Seroconversion was observed in all 34 participants for spike protein and 32 (94%) for nucleocapsid protein (p

BackgroundRelapse is the major cause of mortality in patients with resected endometrial cancer (EC). There is an urgent need for a feasible method to identify patients with high risk of relapse.PurposeTo develop a multi-parameter magnetic resonance imaging (MRI) radiomics-based nomogram model to predict 5-year progression-free survival (PFS) in EC.MethodsFor this retrospective study, 202 patients with EC followed up for at least 5 years after hysterectomy. A radiomics signature was extracted from T2-weighted imaging (T2WI), apparent diffusion coefficient (ADC) and a dynamic contrast-enhanced three-dimensional volumetric interpolated breath-hold examination (3D-VIBE). The radiomics score (RS) was calculated based on the least absolute shrinkage and selection operator (LASSO) regression. We have developed a radiomics based nomogram model (ModelN) incorporating the RS and clinical and conventional MR (cMR) risk factors. The performance was evaluated by the receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA).ResultsThe ModelN demonstrated a good calibration and satisfactory discrimination, with a mean area under the curve (AUC) of 0.840 and 0.958 in the training and test cohorts, respectively. In comparison with clinical prediction model (ModelC), the discrimination ability of ModelN showed an improvement with P < 0.001 for the training cohort and P=0.032 for the test cohort. Compared to the radiomics prediction model (ModelR), ModelN discrimination ability showed an improvement for the training cohort with P = 0.021, with no statistically significant difference in the test cohort (P = 0.106). Calibration curves suggested a good fit for probability (Hosmer–Lemeshow test, P = 0.610 and P = 0.956 for the training and test cohorts, respectively).ConclusionThis multi-parameter nomogram model incorporating clinical and cMR findings is a valid method to predict 5-year PFS in patients with EC.

Pioneer species are crucial for the ecological restoration of degraded forests, but what drives variation in their demographic performance is still unclear. Here, we studied three populations of the dominant tree, Pinus massoniana, corresponding to three levels (low, medium, high) of ecological restoration of secondary subtropical forests. Vital rates (growth, survival, and reproduction) were censused during 2019–2020, and integral projection models (IPMs) were parameterized to evaluate the population growth rate (λ) of P. massoniana. The results showed that the survival probability of large-sized individuals, stem growth, and λ of P. massoniana increased as the ecological restoration progressed. In contrast, the survival rate of seedlings declined substantially. The reproduction probability of small individuals was more likely at low than medium/high restoration levels. Elasticity analysis showed that survival contributes most to λ and fecundity the least. λ was primarily determined by the high survival of seedlings/small trees and large trees in the low- and high-restoration level populations, respectively. Life table response experiments showed that increases in survival were mostly responsible for augmented λ during ecological restoration; hence, the high-restoration population had the highest λ due to a higher survival rate. This work shows P. massoniana is capable of undergoing life-history strategy shifts. Its high recruitment and survival of small individuals make it a suitable species for restoring forests, whereby large-sized individuals eventually maintain populations at low risk of mortality.

The attentional processes are conceptualized as a system of anatomical brain areas involving three specialized networks of alerting, orienting and executive control, each of which has been proven to have a relation with specified time-frequency oscillations through electrophysiological techniques. Nevertheless, at present, it is still unclear how the idea of these three independent attention networks is reflected in the specific short-time topology propagation of the brain, assembled with complexity and precision. In this study, we investigated the temporal patterns of dynamic information flow in each attention network via electroencephalograph (EEG)-based analysis. A modified version of the attention network test (ANT) with an EEG recording was adopted to probe the dynamic topology propagation in the three attention networks. First, the event-related potentials (ERP) analysis was used to extract sub-stage networks corresponding to the role of each attention network. Then, the dynamic network model of each attention network was constructed by post hoc test between conditions followed by the short-time-windows fitting model and brain network construction. We found that the alerting involved long-range interaction among the prefrontal cortex and posterior cortex of brain. The orienting elicited more sparse information flow after the target onset in the frequency band 1–30 Hz, and the executive control contained complex top-down control originating from the frontal cortex of the brain. Moreover, the switch of the activated regions in the associated time courses was elicited in attention networks contributing to diverse processing stages, which further extends our knowledge of the mechanism of attention networks.

Brain–computer interface (BCI) has developed rapidly over the past two decades, mainly due to advancements in machine learning. Subjects must learn to modulate their brain activities to ensure a successful BCI. Feedback training is a practical approach to this learning process; however, the commonly used classifier-dependent approaches have inherent limitations such as the need for calibration and a lack of continuous feedback over long periods of time. This paper proposes an online data visualization feedback protocol that intuitively reflects the EEG distribution in Riemannian geometry in real time. Rather than learning a hyperplane, the Riemannian geometry formulation allows iterative learning of prototypical covariance matrices that are translated into visualized feedback through diffusion map process. Ten subjects were recruited for MI-BCI (motor imagery-BCI) training experiments. The subjects learned to modulate their sensorimotor rhythm to centralize the points within one category and to separate points belonging to different categories. The results show favorable overall training effects in terms of the class distinctiveness and EEG feature discriminancy over a 3-day training with 30% learners. A steadily increased class distinctiveness in the last three sessions suggests that the advanced training protocol is effective. The optimal frequency band was consistent during the 3-day training, and the difference between subjects with good or low MI-BCI performance could be clearly observed. We believe that the proposed feedback protocol has promising application prospect.

As a dominant and active component across ecological restoration processes, the population dynamics of pioneer tree species significantly affect species composition and community assemblage. To assess the effect of pioneer populations on species diversity, this study investigated species diversity and population characteristics in five secondary forests dominated by Pinus massoniana in southeastern China. For 40 years, all anthropogenic activities (e.g., logging, farming, etc.) have been banned on the hillsides of these five secondary forests to promote afforestation, for which these forests have thereafter been left to grow naturally. We found that: (1) the basal area (BA) of P. massoniana drove changes in species diversity across forest plots, explaining 31.6% of total variation. The species richness of the herb layer was negatively correlated to BA, while the diversity and evenness of the tree and shrub layers were both positively correlated to the BA. (2) As the size of individual P. massoniana specimens increased, the trend in species richness of the shrub layer and the diversity indexes of both the tree and shrub layer was first to increase and then to decrease once again, while the species richness of the tree layer stabilized after reaching a certain threshold. (3) Species diversity of the forest plots did not improve over time along with an increase in the density of the pioneer species. When the P. massoniana population density was low, the diversity indexes of both the tree and shrub layer increased with an increase in population density. Conversely, when the P. massoniana population density reached 2800 plants/ha, species diversity began to decline. However, when the P. massoniana population density increased to 3733 plants/ha, species diversity of the plant community exhibited an upward trend. Our results indicated that forest species diversity was extremely sensitive to P. massoniana population dynamics during the pioneer stage of ecological succession. Moreover, the pioneer population was the driving factor for both development and change in species diversity, and it did so through habitat adjustment of its ecological relationships.

Objectives The study analysed medical malpractice claims to assess patient safety in hospitals. The information derived from malpractice claims reflects potential risks and could help lead to reducing medical errors and improving patient safety.Design, setting We analysed 4380 medical malpractice claims from 351 grade-A tertiary hospitals in China for 2008–2017. We examined the characteristics of medical errors and patient safety, including the types of medical errors, proportionate liabilities and payments for medical malpractice in different clinical specialties.Main outcome measures We assessed claim characteristics, payment amounts and liability.Results Our data analysis demonstrated that 72.5% of the claims involved medical errors, with average payments of US$31 430. The hospital’s errors in medical malpractice resulted in 41.4% average liability in patient injury payments. Most medical malpractice cases occurred in Shanghai (817 claims, 18.7%) and Beijing (468 claims, 10.7%). The highest risks for medical error and malpractice claims were related to orthopaedics (11.3% of all claims, 72.8% with medical errors) and obstetrics and gynaecology (10.0% of all claims, 76.0% with medical errors). The highest rates related to proportionate liabilities were observed in otolaryngology (51.9%) and endocrinology (47.7%). Respiratory medicine had the highest proportion of claims in death rates (77.3%). Medical technology errors accounted for 91.8% of the claims and medical ethics errors for 5.8%. The highest average payment was found in cardiovascular surgery (US$41 733) and the lowest in stomatology (US$8822).Conclusions A previous study found that grade-A tertiary hospitals in China have similar medical error rates to general Chinese hospitals. 36Different specialties had different risk characteristics regarding medical errors, payments and proportionate liabilities. Orthopaedics had the highest number of malpractices claims and higher proportionate liability but lower death rates.

Objective: The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other. Methods: The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs. Results: A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = −6.12, 95%CI = −12.07–0.17; CS: MD = −6.43, 95%CI = −12.53–0.3), ulnar variance (RCT: MD = −0.81, 95%CI = −1.25–0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10–0.65; CS: RR = 0.15, 95%CI = 0.06–0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs. Conclusions: VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs. Level of evidence: Level 1, Therapeutic study. Keywords: Distal radial fractures, Volar locking plate, External fixation, Meta-analysis, GRADE analysis

Background. Socioeconomic barriers can prevent successful kidney transplant (KT) but are difficult to measure efficiently in clinical settings. We created and validated an individual-level, single score Kidney Transplant Derailers Index (KTDI) and assessed its association with waitlisting and living donor KT (LDKT) rates. Methods. The dataset included 733 patients presenting for KT evaluation in a transplant center in California. Exploratory factor analysis was used to identify socioeconomic barriers to KT (derailers) to include in the index. Potential KT derailers included health insurance, employment, financial insecurity, educational attainment, perception of neighborhood safety, access to a vehicle, having a washer/dryer, and quality of social support. Validity was tested with associations between KTDI scores and the following: (1) the Area Deprivation Index (ADI) and (2) time to KT waitlisting and LDKT. Results. Nine derailers were retained, omitting only social support level from the original set. The KTDI was scored by summing the number of derailers endorsed (mean: 3.0; range: 0–9). Black patients had higher estimated KTDI scores than other patient groups (versus White patients, 3.8 versus 2.1; P < 0.001, effect size = 0.81). In addition, the KTDI was associated with the ADI (γ = 0.70, SE = 0.07; P < 0.001). Finally, in comparison to the lower tertile, patients in the upper and middle KTDI tertiles had lower hazard of waitlisting (upper tertile hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.25-0.45; middle tertile HR: 0.54, 95% CI: 0.40-0.72) and receiving an LDKT (upper tertile HR: 0.15, 95% CI: 0.08-0.30; middle tertile HR: 0.35, 95% CI: 0.20-0.62). These associations remained significant when adjusting for the ADI and other patient characteristics. Conclusions. The KTDI is a valid indicator of socioeconomic barriers to KT for individual patients that can be used to identify patients at risk for not receiving a KT.

The title compound, [Cu4I4(C9H13N)4], has a distorted cubane-like [Cu4I4] core structure. Each CuI atom is tetrahedrally coordinated by three I atoms and one N atom of an benzyldimethylamine ligand. Each I atom acts as a μ3-ligand, linking three CuI atoms. The Cu—I bond distances vary between 2.6328 (7) and 2.7121 (6) Å, while the Cu—N bond distances vary between 2.107 (3) and 2.122 (3) Å.

Ovarian cancer (OC) is a common malignant reproductive tumor among women that adversely affects their health. It has been proven that Sauchinone (Sau) derived from Saururus chinensis (Lour.) Baill may aid tumorigenesis in diversiform cancers. Despite this, the regulatory impact of Sau on OC progression remains unclear. In this study, firstly, Sau (10 or 20 µM) had been confirmed to possess no cytotoxicity, so Sau (10 or 20 µM) was utilized for the next experiments. Sau was shown to prevent cell growth in OC. Furthermore, Sau inhibited cell migration and invasion in OC. Our findings demonstrated that Sau attenuated the epithelial-mesenchymal transition (EMT) process by elevating E-cadherin and declining N-cadherin and alpha-smooth muscle actin (a-SMA) expressions. Lastly, Sau blocked the wingless/integrated (Wnt)/ß-catenin pathway. In summary, Sau inhibited cell growth, EMT, and blocked the Wnt/ß-catenin pathway in OC progression. Sau may offer novel perspectives on OC treatment in this study. [ABSTRACT FROM AUTHOR]