Development and validation of a Chinese version chronic wound health-related quality of life instrument: A methodological study

AIMS AND OBJECTIVES

To develop a Chinese version of a chronic wound health-related quality of life (QoL) instrument and to examine the psychometric properties of this instrument.

BACKGROUND

Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care.

DESIGN

A methodological study.

METHODS

The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was .89.

RESULTS

A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were .807, .773, .799 and .713, respectively.

CONCLUSION

The Chinese version of a chronic wound health-related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity.

RELEVANCE TO CLINICAL PRACTICE

This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health-related QoL. Scholars in Chinese-speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds.

PATIENT OR PUBLIC CONTRIBUTION

Two hundred twenty-six participants provided their perspectives on health-related QoL.

Case Report: Neurally adjusted ventilatory assist as an effective rescue treatment for pulmonary interstitial emphysema in extremely low birth weight infants

Pulmonary interstitial emphysema (PIE) is a complication observed in extremely low birth weight (ELBW) infants on mechanical ventilation. Despite various proposed therapeutic interventions, the success rates have shown inconsistency. Neurally adjusted ventilatory assist (NAVA) stands out as a novel respiratory support mode, offering lower pressure and tidal volume in comparison to conventional ventilation methods. In this case report, we present five ELBW infants with refractory PIE who were transitioned to NAVA ventilation. Following the switch to NAVA, all cases of PIE gradually resolved. In contrast to traditional modes, NAVA provided respiratory support with significantly lower fraction of inspired oxygen, reduced peak inspiratory pressure, diminished mean airway pressure, and decreased tidal volume within 7 days of NAVA utilization (p = 0.042, 0.043, 0.043, and 0.042, respectively). Consequently, we propose that NAVA could serve as a valuable rescue treatment for ELBW infants with PIE.

Ultrasound tissue scatterer distribution imaging: An adjunctive diagnostic tool for shear wave elastography in characterizing focal liver lesions

OBJECTIVES

Focal liver lesion (FLL) is a prevalent finding in cross-sectional imaging, and distinguishing between benign and malignant FLLs is crucial for liver health management. While shear wave elastography (SWE) serves as a conventional quantitative ultrasound tool for evaluating FLLs, ultrasound tissue scatterer distribution imaging (TSI) emerges as a novel technique, employing the Nakagami statistical distribution parameter to estimate backscattered statistics for tissue characterization. In this prospective study, we explored the potential of TSI in characterizing FLLs and evaluated its diagnostic efficacy with that of SWE.

METHODS

A total of 235 participants (265 FLLs; the study group) were enrolled to undergo abdominal examinations, which included data acquisition from B-mode, SWE, and raw radiofrequency data for TSI construction. The area under the receiver operating characteristic curve (AUROC) was used to evaluate performance. A dataset of 20 patients (20 FLLs; the validation group) was additionally acquired to further evaluate the efficacy of the TSI cutoff value in FLL characterization.

RESULTS

In the study group, our findings revealed that while SWE achieved a success rate of 49.43 % in FLL measurements, TSI boasted a success rate of 100 %. In cases where SWE was effectively implemented, the AUROCs for characterizing FLLs using SWE and TSI stood at 0.84 and 0.83, respectively. For instances where SWE imaging failed, TSI achieved an AUROC of 0.78. Considering all cases, TSI presented an overall AUROC of 0.81. There was no statistically significant difference in AUROC values between TSI and SWE (p > 0.05). In the validation group, using a TSI cutoff value of 0.67, the AUROC for characterizing FLLs was 0.80.

CONCLUSIONS

In conclusion, ultrasound TSI holds promise as a supplementary diagnostic tool to SWE for characterizing FLLs.

Dual Biologic Therapy for Refractory Crohn's Disease With Perforation in a Patient Declining Surgical Intervention

Dual biologic therapy can improve clinical, biomarker, and endoscopic outcomes in selected patients with refractory Crohn's disease in whom multiple biologics had failed. We presented a patient with refractory Crohn's disease who was admitted for terminal ileal perforation, massive bloody stool, shock, and disseminated intravascular coagulation. He refused further surgical resection because of the fear of short bowel syndrome. He was successfully treated with dual biologic therapy, antimicrobial agents, and percutaneous needle decompressions. Dual biologic treatment could be a viable option for patients with refractory Crohn's disease with complications in selected critical conditions who refuse surgery.

SeqNovo: De Novo Peptide Sequencing Prediction in IoMT via Seq2Seq

In the Internet of Medical Things (IoMT), de novo peptide sequencing prediction is one of the most important techniques for the fields of disease prediction, diagnosis, and treatment. Recently, deep-learning-based peptide sequencing prediction has been a new trend. However, most popular deep learning models for peptide sequencing prediction suffer from poor interpretability and poor ability to capture long-range dependencies. To solve these issues, we propose a model named SeqNovo, which has the encoding-decoding structure of sequence to sequence (Seq2Seq), the highly nonlinear properties of multilayer perceptron (MLP), and the ability of the attention mechanism to capture long-range dependencies. SeqNovo use MLP to improve the feature extraction and utilize the attention mechanism to discover key information. A series of experiments have been conducted to show that the SeqNovo is superior to the Seq2Seq benchmark model, DeepNovo. SeqNovo improves both the accuracy and interpretability of the predictions, which will be expected to support more related research.

Association between traditional Chinese medicine body constitution deviation and chronic pelvic pain: A cross-sectional study

OBJECTIVE

Chronic pelvic pain (CPP) is one of the most challenging conditions that physicians and patients face nowadays. This study aimed to assess the traditional Chinese medicine (TCM) body constitution profiles, demographic characteristics, and lifestyle of women suffering from CPP.

MATERIALS AND METHODS

This study included 378 female patients of reproductive potential from a single Obstetrics and Gynecology clinic in Taiwan. Data were collected using the Short Form 36 Health Survey Questionnaire (SF-36), the TCM Body Constitution Deviation (BCQ-44) Questionnaire, and the Behavior Rating Scale. The chi-squared test, the Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's correlation were used to analyze the data.

RESULTS

TCM body composition deviation was correlated with the level of pain in patients with CPP. Moreover, the quality of life (QOL) of these patients was found to be affected by the level of pain. Additionally, the QOL was correlated with the TCM body composition deviation profile.

CONCLUSION

The TCM BCQ-44 can be used in the medical practice to assess patients' health status and can also serve as a guide to address the risk factors for CPP.

Intraductal papillary neoplasm of the bile duct presenting with hepatogastric fistula: a case report and literature review

Intraductal papillary neoplasm of the bile duct (IPNB) is an uncommon entity characterized by papillary growth within the bile duct lumen. IPNB is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas, which sometimes complicates with fistula formation to adjacent organs, mainly due to high-pressure related erosion from mucin-filled ducts. However, fistula formation from IPNB is quite rare. Here we report a case of IPNB complicated with hepatogastric fistula. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed disproportional dilatation of left intrahepatic duct with intraluminal soft tissue nodules and fistulous connections to gastric high body. Endoscopy revealed ulcers with two fistulous orifices at upper gastric body. The patient underwent left hepatectomy with gastric wedge resection. Histopathology examination revealed IPNB with invasive cholangiocarcinoma, directly invading to gastric wall leading to hepatogastric fistula. In summary, we have presented the clinical, imaging and pathological findings, along with a comprehensive review of relevant literature, in order to enhance the understanding of this rare condition.

Enabling Secure Communication in Wireless Body Area Networks with Heterogeneous Authentication Scheme

Thanks to the widespread availability of Fifth Generation (5G) wireless connectivity, it is now possible to provide preventative or proactive healthcare services from any location and at any time. As a result of this technological improvement, Wireless Body Area Networks (WBANs) have emerged as a new study of research in the field of healthcare in recent years. WBANs, on the one hand, intend to gather and monitor data from the human body and its surroundings; on the other hand, biomedical devices and sensors interact through an open wireless channel, making them exposed to a range of cyber threats. However, WBANs are a heterogeneous-based system; heterogeneous cryptography is necessary, in which the transmitter and receiver can employ different types of public key cryptography. This article proposes an improved and efficient heterogeneous authentication scheme with a conditional privacy-preserving strategy that provides secure communication in WBANs. In the proposed scheme, we employed certificateless cryptography on the client side and Identity-Based Cryptography on the receiver side. The proposed scheme employs Hyperelliptic Curve Cryptography (HECC), a more advanced variation of Elliptic Curve Cryptography (ECC). HECC achieves the same level of security with a smaller key size and a more efficient approach than its counterpart methods. The proposed scheme not only meets the security and privacy standards of WBANs but also enhances efficiency in terms of computation and communication costs, according to the findings of the security and performance analysis.

Marked Response to Larotrectinib in Pelvic Spindle Cell Sarcoma With Concurrent TPM3-NTRK1 Fusion and CDK4/MDM2 Amplification: A Case Report

Pelvic sarcoma with NTRK fusion saves pelvic exenteration given marked response to lantrectinib

LAP-IoHT: A Lightweight Authentication Protocol for the Internet of Health Things

The Internet of Health Things (IoHT), which is an extension of the Internet of Things (IoT) in healthcare, has provided a new type of telemedicine approach. In IoHT, wearable sensors are used to collect patient health data, and information is transmitted remotely to doctors who can develop accurate treatment plans and provide timely telemedicine services to patients. However, patient health data are transmitted over a public channel, which means that the privacy and medical data of patients are at significant risk of leakage and can be confronted by serious security problems. We proposed a lightweight authentication protocol known as LAP-IoHT for IoHT environments to overcome the various threats that are currently faced by IoHT. We verified the security of LAP-IoHT using a Real-or-Random model and demonstrated its significant performance advantage by conducting a comparative analysis with other similar protocols for a better adaptation to the IoHT environment.

Smart System: Joint Utility and Frequency for Pattern Classification

Nowadays, the environments of smart systems for Industry 4.0 and Internet of Things (IoT) are experiencing fast industrial upgrading. Big data technologies such as design making, event detection, and classification are developed to help manufacturing organizations to achieve smart systems. By applying data analysis, the potential values of rich data can be maximized and thus help manufacturing organizations to finish another round of upgrading. In this paper, we propose two new algorithms with respect to big data analysis, namely UFC gen and UFC fast . Both algorithms are designed to collect three types of patterns to help people determine the market positions for different product combinations. We compare these algorithms on various types of datasets, both real and synthetic. The experimental results show that both algorithms can successfully achieve pattern classification by utilizing three different types of interesting patterns from all candidate patterns based on user-specified thresholds of utility and frequency. Furthermore, the list-based UFC fast algorithm outperforms the level-wise-based UFC gen algorithm in terms of both execution time and memory consumption.

Gastric hydrodistension CT versus CT without gastric distension in preoperative TN staging of gastric carcinoma: analysis of single-center cancer registry

Accurate staging of gastric cancer is essential for the selection and optimization of therapy. Hydrodistension of the stomach is recommended to improve the accuracy of preoperative staging with contrast-enhanced multidetector computed tomography (MDCT). This study compares the performance of contrast-enhanced gastric water distension versus a nondistension MDCT protocol for T and N staging and serosal invasion in comparison to surgical histopathology. After propensity score matching, 86 patients in each group were included for analysis. The overall accuracy of distension versus nondistension group in T staging was 45% (95% CI 35-56) and 55% (95% CI 44-65), respectively (p = 0.29). There was no difference in the sensitivity and specificity in individual T staging and assessment of serosal invasion (all p > 0.41). Individual stage concordance with pathology was not significantly different (all p > 0.41). The overall accuracy of N staging was the same for distension and nondistension groups (51% [95% CI 40-62]). The majority of N0 staging (78-81%) were correctly staged, whereas N3 staging cases (63-68%) were predominantly understaged. In summary, there was no significant difference in the diagnostic performance of individual TN staging and assessment of serosal invasion using MDCT with or without gastric water distension.

[Construction of prediction model combined dual-energy CT quantitative parameters and conventional CT features for assessing the Ki-67 expression levels in invasive breast cancer]

Objective: To develop a model combined with dual-energy CT quantitative parameters and conventional CT features for evaluating the expression level of Ki-67 in invasive breast cancer. Methods: A total of 191 patients with histologically confirmed invasive breast cancer in Lishui Central Hospital from March 2019 to December 2020, were retrospectively enrolled, all of them were females, aged from 25 to 77 (53.2±11.3) years. All patients underwent preoperative non-contrast chest and contrast-enhanced Dual energy CT scans, and the normalized iodine concentration (NIC) of lesions on arterial and venous phase, spectral curve slope (λ_HU), and normalized effective atomic number (nZ_eff) were measured and calculated, and their conventional CT characteristics were assessed. According to the results of immunohistochemistry (IHC), the patients were divided into Ki-67 high expression group (n=129 patients) and low expression group (n=62 patients) level. The differences in clinical data, conventional CT characteristics and dual-energy CT quantitative parameters between the two groups were analyzed. The receiver operating characteristic curve (ROC) curve was conducted to assess the efficacy of each individual model and joint model in evaluating Ki-67 expression levels, and the area under the curve (AUC), sensitivity, specificity, and accuracy were calculated, respectively. Results: In the analysis of CT features, the longest diameter, shape and enhancement pattern of the tumor were significantly difference between the two groups (all P<0.05). The NIC, nZ_eff on the arterial phase and NIC, nZ_eff and λ_HU [M(Q₁,Q₃)] on the venous phase were higher in the high Ki-67 expression group compared to the low expression group [0.13 (0.12, 0.16) vs 0.11 (0.08, 0.14), 0.71 (0.70, 0.75) vs 0.70 (0.67, 0.72), 0.40 (0.32, 0.48) vs 0.23 (0.17, 0.32), 3.10 (2.58, 3.63) vs 2.86 (2.19, 3.48), 0.88 (0.85, 0.92) vs 0.85 (0.84, 0.86), all P<0.05]. The logistic regression model, which integrated significant conventional CT features and dual-energy CT quantitative parameters, demonstrated the highest diagnostic performance for assessing Ki-67 expression levels, with an AUC of 0.924, sensitivity of 88.37%, specificity of 83.87%, and accuracy of 86.91%; the AUC of the dual-energy CT parameter model was 0.908, sensitivity of 82.17%, specificity of 88.71%, and accuracy of 84.29%. Though the diagnostic efficacy was no significant difference (P=0.238), both models showed superior to the conventional CT feature model (all P<0.001). Conclusion: A dual-energy CT quantitative parameter combined with a conventional CT feature model was successfully constructed, which has a good evaluation performance on the expression level of Ki-67 in invasive breast cancer.

Fabrication of biodegradable films using <sc>l</sc>-lactate as a chiral material to produce circularly polarized light

<abstract> <p>Optical activity and its relation to molecular chirality are significant in the measurement of optical rotation or circular dichroism characteristics to determine the absolute configuration of a chiral molecule. A quarter-wave plate, which is usually made from quartz, can convert linearly polarized light into circularly polarized light. In this study, we suggest using <sc>l</sc>-lactic acid (<sc>l</sc>-LA), a chiral material, and a water-based transparent glue to produce biodegradable films. Adjusting the number of thin layers, which are deposited from the mixture of <sc>l</sc>-LA and polyvinyl alcohol, leads to different phase differences, forming <sc>l</sc>-LA films. A modified microscope system was used to observe the appearance of the <sc>l</sc>-LA wave plates. Six layers and 0.8% <sc>l</sc>-LA solution were the optimal conditions to fabricate an <sc>l</sc>-LA film. The circular polarization experiment showed that the changes in maximum and minimum light intensity were within 2% compared to the average light intensity at a specific angle of the <sc>l</sc>-LA film. The performance of the <sc>l</sc>-LA film was consistent with that of a commercial quarter-wave plate. In conclusion, circularly polarized light was successfully produced using the <sc>l</sc>-LA film. The biodegradable <sc>l</sc>-LA film has widespread application in the field of biomedicine. Featured Application: <sc>l</sc>-Lactic acid film uses biodegradable and biocompatible materials. It can produce circularly polarized light and is beneficial for application in biomedicine.</p> </abstract>

Highly efficient mode-locked and Q-switched Er3+-doped fiber lasers using a gold nanorod saturable absorber

Mode-locked and Q-switched pulsed fiber laser sources with wavelengths of 1.55 μm are widely used in various fields. Gold nanorods (GNRs) have been applied in biomedicine and optics owing to their biocompatibility, easy fabrication, and unique optical properties. This paper presents the analysis of a saturable absorber based on a colloidal gold nanorod (GNR) thin film for dual-function passively mode-locked and Q-switched 1.55-μm fiber lasers. The colloidal GNR thin film possesses superior properties such as a wide operating wavelength range, large nonlinear absorption coefficient, and a picosecond-order recovery time. Its modulation depth and saturation intensity at 1.55 μm are 7.8% and 6.55 MW/cm², respectively. Passive mode-locked or Q-switched laser operation is achieved by changing the number of GNR thin-film layers. The advantages of these high-quality GNRs in mode-locked and Q-switched fiber lasers with record-high slope efficiency are verified by conducting comprehensive material and laser dynamic analyses. The self-starting mode-locked fiber laser with an efficiency as high as 24.91% and passively Q-switched fiber laser with the maximum energy of 0.403 μJ are successfully demonstrated. This paper presents the novel demonstration of reconfigurable mode-locked and Q-switched all-fiber lasers by incorporating colloidal GNR thin films.

Clinical manifestations, risk factors, and prognostic factors of cytomegalovirus enteritis

BACKGROUND

To comprehensively analyze the risk factors, clinical characteristics, outcomes, and prognostic factors of Cytomegalovirus (CMV) enteritis.

METHODS

This retrospective cohort study enrolled patients who had undergone pathological examinations for CMV enteritis. They were divided into CMV and non-CMV groups according to immunohistochemistry staining results. The risk factors, clinical presentations, endoscopic features, treatments, outcomes, and prognostic factors of CMV enteritis were then analyzed.

RESULTS

Forty-two patients (18 CMV, 24 non-CMV group) were included in the study. Major clinical presentations in the CMV group included gastrointestinal bleeding (72.2%), abdominal pain (55.6%), and fever (33.3%); ulcers (72.2%) were the most common endoscopic findings. In-hospital and overall mortality rates were 27.8% and 38.9%, respectively; and longer hospital stays and higher overall mortality rates were observed. Radiotherapy and C-reactive protein levels were prognostic factors for in-hospital mortality. The risk factors for CMV enteritis included immunocompromised status (p = 0.013), steroid use (p = 0.014), shock (p = 0.031), concurrent pneumonia (p = 0.01), antibiotic exposure (p < 0.001), radiotherapy (p = 0.027), chronic kidney disease (p = 0.041), and CMV colitis (p = 0.031).

CONCLUSIONS

Physicians should pay attention to the characteristics of CMV enteritis in high-risk patients to make an early diagnosis and potentially improve the clinical outcome.

Vedolizumab combined with surgical resection successfully treated perforating Crohn's disease with peritoneal space to rectal and vaginal fistulas: a case report

Background

Intestinal perforations and fistulas are common complications of Crohn’s disease. However, chronic perforation with peritoneal space to rectal and vaginal fistulas have not been previously reported.

Case presentation

A 38-year-old female suffered from progressive lower abdominal pain, diarrhea and weight loss. Terminal ileal chronic perforation with intra-abdominal abscess, peritoneal space to rectal and vaginal fistulas were noted. The patient received surgical resection of the cecum and terminal ileum, and then vedolizumab treatment. Three months later, she had complete fistula closure, and her body mass index had increased from 13 to 22.

Conclusion

Vedolizumab combined with stool diversion is effective at treating Crohn’s disease with chronic perforation and complex peritoneal space to rectal and vaginal fistulas.

Multimodal neuroimaging markers of variation in cognitive ability in older HIV+ men

OBJECTIVE

This study used converging methods to examine the neural substrates of cognitive ability in middle-aged and older men with well-controlled HIV infection.

METHODS

Seventy-six HIV+ men on antiretroviral treatment completed an auditory oddball task and an inhibitory control (Simon) task while time-locked high-density EEG was acquired; 66 had usable EEG data from one or both tasks; structural MRI was available for 43. We investigated relationships between task-evoked EEG responses, cognitive ability and immunocompromise. We also explored the structural correlates of these EEG markers in the sub-sample with complete EEG and MRI data (N = 27).

RESULTS

EEG activity was associated with cognitive ability at later (P300) but not earlier stages of both tasks. Only the oddball task P300 was reliably associated with HIV severity (nadir CD4). Source localization confirmed that the tasks engaged partially distinct circuits. Thalamus volume correlated with oddball task P300 amplitude, while globus pallidus volume was related to the P300 in both tasks.

INTERPRETATION

This is the first study to use task-evoked EEG to identify neural correlates of individual differences in cognition in men living with well-controlled HIV infection, and to explore the structural basis of the EEG markers. We found that EEG responses evoked by the oddball task are more reliably related to cognitive performance than those evoked by the Simon task. We also provide preliminary evidence for a subcortical contribution to the effects of HIV infection severity on P300 amplitudes. These results suggest brain mechanisms and candidate biomarkers for individual differences in cognition in HIV.

Enhanced Paclitaxel Efficacy to Suppress Triple-Negative Breast Cancer Progression Using Metronomic Chemotherapy with a Controlled Release System of Electrospun Poly-d-l-Lactide-Co-Glycolide (PLGA) Nanofibers

Simple Summary

Treatment of metastatic triple-negative breast cancer (TNBC) relies on chemotherapy. To improve the efficacy of chemotherapy and avoid systemic toxicity, metronomic chemotherapy using continuous administration of low-dose chemotherapy could be a solution. The paclitaxel-loaded PLGA nanofibers allow for continuous and prolonged drug release, which is compatible with the concept of metronomic chemotherapy. The animal study revealed that the strategy successfully inhibited the growth of the primary tumor and distant metastasis without sarcopenia. These data offer new insights into the role of drug-loaded nanofibers in the treatment of metastatic TNBC.

Abstract

Triple-negative breast cancer (TNBC) is highly aggressive and responds poorly to conventional chemotherapy. The challenge of TNBC therapy is to maximize the efficacies of conventional chemotherapeutic agents and reduce their toxicities. Metronomic chemotherapy using continuous low-dose chemotherapy has been proposed as a new treatment option, but this approach is limited by the selection of drugs. To improve antitumor therapeutic effects, we developed electrospun paclitaxel-loaded poly-d-l-lactide-co-glycolide (PLGA) nanofibers as a topical implantable delivery device for controlled drug release and site-specific treatment. The subcutaneously implanted paclitaxel-loaded nanofibrous membrane in mice was compatible with the concept of metronomic chemotherapy; it significantly enhanced antitumor activity, inhibited local tumor growth, constrained distant metastasis, and prolonged survival compared with intraperitoneal paclitaxel injection. Furthermore, under paclitaxel-loaded nanofiber treatment, systemic toxicity was low with a persistent increase in lean body weight in mice; in contrast, body weight decreased in other groups. The paclitaxel-loaded nanofibrous membranes provided sustained drug release and site-specific treatment by directly targeting and changing the tumor microenvironment, resulting in low systemic toxicity and a significant improvement in the therapeutic effect and safety compared with conventional chemotherapy. Thus, metronomic chemotherapy with paclitaxel-loaded nanofibrous membranes offers a promising strategy for the treatment of TNBC.

Evaluation of the nephrotoxicity and safety of low-dose aristolochic acid, extending to the use of Xixin (Asurum), by determination of methylglyoxal and d-lactate

ETHNOPHARMACOLOGICAL RELEVANCE

Most Aristolochiaceae plants are prohibited due to aristolochic acid nephropathy (AAN), except Xixin (Asarum spp.). Xixin contains trace amounts of aristolochic acid (AA) and is widely used in Traditional Chinese Medicine. Methylglyoxal and d-lactate are regarded as biomarkers for nephrotoxicity.

AIM OF THE STUDY

The use of Xixin (Asarum spp.) is essential and controversial. This study aimed to evaluate tubulointerstitial injury and interstitial renal fibrosis by determining urinary methylglyoxal and d-lactate after withdrawal of low-dose AA in a chronic mouse model.

MATERIALS AND METHODS

C3H/He mice in the AA group (n = 24/group) were given ad libitum access to distilled water containing 3 μg/mL AA (0.5 mg/kg/day) for 56 days and drinking water from days 57 to 84. The severity of tubulointerstitial injury and fibrosis were evaluated using the tubulointerstitial histological score (TIHS) and Masson's trichrome staining. Urinary and serum methylglyoxal were determined by high-performance liquid chromatography (HPLC); urinary d-lactate were determined by column-switching HPLC.

RESULTS

After AA withdrawal, serum methylglyoxal in the AA group increased from day 56 (429.4 ± 48.3 μg/L) to 84 (600.2 ± 99.9 μg/L), and peaked on day 70 (878.3 ± 171.8 μg/L; p < 0.05); TIHS and fibrosis exhibited similar patterns. Urinary methylglyoxal was high on day 56 (3.522 ± 1.061 μg), declined by day 70 (1.583 ± 0.437 μg) and increased by day 84 (2.390 ± 0.130 μg). Moreover, urinary d-lactate was elevated on day 56 (82.10 ± 18.80 μg) and higher from day 70 (201.10 ± 90.82 μg) to 84 (193.28 ± 61.32 μg).

CONCLUSIONS

Methylglyoxal is induced after AA-induced tubulointerstitial injury, so methylglyoxal excretion and metabolism may be a detoxification and repair strategy. A low cumulative AA dose is the key factor that limits tubulointerstitial injury and helps to repair. Thus, AA-containing herbs, especially Xixin, should be used at low doses for short durations (less than one month).

Predicting Healthy C5 Spinal Nerve Stumps Eligible for Grafting with MRI, Tinel Test, and Rhomboid Electromyography: A Retrospective Study of 295 Consecutive Brachial Plexus Surgeries

Background MRI, Tinel test, and rhomboid electromyography (EMG) can be used to predict whether C5 spinal nerve stumps are healthy and eligible for grafting in acute adult brachial plexus injuries, but their comparative diagnostic efficacies have not been evaluated. Purpose To compare diagnostic performances of MRI, Tinel test, and rhomboid EMG in predicting healthy C5 spinal nerve stumps that are eligible for grafting. Materials and Methods This retrospective study included consecutive adult patients with acute brachial plexus injury who underwent microreconstructions between January 2008 and December 2018. Healthy C5 spinal nerve stumps eligible for grafting with preceding normal intradural nerve rootlets were diagnosed by an experienced neuroradiologist using an avulsion severity score system based on fast imaging employing steady-state acquisition or FIESTA neurography, which separates intradural nerve rootlets into normal, partial mild, severe, and complete avulsions. Tinel test and rhomboid EMG results were assessed by an experienced nerve surgeon and neurologist, respectively. The accuracy, sensitivity, and specificity of the three tests were compared using microdissection as the reference standard. P < .05 was considered to indicate a significant difference. Results A total of 251 patients (mean age, 31 years ± 13 [standard deviation]; 217 men) with brachial plexus injuries who had -undergone MRI (n = 251), Tinel test (n = 235), rhomboid EMG (n = 181) and MRI, Tinel test, and EMG (n = 172) were -included. Accuracy, sensitivity, and specificity, respectively, in predicting healthy C5 spinal nerve stumps eligible for grafting were 93% (233 of 251), 84% (58 of 69), and 96% (175 of 182) for MRI; 59% (139 of 235), 56% (37 of 66), and 60% (102 of 169) for Tinel test; and 39% (71 of 181), 85% (43 of 50), and 21% (28 of 131) for rhomboid EMG. MRI (area under the receiver operating characteristic curve [AUC], 0.90; P < .001) -outperformed MRI and Tinel test (AUC, 0.74), Tinel test (AUC, 0.59), and rhomboid EMG (AUC, 0.53). Conclusion MRI performed best in the prediction of healthy graftable C5 spinal nerve stumps in acute adult brachial plexus injuries. © RSNA, 2021 Online supplemental material is available for this article.

A preliminary study of hepatocellular carcinoma post proton beam therapy using MRI as an early prediction of treatment effectiveness

Purpose

To demonstrate the feasibility of magnetic resonance imaging (MRI) for early prediction of proton beam therapy (PBT) effectiveness in hepatocellular carcinoma (HCC).

Methods

Clinical data of the HCC patients without regional lymph node involvement or distant metastasis who received PBT at this institution between 2014 and 2017 were reviewed. A total of 43 patients were included. Tumor regression pattern after PBT were examined on the basis of follow-up duration. The variables were compared between patients with and without early tumor regression (ETR).

Results

The median follow-up duration was 40 months (range, 9–62 months). The cumulative overall survival rate at 6 months, 1 years and 5 years was 100%, 88.4%, 63.4%, respectively. Child-Pugh class A, local tumor control (LTC), complete response (CR), and ETR were significantly associated with overall survival (p < 0.05 each). Of 43 patients, 25 patients (58.1%) reached CR in the PBT-irradiated region. Twelve patients (27.9%) had a partial response and 3 patients (7.0%) had a stationary disease. Three patients (7.0%) developed in-field progression. The LTC rate at 5 years was 93.0%. Of the 25 patients who achieved a CR in the PBT-irradiated region, the median time to CR was 5 months (range, 1–19 months). Twenty-two patients (51.2%) showed ETR of the HCC, while 21 patients (48.8%) showed non-ETR. A significant association was observed between ETR and CR of the HCC after PBT (p < 0.001).

Conclusion

The post-PBT MRI follow-up at 3 months is helpful for monitoring therapeutic response. ETR of the HCC predicted a higher rate of CR and was associated with overall survival, which provides more accurate clinical management.

Vedolizumab in Crohn’s disease with rectal fistulas and presacral abscess: A case report

BACKGROUND

Fistula and intraabdominal abscess are common complications of Crohn’s disease (CD), but complex rectal fistula with abscess formation is rare. Tumor necrosis factor antagonists combined with percutaneous drainage or surgical intervention is optimal treatment for fistulizing CD with intraabdominal abscess. There is no study showing the efficacy of vedolizumab in such complicated condition.

CASE SUMMARY

A 47-year-old man has decompensated liver cirrhosis, Child B. He suffered from abdominal pain, bloody diarrhea, fever, and body weight loss. CD with rectoprostatic fistula, rectopresacral fistula, presacral abscess and cyto-megalovirus (CMV) infection were noted. He received antibiotics, anti-viral therapy, transverse colostomy and vedolizumab treatment. Six months later, he had deep remission and complete fistula tracts closure.

CONCLUSION

Early vedolizumab and stool diversion are effective and safe in treating CD with complex rectal fistula with abscess formation.

Efficient solid-state Raman yellow laser at 579.5 nm

A highly efficient diode-pumped Nd:YVO₄/KGW Raman yellow laser is developed to produce a 6.8 W yellow light at 579.5 nm accompanied by a 3.2 W Stokes wave at 1159 nm under an incident pump power of 30 W. The intracavity stimulated Raman scattering with the shift of 768cm^-1 is generated by setting the polarization of the fundamental wave along the N_g direction of an N_p-cut KGW crystal. The Nd:YVO₄ gain medium is coated as a cavity mirror to reduce the cavity losses for the fundamental wave. More importantly, the KGW crystal is specially coated to prevent the Stokes wave from propagating through the gain medium to minimize the cavity losses for the Stokes wave.

Roles of nurses and National Nurses Associations in combating COVID-19: Taiwan experience

As the COVID‐19 pandemic continues to expand worldwide, Taiwan has effectively contained the spread domestically and protected its citizens after registering its first case relatively early on 21 January 2020. Proactive preparedness and deployment by the national government, timely evidence and experience‐based judgements and decision‐making, information transparency, rapid response, and effective communication and measures have all been critical to combating COVID‐19 in Taiwan. Nurses play a pivotal role in providing direct health care as well as providing contact tracing and care for the quarantined clients and community care services. The Taiwan Nurses Association and other nurses’ associations serve a vital leadership role in advocating for nurses, raising public awareness, enhancing nursing’s professional profile, and sharing experiences via national and international platforms. The implications for nursing and health policy are that we need to well prepare for any unpredicted emerging pandemic in the future. Providing adequate personal protective equipment and safe staffing should be the highest priority for the governments and policymakers around the world to combat pandemic successfully.

Methylglyoxal and D-lactate in cisplatin-induced acute kidney injury: Investigation of the potential mechanism via fluorogenic derivatization liquid chromatography-tandem mass spectrometry (FD-LC-MS/MS) proteomic analysis

Nephrotoxicity severely limits the chemotherapeutic efficacy of cisplatin (CDDP). Oxidative stress is associated with CDDP-induced acute kidney injury (AKI). Methylglyoxal (MG) forms advanced glycation end products that elevate oxidative stress. We aimed to explore the role of MG and its metabolite D-lactate and identify the proteins involved in CDDP-induced AKI. Six-week-old female BALB/c mice were intraperitoneally administered CDDP (5 mg/kg/day) for 3 or 5 days. Blood urea nitrogen (42.6 ± 7.4 vs. 18.3 ± 2.5; p < 0.05) and urinary N-acetyl-β-D-glucosaminide (NAG; 4.89 ± 0.61 vs. 2.43 ± 0.31 U/L; p < 0.05) were significantly elevated in the CDDP 5-day group compared to control mice. Histological analysis confirmed AKI was successfully induced. Confocal microscopy revealed TNF-α was significantly increased in the CDDP 5-day group. Fluorogenic derivatized liquid chromatography-tandem mass spectrometry (FD-LC-MS/MS) showed the kidney MG (36.25 ± 1.68 vs. 18.95 ± 2.24 mg/g protein, p < 0.05) and D-lactate (1.78 ± 0.29 vs. 1.12 ± 0.06 mol/g protein, p < 0.05) contents were significantly higher in the CDDP 5-day group than control group. FD-LC-MS/MS proteomics identified 33 and nine altered peaks in the CDDP 3-day group and CDDP 5-day group (vs. control group); of the 35 proteins identified using the MOSCOT database, 11 were antioxidant-related. Western blotting confirmed that superoxide dismutase 1 (SOD-1) and parkinson disease protein 7 (DJ-1) are upregulated and may participate with MG in CDDP-induced AKI. This study demonstrates TNF-α, MG, SOD-1 and DJ-1 play crucial roles in CDDP-induced AKI.

[Prediction of short-term prognosis of hepatocellular carcinoma after TACE surgery based on MRI texture analysis technology]

Objective: To explore the feasibility of short-term efficacy prognosis prediction model for HCC patients undergoing transcatheter arterial chemoembolization (TACE) based on MRI-based radiomics technique. Methods: A total of 123 patients with liver cancer who received TACE treatment in Lishui Central Hospital from June 2016 to July 2018 were retrospectively collected, including 90 males and 33 females, with an average age of 24-83 (58±10) years. All the patients were pathologically confirmed as hepatocellular carcinoma and underwent MRI scan before surgery.All patients were followed up 3-4 months after TACE, and further divided into training group (n=85, 42 of which were effective and 43 cases were ineffective) and the validation group (n=38, 19 of which were effective and 19 were ineffective) according to the modified response evaluation criteria in solid tumors (mRECIST). There was no statistical difference in the general information between the two groups of patients, which was comparable. Then, preoperative T(2)WI images were used for radiomics analysis, texture parameters were screened based on R language, and short-term efficacy prediction model of TACE for training group and verification group was constructed. Results: T(2)WI image analysis of each patient received 396 different texture parameters, and further used Lasso dimensionality reduction and 10 times cross-validation screening to obtain 5 characteristic texture parameters, specifically stdDeviation, ClusterProminence_angle135_offset4, Correlation_angle135_offset4, Inertia_angle135_offset4, InverseDifferenceMoment_angle45_offset4. According to the above five texture parameters and their corresponding coefficient values, the corresponding radiomics scores (Radscore) were calculated, and the prediction models of the training group and the verification group were further constructed.It was found that the area under the ROC curve of the training group was 0.812 (95%CI: 0.722-0.901), the sensitivity and specificity were 83.7% and 69.0%, respectively. The area under the ROC curve of the validation group was 0.801 (95%CI:0.654-0.947), and the sensitivity and specificity were 89.5% and 63.2%, respectively. Conclusion: The constructed TACE prediction model in the present study has high prediction accuracy, sensitivity and specificity.The short-term efficacy prognosis prediction model for HCC based on MRI is constructed, stable and reliable.

Criterion for optimizing high-power acousto-optically Q-switched self-Raman yellow lasers with repetition rates up to 500 kHz

The criterion for optimizing the high-power acousto-optically ${Q}$Q-switched self-Raman yellow laser is originally explored for the repetition rate within 100-500 kHz. The minimum allowed value for the gate-open time is experimentally verified to be determined by the pulse buildup time. By using the minimum allowed gate-open time, the highest conversion efficiency can be achieved to raise the output power by approximately 20% in comparison with the conventional results. At a repetition rate of 200 kHz, the maximum output power at 588 nm can be up to 8.8 W at an incident pump power of 26 W. Furthermore, a practical formula is developed to accurately calculate the threshold pump power as a function of the gate-open time for a given repetition rate.

Compact efficient high-power triple-color Nd:YVO4 yellow-lime-green self-Raman lasers

A novel, to the best of our knowledge, approach is developed to realize a high-power compact efficient yellow-lime-green triple-color ${\rm Nd}:{{\rm YVO}_4}$Nd:YVO₄ self-Raman laser. The 588 nm yellow laser, the 559 nm lime laser, and the 532 nm green laser are converted from the 1064 nm fundamental wave and the 1176 nm Stokes Raman field. The simultaneous three-color operation is accomplished with three stages to step-by-step generate the 588 nm, 559 nm, and 532 nm lasers by using three different lithium triborate (LBO) crystals. By tuning the temperature of each individual LBO crystal, the 588 nm, 559 nm, and 532 nm output powers can be nearly the same and concurrently up to 2.4 W at the incident pump power of 30 W, corresponding to a conversion efficiency of 24% for the total output power.

[Percutaneous full-endoscopic removalof lumbar dumbbell tumors viatransforaminal approach]

Objective: To investigate the novel application and effectof Percutaneous Full-Endoscopic transforaminal approach for lumbar dumbbell tumors. Methods: A retrospective analysis of 12 cases of lumbar dumbbell tumors was conducted by Percutaneous full-endoscopic transforaminal approach in the Department of Neurosurgery, Fujian Medical University Union Hospital from Feb, 2018 to Jul, 2019. According to Eden classification, 5 cases in type Ⅲ and 7 cases in type Ⅳ. The Japanese Orthopaedic Association (JOA) score and Pain Visual analogue Scale (VAS) were used to compare the recovery of neurological function before and after surgery. Results: All the 12 tumors were completely removed in one stage. The pathological reports were all schwannomas (WHO grade Ⅰ). The VAS scores were significantly decreased compared with preoperative ones (P<0.001). The JOA scores were significantly improved without obvious complications and spinal instability. Median length of follow-up was 14 months with a range of 4 months to 20 months, there is no tumor recurrence and spinal instability. Conclusion: In the treatment of lumbar dumbbell spinal tumor, the full endoscopic transforaminal approach is a novel, safe and effective surgical procedure which removes the tumors intra-foramen and extra-foramen with less damage of spine, smaller possibility of instability and faster recovery.

Flexible, Efficient, and Secure Access Delegation in Cloud Computing

The convenience of the cloud-assisted Internet of Things has led to the need for improved protections for the large volumes of data collected from devices around the world and stored on cloud-based servers. Proxy re-encryption (PRE) has been presented as a suitable mechanism for secure transmission and sharing of files within the cloud. However, existing PRE schemes do not support unidirectional data transformation, fine-grained controls, multiple hops, and identity-based encryption simultaneously. To solve these problems, we propose a unidirectional multi-hop identity based-conditional PRE scheme that meets all of the above requirements. Our proposal has the additional benefits of a constant ciphertext size, non-interactivity, and collusion resistance. We also prove that our scheme is secure against adaptive identity chosen-ciphertext attacks in the standard model.

Adaptive Iterative Dose Reduction 3D Integrated with Automatic Tube Current Modulation for CT Coronary Artery Calcium Quantification: Comparison to Traditional Filtered Back Projection in an Anthropomorphic Phantom and Patients

RATIONALE AND OBJECTIVES

We aimed to evaluate integrated adaptive iterative dose reduction 3D (AIDR 3D) algorithm in automatic tube current modulation (ATCM) for the quantification of coronary artery calcium score (CACS) and cardiac risk stratification.

MATERIALS AND METHODS

A thoracic phantom with calcium inserts of known densities was scanned with filtered back projection (FBP) and AIDR 3D algorithms in small- and medium-sized phantoms. Twenty-four patients underwent two consecutive scans of CACS with FBP and AIDR 3D algorithms. The absolute Agatston score, Agatston score risk, volume score, and Agatston score percentile-based risk were compared, and concordance coefficients and agreement plots were made.

RESULTS

Agatston and volume scores were significantly different between the phantom sizes (P < .01). There were no significant differences in the Agatston scores between FBP and AIDR 3D for the medium phantoms (P = .25). In the patients, there were no significant differences in Agatston and volume scores between FBP and AIDR 3D (P = .06 and P = .09, respectively). The correlation coefficients of Agatston and volume scores with AIDR 3D were excellent compared to those of FBP. There were no significant differences in Agatston score risk and Agatston score percentile-based risk between FBP and AIDR 3D (P = .74 and P = 1, respectively). There was mean dose reduction of 57.8% ± 18.6% for AIDR 3D.

CONCLUSION

The absolute Agatston score differed between FBP and AIDR 3D reconstructions. However, the cardiac risk categorizations of the two methods were comparable. An integrated AIDR 3D algorithm with automatic tube current modulation enables radiation dose savings at a consistent noise level without sacrificing CACS.

Construction of CuO/In2S3/ZnO heterostructure arrays for enhanced photocatalytic efficiency

Novel one-dimensional (1D) heterostructure arrays composed of CuO nanowire cores, intermediate In₂S₃ nanostructures, and ZnO nanorod sheaths (i.e. CuO/In₂S₃/ZnO heterostructure arrays) have been successfully synthesized by a multi-step process. First, single-crystalline CuO nanowires were directly grown on flexible Cu mesh substrates using a one-step annealing process under ambient conditions. Second, In₂S₃ nanostructures and ZnO nanorods were sequentially grown on the CuO nanowires by a two-step hydrothermal method at low reaction temperature. The morphology, crystal structures, and optical properties of the CuO/In₂S₃/ZnO heterostructure arrays were studied by scanning electron microscopy, X-ray diffraction, transmission electron microscopy, energy-dispersive spectroscopy, and photoluminescence spectroscopy. The resultant ternary CuO/In₂S₃/ZnO heterostructure arrays exhibit excellent photocatalytic activity in the photodegradation of rhodamine 6G (R6G) under 10 W UV light irradiation, which is much higher than that of single-component (CuO nanowire arrays) or two-component systems (CuO/In₂S₃ heterostructure arrays). Furthermore, the reusability test demonstrates that the CuO/In₂S₃/ZnO heterostructure arrays on the Cu mesh still maintain high photocatalytic activity in the degradation of three kinds of organic pollutants even after five cycles, without any significant decline. These findings provide an insight into the design and synthesis of new CuO-based composites to effectively improve their photocatalytic performance.

An Efficient User Authentication and User Anonymity Scheme with Provably Security for IoT-Based Medical Care System

In recent years, with the increase in degenerative diseases and the aging population in advanced countries, demands for medical care of older or solitary people have increased continually in hospitals and healthcare institutions. Applying wireless sensor networks for the IoT-based telemedicine system enables doctors, caregivers or families to monitor patients' physiological conditions at anytime and anyplace according to the acquired information. However, transmitting physiological data through the Internet concerns the personal privacy of patients. Therefore, before users can access medical care services in IoT-based medical care system, they must be authenticated. Typically, user authentication and data encryption are most critical for securing network communications over a public channel between two or more participants. In 2016, Liu and Chung proposed a bilinear pairing-based password authentication scheme for wireless healthcare sensor networks. They claimed their authentication scheme cannot only secure sensor data transmission, but also resist various well-known security attacks. In this paper, we demonstrate that Liu-Chung's scheme has some security weaknesses, and we further present an improved secure authentication and data encryption scheme for the IoT-based medical care system, which can provide user anonymity and prevent the security threats of replay and password/sensed data disclosure attacks. Moreover, we modify the authentication process to reduce redundancy in protocol design, and the proposed scheme is more efficient in performance compared with previous related schemes. Finally, the proposed scheme is provably secure in the random oracle model under ECDHP.