Delayed and nonhealing of diabetic wounds imposes substantial economic burdens and physical pain on patients.Mesenchymal stem cells(MSCs)promote diabetic wound healing.Particularly when MSCs aggregate into multicellul...Delayed and nonhealing of diabetic wounds imposes substantial economic burdens and physical pain on patients.Mesenchymal stem cells(MSCs)promote diabetic wound healing.Particularly when MSCs aggregate into multicellular spheroids,their therapeutic effect is enhanced.However,traditional culture platforms are inadequate for the efficient preparation and delivery of MSC spheroids,resulting in inefficiencies and inconveniences in MSC spheroid therapy.In this study,a three-dimensional porous nanofibrous dressing(NFD)is prepared using a combination of electrospinning and homogeneous freeze-drying.Using thermal crosslinking,the NFD not only achieves satisfactory elasticity but also maintains notable cytocompatibility.Through the design of its structure and chemical composition,the NFD allows MSCs to spontaneously form MSC spheroids with controllable sizes,serving as MSC spheroid delivery systems for diabetic wound sites.Most importantly,MSC spheroids cultured on the NFD exhibit improved secretion of vascular endothelial growth factor,basic fibroblast growth factor,and hepatocyte growth factor,thereby accelerating diabetic wound healing.The NFD provides a competitive strategy for MSC spheroid formation and delivery to promote diabetic wound healing.展开更多
目的 从医护人员的视角评价上海市已故肿瘤患者的善终质量现状,为提高安宁疗护服务水平提供科学依据。方法 采用横断面调查法,于2023年4月-7月,通过方便抽样邀请上海市2所三级医院、2所二级医院以及4所社区卫生服务中心的261名有照顾临...目的 从医护人员的视角评价上海市已故肿瘤患者的善终质量现状,为提高安宁疗护服务水平提供科学依据。方法 采用横断面调查法,于2023年4月-7月,通过方便抽样邀请上海市2所三级医院、2所二级医院以及4所社区卫生服务中心的261名有照顾临终肿瘤患者经历的医护人员参与调查。采用一般资料问卷及基于健康照护视角的优逝量表(The Good Death Scale for Patients in China, GDS-PCN)对其进行调查。GDS-PCN包括专业照护、家人陪伴、有备无憾、平静离世、保持尊严、维持控制、躯体安适7个维度,共36个条目。每名参与调查的医护人员使用问卷评价其最近照顾的1例已故肿瘤患者的死亡情况,共评价261例已故肿瘤患者的离世情况。结果 GDS-PCN量表总分为(144.11±17.86)分,其中专业照护维度平均分最高为(4.21±0.58)分,有备无憾维度和维持控制维度得分较低,分别为(3.75±0.70)分和(3.86±0.70)分。不同医疗机构等级、病房类型、住院时间、与医护人员之间沟通(病情、治疗方案和死亡相关话题)情况、治疗方案决策类型的患者量表得分的比较,差异有统计学意义(P<0.05)。曾在社区卫生服务中心住院的患者的得分高于三级医院的患者(P<0.05);安宁疗护病房的患者得分高于非安宁疗护病房的患者(P<0.05);住院15天以上患者的得分高于住院少于3天的患者(P<0.05);与医护人员沟通部分或全部病情的患者得分高于从未沟通过的患者(P<0.05);与医护人员讨论部分、大部分或更多的治疗计划的患者得分分别高于从未讨论过治疗计划的患者(P<0.05)和仅有限沟通过治疗计划的患者(P<0.05)。与医护人员部分谈论过死亡相关话题的患者的得分高于从未谈论过的患者(P<0.05);而与家庭成员共同参与治疗决策的患者的得分高于仅家庭成员参与决策的患者(P<0.05)。结论 上海市肿瘤患者的善终情况总体处于中高等水平。提高安宁疗护资源利用、加强医护人员与患者沟通临终事宜是提高患者善终水平的有效途径。未来需开展更多的研究,从多角度探究中国患者的善终质量。展开更多
Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Canc...Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Cancer-related Distress Management Guidelines in the context of the research site.Methods According to CAN-IMPLEMENT,the symptoms of cancer patients in Shanghai were investigated,and a work plan was formulated to adapt cancer-related distress management guidelines.The relevant clinical practice guidelines for distress management in cancer patients were searched,screened and assessed,the contents of the included clinical practice guidelines were screened,extracted and integrated,and the Cancer-related Distress Management Guidelines was developed.After peer review,the Cancer-related Distress Management Guidelines was finally formed.Results The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai.Two clinical practice guidelines related to distress management in cancer patients were included after searching,screening,assessment and selection systematically.The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II(AGREE II)were 73.75%–87.50%,respectively.The scores of most recommendations on feasibility,appropriateness,meaningfulness and effectiveness were at least 90%.The final guidelines included 13 recommendations.Conclusions The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted.The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility,suitability and effectiveness.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.AIM To predict early recurrence(ER)and overall survival(OS)in patients with HCC after radical resection using deep learning-based rad...BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.AIM To predict early recurrence(ER)and overall survival(OS)in patients with HCC after radical resection using deep learning-based radiomics(DLR).METHODS A total of 414 consecutive patients with HCC who underwent surgical resection with available preoperative grayscale and contrast-enhanced ultrasound images were enrolled.The clinical,DLR,and clinical+DLR models were then designed to predict ER and OS.RESULTS The DLR model for predicting ER showed satisfactory clinical benefits[area under the curve(AUC=0.819 and 0.568 in the training and testing cohorts,respectively)],similar to the clinical model(AUC=0.580 and 0.520 in the training and testing cohorts,respectively;P>0.05).The C-index of the clinical+DLR model in the prediction of OS in the training and testing cohorts was 0.800 and 0.759,respectively.The clinical+DLR model and the DLR model outperformed the clinical model in the training and testing cohorts(P<0.001 for all).We divided patients into four categories by dichotomizing predicted ER and OS.For patients in class 1(high ER rate and low risk of OS),retreatment(microwave ablation)after recurrence was associated with improved survival(hazard ratio=7.895,P=0.005).CONCLUSION Compared to the clinical model,the clinical+DLR model significantly improves the accuracy of predicting OS in HCC patients after radical resection.展开更多
Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer pa...Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.展开更多
China’s Bohai Bay has experienced large-scale land reclamation since 2000.These reclamation projects create a nearshore ecological imbalance and shift sediment transport by changing the tidal current.However,these ti...China’s Bohai Bay has experienced large-scale land reclamation since 2000.These reclamation projects create a nearshore ecological imbalance and shift sediment transport by changing the tidal current.However,these tidal current changes are not comprehensively understood.In this paper,the coastline changes in Bohai Bay due to reclamation are investigated and the responses of the tidal current are calculated through numerical methods.The results show that the coastline length of the bay increases by more than 500 km from 2000 to 2015 with the largest reclamation rate of 150.9 km^(2)/a.Consequently,the current velocity changes with an uneven distribution near the reclamation due to construction masking and dike protrusion.The tidal symmetry also changes in most nearshore areas,with opposite variations in the current velocity at peak flood and ebb tide.In addition,the tide direction deflects to bypass the reclamation and is usually consistent with the coastline.Harmonic analysis of the dominant M2 tidal constituent shows that the range of the reciprocating current is widely extended.The total influence of the reclamation can reach the-8-m isobaths in Bohai Bay.Changes in the tidal current are the main causes of water environment deterioration.Therefore,the arrangement and structural optimization of reclamation projects should be considered in the future.展开更多
Background: Acetylshikonin, a major constituent isolated from Arnebia euchroma, is a potential candidate for anti-colorectal cancer drugs. However, the potential activity and underlying mechanism of Acetylshikonin aga...Background: Acetylshikonin, a major constituent isolated from Arnebia euchroma, is a potential candidate for anti-colorectal cancer drugs. However, the potential activity and underlying mechanism of Acetylshikonin against colorectal cancer remain unclear. Methods: In this study, Acetylshikonin was isolated from the active CHCl3 extract of Arnebia euchroma using activity-guided screening, and elucidated by the extensive spectroscopic analysis and comparison with literature data. Human colorectal cancer cells HT29, DLD-1, HCT116 or Caco-2 were exposed to different concentrations of Acetylshikonin (6.25 - 100 μg/mL) for 24 or 48 h. Cell viability, cell apoptosis and cell cycle distribution were detected. The activity of Acetylshikonin and potential mechanism of the phosphoinositide 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway were evaluated in vitro and vivo. Results: We found that Acetylshikonin exhibited remarkable anti-proliferative activity in a dose-dependent manner against HT29 cells with the IC50 values of 60.82 μg/ml and 30.78 μg/ml at 24, 48 h, respectively. Moreover, Acetylshikonin induced cell cycle arrest at G0/G1 phase and early apoptosis through inhibition of PI3K/Akt/mTOR pathway. Furthermore, the assays of cell inhibition, early apoptosis and G0/G1 phase distribution showed that suppression of the PI3K/Akt pathway using LY294002 enhanced the anti-cancer effect of Acetylshikonin. Similarly, Acetylshikonin also decreased the growth of tumour in colorectal cancer xenografts in mice through PI3K/Akt/mTOR pathway. Conclusions: To sum up, these new findings provided a framework for further exploration of Acetylshikonin which possessed the potential antitumor activity by inhibiting PI3K/Akt/mTOR pathway.展开更多
With the development of smart grid, operation and control of a power system can be realized through the power communication network, especially the power production and enterprise management business involve a large a...With the development of smart grid, operation and control of a power system can be realized through the power communication network, especially the power production and enterprise management business involve a large amount of sensitive information, and the requirements for data security and real-time transmission are gradually improved. In this paper, a new 9-dimensional(9D) complex chaotic system with quaternion is proposed for the encryption of smart grid data. Firstly, we present the mathematical model of the system, and analyze its attractors, bifurcation diagram, complexity,and 0–1 test. Secondly, the pseudo-random sequences are generated by the new chaotic system to encrypt power data.Finally, the proposed encryption algorithm is verified with power data and images in the smart grid, which can ensure the encryption security and real time. The verification results show that the proposed encryption scheme is technically feasible and available for power data and image encryption in smart grid.展开更多
Objective Protein disulfide isomerase A2(PDIA2),a member of the protein disulfide isomerase family,plays a key role in the folding of nascent proteins in the endoplasmic reticulum by forming disulfide bonds,together w...Objective Protein disulfide isomerase A2(PDIA2),a member of the protein disulfide isomerase family,plays a key role in the folding of nascent proteins in the endoplasmic reticulum by forming disulfide bonds,together with enzymes such as thiol isomerase,oxidase,and reductase.This study investigated the clinical significance and potential functions of PDIA2 in glioma.Methods The expression of PDIA2 in gliomas was explored using The Cancer Genome Atlas and Gene Expression Omnibus databases.We analyzed the clinical characteristics of glioma patients and the prognostic and diagnostic value of PDIA2 expression.Kaplan-Meier and Cox regression analyses were used to examine the effect of PDIA2 expression on overall survival,progression-free interval,and disease-specific survival.Furthermore,we performed Gene Set Enrichment Analysis and immune infiltration analysis to investigate the functions of PDIA2.PDIA2 mRNA and protein expression was evaluated in cell lines and glioma tissues.Results PDIA2 was expressed at low levels in glioma patients.Kaplan-Meier survival analysis showed that glioma patients with low PDIA2 levels had a worse prognosis than those with high PDIA2 levels.Receiver operating characteristic curve analysis indicated the diagnostic and prognostic ability of PDIA2(area under the curve=0.918).Pathways associated with PD1,PI3K/AKT,cancer immunotherapy via PD1 blockade,Fceri-mediated NF-kB activation,FOXM1,and DNA repair were enriched in glioma patients with low levels of PDIA2.PDIA2 expression levels were negatively correlated with immune cell infiltrate levels.Conclusion PDIA2 levels are significantly downregulated in glioma.PDIA2 expression may be a potential biomarker for the diagnosis and prognosis of glioma patients.展开更多
A tunable dual-band terahertz absorber is designed and investigated. The unit cell of the proposed absorber consists of a graphene monolayer on a guided-mode resonant filter. The graphene absorber presents > 40% ab...A tunable dual-band terahertz absorber is designed and investigated. The unit cell of the proposed absorber consists of a graphene monolayer on a guided-mode resonant filter. The graphene absorber presents > 40% absorption at two resonance frequencies, which is attributed to the guided mode resonances with different mode numbers. The electric field intensity distribution is analyzed to disclose the physical mechanism of such a dual-band absorption effect. Furthermore,the influence of optical properties of graphene, including Fermi level and relaxation time, on the absorption spectra are investigated. Finally, the influence of geometric parameters on the absorption spectrum is studied, which will provide useful guidance for the fabrication of this absorber. We believe that the results may be useful for developing the next-generation graphene-based optoelectronic devices.展开更多
Signatures of topological superconductivity(TSC)in superconducting materials with topological nontrivial states prompt intensive researches recently.Utilizing high-resolution angle-resolved photoemission spectroscopy ...Signatures of topological superconductivity(TSC)in superconducting materials with topological nontrivial states prompt intensive researches recently.Utilizing high-resolution angle-resolved photoemission spectroscopy and first-principles calculations,we demonstrate multiple Dirac fermions and surface states in superconductor BaSn_(3) with a critical transition temperature of about 4.4 K.We predict and then unveil the existence of two pairs of type-Ⅰtopological Dirac fermions residing on the rotational axis.Type-ⅡDirac fermions protected by screw axis are confirmed in the same compound.Further calculation for the spin helical texture of the observed surface states originating from the Dirac fermions gives an opportunity for realization of TSC in one single material.Hosting multiple Dirac fermions and topological surface states,the intrinsic superconductor BaSn_(3) is expected to be a new platform for further investigation of topological quantum materials as well as TSC.展开更多
In the era of experience economy, customers do not always focus on the functional attributes of goods or services, but pay more attention to experiences. Therefore, firms have to manage to offer their customers a uniq...In the era of experience economy, customers do not always focus on the functional attributes of goods or services, but pay more attention to experiences. Therefore, firms have to manage to offer their customers a unique, memorable and valuable experience actively in the process brand establishment. With the development of mobile Internet and the use of application （APP）, the brand communication among customers and providers has been strengthened. The research purpose is to help hotel marketers figure out how to implement brand communication with brand experience of APP for hotel. It is founded that sensory brand experience design and social brand experience all have positive influence on customer brand loyalty.展开更多
Background:To systematically summarize and categorize the Chinese herbal medicine in the domestic traditional Chinese medicine(TCM)literature on type 2 diabetes mellitus(T2DM),in this paper,we mine traditional Chinese...Background:To systematically summarize and categorize the Chinese herbal medicine in the domestic traditional Chinese medicine(TCM)literature on type 2 diabetes mellitus(T2DM),in this paper,we mine traditional Chinese medicine data for relationships and provide for future practitioners and researchers.Methods:Taking randomized controlled trials on the treatment of T2DM in TCM as the research theme,we searched for full-text literature in three major clinical databases,including CNKI,Wan Fang,and VIP,published between 1990 and 2020.We then conducted frequency statistics,cluster analysis,association rules extraction,and principal component analysis based on a corpus of medical academic words extracted from 1116 research articles.Results:The most frequently used is Astragali Radix,and the most commonly used two-herb combination in T2DM treatment consisted of Coptidis Rhizoma and Moutan Cortex.Moutan Cortex,Alismatis Rhizoma,and Dioscoreae Rhizoma were the most frequently used three-herb combination.We found a“lung”and“liver”and“kidney”model and confirmed the value of classical meridian tropism theory and pattern identification.The treatment is mainly to fill deficiency and clear heat and consider water infiltration,dampness,blood circulation,and silt.Conclusion:This study provides an in-depth perspective on the TCM medication rules for T2DM and offers practitioners and researchers valuable information about the current status and frontier trends of TCM research on T2DM in terms of diagnosis and treatment.展开更多
Wound dressing management is critical in healthcare,and frequent dressing changes for full-thickness skin wounds can hinder healing.Nanofiber dressings that resemble the extracellular matrix,have gained popularity in ...Wound dressing management is critical in healthcare,and frequent dressing changes for full-thickness skin wounds can hinder healing.Nanofiber dressings that resemble the extracellular matrix,have gained popularity in wound repair,however,it is challenging to explore how to frequently change it without affecting healing processing and avoiding secondary damage.Here,we developed a self-adhesive and detachable nanofiber dressing inspired by Andrias davidianus.Our asymmetric nanofiber dressing exhibits strong adhesion(26 kPa),to the wound at high temperature(approximately 25°C)to the wound surface and can be easily detached(4 kPa)at low temperature(below 8°C),enabling painless dressing changes that minimize secondary injuries.The dressing comprises an outer layer of polylactic acid which provides mechanical property,support,and pollution resistance,with an inner layer of nanofibrous membrane,composed of gelatin and Andrias davidianus skin secretions,which promotes cellular migration,enhances wound healing and possesses inherent antimicrobial properties.Furthermore,the all-natural nanofiber dressings can be prepared on a large scale and offer favorable biocompatibility to meet the basic requirements of wound dressings.These findings demonstrate the potential applicability of our multilayer nanofiber dressing for advancing wound healing practices.展开更多
To the Editor:Insomnia affects 30%-50%of adults globally,leading to diminished quality of life and increased risks of developing physically and mentally demanding disorders.[1]Previous research,primarily in Western po...To the Editor:Insomnia affects 30%-50%of adults globally,leading to diminished quality of life and increased risks of developing physically and mentally demanding disorders.[1]Previous research,primarily in Western populations,reported the association between insomnia and poor diet quality,characterized by higher energy intake,lower vegetable consumption,and a preference for fatty foods,risk factors contributing to major chronic conditions.[2]This association,however,remains under-explored in Asian populations.展开更多
Unconventional fermions in the immensely studied topological semimetals are the source for rich exotic topological properties.Here,using symmetry analysis and first-principles calculations,we propose the coexistence o...Unconventional fermions in the immensely studied topological semimetals are the source for rich exotic topological properties.Here,using symmetry analysis and first-principles calculations,we propose the coexistence of multiple topological nodal structure in LaSb_(2),including topological nodal surfaces,nodal lines and in particular eightfold degenerate nodal points,which have been scarcely observed in a single material.Further,utilizing angle-resolved photoemission spectroscopy,we confirm the existence of nodal surfaces and eightfold degenerate nodal points in LaSb_(2).The intriguing multiple topological nodal structure might play a crucial role in giving rise to the large linear magnetoresistance.Our work renews the insights into the exotic topological phenomena in LaSb_(2).展开更多
While rich chemistry of phospholyl anions is discovered,phosphafluorenyl anions are only proposed as the critical intermediates for the synthesis of phosphafluorenes.In this article,we reported the direct synthesis of...While rich chemistry of phospholyl anions is discovered,phosphafluorenyl anions are only proposed as the critical intermediates for the synthesis of phosphafluorenes.In this article,we reported the direct synthesis of phosphafluorenyl lithiums from white phosphorus(P_(4))through direct P-C bond formation.The reaction between P4 and biphenyl dilithio reagents efficiently afforded phosphafluorenyl lithiums,which were further used to synthesize different kinds of organophosphorus compounds.The aggregation states of phosphafluorenyl lithiums were investigated for the first time.Mechanistic studies by DFT calculations revealed a cooperative nucleophilic attack of two C−Li bonds on P_(4)molecule.展开更多
Health and disaster risk reduction are important and necessary components in building a smart city,especially when climate change may increase the frequency of extreme temperatures and the health risks of urban dwelle...Health and disaster risk reduction are important and necessary components in building a smart city,especially when climate change may increase the frequency of extreme temperatures and the health risks of urban dwellers.However,limited knowledge is available about the best way to disseminate weather warnings and health protection information.This study explores the weather information acquisition patterns of the Hong Kong public and examines the sociodemographic predictors of these patterns to establish the potential public health implications of smart city development.A population-based,stratified crosssectional,random digit dialing telephone survey was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong in early 2016.Analyses were conducted based on 1017 valid samples,with a response rate of 63.6%.Cold Weather Warnings were well disseminated in Hong Kong,with 95.7% of the respondents reporting awareness of the public warnings.Television and smartphone apps were the two most important channels for weather information acquisition.Age and education level are the main social-demographic variables associated with the current utilization and future preference of smartphone technology.Among those who were not using a preferredchannel to acquire weather information,61.3% considered switching to a smartphone app.Moreover,the patterns of individual health protection measures and self-reported health impacts were significantly different between smartphone app users and non-users.Weather information dissemination should be tailored to the sociodemographic characteristics of the users.展开更多
基金supported by Fundamental Research Program of Shanxi Province(202203021222199)the Taiyuan University of Science and Technology Scientific Research Initial Funding(20222090)the National Natural Science Foundation of China(21975019).
文摘Delayed and nonhealing of diabetic wounds imposes substantial economic burdens and physical pain on patients.Mesenchymal stem cells(MSCs)promote diabetic wound healing.Particularly when MSCs aggregate into multicellular spheroids,their therapeutic effect is enhanced.However,traditional culture platforms are inadequate for the efficient preparation and delivery of MSC spheroids,resulting in inefficiencies and inconveniences in MSC spheroid therapy.In this study,a three-dimensional porous nanofibrous dressing(NFD)is prepared using a combination of electrospinning and homogeneous freeze-drying.Using thermal crosslinking,the NFD not only achieves satisfactory elasticity but also maintains notable cytocompatibility.Through the design of its structure and chemical composition,the NFD allows MSCs to spontaneously form MSC spheroids with controllable sizes,serving as MSC spheroid delivery systems for diabetic wound sites.Most importantly,MSC spheroids cultured on the NFD exhibit improved secretion of vascular endothelial growth factor,basic fibroblast growth factor,and hepatocyte growth factor,thereby accelerating diabetic wound healing.The NFD provides a competitive strategy for MSC spheroid formation and delivery to promote diabetic wound healing.
基金funded by the Huhang Nursing Research Fund of Shanghai Anticancer Association[SACA-HH202203]Fudan-Fosun Nursing Research Fund[FNF202241].
文摘目的 从医护人员的视角评价上海市已故肿瘤患者的善终质量现状,为提高安宁疗护服务水平提供科学依据。方法 采用横断面调查法,于2023年4月-7月,通过方便抽样邀请上海市2所三级医院、2所二级医院以及4所社区卫生服务中心的261名有照顾临终肿瘤患者经历的医护人员参与调查。采用一般资料问卷及基于健康照护视角的优逝量表(The Good Death Scale for Patients in China, GDS-PCN)对其进行调查。GDS-PCN包括专业照护、家人陪伴、有备无憾、平静离世、保持尊严、维持控制、躯体安适7个维度,共36个条目。每名参与调查的医护人员使用问卷评价其最近照顾的1例已故肿瘤患者的死亡情况,共评价261例已故肿瘤患者的离世情况。结果 GDS-PCN量表总分为(144.11±17.86)分,其中专业照护维度平均分最高为(4.21±0.58)分,有备无憾维度和维持控制维度得分较低,分别为(3.75±0.70)分和(3.86±0.70)分。不同医疗机构等级、病房类型、住院时间、与医护人员之间沟通(病情、治疗方案和死亡相关话题)情况、治疗方案决策类型的患者量表得分的比较,差异有统计学意义(P<0.05)。曾在社区卫生服务中心住院的患者的得分高于三级医院的患者(P<0.05);安宁疗护病房的患者得分高于非安宁疗护病房的患者(P<0.05);住院15天以上患者的得分高于住院少于3天的患者(P<0.05);与医护人员沟通部分或全部病情的患者得分高于从未沟通过的患者(P<0.05);与医护人员讨论部分、大部分或更多的治疗计划的患者得分分别高于从未讨论过治疗计划的患者(P<0.05)和仅有限沟通过治疗计划的患者(P<0.05)。与医护人员部分谈论过死亡相关话题的患者的得分高于从未谈论过的患者(P<0.05);而与家庭成员共同参与治疗决策的患者的得分高于仅家庭成员参与决策的患者(P<0.05)。结论 上海市肿瘤患者的善终情况总体处于中高等水平。提高安宁疗护资源利用、加强医护人员与患者沟通临终事宜是提高患者善终水平的有效途径。未来需开展更多的研究,从多角度探究中国患者的善终质量。
文摘Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Cancer-related Distress Management Guidelines in the context of the research site.Methods According to CAN-IMPLEMENT,the symptoms of cancer patients in Shanghai were investigated,and a work plan was formulated to adapt cancer-related distress management guidelines.The relevant clinical practice guidelines for distress management in cancer patients were searched,screened and assessed,the contents of the included clinical practice guidelines were screened,extracted and integrated,and the Cancer-related Distress Management Guidelines was developed.After peer review,the Cancer-related Distress Management Guidelines was finally formed.Results The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai.Two clinical practice guidelines related to distress management in cancer patients were included after searching,screening,assessment and selection systematically.The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II(AGREE II)were 73.75%–87.50%,respectively.The scores of most recommendations on feasibility,appropriateness,meaningfulness and effectiveness were at least 90%.The final guidelines included 13 recommendations.Conclusions The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted.The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility,suitability and effectiveness.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.AIM To predict early recurrence(ER)and overall survival(OS)in patients with HCC after radical resection using deep learning-based radiomics(DLR).METHODS A total of 414 consecutive patients with HCC who underwent surgical resection with available preoperative grayscale and contrast-enhanced ultrasound images were enrolled.The clinical,DLR,and clinical+DLR models were then designed to predict ER and OS.RESULTS The DLR model for predicting ER showed satisfactory clinical benefits[area under the curve(AUC=0.819 and 0.568 in the training and testing cohorts,respectively)],similar to the clinical model(AUC=0.580 and 0.520 in the training and testing cohorts,respectively;P>0.05).The C-index of the clinical+DLR model in the prediction of OS in the training and testing cohorts was 0.800 and 0.759,respectively.The clinical+DLR model and the DLR model outperformed the clinical model in the training and testing cohorts(P<0.001 for all).We divided patients into four categories by dichotomizing predicted ER and OS.For patients in class 1(high ER rate and low risk of OS),retreatment(microwave ablation)after recurrence was associated with improved survival(hazard ratio=7.895,P=0.005).CONCLUSION Compared to the clinical model,the clinical+DLR model significantly improves the accuracy of predicting OS in HCC patients after radical resection.
基金funded by Fudan-Fuxing Nursing Research Funds(No.FNF201701)JBI Evidence Based Clinical Fellowship Pro-gram Funds(No.FNF201861)from Hehai University,China.
文摘Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.
基金Supported by the National Natural Science Foundation of China(Nos.52109097,51979185)。
文摘China’s Bohai Bay has experienced large-scale land reclamation since 2000.These reclamation projects create a nearshore ecological imbalance and shift sediment transport by changing the tidal current.However,these tidal current changes are not comprehensively understood.In this paper,the coastline changes in Bohai Bay due to reclamation are investigated and the responses of the tidal current are calculated through numerical methods.The results show that the coastline length of the bay increases by more than 500 km from 2000 to 2015 with the largest reclamation rate of 150.9 km^(2)/a.Consequently,the current velocity changes with an uneven distribution near the reclamation due to construction masking and dike protrusion.The tidal symmetry also changes in most nearshore areas,with opposite variations in the current velocity at peak flood and ebb tide.In addition,the tide direction deflects to bypass the reclamation and is usually consistent with the coastline.Harmonic analysis of the dominant M2 tidal constituent shows that the range of the reciprocating current is widely extended.The total influence of the reclamation can reach the-8-m isobaths in Bohai Bay.Changes in the tidal current are the main causes of water environment deterioration.Therefore,the arrangement and structural optimization of reclamation projects should be considered in the future.
文摘Background: Acetylshikonin, a major constituent isolated from Arnebia euchroma, is a potential candidate for anti-colorectal cancer drugs. However, the potential activity and underlying mechanism of Acetylshikonin against colorectal cancer remain unclear. Methods: In this study, Acetylshikonin was isolated from the active CHCl3 extract of Arnebia euchroma using activity-guided screening, and elucidated by the extensive spectroscopic analysis and comparison with literature data. Human colorectal cancer cells HT29, DLD-1, HCT116 or Caco-2 were exposed to different concentrations of Acetylshikonin (6.25 - 100 μg/mL) for 24 or 48 h. Cell viability, cell apoptosis and cell cycle distribution were detected. The activity of Acetylshikonin and potential mechanism of the phosphoinositide 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway were evaluated in vitro and vivo. Results: We found that Acetylshikonin exhibited remarkable anti-proliferative activity in a dose-dependent manner against HT29 cells with the IC50 values of 60.82 μg/ml and 30.78 μg/ml at 24, 48 h, respectively. Moreover, Acetylshikonin induced cell cycle arrest at G0/G1 phase and early apoptosis through inhibition of PI3K/Akt/mTOR pathway. Furthermore, the assays of cell inhibition, early apoptosis and G0/G1 phase distribution showed that suppression of the PI3K/Akt pathway using LY294002 enhanced the anti-cancer effect of Acetylshikonin. Similarly, Acetylshikonin also decreased the growth of tumour in colorectal cancer xenografts in mice through PI3K/Akt/mTOR pathway. Conclusions: To sum up, these new findings provided a framework for further exploration of Acetylshikonin which possessed the potential antitumor activity by inhibiting PI3K/Akt/mTOR pathway.
基金Project supported by the International Collaborative Research Project of Qilu University of Technology (Grant No.QLUTGJHZ2018020)the Project of Youth Innovation and Technology Support Plan for Colleges and Universities in Shandong Province,China (Grant No.2021KJ025)the Major Scientific and Technological Innovation Projects of Shandong Province,China (Grant Nos.2019JZZY010731 and 2020CXGC010901)。
文摘With the development of smart grid, operation and control of a power system can be realized through the power communication network, especially the power production and enterprise management business involve a large amount of sensitive information, and the requirements for data security and real-time transmission are gradually improved. In this paper, a new 9-dimensional(9D) complex chaotic system with quaternion is proposed for the encryption of smart grid data. Firstly, we present the mathematical model of the system, and analyze its attractors, bifurcation diagram, complexity,and 0–1 test. Secondly, the pseudo-random sequences are generated by the new chaotic system to encrypt power data.Finally, the proposed encryption algorithm is verified with power data and images in the smart grid, which can ensure the encryption security and real time. The verification results show that the proposed encryption scheme is technically feasible and available for power data and image encryption in smart grid.
基金the Natural Science Foundation of Southwest Medical University(No.2016XNYD217,No.2018-ZRQN-032 and No.2016LZXNYD-G03)the National Natural Science Foundation of China(No.82072780)Sichuan Science and Technology Program(No.2022YFS0630).
文摘Objective Protein disulfide isomerase A2(PDIA2),a member of the protein disulfide isomerase family,plays a key role in the folding of nascent proteins in the endoplasmic reticulum by forming disulfide bonds,together with enzymes such as thiol isomerase,oxidase,and reductase.This study investigated the clinical significance and potential functions of PDIA2 in glioma.Methods The expression of PDIA2 in gliomas was explored using The Cancer Genome Atlas and Gene Expression Omnibus databases.We analyzed the clinical characteristics of glioma patients and the prognostic and diagnostic value of PDIA2 expression.Kaplan-Meier and Cox regression analyses were used to examine the effect of PDIA2 expression on overall survival,progression-free interval,and disease-specific survival.Furthermore,we performed Gene Set Enrichment Analysis and immune infiltration analysis to investigate the functions of PDIA2.PDIA2 mRNA and protein expression was evaluated in cell lines and glioma tissues.Results PDIA2 was expressed at low levels in glioma patients.Kaplan-Meier survival analysis showed that glioma patients with low PDIA2 levels had a worse prognosis than those with high PDIA2 levels.Receiver operating characteristic curve analysis indicated the diagnostic and prognostic ability of PDIA2(area under the curve=0.918).Pathways associated with PD1,PI3K/AKT,cancer immunotherapy via PD1 blockade,Fceri-mediated NF-kB activation,FOXM1,and DNA repair were enriched in glioma patients with low levels of PDIA2.PDIA2 expression levels were negatively correlated with immune cell infiltrate levels.Conclusion PDIA2 levels are significantly downregulated in glioma.PDIA2 expression may be a potential biomarker for the diagnosis and prognosis of glioma patients.
基金Project supported by the National Natural Science Foundation of China(Grant No.61405217)the Zhejiang Provincial Natural Science Foundation,China(Grant No.LY20F050001)+1 种基金the Anhui Polytechnic University Research Startup Foundation,China(Grant No.2020YQQ042)the Pre-research Project of Natural Science Foundation of Anhui Polytechnic University,China(Grant No.Xjky2020021)。
文摘A tunable dual-band terahertz absorber is designed and investigated. The unit cell of the proposed absorber consists of a graphene monolayer on a guided-mode resonant filter. The graphene absorber presents > 40% absorption at two resonance frequencies, which is attributed to the guided mode resonances with different mode numbers. The electric field intensity distribution is analyzed to disclose the physical mechanism of such a dual-band absorption effect. Furthermore,the influence of optical properties of graphene, including Fermi level and relaxation time, on the absorption spectra are investigated. Finally, the influence of geometric parameters on the absorption spectrum is studied, which will provide useful guidance for the fabrication of this absorber. We believe that the results may be useful for developing the next-generation graphene-based optoelectronic devices.
基金Supported by the National Key R&D Program of China (Grant No. 2016YFA0300204)the National Natural Science Foundation of China (Grant Nos. U2032208 and 11874264)+6 种基金the Natural Science Foundation of Shanghai (Grant No. 14ZR1447600)the starting grant of Shanghai Tech University and the Program for Professor of Special Appointment (Shanghai Eastern Scholar)supported by ME~2 project (Grant No. 11227902) from the National Natural Science Foundation of Chinasupported by the National Natural Science Foundation of China (Grant No. 11974395)the Strategic Priority Research Program of Chinese Academy of Sciences (Grant No. XDB33000000)the Center for Materials Genomethe support from Analytical Instrumentation Center,SPST,Shanghai Tech University (Grant No. SPST-AIC10112914)
文摘Signatures of topological superconductivity(TSC)in superconducting materials with topological nontrivial states prompt intensive researches recently.Utilizing high-resolution angle-resolved photoemission spectroscopy and first-principles calculations,we demonstrate multiple Dirac fermions and surface states in superconductor BaSn_(3) with a critical transition temperature of about 4.4 K.We predict and then unveil the existence of two pairs of type-Ⅰtopological Dirac fermions residing on the rotational axis.Type-ⅡDirac fermions protected by screw axis are confirmed in the same compound.Further calculation for the spin helical texture of the observed surface states originating from the Dirac fermions gives an opportunity for realization of TSC in one single material.Hosting multiple Dirac fermions and topological surface states,the intrinsic superconductor BaSn_(3) is expected to be a new platform for further investigation of topological quantum materials as well as TSC.
文摘In the era of experience economy, customers do not always focus on the functional attributes of goods or services, but pay more attention to experiences. Therefore, firms have to manage to offer their customers a unique, memorable and valuable experience actively in the process brand establishment. With the development of mobile Internet and the use of application （APP）, the brand communication among customers and providers has been strengthened. The research purpose is to help hotel marketers figure out how to implement brand communication with brand experience of APP for hotel. It is founded that sensory brand experience design and social brand experience all have positive influence on customer brand loyalty.
基金supported by China’s National Key R&D Program,NO.2019YFC1709801.
文摘Background:To systematically summarize and categorize the Chinese herbal medicine in the domestic traditional Chinese medicine(TCM)literature on type 2 diabetes mellitus(T2DM),in this paper,we mine traditional Chinese medicine data for relationships and provide for future practitioners and researchers.Methods:Taking randomized controlled trials on the treatment of T2DM in TCM as the research theme,we searched for full-text literature in three major clinical databases,including CNKI,Wan Fang,and VIP,published between 1990 and 2020.We then conducted frequency statistics,cluster analysis,association rules extraction,and principal component analysis based on a corpus of medical academic words extracted from 1116 research articles.Results:The most frequently used is Astragali Radix,and the most commonly used two-herb combination in T2DM treatment consisted of Coptidis Rhizoma and Moutan Cortex.Moutan Cortex,Alismatis Rhizoma,and Dioscoreae Rhizoma were the most frequently used three-herb combination.We found a“lung”and“liver”and“kidney”model and confirmed the value of classical meridian tropism theory and pattern identification.The treatment is mainly to fill deficiency and clear heat and consider water infiltration,dampness,blood circulation,and silt.Conclusion:This study provides an in-depth perspective on the TCM medication rules for T2DM and offers practitioners and researchers valuable information about the current status and frontier trends of TCM research on T2DM in terms of diagnosis and treatment.
基金supported by the National Natural Science Foundation of China(52273120,21975019,T2222029,and U21A20396)CAS Project for Young Scientists in Basic Research(YSBR-012)+3 种基金Incubation Foundation of Beijing Institute for Stem Cell and Regenerative Medicine(2022FH125,2023FH122)and,the China Scholarship Council(No.202206465017)the Fundamental Research Funds for the Central Universities(FRFTP-20-019A2,FRF-BR-20-03B)the Project was supported by the Science Fund of Shandong Laboratory of Advanced Materials and Green Manufacturing(Yantai)(AMGM2023F04)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDA16020802).
文摘Wound dressing management is critical in healthcare,and frequent dressing changes for full-thickness skin wounds can hinder healing.Nanofiber dressings that resemble the extracellular matrix,have gained popularity in wound repair,however,it is challenging to explore how to frequently change it without affecting healing processing and avoiding secondary damage.Here,we developed a self-adhesive and detachable nanofiber dressing inspired by Andrias davidianus.Our asymmetric nanofiber dressing exhibits strong adhesion(26 kPa),to the wound at high temperature(approximately 25°C)to the wound surface and can be easily detached(4 kPa)at low temperature(below 8°C),enabling painless dressing changes that minimize secondary injuries.The dressing comprises an outer layer of polylactic acid which provides mechanical property,support,and pollution resistance,with an inner layer of nanofibrous membrane,composed of gelatin and Andrias davidianus skin secretions,which promotes cellular migration,enhances wound healing and possesses inherent antimicrobial properties.Furthermore,the all-natural nanofiber dressings can be prepared on a large scale and offer favorable biocompatibility to meet the basic requirements of wound dressings.These findings demonstrate the potential applicability of our multilayer nanofiber dressing for advancing wound healing practices.
基金supported by grants from the Startup Grant at Hehai University(Nos.JIF201036Y and JIF201040Y).
文摘To the Editor:Insomnia affects 30%-50%of adults globally,leading to diminished quality of life and increased risks of developing physically and mentally demanding disorders.[1]Previous research,primarily in Western populations,reported the association between insomnia and poor diet quality,characterized by higher energy intake,lower vegetable consumption,and a preference for fatty foods,risk factors contributing to major chronic conditions.[2]This association,however,remains under-explored in Asian populations.
基金supported by the National Key R&D Program of China(Grant No.2023YFA1406304)the National Natural Science Foundation of China(Grant Nos.U2032208,12222413,11874264,12074181,11834006,and 12104217)+9 种基金the Natural Science Foundation of Shanghai(Grant Nos.23ZR1482200,22ZR1473300,and 14ZR1447600)the Shanghai Science and Technology Innovation Action Plan(Grant No.21JC1402000)the Open Projects from State Key Laboratory of Functional Materials for Informatics(Grant No.SKL2022)the Double First-Class Initiative Fund of Shanghai Tech Universitythe fund of Science and Technology on Surface Physics and Chemistry Laboratory(Grant No.6142A02200102)supported by ME2Project(Grant No.11227902)from the National Natural Science Foundation of Chinasupported by the National Key Projects for Research and Development of China(Grant No.2021YFA1400400)the Fundamental Research Funds for the Central Universities(Grant No.020414380185)the Natural Science Foundation of Jiangsu Province(Grant No.BK20200007)the Fok Ying-Tong Education Foundation of China(Grant No.161006)。
文摘Unconventional fermions in the immensely studied topological semimetals are the source for rich exotic topological properties.Here,using symmetry analysis and first-principles calculations,we propose the coexistence of multiple topological nodal structure in LaSb_(2),including topological nodal surfaces,nodal lines and in particular eightfold degenerate nodal points,which have been scarcely observed in a single material.Further,utilizing angle-resolved photoemission spectroscopy,we confirm the existence of nodal surfaces and eightfold degenerate nodal points in LaSb_(2).The intriguing multiple topological nodal structure might play a crucial role in giving rise to the large linear magnetoresistance.Our work renews the insights into the exotic topological phenomena in LaSb_(2).
基金supported by the National Natural Science Foundation of China(22131001,21725201,21890721)the High-performance Computing Platform of Peking University。
文摘While rich chemistry of phospholyl anions is discovered,phosphafluorenyl anions are only proposed as the critical intermediates for the synthesis of phosphafluorenes.In this article,we reported the direct synthesis of phosphafluorenyl lithiums from white phosphorus(P_(4))through direct P-C bond formation.The reaction between P4 and biphenyl dilithio reagents efficiently afforded phosphafluorenyl lithiums,which were further used to synthesize different kinds of organophosphorus compounds.The aggregation states of phosphafluorenyl lithiums were investigated for the first time.Mechanistic studies by DFT calculations revealed a cooperative nucleophilic attack of two C−Li bonds on P_(4)molecule.
基金co-funded by the Chinese University of Hong Kong (CUHK) Focused Innovations Scheme–Scheme A: Biomedical Sciences (Phase 2) and the CUHK Climate Change and Health research project fund
文摘Health and disaster risk reduction are important and necessary components in building a smart city,especially when climate change may increase the frequency of extreme temperatures and the health risks of urban dwellers.However,limited knowledge is available about the best way to disseminate weather warnings and health protection information.This study explores the weather information acquisition patterns of the Hong Kong public and examines the sociodemographic predictors of these patterns to establish the potential public health implications of smart city development.A population-based,stratified crosssectional,random digit dialing telephone survey was conducted among the Cantonese-speaking population aged over 15 years in Hong Kong in early 2016.Analyses were conducted based on 1017 valid samples,with a response rate of 63.6%.Cold Weather Warnings were well disseminated in Hong Kong,with 95.7% of the respondents reporting awareness of the public warnings.Television and smartphone apps were the two most important channels for weather information acquisition.Age and education level are the main social-demographic variables associated with the current utilization and future preference of smartphone technology.Among those who were not using a preferredchannel to acquire weather information,61.3% considered switching to a smartphone app.Moreover,the patterns of individual health protection measures and self-reported health impacts were significantly different between smartphone app users and non-users.Weather information dissemination should be tailored to the sociodemographic characteristics of the users.
