[Analysis of microsatellite instability in endometrial cancer: The significance of minimal microsatellite shift]

OBJECTIVE

To analyze the differences and characteristics of microsatellite instability (MSI) in endometrial cancer (EMC), by using colorectal cancer (CRC) as control.

METHODS

In the study, 228 cases of EMC were collected. For comparative analysis, 770 cases of CRC were collected. Mismatch repair (MMR) expression was detected by immunohistochemistry (IHC), and microsatellite instability (MSI) was analyzed by PCR and capillary electrophoresis fragment analysis (MSI-PCR). MSI-PCR was detected using five mononucleotide repeat markers: BAT-25, BAT-26, NR-21, NR-24, and MONO-27.

RESULTS

In EMC, we found 27.19% (62/228) of deficient mismatch repair (dMMR) using IHC, significantly higher than CRC (7.79%, 60/770). Meanwhile, subclonal expression of MMR protein was found in 4 cases of dMMR-EMC and 2 cases of dMMR-CRC. According to the criteria of major micro-satellite shift, we found 16.23% (37/228) of MSI-high (MSI-H), 2.63% (6/228) of MSI-low (MSI-L), and 81.14% (185/228) of microsatellite stability (MSS) in EMC using MSI-PCR. The discor-dance rate between MMR-IHC and MSI-PCR in EMC was 11.84% (27/228). In CRC, we found 8.05% (62/770) of MSI-H, 0.13% (1/770) of MSI-L, and 91.82% (707/770) of MSS. The discordance rate between MMR-IHC and MSI-PCR in CRC was only 0.52% (4/770). However, according to the criteria of minimal microsatellite shift, 12 cases of EMC showed minimal microsatellite shift including 8 cases of dMMR/MSS and 4 cases of dMMR/MSI-L and these cases were ultimately evaluated as dMMR/MSI-H. Then, 21.49% (49/228) of EMC showed MSI-H and the discordance rate MMR-IHC and MSI-PCR in EMC decreased to 6.58% (15/228). No minimal microsatellite shift was found in CRC. Compared with EMC group with major microsatellite shift, cases with minimal microsatellite shift showed younger age, better tumor differentiation, and earlier International Federation of Gynecology and Obstetrics (FIGO) stage. There were significant differences in histological variant and FIGO stage between the two groups (P < 0.001, P=0.006).

CONCLUSION

EMC was more prone to minimal microsatellite shift, which should not be ignored in the interpretation of MSI-PCR results. The combined detection of MMR-IHC and MSI-PCR is the most sensitive and specific method to capture MSI tumors.

[Endometrioid adenocarcinoma with proliferated stromal cells, hyalinization and cord-like formations: A case report]

Corded and hyalinized endometrioid carcinoma (CHEC) is a morphologic variant of endo-metrioid adenocarcinoma. The tumor exhibits a biphasic appearance with areas of traditional low-grade adenocarcinoma merging directly with areas of diffuse growth composed of epithelioid or spindled tumor cells forming cords, small clusters, or dispersed single cells. It is crucial to distinguish CHEC from its morphological mimics, such as malignant mixed mullerian tumor (MMMT), because CHECs are usually low stage, and are associated with a good post-hysterectomy prognosis in most cases while the latter portends a poor prognosis. The patient reported in this article was a 54-year-old woman who presented with postmenopausal vaginal bleeding for 2 months. The ultrasound image showed a thickened uneven echo endometrium of approximately 12.2 mm and a detectable blood flow signal. Magnetic resonance imaging revealed an abnormal endometrial signal, considered endometrial carcinoma (Stage Ⅰ B). On hysterectomy specimen, there was an exophytic mass in the uterine cavity with myometrium infiltrating. Microscopically, most component of the tumor was well to moderately differentiated endometrioid carcinoma. Some oval and spindle stromal cells proliferated on the superficial surface of the tumor with a bundle or sheet like growth pattern. In the endometrial curettage specimen, the proliferation of these stromal cells was more obvious, and some of the surrounding stroma was hyalinized and chondromyxoid, which made the stromal cells form a cord-like arrangement. Immunostains were done and both the endometrioid carcinoma and the proliferating stroma cells showed loss of expression of DNA mismatch repair protein MLH1/PMS2 and wild-type p53 protein. Molecular testing demonstrated that this patient had a microsatellite unstable (MSI) endometrial carcinoma. The patient was followed up for 6 months, and there was no recurrence. We diagnosed this case as CHEC, a variant of endometrioid carcinoma, although this case did not show specific β-catenin nuclear expression that was reported in previous researches. The striking low-grade biphasic appearance without TP53 mutation confirmed by immunohistochemistry and molecular testing supported the diagnosis of CHEC. This special morphology, which is usually distributed in the superficial part of the tumor, may result in differences between curettage and surgical specimens. Recent studies have documented an aggressive clinical course in a significant proportion of cases. More cases are needed to establish the clinical behaviors, pathologic features, and molecular profiles of CHECs. Recognition of the relevant characteristics is the prerequisite for pathologists to make correct diagnoses and acquire comprehensive interpretation.

Experience of pediatric nurses in nursing dying children - a qualitative study

PURPOSE

To explore pediatric nurses' challenges and effective coping strategies in caring for dying children.

METHODS

A descriptive qualitative study was adopted. Data were collected using a semi-structured interview with ten nurses from the pediatric, pediatric emergency, and neonatology departments.

RESULTS

Three themes were generated: stressors, consequences, and coping strategies. Ten sub-themes were generalized: negative emotions; helplessness; questioning rescue behavior; fear of communication; lack of workforce for night rescue; compassion fatigue; burnout; changes in life attitudes; self-regulation; leadership approval and no accountability.

CONCLUSIONS

Through qualitative research, nurses' challenges and effective coping strategies in caring for dying children were found, which provides information for nurses' career development and related policy formulation in China.

CLINICAL RELEVANCE

While there are many articles in China on hospice care, there is little research on the nurses' experience of caring for dying children. Many studies have mentioned the adverse consequences of caring for dying children in foreign countries, leading to post-traumatic stress disorder (PTSD). However, domestic discussion of such problems is rare, and no corresponding coping strategies exist. This study explores pediatric nurses' challenges and effective coping strategies in caring for dying children.

Malignant progression of liver cancer progenitors requires lysine acetyltransferase 7-acetylated and cytoplasm-translocated G protein GαS

BACKGROUND AND AIMS

Hepatocarcinogenesis goes through HCC progenitor cells (HcPCs) to fully established HCC, and the mechanisms driving the development of HcPCs are still largely unknown.

APPROACH AND RESULTS

Proteomic analysis in nonaggregated hepatocytes and aggregates containing HcPCs from a diethylnitrosamine-induced HCC mouse model was screened using a quantitative mass spectrometry-based approach to elucidate the dysregulated proteins in HcPCs. The heterotrimeric G stimulating protein α subunit (GαS) protein level was significantly increased in liver cancer progenitor HcPCs, which promotes their response to oncogenic and proinflammatory cytokine IL-6 and drives premalignant HcPCs to fully established HCC. Mechanistically, GαS was located at the membrane inside of hepatocytes and acetylated at K28 by acetyltransferase lysine acetyltransferase 7 (KAT7) under IL-6 in HcPCs, causing the acyl protein thioesterase 1-mediated depalmitoylation of GαS and its cytoplasmic translocation, which were determined by GαS K28A mimicking deacetylation or K28Q mimicking acetylation mutant mice and hepatic Kat7 knockout mouse. Then, cytoplasmic acetylated GαS associated with signal transducer and activator of transcription 3 (STAT3) to impede its interaction with suppressor of cytokine signaling 3, thus promoting in a feedforward manner STAT3 phosphorylation and the response to IL-6 in HcPCs. Clinically, GαS, especially K28-acetylated GαS, was determined to be increased in human hepatic premalignant dysplastic nodules and positively correlated with the enhanced STAT3 phosphorylation, which were in accordance with the data obtained in mouse models.

CONCLUSIONS

Malignant progression of HcPCs requires increased K28-acetylated and cytoplasm-translocated GαS, causing enhanced response to IL-6 and driving premalignant HcPCs to fully established HCC, which provides mechanistic insight and a potential target for preventing hepatocarcinogenesis.

SELF-SUPERVISED LEARNING WITH RADIOLOGY REPORTS, A COMPARATIVE ANALYSIS OF STRATEGIES FOR LARGE VESSEL OCCLUSION AND BRAIN CTA IMAGES

Scarcity of labels for medical images is a significant barrier for training representation learning approaches based on deep neural networks. This limitation is also present when using imaging data collected during routine clinical care stored in picture archiving communication systems (PACS), as these data rarely have attached the high-quality labels required for medical image computing tasks. However, medical images extracted from PACS are commonly coupled with descriptive radiology reports that contain significant information and could be leveraged to pre-train imaging models, which could serve as starting points for further task-specific fine-tuning. In this work, we perform a head-to-head comparison of three different self-supervised strategies to pre-train the same imaging model on 3D brain computed tomography angiogram (CTA) images, with large vessel occlusion (LVO) detection as the downstream task. These strategies evaluate two natural language processing (NLP) approaches, one to extract 100 explicit radiology concepts (Rad-SpatialNet) and the other to create general-purpose radiology reports embeddings (DistilBERT). In addition, we experiment with learning radiology concepts directly or by using a recent self-supervised learning approach (CLIP) that learns by ranking the distance between language and image vector embeddings. The LVO detection task was selected because it requires 3D imaging data, is clinically important, and requires the algorithm to learn outputs not explicitly stated in the radiology report. Pre-training was performed on an unlabeled dataset containing 1,542 3D CTA - reports pairs. The downstream task was tested on a labeled dataset of 402 subjects for LVO. We find that the pre-training performed with CLIP-based strategies improve the performance of the imaging model to detect LVO compared to a model trained only on the labeled data. The best performance was achieved by pre-training using the explicit radiology concepts and CLIP strategy.

Highly efficient and tunable polarization rotator based on lithium niobate on an insulator

The lithium niobate on an insulator (LNOI) platform has greatly advanced the development of integrated photonics recently, where efficient polarization management components are indispensable. In this work, we propose a highly efficient and tunable polarization rotator based on the LNOI platform and the low-loss optical phase change material antimony triselenide (S b ₂ S e ₃). The key polarization rotation region is formed by a LNOI waveguide with a cross section of the double trapezoidal shape and a S b ₂ S e ₃ layer deposited atop the LNOI waveguide in an asymmetrical way, where an isolating layer of silicon dioxide is sandwiched between them to reduce the material absorption loss. Based on such a structure, we have achieved the efficient polarization rotation in a length of only 17.7 µm, where the polarization conversion efficiency and insertion loss are 99.6% (99.2%) and 0.38 dB (0.4 dB) for the trans-electric (TE)-to-trans-magnetic (TM) rotation. If we further change the phase state of the S b ₂ S e ₃ layer, other polarization rotation angles besides 90° can also be obtained for the same device, revealing a tunable function. We believe that the proposed device and design scheme could offer an efficient method for realizing the polarization management on the LNOI platform.

Performance optimization and mechanism analysis of applied Enteromorpha-based composite dust suppressant

In order to solve the problem of environmental pollution caused by the escape of coal dust in open-pit coal mines, a composite dust suppressant was prepared from Enteromorpha, and the preparation factors (water-soluble polymer, temperature, solid content and surfactant) were optimized. The mechanism of dust suppression and the possibility of large-scale field application were discussed. The research results on the related properties of dust suppressants showed that the performance of Enteromorpha-based dust suppressants prepared by this method was excellent compared with similar studies. Among them, polyacrylamide (PAM) Enteromorpha-based dust suppressant had the best performance, with viscosity of 25.1 mPa s and surface tension of 27.05 mN/m. Moreover, PAM Enteromorpha-based dust suppressant had the best effect, with the mass loss of 2.94% under the wind speed of 10 m/s and the coal dust loss rate of 4.6% after rain erosion, and it had strong water retention performance. Through the discussion of dust suppression mechanism, it was found that the mechanical entangled network structure with hydrogen bonds as nodes was formed after the graft copolymerization of PAM and Enteromorpha. It had high permeability and good adhesion. After quickly wetting coal dust, it formed a dense package for coal dust. The field experiment also showed that the use of Enteromorpha-based dust suppressant can effectively inhibit the escape of coal dust. From the point of view of economy and efficiency, Enteromorpha can save 30% of the material cost and the dust suppression efficiency can reach 89-94%. Therefore, the Enteromorpha-based dust suppressant may stably suppress coal dust on the basis of reducing the cost.

[Early results of left ventricular assist device implantation for the treatment of heart failure]

Twenty-four male patients who underwent left ventricular assist device (LVAD) implantation due to advanced heart failure in Union Hospital, Fujian Medical University from June 2019 to June 2022 were retrospectively included. The age of patients was 32-61 (48.4±8.4) years. Everheat-Ⅰ, HeartCon and Corheart 6 left ventricular assist systems were used in 10, 6 and 8 cases, respectively. All patients were discharged successfully without mechanical failure, thrombosis or secondary thoracotomy for hemostasis. Early postoperative hemodynamics were significantly improved, left ventricular systolic diameter was reduced, left ventricular ejection fraction was gradually improved, and no hemolysis occurred. The patients were followed up for 3 to 39 (17.9±8.6) months, the cardiac function was restored to grade Ⅰ to Ⅱ, and the 6-minute walking test distance increased significantly. Therefore, satisfactory early results can be achieved with left ventricular assist device implantation for the treatment of heart failure.

Facilitators and barriers to the implementation of new critical care practices during COVID-19: a multicenter qualitative study using the Consolidated Framework for Implementation Research (CFIR)

BACKGROUND

The COVID-19 pandemic produced unprecedented demands and rapidly changing evidence and practices within critical care settings. The purpose of this study was to identify factors and strategies that hindered and facilitated effective implementation of new critical care practices and policies in response to the pandemic.

METHODS

We used a cross-sectional, qualitative study design to conduct semi-structured in-depth interviews with critical care leaders across the United States. The interviews were audio-taped and professionally transcribed verbatim. Guided by the Consolidated Framework for Implementation Research (CFIR), three qualitative researchers used rapid analysis methods to develop relevant codes and identify salient themes.

RESULTS

Among the 17 hospitals that agreed to participate in this study, 31 clinical leaders were interviewed. The CFIR-driven rapid analysis of the interview transcripts generated 12 major themes, which included six implementation facilitators (i.e., factors that promoted the implementation of new critical care practices) and six implementation barriers (i.e., factors that hindered the implementation of new critical care practices). These themes spanned the five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Process) and 11 distinct CFIR constructs. Salient facilitators to implementation efforts included staff resilience, commitment, and innovation, which were supported through collaborative feedback and decision-making mechanisms between leadership and frontline staff. Major identified barriers included lack of access to reliable and transferable information, available resources, uncollaborative leadership and communication styles.

CONCLUSIONS

Through applying the CFIR to organize and synthesize our qualitative data, this study revealed important insights into implementation determinants that influenced the uptake of new critical care practices during COVID-19. As the pandemic continues to burden critical care units, clinical leaders should consider emulating the effective change management strategies identified. The cultivation of streamlined, engaging, and collaborative leadership and communication mechanisms not only supported implementation of new care practices across sites, but it also helped reduce salient implementation barriers, particularly resource and staffing shortages. Future critical care implementation studies should seek to capitalize on identified facilitators and reduce barriers.

Deep accumulation of soluble organic nitrogen after land-use conversion from woodlands to orchards in a subtropical hilly region

Accumulation of soluble organic nitrogen (SON) in soil poses a significant threat to groundwater quality and plays an important role in regulating the global nitrogen cycle; however, most related studies have focused only on the upper 100-cm soil layers. Surface land-use management and soil properties may affect the vertical distribution of SON; however, their influence is poorly understood in deep soil layers. Therefore, this study assessed the response of SON concentration, pattern, and storage in deep regoliths to land-use conversion from woodlands to orchards in a subtropical hilly region. Our results showed that the SON stocks of the entire soil profile (up to 19.5 m) ranged from 254.5 kg N ha^-1 to 664.1 kg N ha^-1. Land-use conversion not only reshaped the distribution pattern of SON, but also resulted in substantial accumulation of SON at the 0-200 cm soil profile in the orchards compared to that in the woodlands (124.1 vs 190.5 kg N ha^-1). Land-use conversion also altered the SON/total dissolved nitrogen ratio throughout the regolith profile, resulting in a relatively low (<50 %) ratio in orchard soils below 200 cm. Overall, 76.8 % of SON (338.4 ± 162.0 kg N ha^-1) was stored in the layers from 100 cm below the surface to the bedrock. Regolith depth (r = -0.52 and p < 0.05) was found to be significantly correlated with SON concentration, explaining 17.8 % of the variation in SON, followed by total nitrogen (14.4 %), total organic carbon/total nitrogen ratio (10.1 %), and bulk density (9.3 %). This study provides insights into the estimation of terrestrial nitrogen and guidance for mitigation of groundwater contamination risk due to deep accumulation of SON.

High-performance thin-film lithium niobate electro-optic modulator based on etching slot and ultrathin silicon film

An electro-optic modulator (EOM) is an indispensable component to connect the electric and optical fields. Here, we propose a high-performance, thin-film lithium niobate-based EOM, where the modulation waveguide is formed by an etching slot on the lithium niobate film and the deposit of an ultrathin silicon film in the slot region. Therefore, a small mode size and high mode energy can be simultaneously achieved in the LN region with a high EO coefficient, which will be beneficial to increase the EO overlap and gradually decrease in the mode size. Further, we employed a waveguide structure to construct a typical Mach-Zehnder interference-type EOM. According to the requirements of high-speed traveling wave modulation, we conduct the index matching, impedance matching, and low-loss operation. From the results, the key half-wave voltage length product and 3 dB modulation bandwidth are, respectively, 1.45 V cm and 119 GHz in a modulation length of 4 mm. Moreover, a larger 3 dB bandwidth also can be achieved by shortening the modulation length. Therefore, we believe the proposed waveguide structure and EOM will provide new ways to enhance the performance of LNOI-based EOMs.

Network pharmacology and bioinformatics analysis on the underlying mechanisms of baicalein against oral squamous cell carcinoma

BACKGROUND AND AIMS

This study performed a network pharmacology analysis to explore the potential anticancer activity of baicalein against oral squamous cell carcinoma (OSCC).

METHODS

The differentially expressed genes in OSCC were identified by the OSCC, and the key module related to OSCC was acquired by the weighted gene co-expression network analysis from GSE30784. Baicalein targets were obtained from GeneCards, SwissTargetPrediction and TCMSP (the traditional Chinese medicine systems pharmacology database and analysis platform) databases. Apart from GSE30784, OSCC-related genes were acquired from the Comparative Toxicogenomics Database and DisGeNET platform. The baicalein targets and OSCC-related genes were overlapped to acquire the drug-disease interaction genes. We input the candidate drug-disease interaction genes into the STRING database and created the protein-protein interaction network. The hub genes in the network were identified by cytoHubba. The expression levels of hub genes between cancer tissues and normal tissues were evaluated based on The Cancer Genome Atlas. Moreover, we performed the cancer immune infiltration analysis and evaluated the association between the expression of HIF1A and the abundance of infiltrating immune cells. The molecular docking between HIFA and baicalein was also performed and visualized. Additionally, the enrichment analysis was performed based on Gene Ontology and Kyoto Encyclopedia of Genes and Genomes database.

RESULTS

After overlapping the candidate baicalein targets with OSCC-related genes, 34 candidate drug-disease interaction genes were obtained. cytoHubba identified the top 10 genes with high centrality measures from the network, including AKT1, CD44, EGFR, HIF1A, IGF1, MMP2, MYC, PTGS2, STAT3 and TP53. The enriched biological process terms included regulation of apoptotic signaling pathway, regulation of cysteine-type endopeptidase activity and cellular response to chemical stress. The top five enriched pathways comprised Kaposi sarcoma-associated herpesvirus infection, hepatitis C, p53 signaling pathway, Epstein-Barr virus infection and proteoglycans in cancer. The expression of HIF1A was positively associated with the infiltration levels of CD4 + T cells (cor = 0.131, p = 0.004) and dendritic cells (cor = 0.098, p = 0.03), whereas negatively associated with B cells (cor = -0.098, p = 0.03).

CONCLUSION

Our results suggested that baicalein might be a candidate drug against OSCC. More studies are necessary to validate its anticancer effect and explore the underlying mechanisms.

Biological functionality and characteristics of Jerusalem artichoke (Helianthus tuberosus L.) tuber extracts

Jerusalem artichoke tuber extracts (JAE) bioactivity including anticancer, antimicrobial, and digestion-inhibiting properties were investigated. The findings showed that the extracts were able to inhibit cancer growth in the HT-29 colon cancer cell line (HT-29 cc cell line) in a dose-dependent form. The suppression of cell proliferation rose to about 78.05 ± 3.9 percent at a dose of 250 μg mL−1. The Annexin V assay showed dose-dependent DNA fragmentation and detected late apoptotic induction in the HT-29 cc cell line. Depending on the concentration, the extract was able to stop the cell cycle in the HT-29 cc cell line at the G1 phase. Also, JAE prevented the HT-29 cc cell line growth, which resulted in programmed cell death. Additionally, the extracts are potential antibacterial agents and may inhibit lipase and α-amylase.

GPU-accelerated Monte Carlo simulation of electron and photon interactions for radiotherapy applications

Objective. The Monte Carlo simulation software is a valuable tool in radiation therapy, in particular to achieve the needed accuracy in the dose evaluation for the treatment plans optimisation. The current challenge in this field is the time reduction to open the way to many clinical applications for which the computational time is an issue. In this manuscript we present an innovative GPU-accelerated Monte Carlo software for dose valuation in electron and photon based radiotherapy, developed as an update of the FRED (Fast paRticle thErapy Dose evaluator) software.Approach. The code transports particles through a 3D voxel grid, while scoring their energy deposition along their trajectory. The models of electromagnetic interactions in the energy region between 1 MeV-1 GeV available in literature have been implemented to efficiently run on GPUs, allowing to combine a fast tracking while keeping high accuracy in dose assessment. The FRED software has been bench-marked against state-of-art full MC (FLUKA, GEANT4) in the realm of two different radiotherapy applications: Intra-Operative Radio Therapy and Very High Electron Energy radiotherapy applications.Results. The single pencil beam dose-depth profiles in water as well as the dose map computed on non-homogeneous phantom agree with full-MCs at 2% level, observing a gain in processing time from 200 to 5000.Significance. Such performance allows for computing a plan with electron beams in few minutes with an accuracy of ∼%, demonstrating the FRED potential to be adopted for fast plan re-calculation in photon or electron radiotherapy applications.

Multiparametric MRI-based radiomics for the prediction of microvascular invasion in hepatocellular carcinoma

BACKGROUND

Preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is essential in obtaining a successful surgical treatment, in decreasing recurrence, and in improving survival.

PURPOSE

To investigate the value of multiparametric magnetic resonance imaging (MRI)-based radiomics in the prediction of peritumoral MVI in HCC.

MATERIAL AND METHODS

A total of 102 patient with pathologically proven HCC after surgical resection from June 2014 to March 2018 were enrolled in this retrospective study. Histological analysis of resected specimens confirmed positive MVI in 48 patients and negative MVI in 54 patients. Radiomics features were extracted from four MRI sequences and selected with the least absolute shrinkage and selection operator (LASSO) regression and used to analyze the tumoral and peritumoral regions for MVI. Univariate logistic regression was employed to identify the most important clinical factors, which were integrated with the radiomics signature to develop a nomogram.

RESULTS

In total, 11 radiomics features were selected and used to build the radiomics signature. The serum level of alpha-fetoprotein was identified as the clinical factor with the highest predictive value. The developed nomogram achieved the highest AUC in predicting MVI status. The decision curve analysis confirmed the potential clinical utility of the proposed nomogram.

CONCLUSION

The multiparametric MRI-based radiomics nomogram is a promising tool for the preoperative diagnosis of peritumoral MVI in HCCs and helps determine the appropriate medical or surgical therapy.

Implementation of a Multimodal Knowledge-Exchange Platform to Provide Trauma Critical Care Education During the Ongoing Conflict in Ukraine

IMPORTANCE

The conflict in Ukraine has forced civilian hospitals with limited trauma and battlefield medicine experience to care for casualties of war, placing significant strain on the health care system. Using the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) program, a multimodal trauma critical care knowledge-exchange platform was created for clinicians practicing in these institutions.

OBJECTIVES

To describe the development and implementation of the CERTAIN for Ukraine program and to evaluate the reach of this intervention, together with participant engagement and satisfaction.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study included clinicians caring for critically ill patients during the ongoing Ukrainian conflict who were part of a community developed using a messaging app. The program was implemented by a group of international trauma and critical care experts in collaboration with critical care leaders from the Shupyk National Healthcare University in Kyiv, Ukraine. This study evaluates data collected from the CERTAIN for Ukraine program from its launch on April 9, 2022, to August 31, 2022.

INTERVENTIONS

The initiative comprised a longitudinal series of interactive tele-education sessions, a webpage containing the CERTAIN approach and current trauma critical care guidelines translated into Ukrainian and Russian, and a private messaging chat for asynchronous discussion.

MAIN OUTCOMES AND MEASURES

Participant engagement and satisfaction were tracked using multimedia analytics and a post-session survey.

RESULTS

Since program launch, 838 participants have joined the messaging group, and 6 tele-education sessions have been delivered, with 1835 total views. The CERTAIN website has had 3527 visits, mainly from Ukraine (1378 [39%]) and the United States (1060 [30%]). Of the 74 completed postsession surveys, 65 respondents (88%) rated the course content excellent or very good, and 73 (99%) recommended it to others.

CONCLUSIONS AND RELEVANCE

The findings of this quality improvement study indicate that, using widely available and low-cost platforms, knowledge was shared rapidly and efficiently to a large community of clinicians practicing in a wartime environment with broad-based engagement and a high level of learner satisfaction.

Revealing the Self-Doping Defects in Carbon Materials for the Compact Capacitive Energy Storage of Zn-Ion Capacitors

Zn-ion capacitors are attracting great attention owing to the abundant and relatively stable Zn anodes but are impeded by the low capacitance of porous carbon cathodes with insufficient energy storage sites. Herein, using ball-milled graphene with different defect densities as the models, we reveal that the self-doping defects of carbon show a capacitive energy storage behavior with robust charge-transfer kinetics, providing a capacitance contribution of ca. 90 F g^-1 per unit of defect density (A_D/A_G value from Raman spectra) in both aqueous and organic electrolytes. Furthermore, a simple NaCl-assisted ball-milling method is developed to prepare novel graphene blocks (BSG) with abundant self-doping defect density, enriched pores, balanced electric conductivity, and high compact density (0.83 g cm^-3). The optimized ion and electron transfer paths promote efficient utilization of the self-doping defects in BSG, contributing to improved gravimetric and volumetric capacitance (224 F g^-1/186 F cm^-3 at 0.5 A g^-1) and remarkable rate performance (52.2% capacitance retention at 20 A g^-1). The defect engineering strategy may open up a new avenue to improve the capacitive performance of dense carbons for Zn-ion capacitors.

Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients

There is a lack of diagnostic performance measures associated with pulmonary embolism (PE). We aimed to explore the concept of the time to diagnostic certainty, which we defined as the time interval that elapses between first presentation of a patient to a confirmed PE diagnosis with computed tomography pulmonary angiogram (CT PA). This approach could be used to highlight variability in health system diagnostic performance, and to select patient outliers for structured chart review in order to identify underlying contributors to diagnostic error or delay. We performed a retrospective observational study at academic medical centers and associated community-based hospitals in one health system, examining randomly selected adult patients admitted to study sites with a diagnosis of acute saddle PE. One hundred patients were randomly selected from 340 patients discharged with saddle PE. Twenty-four patients were excluded. Among the 76 included patients, time to diagnostic certainty ranged from 1.5 to 310 hours. We found that 73/76 patients were considered to have PE present on admission (CT PA ≤ 48 hours). The proportion of patients with PE present on admission with time to diagnostic certainty of > 6 hours was 26% (19/73). The median (IQR) time to treatment (thrombolytics/anticoagulants) was 3.5 (2.5-5.1) hours among the 73 patients. The proportion of patients with PE present on admission with treatment delays of > 6 hours was 16% (12/73). Three patients acquired PE during hospitalization (CT PA > 48 hours). In this study, we developed and successfully tested the concept of time to diagnostic certainty for saddle PE.

Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients

There is a lack of diagnostic performance measures associated with pulmonary embolism (PE). We aimed to explore the concept of the time to diagnostic certainty, which we defined as the time interval that elapses between first presentation of a patient to a confirmed PE diagnosis with computed tomography pulmonary angiogram (CT PA). This approach could be used to highlight variability in health system diagnostic performance, and to select patient outliers for structured chart review in order to identify underlying contributors to diagnostic error or delay. We performed a retrospective observational study at academic medical centers and associated community-based hospitals in one health system, examining randomly selected adult patients admitted to study sites with a diagnosis of acute saddle PE. One hundred patients were randomly selected from 340 patients discharged with saddle PE. Twenty-four patients were excluded. Among the 76 included patients, time to diagnostic certainty ranged from 1.5 to 310 hours. We found that 73/76 patients were considered to have PE present on admission (CT PA ≤ 48 hours). The proportion of patients with PE present on admission with time to diagnostic certainty of > 6 hours was 26% (19/73). The median (IQR) time to treatment (thrombolytics/anticoagulants) was 3.5 (2.5-5.1) hours among the 73 patients. The proportion of patients with PE present on admission with treatment delays of > 6 hours was 16% (12/73). Three patients acquired PE during hospitalization (CT PA > 48 hours). In this study, we developed and successfully tested the concept of time to diagnostic certainty for saddle PE.

Characterization and genomic analysis of phage vB_ValR_NF, representing a new viral family prevalent in the Ulva prolifera blooms

Introduction

Vibrio is an important bacterial genus containing many pathogenic species. Although more and more Vibrio phages were isolated, the genome, ecology and evolution of Vibrio phages and their roles in bacteriophage therapy, have not been fully revealed.

Methods

Novel Vibrio phage vB_ValR_NF infecting Vibrio alginolyticus was isolated from the coastal waters of Qingdao during the Ulva prolifera blooms, Characterization and genomic feature of phage vB_ValR_NF has been analysed using phage isolation, sequencing and metagenome method.

Results and Discussion

Phage vB_ValR_NF has a siphoviral morphology (icosahedral head 114±1 nm in diameter; a tail length of 231±1 nm), a short latent period (30 minutes) and a large burst size (113 virions per cell), and the thermal/pH stability study showed that phage vB_ValR_NF was highly tolerant to a range of pHs (4-12) and temperatures (-20 - 45 °C), respectively. Host range analysis suggests that phage vB_ValR_NF not only has a high inhibitory ability against the host strain V. alginolyticus, but also can infect 7 other Vibrio strains. In addition, the phage vB_ValR_NF has a double-stranded 44, 507 bp DNA genome, with 43.10 % GC content and 75 open reading frames. Three auxiliary metabolic genes associated with aldehyde dehydrogenase, serine/threonine protein phosphatase and calcineurin-like phosphoesterase were predicted, might help the host V. alginolyticus occupy the survival advantage, thus improving the survival chance of phage vB_ValR_NF under harsh conditions. This point can be supported by the higher abundance of phage vB_ValR_NF during the U. prolifera blooms than in other marine environments. Further phylogenetic and genomic analysis shows that the viral group represented by Vibrio phage vB_ValR_NF is different from other well-defined reference viruses, and can be classified into a new family, named Ruirongviridae. In general, as a new marine phage infecting V. alginolyticus, phage vB_ValR_NF provides basic information for further molecular research on phage-host interactions and evolution, and may unravel a novel insight into changes in the community structure of organisms during the U. prolifera blooms. At the same time, its high tolerance to extreme conditions and excellent bactericidal ability will become important reference factors when evaluating the potential of phage vB_ValR_NF in bacteriophage therapy in the future.

Gut microbiota-derived short-chain fatty acids regulate gastrointestinal tumor immunity: a novel therapeutic strategy?

Tumor immune microenvironment (TIME), a tumor-derived immune component, is proven to be closely related to the development, metastasis, and recurrence of tumors. Gut microbiota and its fermented-metabolites short-chain fatty acids (SCFAs) play a critical role in maintaining the immune homeostasis of gastrointestinal tumors. Consisting mainly of acetate, propionate, and butyrate, SCFAs can interact with G protein-coupled receptors 43 of T helper 1 cell or restrain histone deacetylases (HDACs) of cytotoxic T lymphocytes to exert immunotherapy effects. Studies have shed light on SCFAs can mediate the differentiation and function of regulatory T cells, as well as cytokine production in TIME. Additionally, SCFAs can alter epigenetic modification of CD8⁺ T cells by inhibiting HDACs to participate in the immune response process. In gastrointestinal tumors, the abundance of SCFAs and their producing bacteria is significantly reduced. Direct supplementation of dietary fiber and probiotics, or fecal microbiota transplantation to change the structure of gut microbiota can both increase the level of SCFAs and inhibit tumor development. The mechanism by which SCFAs modulate the progression of gastrointestinal tumors has been elucidated in this review, aiming to provide prospects for the development of novel immunotherapeutic strategies.

Comparison of newly diagnosed COPD patients and the non-COPD residents in Shanghai Minhang District

Background

To compare whether the general population, especially those without characteristic symptoms, need spirometry screening for chronic obstructive pulmonary disease (COPD).

Methods

Residents aged > 40 years old in Minhang, Shanghai, China, filled out screening questionnaires and underwent spirometry. The structured questionnaire integrating COPD population screening and COPD screening questionnaire was designed to obtain data on demographic characteristics, risk factors of COPD, respiratory symptoms, lifestyle habits, and comorbidities. We assessed the correlations between variables and COPD and the impact factors of FEV₁% predicted.

Results

A total of 1,147 residents were included with a newly diagnosed mild to moderate COPD prevalence of 9.4% (108/1,147); half of the patients (54/108) were asymptomatic. Multivariate analysis did not reveal any significant differences in symptoms or lifestyle factors between newly diagnosed COPD patients and non-COPD participants. However, according to the generalized linear model, older age (β = -0.062, p < 0.001), male sex (β = -0.031, p = 0.047), and respiratory symptoms (β = -0.025, p = 0.013) were associated with more severe airflow limitation.

Conclusion

Newly diagnosed COPD patients had few differences compared with the general population, which suggests that a targeted case finding strategy other than general screening was currently preferred. More attention should be paid to respiratory symptoms when making a diagnosis and exploring new therapies and interventions for COPD in the early stage.