The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

Spousal Involvement in the Workplace of Doctors: What Is Defined as Appropriate or Inappropriate

Background: Workers spend a significant amount of time in the workspace. Involvement of a spouse in a doctor’s workplace can take different forms and come with different intentions. Objectives: The survey aimed to determine the prevalence and extent of spousal involvement in physicians’ workplaces as well as the outcome of such involvement on doctor’ swell-being, productivity, and relationship with colleagues. Methods: This cross-sectional online survey on spousal involvement in the workplace of doctors was conducted among 83 responding doctors from July to August 2023. Results: Among the respondents, 60 (72.3%) had witnessed a doctor’s spouse being involved in the workplace. The most common reason for spousal involvement in the workplace was to protect the spouse from what they perceived as a threat 34 (54.0%). Spouse’s ignorance of boundaries in the workplace (OR: 6.09 (95% CI: 1.70, 21.79) P: 0.003) and exertion of control by the spouse (OR: 11.2 (95% CI: 2.26, 56.41) P: 0.002) were significantly associated with higher odds of inappropriate spousal involvement in the workplace, while expression of love for spouse with acts of kindness was significantly associated with a lowered odd of inappropriate spousal involvement (OR: 0.11 (95% CI: 0.03, 0.36) P: 0.0001). Conclusion: Spousal involvement in the workplace is relatively common. Ignorance of the boundaries of the workplace and exertion of control by the spouse were significant enablers of inappropriate spousal involvement in the workplace of doctors. The establishment of workplace policies that define the limits of spousal involvement in the doctor’s workplace can foster a healthy workspace environment, enhance doctors’ well-being, and improve patient care.

Corrigendum:Sorl1 knockout inhibits expression of brain-derived neurotrophic factor:involvement in the development of late-onset Alzheimer’s disease

https://doi.org/10.4103/1673-5374.393108 In the article titled“Sorl1 knockout inhibits expression of brain-derived neurotrophic factor:involvement in the development of late-onset Alzheimer’s disease”,published on pages 1602-1607,Issue 7,Volume 19 of Neural Regeneration Research(Zhao et al.,2024),the first author’s affiliations were incorrectly tagged.

Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy

BACKGROUND The use of neoadjuvant therapy(NAT)in distal cholangiocarcinoma(dCCA)with regional arterial or extensive venous involvement,is not widely accepted and evidence is sparse.AIM To synthesise evidence on NAT for dCCA and present the experience of a highvolume tertiary-centre managing dCCA with arterial involvement.METHODS A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT.All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database.Baseline characteristics,NAT type,progression to surgery and oncological outcomes were collected.RESULTS Twelve studies were included.The definition of“unresectable”locally advanced dCCA was heterogenous.Four studies reported outcomes for 9 patients who received NAT for dCCA with extensive vascular involvement.R0 resection rate ranged between 0 and 100%but without survival benefit in most cases.Remaining studies considered either NAT in resectable dCCA or inclusive with extrahepatic CCA.The presented case series includes 9 patients(median age 67,IQR 56-74 years,male:female 5:4)referred for NAT for borderline resectable or locally advanced disease.Three patients progressed to surgery and 2 were resected.One patient died at 14 months with evidence of recurrence at 6 months and the other died at 51 months following recurrence 6 months postoperatively.CONCLUSION Evidence for benefit of NAT is limited.Consensus on criteria for uniform definition of resectability for dCCA is required.We propose using the established National-Comprehensive-Cancer-Network®criteria for pancreatic ductal adenocarcinoma.

Shared decision making in rural general practices:a qualitative exploration of older rural South Australians'perceived involvement in clinical consultations with doctors

Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.

Safety Evaluation and Improvement of Homestays from the Perspective of Tourists’Perception: A Case Study of Tangjiajia Hot Spring Village in Nanjing

Safety is one of the basic needs of tourists,and their sense of security is a necessary condition for the successful operation of homestays.Based on the theory of tourist perception,Nanjing Tangjiajia Hot Spring Village is taken as the research object.This paper analyzes the tourists’perception of homestay safety facilities and services through questionnaire survey,field investigation,interview,and other methods.It proposes strategies for improving homestay safety,aiming to provide safety management references for China’s homestay industry and promote its sustainable development.

Determinants of Occipital Involvement in Males and Females with Pattern Hair Loss: A Retrospective Study

Background: Pattern hair loss (PHL) is the most common form of hair loss affecting both men and women. The occipital region, located at the back of the scalp, has been considered resistant to hair loss in PHL. It is often used as a donor site for hair transplantation procedures. However, evidence suggests that the occipital region may also be affected by PHL, although to a lesser extent compared to the frontal and vertex regions. Objective: To assess the levels and determinants of occipital involvement in PHL, focusing on gender and disease severity. Such data would enhance the comprehensive understanding of PHL progression and inform development of improved treatment strategies. Methods: This retrospective study involved 1993 adults (1000 males, 993 females) following for PHL at a specialized hair clinic in Jeddah, Saudi Arabia. Any patient who had hair transplantation in the past and any male who had balding areas (Hamilton-Norwood scales 4 to 7) at the initial consultation was excluded. The primary outcome was occipital involvement, defined as >10% thin hairs in the trichometry assessments of the occipital region. Additional data included patients age, treatment status, disease severity, and other trichometry parameters. Results: The prevalence of occipital involvement was found to be 23.8% overall, significantly more frequent in females (35.6%) than males with early PHL (Hamilton-Norwood scales 2 and 3) (12.1%) (p Conclusion: This study underscored the relevance of gender and disease severity in occipital involvement in PHL. Females had significantly higher rates of occipital involvement, suggesting that gender differences are critical in understanding PHL progression. Future research should aim to validate these findings, with an aim to refine therapeutic and surgical approaches to improve patient outcomes.

How Sense of Ritual in Tourism Impacts Tourists’Co-Creation of Tourism Experience Values:A Study Based on the Theory of Value Co-Creation

Establishing a sense of ritual within tourism consumption scenarios offers tourists the opportunity for interactive engagement.Drawing upon the value co-creation theory,this study constructed an influence mechanism model to examine tourists'active engagement in the process of co-creating tourism experience values.It employed Partial Least Squares Structural Equation Modeling(PLS-SEM)to empirically test the proposed hypotheses.The findings demonstrate that the model constructed in the present study exhibits robust reliability,validity,and explanatory power.The perception of the sense of ritual in tourism exerts a significant positive influence on tourists’co-creation of tourism experience values,thereby significantly enhancing both the communitas and flow experienced by tourists during their travels.Moreover,such communitas and flow can mediate the influence of the sense of ritual in tourism on tourists’co-creation of tourism experience values.This study contributes to advancing the current research on tourists’co-creation of tourism experience values and the sense of ritual in tourism,thereby providing theoretical foundations for cultivating a sense of ritual within tourism consumption scenarios.

Experienced Involvement (ExIn) in Social-Psychiatric Care of Germany-Challenges and Chances

This study explores the integration of Experienced Involvement(ExIn)in social-psychiatric care in Germany,emphasizing both the challenges and opportunities it presents.The European Leonardo da Vinci Project(2005-2007)established a curriculum for ExIn,promoting participatory structures in psychiatric services.While peer support is well-established in other European countries,Germany’s experience is still developing.This research uses a mixed methods design,combining quantitative surveys and qualitative interviews,to investigate the professional experiences of ExIn recovery companions and team colleagues in German clinics and support services.The findings reveal numerous benefits:for social-psychiatric services,ExIn enhances service quality,inclusivity,and accessibility;for team colleagues,it fosters reflexivity,hope,and trust,and improves self-care;for service users,it provides empowerment,easy access to support,trust,and hope,and offers credible role models.Despite these benefits,challenges such as stigmatization,lack of recognition,and financial constraints remain and require to be addressed.The study highlights the need and provides implications for a dedicated and inclusive approach to effectively implementing ExIn,ultimately enriching psychiatric care through experiential knowledge and reducing prejudice within mental health services.

Involvement Load Hypothesis and Senior Middle School Students' Vocabulary Retention

The purpose of the paper is to study retention of vocabulary acquired incidentally on task-induced involvement by senior middle school students. Grade two of senior middle students participated in the experiments, testing whether retention of vocabulary acquired incidentally is contingent on amount of task-induced involvement.Using short-and long term, namely immediate posttest and delayed posttest, retention of twelve unfamiliar words was investigated in three learning tasks (reading, reading plus fill-in and writing) with varying degrees of “involvement load”- various combinations of need, search and evaluation. The results of the experiment partially support the Involvement Load Hypothesis: retention in the writing group was higher than that in the reading plus fill-in group; retention in the reading plus fill-in group was higher than that in the reading group. The results are discussed in light of the construct of task-induced involvement.

Investigation on Tourists' Satisfaction Degree in Xionger Mountain of Shandong Province

Through the field investigation in Xionger Mountain,it was found that the scenic area is rich in tourism resources.However,the development of tourism is lagging behind.By the method of random sampling,a survey for visitors was conducted.A total of 100 questionnaires were issued,100 of which were valid.With the help of TSI evaluating model,tourists' satisfaction degree was calculated accurately.The results showed that ratio of tourism performance to price in Xionger Mountain wasn't high,of which tourists generally expressed dissatisfaction;that the overall environment was quite good,of which tourists showed higher satisfaction degree;that some tourists' expectations to this scenic area were not high;that revisit willing was comparatively high;that there was a certain gap compared with other scenic spot.Tourists' satisfaction degree on Xionger Mountain is 55.89% through calculating TSI index.Finally,aiming at the existent problems,some countermeasures for improving the tourists' satisfaction degree on Xionger Mountain were put forward from the aspects of tour value,environmental perception,marketing philosophy and modes.

Study on Consumer Behaviors of Tourists in Rural Areas of Liaoning Province

This study takes Liaoning Province for an example,investigates and analyzes a series of consumer decision behaviors of tourists in rural tourist sites,such as need recognition,data collection,purchase decision,summarizes law of tourists' behaviors,points out internal interaction between tourists' behaviors and demography features,proposes improvement measures for promoting the sustainable development of rural tourism.

Study on Ecological Footprint of Sightseeing Tourists and Vacation Tourists in Sanya City

Based on the theory of ecological footprint and tourists' consumption structure, the model of tourist ecological footprint was divided into six sub-models including catering, accommodation, shopping, sightseeing, shopping and entertainment, and ecological footprint of sightseeing tourists and vacation tourists in Sanya City was analyzed. The result showed that per capita ecological footprint of vacation tourists was higher than that of sightseeing tourists in Sanya City. The influential factor of the two kinds of tourists was slightly different in their proportion of sightseeing and entertainment factors. In the future, it should advocate sightseeing tourists to rationally make use of ecological resources, vacation tourists to have a healthy and ecological holiday, so as to ensure sustainable development of tourism.

Behavior Characteristics of Tourists and Detailed Classification of Tourist Source Market in Liuxihe National Forest Park

On the basis of questionnaires and field investigation,behavior characteristics of tourists in Liuxihe National Forest Park were analyzed,and the results showed that tourists in the study area mainly come from the Pearl River Delta for sightseeing,mostly 21-45 years old,with higher revisit rate but less residence time.And meanwhile,key tourist source markets of Liuxihe National Forest Park were classified on the basis of spatial distance features,social and economic features,and behavior characteristics of tourists,specifically,The Pearl River Delta Sightseeing Tourist Market,The Pearl River Delta Vacationing Tourist Market,The Pearl River Delta Business Tourist Market,and The Pearl River Delta Special-interest Tourist Market.Moreover,corresponding development strategies were proposed according to actual conditions of each market.

Marketing Strategies Based on Tourists' Satisfaction on Rural Tourism in Suzhou City of China

To further promote rural tourism brand of Suzhou and enhance its competitiveness,tourist source market of rural tourism in Suzhou City was analyzed through questionnaire survey from the perspectives of demographic features and behavioral characteristics of tourists.Moreover,significance of service items and tourists' satisfaction on these items were investigated from the perspectives of scenic area management,traffic conditions,accommodation services,hygienic conditions,commodity price,infrastructure,guide services,food and recreational activities.Through sorting out statistics obtained in the investigation,corresponding marketing strategies were proposed.First,orientation of rural tourism market should be defined,local tourist source market taken as the principal one,especially tourists from the middle-class and upper-class.Second,rural cultural connotations should be further explored to build villages of dominant cultures and bring new ideas to traditional festivals.Third,integrated marketing should be introduced to the promotion of rural tourism,marketing channels further integrated,and online marketing of rural tourism enhanced.

Study on Tourism Decision-making Pattern of European Tourists in China——With European Tourists in Xi’an City as a Study Case

With the inbound tourism market data supported by National Natural Science Foundation of China as the basis, this study through researching the tourism decision-making behaviors of inbound tourists, adopting questionnaire survey among European tourists in Xi'an City, analyzed their tourism decision behaviors and influencing factors, and aimed to propose pertinent suggestions for the expansion of European tourist market for Xi'an City.

二语词汇间接学习与认知加工层次——评Laufer和Hulstijn的“Task-Induced Involvement”建构的提出

以Craik和Lockhart(1 972 )的认知加工层次理论为理论框架对二语词汇间接学习的必要性进行了详尽阐述。但由于认知加工层次不宜观察 ,难以操作、测量 ,间接学习也有其局限性。因此 ,依据Laufer和Hulstijn(2 0 0 1 )的“任务诱导型参与活动”建构 。

二语词汇伴随性学习与“Task-Induced Involvement”建构

本文以认知加工层次理论为理论框架 ,对二语词汇伴随性学习的必要性和局限性进行了详尽的阐述。但由于认知加工层次理论不宜观察、难以操作、无法测量 ,因此 L aufer & Hulstijn提出了“任务诱导型参与活动”建构 ,作者依据该建构对二语词汇伴随性学习理论进行了一些新的探讨。

Pulmonary involvement and allergic disorders in inflammatory bowel disease

Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.

Crohn's disease with gastroduodenal involvement: Diagnostic approach

Crohn's disease(CD) is a chronic idiopathic inflammatory disease of gastrointestinal tract characterizedby segmental and transmural involvement of gastrointestinal tract. Ileocolonic and colonic/anorectal is a most common and account for 40% of cases and involvement of small intestine is about 30%. Isolated involvement of stomach is an extremely unusual presentation of the disease accounting for less than 0.07% of all gastrointestinal CD. To date there are only a few documented case reports of adults with isolated gastric CD and no reports in the pediatric population. The diagnosis is difficult to establish in such cases with atypical presentation. In the absence of any other source of disease and in the presence of nonspecific upper gastrointestinal endoscopy and histological findings, serological testing can play a vital role in the diagnosis of atypical CD. Recent studies have suggested that perinuclear anti-neutrophil cytoplasmic antibody and anti-Saccharomycescervisia antibody may be used as additional diagnostic tools. The effectiveness of infliximab in isolated gastric CD is limited to only a few case reports of adult patients and the long-term outcome is unknown.