ChemInform Research Articles

Inference of Onsager coefficient from microscopic simulations by machine learning.

Dynamic density functional theory (DDFT) is a fruitful approach for modeling polymer dynamics, benefiting from its multiscale and hybrid nature. However, the Onsager coefficient, the only free parameter in DDFT, is primarily derived empirically, limiting the accuracy and broad application of DDFT. Herein, we propose a machine learning-based, bottom-up workflow to directly extract the Onsager coefficient from molecular simulations, circumventing partly heuristic assumptions in traditional approaches. In this workflow, the Onsager coefficient is derived from the proposed DDFT-informed ordinary differential equation network, trained to replicate density evolution observed in Brownian dynamics (BD) simulations. We validate our method by studying the lamellar transition in symmetric diblock copolymer melts, where the DDFT model with the extracted Onsager coefficient precisely reproduces both the density evolution and interface narrowing predicted by BD simulations, thereby demonstrating the reliability of the present scheme. Meanwhile, our studies reveal the strong relevance of the Onsager coefficient with dynamic processes and identify the explicit connection between dynamic correlations, characterized by the correlation strength and correlation length, and the system parameters, e.g., the Flory-Huggins interaction parameter. We found that far from the transition point, the correlation that transmits the thermodynamic force into a density current is localized and strong, while close to the transition point, it becomes long-ranged but weak. Our approach aims to develop a more generalized framework to bridge more refined particle-based simulations to more coarse-grained field-based calculations, and the insights gained by using our approach could be extended to other non-equilibrium systems in polymer sciences.

Effects of respiratory sarcopenia on the postoperative course in elderly lung cancer patient: a retrospective study

ObjectivesRecently, sarcopenia has been linked to unfavorable outcomes in various surgical procedures, including lung cancer surgery. This study aimed to investigate the impact of respiratory sarcopenia (RS) on postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery.MethodsThis retrospective study included patients aged 70 years and older who underwent lobectomy with curative intent for lung cancer between 2017 and 2019. RS was defined as having values below the median for both the L3 skeletal muscle index, measured from preoperative PET-CT images, and peak expiratory flow (PEF). An inverse probability of treatment weighting (IPTW) approach was applied to balance covariates between the RS and non-RS groups. Baseline characteristics and postoperative outcomes were compared between groups using t-tests and chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall and recurrence-free survival. Multivariable logistic regression analysis incorporating IPTW weights was performed to assess the impact of RS on respiratory complications.ResultsA total of 509 patients were included, of whom 123 (24.2%) had RS. After IPTW adjustment, baseline characteristics, including pulmonary function, were similar between the RS and non-RS groups. All patients underwent lobectomy, with 78.8% of the RS group and 80.9% of the non-RS group undergoing minimally invasive surgery. The RS group had a significantly higher rate of respiratory complications compared to the non-RS group (14.5% vs. 7.7%, p = 0.041). Multivariable logistic regression analysis showed that male sex (odds ratio = 15.2, p < 0.01) and lower DLCO (odds ratio = 0.96, p < 0.01) were significantly associated with respiratory complications, whereas RS did not show a significant association (p = 0.05). No significant differences were found in overall survival (p = 0.11) or recurrence-free survival (p = 0.51) between the groups.ConclusionsIn this study, RS had a limited impact on both postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery. These findings suggest that other factors, such as DLCO and male sex, may play a more prominent role in predicting respiratory complications.

Surgical risk scores for congenital heart surgery are useful for long-term risk prediction.

The initial and updated Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT and STAT 2020) and Risk Adjusted Classification for Congenital Heart Surgery-1 and Risk Adjusted Classification for Congenital Heart Surgery-2 scoring systems are validated to predict early postoperative mortality following congenital heart surgery in children; however, their ability to predict long-term mortality has not been examined. We performed a retrospective cohort study using data from the Pediatric Cardiac Care Consortium, a US-based registry of cardiac interventions in 47 participating centres between 1982 and 2011. Patients included in this cohort analysis had select congenital heart surgery representing the spectrum of severity as determined by STAT and Risk Adjusted Classification for Congenital Heart Surgery-1 and were less than 21 years of age. We applied STAT, STAT 2020, Risk Adjusted Classification for Congenital Heart Surgery-1, and Risk Adjusted Classification for Congenital Heart Surgery-2 for prediction of early mortality and long-term postoperative survival probability by surgical risk category. Long-term outcomes were obtained by matching Pediatric Cardiac Care Consortium patients with deaths reported in the National Death Index through 2021. Of 20,753 eligible patients, 18,755 survived the postoperative period and 2,058 deaths occurred over a median follow up of 24.4 years (Interquartile Range: 21-28.4). Each scoring system performed well for predicting early postoperative mortality with the following c-statistics: STAT: 0.7872, Risk Adjusted Classification for Congenital Heart Surgery-1: 0.7872, STAT 2020: 0.7724 and Risk Adjusted Classification for Congenital Heart Surgery-2: 0.7668. The predictive ability for long-term risk of death was as follows: STAT: 0.6995, Risk Adjusted Classification for Congenital Heart Surgery-1 c = 0.6741, Risk Adjusted Classification for Congenital Heart Surgery-2: 0.7156 and STAT 2020: c = 0.7156. Risk-adjusted score systems for congenital heart surgery maintain adequate but diminishing discriminative power to predict long-term mortality. Future efforts are warranted to develop a tool with improved long-term survival prediction.

The efficacy of open transanal drainage tube against anastomotic leakage in left-sided colorectal cancer surgery: a propensity score matching study

Background/AimThe effectiveness of a transanal drainage tube (TAT) for the prevention of anastomotic leakage after double stapling technique (DST) anastomosis in colorectal cancer has been reported. Previously, TATs had been placed and connected to drainage bags. It was considered that a higher decompression effect could be expected by inserting an open-type TAT, without connection to a drainage bag. In this study, the relation between anastomotic leakage and the application of this type of TAT in left-sided colorectal cancer surgery was investigated, using propensity score matching (PSM).Materials and methodsFrom January 2016 to July 2023, 233 consecutive patients underwent radical surgery for sigmoid colon and rectal cancers and reconstruction using DST at Osaka Metropolitan University Hospital. Patients were divided into two groups: those who had a closed TAT inserted (CLOSED group), and those who had an open TAT inserted (OPEN group).ResultsOverall, open TATs were inserted in 43 patients, and closed TATs were inserted in 190 patients. PSM was performed between the OPEN and CLOSED groups on the basis of the following 13 factors: age, sex, BMI, diabetes mellitus (DM), smoking history, modified Glasgow prognostic score (mGPS), ASA-PS, location of distal tumor edge, operative procedure, surgical approach, operative time, intraoperative blood loss, and pathological stage. The multivariate analysis of significant factors identified a BMI of 25 or more, a location of distal edge on middle to lower rectum, and a closed TAT, as independent risk factors for anastomotic leakage (HR: 8.72; p = 0.038, HR: 10.06; p = 0.034 and HR: 17.43; p = 0.033).ConclusionAn open TAT may be effective in preventing anastomotic leakage in left-sided colorectal cancer surgery.

Synthesis, Preclinical Evaluation, and First-in-Human Assessment of ICG-PSMA-D5: A PSMA-Targeted Probe for Fluorescence-Guided Surgery of Prostate Cancer.

Precise surgical resection of prostate cancer (PCa) is a significant clinical challenge due to the impact of positive surgical margins on postoperative outcomes. Fluorescence-guided surgery (FGS) enables real-time tumor visualization using fluorescent probes. In this study, we synthesized and evaluated an indocyanine green (ICG)-based PSMA-targeted near-infrared probe, ICG-PSMA-D5, for intraoperative imaging of PCa lesions. Spectroscopic analysis revealed that ICG-PSMA-D5 retained the optical properties of ICG while improving solubility in PBS due to additional carboxyl groups. In vitro assays demonstrated high binding affinity (Ki = 0.39 nM) and minimal cytotoxicity. In vivo studies in tumor-bearing mice showed strong tumor targeting, extended retention at tumor site, and favorable biodistribution, with significant tumor-to-background ratios. The first-in-human study in a patient with localized PCa indicated the probe's potential for real-time, radiation-free surgical guidance. Overall, ICG-PSMA-D5 displayed excellent performance in tumor detection and margin delineation, making it a promising candidate for intraoperative FGS in PCa.

Caregiver alignment with triage acuity levels and drivers for discrepancy between caregiver assessment and triage acuity levels: a cross-sectional questionnaire based study

BackgroundCaregiver concern is the main driver to paediatric emergency departments visits. Understanding caregiver worries is crucial to guide patients to the most appropriate healthcare setting. Previous research shows mixed findings on the accordance between caregiver assessment and professional triage.MethodsWe assessed data from two questionnaire-based studies conducted over 27 months in two tertiary paediatric emergency departments in Switzerland to compare caregiver perception of their child’s medical acuity and standard nurse triage. Furthermore, we examined socioeconomic factors associated with caregiver perception.ResultsOur study of 2,126 children seen in the two paediatric emergency departments showed that caregiver assessment aligned well with the acuity assigned by professional triage in 89% (1,901/2,126) of cases. In 142 cases (7%, 142/2,126), caregivers rating their child’s severity higher than nurse’s triage while in 83 cases (4%, 83/2,126), they rated it lower. In an univariable analysis, we found that family’s difficulties paying bills (20% vs. 12%) and low maternal education (19% vs. 10%) were associated with a higher percentage of caregiver rating their child’s severity higher than nurse’s triage. Fever as the main complaint was associated with caregiver rating their child’s severity lower than nurse’s triage.ConclusionsThis questionnaire-based study shows that caregiver’s assessment of the severity of the child and nurse triage are concordant in most situations. Our study sheds light on the association between caregiver assessment and professional triage in two paediatric emergency departments in Switzerland, revealing some of the factors leading to discordance. These factors most probably reflect health illiteracy. It is important that healthcare professionals recognize and address factors influencing caregiver assessments to facilitate accurate decision-making and enhanced paediatric emergency care outcomes.

Sprayed Aqueous Microdroplets for Spontaneous Synthesis of Functional Microgels.

The development of sustainable synthesis route to produce functional and bioactive polymer colloids has attracted much attention. Most strategies are based on the polymerization of monomers or crosslinking of prepolymers by enzyme- or cell-mediated reactions or specific catalysts in confined emulsions. Herein, a facile solution spray method was developed for spontaneous synthesis of microgels without use of confined emulsion, additional initiators/catalysts and deoxygenation, which addresses the challenges in traditional microgel synthesis. The polarization of air-water interface of the microdroplets can spontaneously split hydroxide ions in water to produce hydroxyl radicals, thereby initiating polymerization and crosslinking in air environment. This synthesis strategy is applicable to a variety of monomers and enables the fabrication of microgels with tunable chemical structures and variable sizes. Importantly, the synthesis route also allows for the preparation of enzyme- or drug-loaded microgels via the in-situ encapsulation, which also display high enzymatic activity and stimuli-triggered drug release. Therefore, this work not only is of great significance to macromolecular science and microdroplet chemistry, but also may bring new insights into cellular biochemistry and even prebiotic chemistry due to the prevalence of microdroplets in the environment.

Serum autoantibody-based biomarkers for prognosis in early-stage lung cancer patients with surgical resection

Background Lung cancer is the cancer with the highest morbidity and mortality in the world. With the increasing diagnosis rate of patients with early-stage lung cancer, surgery treatment becomes an option for more patients. However, there is a lack of effective indicators to assess the risk of recurrence after lung cancer surgery. Methods We collected levels of serum autoantibodies and evaluated their roles as biomarkers especially for postoperative recurrence of lung cancer. In vitro experiments including antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), and complement-dependent cytotoxicity (CDC) were performed to explore the functions of serum autoantibodies. Results Our study demonstrated that serum autoantibody-positive patients with early-stage lung cancer had a longer postoperative progression period. The levels of serum autoantibodies in patients with lung cancer were higher than that in patients with benign lung diseases. But all the serum autoantibodies had no difference between patients with stage I and II. In addition, the results of in vitro experiments indicated that serum autoantibodies can mediate immune responses and enhance anti-tumor effects. Conclusion This study proposed effective biomarkers for prognosis in lung cancer patients after surgery which is critical to reduce the recurrence.

Deciphering the Link Between Diagnosis-Related Group Weight and Nursing Care Complexity in Hospitalized Children: An Observational Study

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. Methods: This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient’s hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Results: Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (rs = 0.507; p &lt; 0.001), as well as between DRG weight and the frequency of NDs (rs = 0.232; p &lt; 0.001) and NAs (rs = 0.184; p &lt; 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R2 = 0.311; adjusted R2 = 0.308; p &lt; 0.001). Conclusions: In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes.

Assessment of quality of presentation of clinical trial results in Russia in accordance with CONSORT standards

The gold standard for presenting evidence of the effectiveness and safety of medical procedures is randomized controlled trials (RCTs). For the research results to be available to other specialists and have potential weight in the scientific community, they must be described and published in accordance with generally accepted international standards, CONSORT, or Consolidated standards of reporting trials.Objective: to analyze the quality of presenting the results of clinical trials in the Russian Federation in accordance with CONSORT standards.Materials and methods. The following Russian journals were selected for the study: "Scientific and Practical Rheumatology", "Good Clinical Practice", "Social and Clinical Psychiatry", "S. S. Korsakov Journal of Neurology and Psychiatry". The selection of target journals was based on two main indicators of the journal rating in the Russian Science Citation Index; according to the SCIENCE INDEX rating and the rating of psychiatric journals by the impact factor RSCI 2016. Journals in the fields of biomedicine (Scientific and Practical Rheumatology), clinical pharmacology (Good Clinical Practice), and journals in the fields of psychology and psychiatry (Social and Clinical Psychiatry, S. S. Korsakov Journal of Neurology and Psychiatry) were selected. Each article was assessed according to the CONSORT checklist items, and the presence or absence of data on the presented items was noted. When studying the articles, the presence or absence of a flowchart in the article was also analyzed, which significantly improves the quality of the written article and compliance with international standards for the design of articles for medical journals.Results. The articles analyzed with the results of RCTs in journals met most of the necessary criteria. The authors paid the least attention to such details of the methodology when publishing a description of the sample calculation (2 out of 5 publications), the type of randomization (2 out of 5 publications), the mechanism of blinding participants (3 out of 5 publications), and implementation and masking (1 out of 5 publications). The inaccessibility of this information may have distorted the reader’s perception and trust in the results.Conclusion. The results show that the reviewed Russian medical journals declare requirements and recommendations for the publication of articles in accordance with the CONSORT standards. To increase readers' confidence in the practical and scientific significance of RCTs, it is necessary to consider the CONSORT requirements and strive to follow them.

A novel tool for assessing pediatric emergency care in low- and middle-income countries: a pilot study

BackgroundGlobally, most children seek emergency care at general rather than specialized pediatric emergency departments. There remains significant variation in the provision of pediatric emergency care, particularly in resource-constrained settings. The objective of this study is to pilot a self-assessment tool to evaluate pediatric emergency care capabilities in low- and middle-income country (LMIC) hospitals on the African Continent.MethodsThis was a prospective cross-sectional descriptive study using a convenience sample of sub-Saharan African hospitals. The assessment tool was developed by operationalizing the technical contents of existing standards and guidelines from international bodies including the World Health Organization and International Federation of Emergency Medicine. The pilot was conducted at emergency departments located across different regions on the African continent. Descriptive statistics were used to evaluate different domains of pediatric emergency care capabilities including pediatric triage, protocols, staffing, training, equipment, consumables, and medicines.ResultsSixteen hospitals with emergency departments completed the assessment tool (participation rate of 76%). The hospitals were in nine different countries across four regions of sub-Saharan Africa. National/academic hospitals comprised 56.3% of the participating hospitals. The majority, 44%, of these hospitals saw pediatric patient volumes of 2,000–4,999 patients per year. Dedicated pediatric triage spaces and resuscitation spaces were available at 37.5% and 56.3%, respectively. Formal pediatric resuscitation guidelines were used at 62.5%. Doctors on the self-assessment teams came from primarily pediatrics and general practitioner training backgrounds (both 68.8%). Basic respiratory and airway support equipment (e.g. oxygen, bag-valve mask devices) were available in all participating hospitals, whereas advanced airway equipment (e.g. pediatric intubation equipment) was available in 37.5% of hospitals. Most medicines from the World Health Organization Essential Medicines list were available at participating hospitals.ConclusionsTo date, this is the first assessment tool dedicated to the comprehensive evaluation of pediatric emergency care in LMICs. This pilot provides a first approach to evaluate pediatric emergency healthcare capabilities in the hospital setting with future directions to improve the tool based on qualitative feedback.

Mesenchymal stem cell-derived extracellular vesicles in periodontal bone repair.

Periodontitis is a chronic inflammatory disease that destroys tooth-supporting structures and poses significant public health challenges due to its high prevalence and links to systemic health conditions. Traditional treatments are effective in reducing the inflammatory response and improving the clinical symptoms of periodontitis. However, these methods are challenging to achieve an ideal treatment effect in alveolar bone repair. Mesenchymal stem cells (MSCs) represent a potential alternative for the treatment of periodontal bone defects due to their self-renewal and differentiation capabilities. Recent research indicates that MSCs exert their effects primarily through paracrine mechanisms. Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) serve as pivotal mediators in intercellular communication, transferring microRNAs (miRNAs), messenger RNAs (mRNAs), proteins, and cytokines to recipient cells, thereby emulating the therapeutic effects of MSCs. In periodontitis, MSC-EVs play a pivotal role in immunomodulation and bone remodeling, thereby facilitating periodontal bone repair. As a cell-free therapy, MSC-EVs demonstrate considerable clinical potential due to their specialized membrane structure, minimal immunogenicity, low toxicity, high biocompatibility, and nanoscale size. This review indicates that MSC-EVs represent a promising approach for periodontitis treatment, with the potential to overcome the limitations of traditional therapies and offer a more effective solution for bone repair in periodontal disease. In this review, we introduce MSC-EVs, emphasizing their mechanisms and clinical applications in periodontal bone repair. It synthesizes recent advances, existing challenges, and future prospects to present up-to-date information and novel techniques for periodontal regeneration and to guide the improvement of MSC-EV therapy in clinical practice.

A Review of the Molecular Understanding of the Mpox Virus (MPXV): Genomics, Immune Evasion, and Therapeutic Targets

The Mpox virus (MPXV), a zoonotic pathogen from the Orthopoxvirus genus, has emerged as a significant global public health concern, especially after the unprecedented outbreak in 2022. This review synthesizes the MPXV’s molecular features, focusing on its genomic structure, replication mechanisms, immune evasion strategies, and implications for diagnostics and therapeutics. The study examines the virus’s genomic organization utilizing recent peer-reviewed literature, highlighting essential genes like OPG027 and D1L, which contribute to host adaptation, increased transmissibility, and immune evasion. Advances in molecular diagnostics, including real-time PCR and genome sequencing, are reviewed, emphasizing their critical role in outbreak monitoring and control. However, challenges persist, such as diagnostic limitations in resource-constrained settings and the lack of targeted vaccines and antivirals. This review discusses new antiviral candidates, confirmed through computational and in vitro techniques, identifying thymidine kinase and VP39 as key therapeutic targets. Emphasizing the need for genomic surveillance to track adaptive evolution, results show that particular mutations, such as in the OPG027 and D1L genes, increase the transmissibility and immune evasion of the MPXV. These molecular revelations highlight the urgent necessity for better diagnostics catered towards addressing present constraints and developing focused treatments that reduce the effect of the virus. This study emphasizes how these results underscore the need for combined public health plans to handle the changing MPXV epidemiology properly.

Prevalence and Risk Factors of Acute Kidney Injury After Colorectal Cancer Surgery.

Acute kidney injury is a sentinel event affecting colorectal cancer patients either as a consequence of surgery or systemic chemotherapy. It is highly correlated with both short and long-term adverse outcomes. This work aimed to study the prevalence, risk factors, and impact on survival of postoperative (PO-AKI) and post-chemotherapy (PC-AKI) after colorectal cancer (CRC) surgery in Egyptian patients. Data of the patients with CRC who underwent surgery over the previous 5 years was retrieved from an internet-based medical system. The incidence of PO-AKI and PC-AKI was calculated, the rate and time to resolution of PO-AKI were recorded, and the possible predictors of AKI were assessed using univariate and multivariate analysis; also, the impact of AKI on patients' survival was tested using survival curves. Five hundred sixty-one cases fulfilled the inclusion criteria and were included in the study. PO-AKI was detected in 10.5% of the patients. Significant risk factors included intraoperative hypotension, sepsis, hypoalbuminemia, amount of intraoperative bleeding, neoadjuvant therapy, and preoperative chronic kidney disease (CKD). However, only neoadjuvant treatment (hazard ratio (HR) 2.2) and CKD (HR 3.3) maintained significant risk in the multivariate analysis. PC-AKI was observed in 18.7% of the patients treated. Significant risk factors were previous CKD and the chemotherapy type, mainly affecting those who received Irinotecan-based therapy. The hazard ratio was 8.5 and 2.4 respectively, in multivariate analysis. The overall survival was significantly worse in those who developed PO- or PC-AKI (p < 0.001). AKI affects more than 25% of CRC patients after surgery and/or chemotherapy. Modifiable risk factors include preoperative hypoalbuminemia, intraoperative bleeding, and/or intraoperative hypotension. While, the more important risk factors were non-modifiable including CKD, neoadjuvant therapy, and Irinotecan-containing regimens. Most kidney injuries are stage I; however, they are associated with shorter overall survival.

Impact of Disability on Postoperative Outcomes After Gastrointestinal Cancer Surgery.

Approximately 61million individuals in the United States have a disability and face unique challenges, resulting in healthcare disparities. We aimed to evaluate the impact of disability on postoperative outcomes and number of healthy days at home (HDAH). Patients who underwent surgery for gastrointestinal (GI) cancer between 2017 and 2020 were identified using the Medicare database. Multivariable regression models were used to examine the association between disability and postoperative complications, discharge disposition, and the number of HDAH. A total of 72,452 individuals underwent GI cancer surgery (pancreas: n=7614, 10.5%; hepatobiliary: n=4994, 6.9%; colorectal: n=59,844, 82.6%). Median patient age was 75 years (interquartile range 71-81) with most patients being female (n=37,167, 51.3%). Overall, 5432 individuals (7.2%) had a disability. Following surgery, patients with a disability were more likely to experience complications (4.6% vs. 3.3%), be discharged to a skilled nursing facility (SNF; 26.6% vs. 12.3%), and experience hospital readmission (20.0% vs. 13.5%) [all p<0.001]. Consequently, individuals with disabilities were more likely to spend fewer (<20th percentile) HDAH (33% vs. 19.2%) [all p<0.001]. On multivariable analysis, disability was associated with higher odds of complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.19-1.56) and hospital readmission (OR 1.55, 95% CI 1.44-1.66). Additionally, disability was associated with higher odds of spending fewer HDAH (OR 1.88, 95% CI 1.77-1.99). Following GI cancer surgery, individuals with disabilities had a higher risk of complications and spent fewer HDAH. There is a need for targeted interventions to improve the care of patients with disabilities and ensure equitable oncological and surgical outcomes.

China’s national continuing medical education program for general practitioners: a cross-sectional survey (2016–2023)

BackgroundPursuing excellence in healthcare delivery systems is an ongoing process. In this process, continuing medical education (CME) is essential for medical professionals to maintain high standards of patient care. In China, where the healthcare sector is undergoing considerable reforms and faces challenges owing to socioeconomic development and demographic shifts, an effective CME system is vital for general practitioners (GPs).MethodsA cross-sectional survey of CME programs was conducted between 2016 and 2023. The external characteristics of the programs were systematically gathered and statistically analyzed. The programs were subsequently subjected to a competency-based assessment by using the six core competencies outlined by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education as a framework. Furthermore, keywords were extracted for the CME program names based on the International Classification of Primary Care. Visual analysis was performed via VOSviewer software, facilitating a content-based evaluation of the programs.ResultsA total of 6,607 items were obtained. A total of 3,815 CME programs were subjected to statistical analysis, and 2,895 CME programs were comprehensively evaluated for content and capability. A diverse range of CME providers were identified, with hospitals and publishing/education companies being the primary providers. Since 2019, a significant increase in online CME offerings has been noted. However, the regional distribution of the CME programs was uneven, with Shanghai, Zhejiang, and Beijing leading but western China lagging. Furthermore, most programs focused on patient care and medical knowledge in competency-based CME evaluations, with less emphasis on interpersonal and communication skills. Content-based CME evaluations revealed that the teaching focus is the diagnosis, treatment, and primary care management of elderly patients and chronic diseases such as diabetes and hypertension.ConclusionsOur findings underscore the essential role of CME in equipping GPs with the competencies required to navigate the evolving landscape of medical knowledge and practice, suggesting a more systematic, relevant, and individualized approach to training GPs. Therefore, there is an opportunity to increase the quality of primary care and contribute to the Healthy China 2030 Plan.

Medical Problems of Chronic Hypoxia in Highlanders Living on the Tibetan Plateau.

Ri-Li Ge. Medical problems of chronic hypoxia in highlanders living on the tibetan plateau. High Alt Med Biol. 00:00-00, 2024.-Health issues at high altitudes arise due to the lower atmospheric pressure and subsequent reduction in the partial pressure of oxygen in ambient air. While much research has been published on health problems of lowlanders who move to high altitudes, less is known about the medical challenges faced by long-term and permanent high-altitude residents, especially in the Qinghai-Tibetan plateau. In this review, we briefly summarized the chronic hypoxia-related health issues in highlanders, focusing on the specific population of the Qinghai-Tibetan plateau. It deals with important health problems for highlanders, including the main disease categories, from chronic mountain sicknesses and pulmonary hypertension (PH) to kidney, neurocognitive impairments, perinatal problems, and congenital heart defect. However, the most hallmark of disorders is excessive erythrocytosis associated with specific symptoms and signs, and high-altitude heart disease is characterized by excessive PH, right ventricular hypertrophy, and right heart failure. We also provide information on potential treatment strategies, including some traditional Tibetan medical practices and also a combination of Western medicine and traditional Chinese medicine to prevent and treat these conditions effectively. This mini-review is heavily based on a couple of decades of research carried out by Chinese high-altitude medical research groups at the Qinghai-Tibetan Plateau. We believe that this review will provide valuable perspective to researchers whose study interest and base lie in high altitude.

Axilla Management in Breast Cancer Surgery: Brief Review and Current Practice Recommendations.

The diagnostic and therapeutic approach to the axilla in breast cancer patients has changed significantly over the past 30 years, with the replacement of complete axillary lymph node dissection practices by less invasive approaches. Reference is made to clinical findings that have led to practical treatment recommendations and are paving the way to new levels of de-escalation in breast cancer surgery.

Complete resection of recurrent anal canal cancer using endoscopic submucosal dissection and transanal resection: A case report

BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dissection (ESD) to preserve anal function. However, if the lesion is in the anal canal, then significant difficulties such as bleeding and challenges associated with scope manipulation can arise. CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line. The patient underwent a combination of ESD and transanal resection (TAR). The specimen was excised in pieces, which resulted in difficulty performing the pathological evaluation of the margins, especially on the anal side where TAR was performed and severe crushing was observed. Careful follow-up was performed, and local recurrence was observed 3 years postoperatively. Because the patient had superficial cancer without lymph node metastasis, local resection was performed again. The second treatment attempt was improved as follows: (1) TAR and ESD were performed appropriately based on the situation by the same physician; (2) A needle scalpel was used during TAR to prevent tissue crushing; and (3) The lesion borders were marked using ESD techniques before treatment. Complete resection was performed without complications. CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.

Editorial Comment to Salvage robot‐assisted radical prostatectomy with pelvic lymph node dissection for radiorecurrent prostate cancer in a patient with a previous history of rectal cancer surgery

Editorial Comment to Salvage robot‐assisted radical prostatectomy with pelvic lymph node dissection for radiorecurrent prostate cancer in a patient with a previous history of rectal cancer surgery