中国上海市医护人员对肿瘤患者善终现状评价的调查研究

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。

Data encryption based on a 9D complex chaotic system with quaternion for smart grid

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.

Coastline changes and tidal current responses due to the large-scale reclamations in the Bohai Bay

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.

Protein Disulfide Isomerase A2 Is Correlated with Immune Infiltrates and Is a Novel Prognostic Biomarker in Glioma Patients

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.

Exploring medication rules in Chinese randomized controlled trials of type 2 diabetes based on data mining technology

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.

Deep learning-based radiomics based on contrast-enhanced ultrasound predicts early recurrence and survival outcome in hepatocellular carcinoma

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.

Acetylshikonin Inhibits Colorectal Cancer Growth via PI3K/Akt/mTOR Signaling Pathway

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.

Photoemission Spectroscopic Evidence of Multiple Dirac Cones in Superconducting BaSn_(3)

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.

Experimental observation of multiple topological nodal structure in LaSb_(2)

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).

Intracranial activity of first-line immune checkpoint inhibitors combined with chemotherapy in advanced non-small cell lung cancer

Background:Immune checkpoint inhibitors(ICIs)are increasingly used as first-line therapy for patients with advanced non-small cell lung cancer(NSCLC)harboring no actionable mutations;however,data on their efficacy among patients presenting with intracranial lesions are limited.This study aimed to explore the efficacy and safety of ICIs combined with chemotherapy in advanced NSCLC patients with measurable brain metastasis at initial diagnosis.Methods:Our study retrospectively analyzed clinical data of a total of 211 patients diagnosed with driver gene mutation-negative advanced NSCLC with measurable,asymptomatic brain metastasis at baseline from Hunan Cancer Hospital between January 1,2019 and September 30,2021.The patients were stratified into two groups according to the first-line treatment regimen received:ICI combined with chemotherapy(n=102)or chemotherapy(n=109).Systemic and intracranial objective response rates(ORRs)and progression-free survival(PFS)were analyzed.Adverse events were also compared between the groups.Results:Compared with the chemotherapy-based regimen,the ICI-containing regimen was associated with a significantly higher intracranial(44.1%[45/102]vs.28.4%[31/109],χ^(2)=5.620,P=0.013)and systemic(49.0%[50/102]vs.33.9%[37/109],χ^(2)=4.942,P=0.019)ORRs and longer intracranial(11.0 months vs.7.0 months,P<0.001)and systemic(9.0 months vs.5.0 months,P<0.001)PFS.Multivariable analysis consistently revealed an independent association between receiving ICI plus platinum-based chemotherapy as a first-line regimen and prolonged intracranial PFS(hazard ratio[HR]=0.52,95%confidence interval[CI]:0.37-0.73,P<0.001)and systemic PFS(HR=0.48,95%CI:0.35-0.66,P<0.001).No unexpected serious adverse effects were observed.Conclusion:Our study provides real-world clinical evidence that ICI combined with chemotherapy is a promising first-line treatment option for driver gene mutation-negative advanced NSCLC patients who present with brain metastasis at initial diagnosis.Clinical trial registration:https://www.clinicaltrials.gov/,OMESIA,NCT05129202.

Investigation of the room-temperature photoelectron spectroscopy of type-Ⅱ Weyl semimetal candidate WTe_(2)

Layered transition metal dichalcogenides have novel physical properties and great potential for applications.Among them,WTe2,which has an extremely large unsaturated magnetoresistance and is theoretically predicted to be a type-Ⅱ Weyl semimetal,has been extensively studied.Here,we systematically probe the electronic structure of WTe_(2) at room temperature using high-resolution angle-resolved photoelectron spectroscopy(ARPES).We find that temperature-driven chemical potential shift and Lifshitz transition,which is equivalent to low-energy band structures shift downward by around 50 meV,compared to the results at low temperatures.Our ARPES experimental results match well with previous theoretical calculations,implying the possible existence of type-Ⅱ Weyl points near the Γ-X axis.Also,as expected,there exists a dominantly electron-like Fermi surface instead of the one with compensated electrons and holes.Meanwhile,our ARPES results show that the flat band(FB) lying below the Fermi level(EF) becomes closer to the Fermi level at room temperature,which might start to dominate the transport behavior and lead to the disappearance of the unsaturated giant magnetoresistance effect.These findings not only reveal the electronic structure features of WTe_(2) at room temperature,but also provide new insights into the development of room-temperature topological quantum devices.

Porous nanofibrous dressing enables mesenchymal stem cell spheroid formation and delivery to promote diabetic wound healing

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.

镍污染土壤植物采矿技术关键过程及其研究进展

植物采矿是利用超积累植物高量吸收土壤中的重金属,并从中提取、冶炼金属产品,在修复污染土壤的同时实现金属的资源化。全世界广泛分布着自然风化的镍污染土壤,植物采矿因其重要的环境、生态及资源价值,被作为一种环境友好且具备经济效益的土壤修复技术,在此类地区具有广阔的应用前景。该植物采矿技术关键过程主要包括超积累植物镍高选择性根际环境响应、植物镍高效吸收转运以及生物质中镍高附加值资源化等过程。近30年,污染土壤中镍的植物采矿已经在美国、阿尔巴尼亚、马来西亚等多个国家进行了野外实践,取得了良好效果。然而,相关技术在我国的研究与应用仍然处于起步阶段。文中通过综述植物采矿技术的关键过程的研究进展,发现其中的瓶颈,为接下来植物采矿的科学研究和技术在全世界推广提供理论基础和技术指导。

Weather Information Acquisition and Health Significance during Extreme Cold Weather in a Subtropical City:A Crosssectional Survey in Hong Kong

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.

Robust and accurate terahertz time-domain spectroscopic ellipsometry

In this work, we show how fiber-based terahertz systems can be robustly configured for accurate terahertz ellipsometry. To this end, we explain how our algorithms can be successfully applied to achieve accurate spectroscopic ellipsometry with a high tolerance on the imperfect polarizer extinction ratio and pulse shift errors. Highly accurate characterization of transparent, absorptive, and conductive samples comprehensively demonstrates the versatility of our algorithms. The improved accuracy we achieve is a fundamental breakthrough for reflectionbased measurements and overcomes the hurdle of phase uncertainty.

Long-Term and Immediate Impacts of Health Emergency and Disaster Risk Management(Health-EDRM) Education Interventions in a Rural Chinese Earthquake-Prone Transitional Village

Ma'an Qiao Village, a Dai and Yi ethnic minority-based community in Sichuan Province, China sustained complete infrastructure devastation during the 2008 Panzhihua earthquake. Health emergency and disaster risk management(Health-EDRM) education intervention programs were implemented in 2010 and 2011. This serial cross-sectional survey study aimed to examine the immediate and long-term impacts of the Health-EDRM interventions in this remote rural community. The findings demonstrate knowledge improvement in areas of water and sanitation, food and nutrition, and disaster preparedness immediately after the Health-EDRM education interventions. Temporal stability of knowledge retention was observed in household hygiene and waste management and smoking beliefs in 2018, 7 years after the interventions.Other important findings include knowledge uptake pattern differences of oral rehydration solution(ORS) between earthquake-prone and flood-prone communities. Usage of Internet and mobile technology for accessing disaster-related information was found to be independent of gender and income. Overall, this study demonstrated the knowledge improvement through Health-EDRM education interventions in a remote rural community. Promoting behavioral changes through interventions to raise awareness has the potential to reduce health risks in transitional post-disaster settings. Future programs should aim to identify evidence-based practices and explore how technology can support Health-EDRM education among vulnerable subgroups.

Risk Perception and Knowledge in Fire Risk Reduction in a Dong Minority Rural Village in China: A Health-EDRM Education Intervention Study

Fire is one of the major disasters in rural communities but evidence of the effectiveness of education interventions against fire risks is limited. This was a 2-year study assessed the effectiveness of face-to-face Health Emergency and Disaster Risk Management(HealthEDRM) education interventions for raising fire risk reduction knowledge in a fire-prone rural ethnic minority community. The study was conducted in various pre-set time points of an intervention-based project in a Dongbased community in Nanjiang Village, Guizhou Province in 2015 and 2016 to increase knowledge among the villagers about how to reduce general-and electrical-fire risks. Pre-and post-intervention questionnaires were used to evaluate the effectiveness of increasing fire risk-related knowledge through these interventions, immediately after the 2015 and 2016 interventions, and 17 months after the 2015 intervention. The knowledge of using fire blanket,recalling the correct emergency telephone number,unplugging unused electrical appliances, and not using water to extinguish electrical fires had immediately improved after the interventions. Subjects demonstrated a better understanding that fire blankets can fight a blaze if used appropriately, and that knowledge was sustained for 17 months. The interventions were effective in improving fire prevention and response knowledge. Targeted interventions should be organized according to communities' culture, the evolution of economic prosperity and lifestyle practices.

Myc inhibition tips the immune balance to promote antitumor immunity

Aberrant expression of Myc is one of the most common oncogenic events in human cancers.Scores of Myc inhibitors are currently under development for treating Myc-driven cancers.In addition to directly targeting tumor cells,Myc inhibition has been shown to modulate the tumor microenvironment to promote tumor regression.However,the effect of Myc inhibition on immune cells in the tumor microenvironment remains poorly understood.Here,we show that the adaptive immune system plays a vital role in the antitumor effect of pharmacologic inhibition of Myc.Combining genetic and pharmacologic approaches,we found that Myc inhibition enhanced CD8 T cell function by suppressing the homeostasis of regulatory T(Treg)cells and the differentiation of resting Treg(rTreg)cells to activated Treg(aTreg)cells in tumors.Importantly,we demonstrated that different Myc expression levels confer differential sensitivity of T cell subsets to pharmacologic inhibition of Myc.Although ablation of the Myc gene has been shown to suppress CD8 T cell function,Treg cells,which express much less Myc protein than CD8 T cells,are more sensitive to Myc inhibitors.The differential sensitivity of CD8 T and Treg cells to Myc inhibitors resulted in enhanced CD8 T cell function upon Myc inhibition.Our findings revealed that Myc inhibitors can induce an antitumor immune response during tumor progression.

Phosphafluorenyl lithiums:direct synthesis from white phosphorus,structure and diversified synthons

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.