ChemInform Research Articles

The real ethical issues with AI for clinical psychiatry

This article explores the ethical issues arising from ordinary AI applications currently used in mental health care, rather than speculative future scenarios. AI tools are already in use for a variety of purposes, including data collection for screening and intake, documentation, decision support, non-clinical support, and, in limited cases, adjunctive treatment. After reviewing the range of and distinctions between those applications, including when those distinctions become blurred, the article discusses selected ethical considerations. The use of AI in psychiatry raises issues related to reflective practice, the seductive allure of AI, varieties of bias, data security, and liability. These examples highlight how seemingly simple AI applications can still present significant ethical implications, suggesting practical considerations for clinicians, professional organizations, treatment organizations, training programs, and policymakers.

Virtual multimodal hub for patients undergoing major gastrointestinal cancer surgery (PRIORITY-CONNECT 2 Pilot) - A pilot randomised type I hybrid effectiveness-implementation trial

BackgroundThe PRIORITY-CONNECT 2 pilot trial will establish the feasibility and acceptability of a virtual multimodal programme following gastrointestinal cancer surgery. The secondary aims are to obtain pilot data on the likely difference in key outcomes, data elements that will guide future implementation studies, and to identify barriers and facilitators that inform the development and execution of a substantive randomised clinical effectiveness trial of teleprehabilitation/rehabilitation. MethodsThis is a multicentre, assessor-blinded, pilot, randomised controlled trial utilising a Hybrid Type I effectiveness-implementation design. 20 participants undergoing major gastrointestinal cancer surgery will be randomised (1:1 allocation) to attend a virtual multimodal prehabilitation-rehabilitation hub (intervention group), delivered before (1–6 weeks) and after (up to 3 months) surgery plus usual care, or to usual care alone (control group). An individualised intervention will be delivered by an experienced multidisciplinary team including a physiotherapist, psychologist, dietitian, nurse, social worker, and a geriatrician. Outcomes will be collected at baseline, 1–2 days before surgery, during the hospital stay, day of discharge from hospital, and 3 months postoperatively. The primary outcomes will be feasibility and acceptability of the virtual multimodal hub. Secondary outcomes assess the rate of postoperative complications within 30 days after surgery, quality of life, the number of days at home within 30 and 90 days after surgery, healthcare use, and implementation outcomes. DiscussionThe PRIORITY-CONNECT 2 pilot trial will generate findings about the feasibility and acceptability of delivering an evidence-based virtual multimodal preoperative (prehabilitation) and postoperative (rehabilitation) intervention targeting patients having major gastrointestinal cancer surgery. Trial registrationThis trial was registered prospectively with the National Library of Medicine ClinicalTrials.gov Registry (NCT06212700) on 8th January 2024.

Information needs in patients with potentially curable gastro-esophageal cancer.

Gastro-esophageal cancer patients' information needs remain understudied, despite their complex treatment trajectories. This study examined the (i) information needs of patients with or without postoperative complications, (ii) information needs of male and female patients, and (iii) the association between information needs and health-related quality of life (HR-QoL) following gastro-esophageal cancer surgery. Patients completed the EORTC-QLQ-INFO25, QLQ-C30, and QLQ-OG25 questionnaires before and after curative surgery. Five information-needs domains were investigated: information about the disease, about treatments, about medical tests, about things patients can do to help themselves, and overall helpfulness. Additionally, HR-QoL domains global health status, eating restrictions, and anxiety were explored. 132 patients completed the questionnaires at baseline, 216 patients at 6-12 months, 184 patients at 18-24 months, and 163 patients at 3-5 years post-operation. There were no significant differences in information needs between patients with or without complications or between male and female patients. Patients with a higher global health status found the information more helpful at 6-12 months (p<0.001), 18-24 months (p<0.001), and 3-5 years (p<0.001) postoperatively, as did patients who experienced more anxiety at 18-24 months (p=0.009) and 3-5 years (p<0.001). Gastro-esophageal cancer patients, regardless of sex or postoperative complications, have consistent information needs; yet, those with higher global health status and elevated anxiety levels find the information particularly helpful, emphasizing the importance of tailored communication strategies.

An artificial intelligence-based nerve recognition model is useful as surgical support technology and as an educational tool in laparoscopic and robot-assisted rectal cancer surgery.

Artificial intelligence (AI) has the potential to enhance surgical practice by predicting anatomical structures within the surgical field, thereby supporting surgeons' experiences and cognitive skills. Preserving and utilising nerves as critical guiding structures is paramount in rectal cancer surgery. Hence, we developed a deep learning model based on U-Net to automatically segment nerves. The model performance was evaluated using 60 randomly selected frames, and the Dice and Intersection over Union (IoU) scores were quantitatively assessed by comparing them with ground truth data. Additionally, a questionnaire was administered to five colorectal surgeons to gauge the extent of underdetection, overdetection, and the practical utility of the model in rectal cancer surgery. Furthermore, we conducted an educational assessment of non-colorectal surgeons, trainees, physicians, and medical students. We evaluated their ability to recognise nerves in mesorectal dissection scenes, scored them on a 12-point scale, and examined the score changes before and after exposure to the AI analysis videos. The mean Dice and IoU scores for the 60 test frames were 0.442 (range 0.0465-0.639) and 0.292 (range 0.0238-0.469), respectively. The colorectal surgeons revealed an under-detection score of 0.80 (± 0.47), an over-detection score of 0.58 (± 0.41), and a usefulness evaluation score of 3.38 (± 0.43). The nerve recognition scores of non-colorectal surgeons, rotating residents, and medical students significantly improved by simply watching the AI nerve recognition videos for 1min. Notably, medical students showed a more substantial increase in nerve recognition scores when exposed to AI nerve analysis videos than when exposed to traditional lectures on nerves. In laparoscopic and robot-assisted rectal cancer surgeries, the AI-based nerve recognition model achieved satisfactory recognition levels for expert surgeons and demonstrated effectiveness in educating junior surgeons and medical students on nerve recognition.

Pediatric asthma knowledge: Insights from a Portuguese central hospital study.

Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants. We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1). The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores. In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.

Dedication to Polymer Science &amp; Engineering Research and Education at UMass Amherst

Dedication to Polymer Science &amp; Engineering Research and Education at <scp>UMass</scp> Amherst

Combination of anti-thymocyte globulin with post-transplant cyclophosphamide for GVHD prophylaxis in patients undergoing haploidentical hematopoietic stem cell transplantation: systematic review and meta-analysis

Haploidentical stem cell transplantation (haplo-HSCT) is associated with higher incidences of graft-versus-host disease (GVHD). A new strategy combining anti-thymocyte globulin with post-transplant cyclophosphamide (ATG/PTCy) for GVHD prevention has been developed, but its benefits and risks remain unclear. This study aims to performs a systematic review and meta-analysis of studies comparing ATG/PTCy with ATG or PTCy in patients with hematological malignancies undergoing haplo-HSCT. Literature search was performed in databases including Ovid Medline, Embase, Cochrane Library and China Biology Medicine (CBM). Two investigators independently screened eligible studies and extracted data. Meta-analysis was conducted with Review Manager version 5.4, pooled hazard ratios (HRs) for time-to-event outcomes were obtained using generic inverse-variance method, and pooled risk ratios (RRs) for dichotomous data were obtained using Mantel-Haenszel method. Fixed-effects model was adopted if there is no significant heterogeneity. The primary outcome is incidence of acute GVHD. Literature search and study selection identified 14 eligible studies, including both 1 randomized controlled trial and 13 retrospective comparative studies. Different dosage adjustment strategies were applied, the total dose is 2.5-10 mg/kg for ATG and 29-100 mg/kg for PTCy. Meta-analysis results suggest that ATG/PTCy is associated with significantly lower risk of grade II-IV acute GVHD compared with ATG (RR 0.52; 95% CI: 0.41-0.65; P < 0.00001) and PTCy (RR 0.53; 95% CI: 0.34-0.83; P = 0.005) without increasing risk of disease relapse. In addition, ATG/PTCy is associated with significantly lower risk of grade III-IV acute GVHD (RR 0.33; 95% CI: 0.23-0.49; P < 0.00001) and chronic GVHD (RR 0.65; 95% CI: 0.51-0.81; P = 0.0002) in comparison with ATG. Further analyses suggest that ATG/PTCy is associated with significantly better overall survival and GVHD-free/relapse-free survival than ATG and PTCy, but the risks of CMV (RR 1.42; 95% CI: 1.03-1.95; P = 0.03) and EBV (RR 3.17; 95% CI: 1.61-6.23; P = 0.0008) reactivation are higher when compared with PTCy. Our results suggest that combination of ATG with PTCy for GVHD prevention in haplo-HSCT is associated with improved efficacy but higher risk of infection. Future researches are required to further establish the benefits and risks of ATG/PTCy and determine the optimal dosage adjustment strategies.

Evaluation of the risk prediction model of pressure injuries in hospitalized patient: A systematic review and meta-analysis.

The main aim of this study is to synthesize the prevalent predictive models for pressure injuries in hospitalized patients, with the goal of identifying common predictive factors linked to pressure injuries in hospitalized patients. This endeavour holds the potential to provide clinical nurses with a valuable reference for providing targeted care to high-risk patients. Pressure injuries (PIs) are a frequently occurring health problem throughout the world. There are mounting studies about risk prediction model of PIs reported and published. However, the prediction performance of the models is still unclear. Systematic review and meta-analysis: The Cochrane Library, PubMed, Embase, CINAHL, Web of Science and Chinese databases including CNKI (China National Knowledge Infrastructure), Wanfang Database, Weipu Database and CBM (China Biology Medicine). This systematic review was conducted following PRISMA recommendations. The databases of Cochrane Library, PubMed, Embase, CINAHL, Web of Science, and CNKI, Weipu Database, Wanfang Database and CBM were searched for all studies published before September 2023. We included studies with cohort, case-control designs, reporting the development of risk model and have been validated externally and internally among the hospitalized patients. Two researchers selected the retrieved studies according to the inclusion and exclusion criteria, and critically evaluated the quality of studies based on the CHARMS checklist. The PRISMA guideline was used to report the systematic review and meta-analysis. Sixty-two studies were included, which contained 99 pressure injuries risk prediction models. The AUC (area under ROC curve) of modelling in 32 prediction models were reported ranged from .70 to .99, while the AUC of verification in 38 models were reported ranged from .70 to .98. Gender (OR = 1.41, CI: .99 ~ 1.31), age (WMD = 8.81, CI: 8.11 ~ 9.57), diabetes mellitus (OR = 1.64, CI: 1.36 ~ 1.99), mechanical ventilation (OR = 2.71, CI: 2.05 ~ 3.57), length of hospital stay (WMD = 7.65, CI: 7.24 ~ 8.05) were the most common predictors of pressure injuries. Studies of PIs risk prediction model in hospitalized patients had high research quality, and the risk prediction models also had good predictive performance. However, some of the included studies lacked of internal or external validation in modelling, which affected the stability and extendibility. The aged, male patient in ICU, albumin, haematocrit, low haemoglobin level, diabetes, mechanical ventilation and length of stay in hospital were high-risk factors for pressure injuries in hospitalized patients. In the future, it is recommended that clinical nurses, in practice, select predictive models with better performance to identify high-risk patients based on the actual situation and provide care targeting the high-risk factors to prevent the occurrence of diseases. The risk prediction model is an effective tool for identifying patients at the risk of developing PIs. With the help of risk prediction tool, nurses can identify the high-risk patients and common predictive factors, predict the probability of developing PIs, then provide specific preventive measures to improve the outcomes of these patients. CRD42023445258.

A combinatorially complete epistatic fitness landscape in an enzyme active site

Protein engineering often targets binding pockets or active sites which are enriched in epistasis-nonadditive interactions between amino acid substitutions-and where the combined effects of multiple single substitutions are difficult to predict. Few existing sequence-fitness datasets capture epistasis at large scale, especially for enzyme catalysis, limiting the development and assessment of model-guided enzyme engineering approaches. We present here a combinatorially complete, 160,000-variant fitness landscape across four residues in the active site of an enzyme. Assaying the native reaction of a thermostable β-subunit of tryptophan synthase (TrpB) in a nonnative environment yielded a landscape characterized by significant epistasis and many local optima. These effects prevent simulated directed evolution approaches from efficiently reaching the global optimum. There is nonetheless wide variability in the effectiveness of different directed evolution approaches, which together provide experimental benchmarks for computational and machine learning workflows. The most-fit TrpB variants contain a substitution that is nearly absent in natural TrpB sequences-a result that conservation-based predictions would not capture. Thus, although fitness prediction using evolutionary data can enrich in more-active variants, these approaches struggle to identify and differentiate among the most-active variants, even for this near-native function. Overall, this work presents a large-scale testing ground for model-guided enzyme engineering and suggests that efficient navigation of epistatic fitness landscapes can be improved by advances in both machine learning and physical modeling.

Enhancing the Biodegradability, Water Solubility, and Thermal Properties of Polyvinyl Alcohol through Natural Polymer Blending: An Approach toward Sustainable Polymer Applications

The escalating environmental crisis posed by single-use plastics underscores the urgent need for sustainable alternatives. This study provides an approach to introduce biodegradable polymer blends by blending synthetic polyvinyl alcohol (PVA) with natural polymers—corn starch (CS) and hydroxypropyl methylcellulose (HPMC)—to address this challenge. Through a comprehensive analysis, including of the structure, mechanical strength, water solubility, biodegradability, and thermal properties, we investigated the enhanced performance of PVA-CS and PVA-HPMC blends over conventional polymers. Scanning electron microscopy (SEM) findings of pure PVA and its blends were studied, and we found a complete homogeneity between the PVA and both types of natural polymers in the case of a high concentration of PVA, whereas at lower concentration of PVA, some granules of CS and HMPC appear in the SEM. Blending corn starch (CS) with PVA significantly boosts its biodegradability in soil environments, since adding starch of 50 w/w duplicates the rate of PVA biodegradation. Incorporating hydroxypropyl methylcellulose (HPMC) with PVA not only improves water solubility but also enhances biodegradation rates, as the addition of HPMC increases the biodegradation of pure PVA from 10 to 100% and raises the water solubility from 80 to 100%, highlighting the significant acceleration of the biodegradation process and water solubility caused by HPMC addition, making these blends suitable for a wide range of applications, from packaging and agricultural films to biomedical engineering. The thermal properties of pure PVA and its blends with natural were studied using diffraction scanning calorimetry (DSC). It is found that the glass transition temperature (Tg) increases after adding natural polymers to PVA, referring to an improvement in the molecular weight and intermolecular interactions between blend molecules. Moreover, the amorphous structure of natural polymers makes the melting temperature ™ lessen after adding natural polymer, so the blends require lower temperature to remelt and be recycled again. For the mechanical properties, both types of natural polymer decrease the tensile strength and elongation at break, which overall weakens the mechanical properties of PVA. Our findings offer a promising pathway for the development of environmentally friendly polymers that do not compromise on performance, marking a significant step forward in polymer science’s contribution to sustainability. This work presents detailed experimental and theoretical insights into novel polymerization methods and the utilization of biological strategies for advanced material design.

An efficient flavonoid glycosyltransferase NjUGT73B1 from Nardostachys jatamansi of alpine Himalayas discovered by structure-based protein clustering

Tilianin and linarin, two rare glycosylated flavonoids in the aromatic endangered medicinal plant Nardostachys jatamansi (D.on)DC., play an important role in the fields of medicine, cosmetics, food and dye industries. However, there remains a lack of comprehensive understanding regarding their biosynthetic pathway. In this study, the phytochemical investigation of Nardostachys jatamansi (D.on)DC. resulted in the isolation of linarin. With help of AlphaFold2 to cluster the entire glycosyltransferase family based on predicted structure similarities, we successfully identified a flavonoid glycosyltransferase NjUGT73B1, which could efficiently catalyse the glucosylation of acacetin at 7-OH to produce tilianin, also the key precursor in the biosynthesis of linarin. Additionally, NjUGT73B1 displayed a high degree of substrate promiscuity, enabling glucosylation at 7-OH of many flavonoids. Molecular modeling and site-directed mutagenesis revealed that H19, H21, H370, F126, and F127 play the crucial roles in the glycosylation ability of NjUGT73B1. Notably, comparation with the wild NjUGT73B1, mutant H19K led to a 50% increase in the activity of producing tilianin from acacetin.

Therapeutic effects of Buzhong Yiqi decoction in patients with spleen and stomach qi deficiency after routine surgery and chemotherapy for colorectal cancer.

According to the theory of traditional Chinese medicine (TCM), the spleen and stomach are the basis of acquired nature and the source of qi and blood biochemistry. After surgery and chemotherapy, patients with colorectal cancer often develop spleen and stomach qi deficiency syndrome, leading to decreased immune function. Buzhong Yiqi decoction, a classic TCM prescription, has the effect of tonifying middle-jiao and invigorating qi, boosting Yang, and suppressing immune-related inflammation. Moreover, it is widely used in the treatment of spleen and stomach qi deficiency syndrome. To investigate the effect of Buzhong Yiqi decoction on spleen and stomach qi deficiency in patients with colorectal cancer. One hundred patients with colorectal cancer who underwent preoperative chemotherapy and laparoscopy at The First TCM Hospital of Changde from January 2022 to October 2023 were retrospectively analyzed. The patients were divided equally into control and observation groups. Both groups underwent conventional rehabilitation surgery, and the observation group was supplemented with Buzhong Yiqi decoction. SPSS 26.0 was used for statistical analyses. The χ 2 test was used for univariate analysis; independent sample t-tests were used in all cases. No significant differences were observed preoperatively in the general characteristics of the two groups. Fourteen days post-surgery, the abdominal distension, emaciation, loose stool, loss of appetite, and vomiting scores were significantly lower in the observation group than in the control group (P < 0.05). Immune function and interleukin (IL)-10 levels in the observation group were significantly higher than those of the control group, whereas IL-6, tumor necrosis factor-α, and C-reactive protein levels, tumor biological indexes, and adverse reactions in the observation group were significantly lower than those of the control group (P < 0.05). One month after surgery, the patients' quality of life in the observation group was significantly higher than that of the patients in the control group (P < 0.05). Buzhong Yiqi decoction can regulate inflammatory responses and metabolic processes by enhancing immune function, thereby promoting overall immune nutrition and restoring the body's balance.

The combined detection of carcinoembryonic antigen, carcinogenic antigen 125, and carcinogenic antigen 19-9 in colorectal cancer patients.

Hepatic metastases are common and difficult to treat after colorectal cancer (CRC) surgery. The predictive value of carcinoembryonic antigen (CEA), cancer antigen (CA) 125 and CA19-9 combined tests for liver metastasis is unclear. To evaluate predictive value of combined tests for CEA, CA125, and CA19-9 levels in patients with liver metastases of CRC. The retrospective study included patients with CRC alone (50 cases) and patients with CRC combined with liver metastases (50 cases) who were hospitalized between January 2021 and January 2023. Serum CEA, CA125 and CA19-9 levels were compared between the two groups, and binary logistic regression was used to analyze the predictive value of the combination of these tumor markers in liver metastasis. In addition, we performed receiver operating characteristic (ROC) curve analysis to assess its diagnostic accuracy. The results showed that the serum CEA, CA125 and CA19-9 levels in the CRC with liver metastasis group were significantly higher than those in the CRC alone group. Specifically, the average serum CEA level in the CRC with liver metastasis group was 162.03 ± 810.01 ng/mL, while that in the CRC alone group was 5.71 ± 9.76 ng/mL; the average serum CA125 levels were 43.47 ± 83.52 U/mL respectively. and 13.5 ± 19.68 U/mL; the average serum CA19-9 levels were 184.46 ± 473.13 U/mL and 26.55 ± 43.96 U/mL respectively. In addition, binary logistic regression analysis showed that CA125 was significant in predicting CRC liver metastasis (P < 0.05). ROC curve analysis results showed that the areas under the ROC curves of CEA, CA125 and CA19-9 were 0.607, 0.692 and 0.586. These results suggest that combined detection of these tumor markers may help early detection and intervention of CRC liver metastasis, thereby improving patient prognosis.

Book Review: Cases in Paediatric Critical Care Transfer and Retrieval Medicine by Shelley Riphagen and Sam Foster

Book Review: <i>Cases in Paediatric Critical Care Transfer and Retrieval Medicine</i> by Shelley Riphagen and Sam Foster

ASO Author Reflection: Reevaluating the Role of Preoperative MRI in Breast Cancer Surgery: Lessons Learned and Future Directions.

ASO Author Reflection: Reevaluating the Role of Preoperative MRI in Breast Cancer Surgery: Lessons Learned and Future Directions.

Clinical efficacy and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in gastrectomy.

With the continuous progress of surgical technology and improvements in medical standards, the treatment of gastric cancer surgery is also evolving. Proximal gastrectomy is a common treatment, but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options. Each of these two surgical methods has advantages and disadvantages, so it is particularly important to compare and analyze their clinical efficacy and safety. To compare the surgical safety, clinical efficacy, and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy. The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study. According to the different anastomosis methods used, the patients were divided into a double-channel anastomosis group (50 patients) and a tubular gastroesophageal anastomosis group (49 patients). In the double-channel anastomosis, Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection, and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux. In the tubular gastroesophageal anastomosis group, after the proximal end of the stomach was cut, tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube. The main outcome measure was quality of life 1 year after surgery in both groups, and the evaluation criteria were based on the postgastrectomy syndrome assessment scale. The greater the changes in body mass, food intake per meal, meal quality subscale score, and total measures of physical and mental health score, the better the condition; the greater the other indicators, the worse the condition. The secondary outcome measures were intraoperative and postoperative conditions, the incidence of postoperative long-term complications, and changes in nutritional status at 1, 3, 6, and 12 months after surgery. In the double-channel anastomosis cohort, there were 35 males (70%) and 15 females (30%), 33 (66.0%) were under 65 years of age, and 37 (74.0%) had a body mass index ranging from 18 to 25 kg/m2. In the group undergoing tubular gastroesophageal anastomosis, there were eight females (16.3%), 21 (42.9%) individuals were under the age of 65 years, and 34 (69.4%) had a body mass index ranging from 18 to 25 kg/m2. The baseline data did not significantly differ between the two groups (P > 0.05 for all), with the exception of age (P = 0.021). The duration of hospitalization, number of lymph nodes dissected, intraoperative blood loss, and perioperative complication rate did not differ significantly between the two groups (P > 0.05 for all). Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group. Specifically, they had lower scores for esophageal reflux [2.8 (2.3, 4.0) vs 4.8 (3.8, 5.0), Z = 3.489, P < 0.001], eating discomfort [2.7 (1.7, 3.0) vs 3.3 (2.7, 4.0), Z = 3.393, P = 0.001], total symptoms [2.3 (1.7, 2.7) vs 2.5 (2.2, 2.9), Z = 2.243, P = 0.025], and other aspects of quality of life. The postoperative symptoms [2.0 (1.0, 3.0) vs 2.0 (2.0, 3.0), Z = 2.127, P = 0.033], meals [2.0 (1.0, 2.0) vs 2.0 (2.0, 3.0), Z = 3.976, P < 0.001], work [1.0 (1.0, 2.0) vs 2.0 (1.0, 2.0), Z = 2.279, P = 0.023], and daily life [1.7 (1.3, 2.0) vs 2.0 (2.0, 2.3), Z = 3.950, P < 0.001] were all better than those of the tubular gastroesophageal anastomosis group. The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score [3.0 (2.0, 4.0) vs 3.5 (2.0, 5.0) (Z = 2.345, P = 0.019] compared to the dual-channel anastomosis group. Hemoglobin, serum albumin, total serum protein, and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups (P > 0.05 for all). The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery. Compared with tubular gastric surgery, double-channel anastomosis is a preferred surgical technique for proximal gastric cancer. It offers advantages such as less esophageal reflux and improved quality of life.

Effect of rapid rehabilitation nursing on improving clinical outcomes in postoperative patients with colorectal cancer.

Surgical resection is the cornerstone treatment for colorectal cancer. Rapid rehabilitation care predicated on evidence-based medical theory aims to improve postoperative nursing care, subsequently reducing the physical and mental traumatic stress response and helping patients who undergo surgery recover rapidly. To assess the effect of rapid rehabilitation care on clinical outcomes, including overall postoperative complications, anastomotic leaks, wound infections, and intestinal obstruction in patients with colorectal cancer. We searched the PubMed, Web of Science, Embase, Elsevier Science Direct, and Springer Link databases from January 1, 2010, to January 1, 2024, to screen eligible studies on rapid rehabilitation care among patients who underwent colorectal cancer surgery. Patients were screened based on the inclusion and exclusion criteria. RevMan 5.4 software was used for statistical analysis of the data. Twelve studies were enrolled, which included 2420 patients. The results showed that rapid rehabilitation care decreased the incidence of overall postoperative complications (OR: 0.44, 95%CI: 0.26-0.74, P = 0.002), anastomotic leaks (OR: 0.68, 95%CI: 0.41-1.12, P = 0.13), wound infections (OR: 0.45, 95%CI: 0.29-0.72, P = 0.0007), and intestinal obstruction (OR: 0.54, 95%CI: 0.34-0.86, P = 0.01) compared to conventional care. Further trials and studies are needed to confirm these results. Rapid rehabilitation care decreased the occurrence of postoperative complications, anastomotic leaks, wound infections, and intestinal obstruction compared to conventional care in patients who underwent colorectal surgery. Therefore, promoting the application of rapid rehabilitation care in clinical practice cannot be overemphasized.

Occurrence of Dumping Syndrome After Esophageal Cancer Surgery: Systematic Review and Meta-analysis.

Dumping syndrome occurs frequently after esophageal cancer surgery, but the reported prevalence varied across previous studies. This systematic review and meta-analysis aimed to clarify the prevalence of dumping syndrome after esophageal cancer surgery, particularly exploring the sources of heterogeneity in previous studies. A comprehensive literature search was conducted in PubMed, MEDLINE, Web of Science, Embase, and the Cochrane Library databases, supplemented by hand-search of reference lists, through March 2023. Random-effects meta-analysis estimated the average prevalence of dumping syndrome after esophageal cancer surgery. Heterogeneity across studies was examined by the I2 statistic and Cochran's Q test. Among the 2949 articles retrieved from the databases, 16 articles (15 cohort studies and 1 randomized controlled trial) met the inclusion criteria. The prevalence of dumping syndrome ranged 0-74% in these studies, showing high heterogeneity (I2 = 99%, P < 0.01), with the pooled prevalence of 27% (95% confidence interval [CI] 14-39%). The pooled prevalence in the three studies using specialized questionnaires was 67% (95% CI 60-73%), with reduced heterogeneity (I2 = 43%, P = 0.17). The prevalence also varied by year of publication, study population, and length and completeness of follow-up. Our findings revealed that dumping syndrome is common after esophageal cancer surgery. The varying prevalence across previous studies was probably owing to differences in measurement of dumping syndrome. Using specific patient reported outcome questionnaires is recommended for future investigations on dumping syndrome after esophageal cancer surgery.

A Novel Luciferase-Based Reporter Gene Technology for Simultaneous Optical and Radionuclide Imaging of Cells

Multimodality reporter gene imaging combines the sensitivity, resolution and translational potential of two or more signals. The approach has not been widely adopted by the animal imaging community, mainly because its utility in this area is unproven. We developed a new complementation-based reporter gene system where the large component of split NanoLuc luciferase (LgBiT) presented on the surface of cells (TM-LgBiT) interacts with a radiotracer consisting of the high-affinity complementary HiBiT peptide labeled with a radionuclide. Radiotracer uptake could be imaged in mice using SPECT/CT and bioluminescence within two hours of implanting reporter-gene-expressing cells. Imaging data were validated by ex vivo biodistribution studies. Following the demonstration of complementation between the TM-LgBiT protein and HiBiT radiotracer, we validated the use of the technology in the highly specific in vivo multimodal imaging of cells. These findings highlight the potential of this new approach to facilitate the advancement of cell and gene therapies from bench to clinic.

Nontuberculous Mycobacteria Isolates in Respiratory Samples and Mycobacterial Pulmonary Disease in an Area of Northern Spain

IntroductionThe epidemiology of nontuberculous mycobacteria (NTM) is not well known. In this study, we aimed to determine the incidence of NTM isolates and nontuberculous mycobacterial pulmonary disease (NTM-PD) in five closely located hospitals in an area of northern Spain and analyse differences between them. Material and methodsDemographic, microbiological, clinical and radiological data were collected retrospectively from all patients with a NTM isolated from respiratory specimens at five hospitals between 2012 and 2019. Mycobacterium gordonae isolates were excluded. Once the data was collected, it was determined which patients met the NMT-PD criteria. Results594 patients were included in the study. The mean incidence rate of NTM isolates across all five hospitals in the period studied was 4.15 per 100,000 person-year, while the rate of NTM-PD was 1.2. The annual number of isolates showed an upward trend over this period, but the same did not occur in the number of cases of NTM-PD. The species most frequently isolated were Mycobacterium avium complex (MAC) and Mycobacterium xenopi and those most frequently causing disease were MAC and Mycobacterium kansassi. There were significant differences between the five centres. ConclusionsOur results are in line with similar studies in Europe in terms of NTM isolation and NTM-PD incidence and species isolated; however, we do not see the upward trend in NTM-PD rates described elsewhere. The great variability in isolation and disease rates, as well as in species isolated in geographically close areas, underlines, in our opinion, the importance of local environmental factors.