Research Group Research Articles

A subpopulation of human bone marrow erythroid cells displays a myeloid gene expression signature similar to that of classic monocytes.

Erythroid cells, serving as progenitors and precursors to erythrocytes responsible for oxygen transport, were shown to exhibit an immunosuppressive and immunoregulatory phenotype. Previous investigations from our research group have revealed an antimicrobial gene expression profile within murine bone marrow erythroid cells which suggested a role for erythroid cells in innate immunity. In the present study, we focused on elucidating the characteristics of human bone marrow erythroid cells through comprehensive analyses, including NanoString gene expression profiling utilizing the Immune Response V2 panel, a BioPlex examination of chemokine and TGF-beta family proteins secretion, and analysis of publicly available single-cell RNA-seq data. Our findings demonstrate that an erythroid cell subpopulation manifests a myeloid-like gene expression signature comprised of antibacterial immunity and neutrophil chemotaxis genes which suggests an involvement of human erythroid cells in the innate immunity. Furthermore, we found that human erythroid cells secreted CCL22, CCL24, CXCL5, CXCL8, and MIF chemokines. The ability of human erythroid cells to express these chemokines might facilitate the restriction of immune cells in the bone marrow under normal conditions or contribute to the ability of erythroid cells to induce local immunosuppression by recruiting immune cells in their immediate vicinity in case of extramedullary hematopoiesis.

Brain functional gradient and structure features in adolescent and adult autism spectrum disorders.

Understanding how function and structure are organized and their coupling with clinical traits in individuals with autism spectrum disorder (ASD) is a primary goal in network neuroscience research for ASD. Atypical brain functional networks and structures in individuals with ASD have been reported, but whether these associations show heterogeneous hierarchy modeling in adolescents and adults with ASD remains to be clarified. In this study, 176 adolescent and 74 adult participants with ASD without medication or comorbidities and sex, age matched healthy controls (HCs) from 19 research groups from the openly shared Autism Brain Imaging Data Exchange II database were included. To investigate the relationship between the functional gradient, structural changes, and clinical symptoms of brain networks in adolescents and adults with ASD, functional gradient and voxel-based morphometry (VBM) analyses based on 1000 parcels defined by Schaefer mapped to Yeo's seven-network atlas were performed. Pearson's correlation was calculated between the gradient scores, gray volume and density, and clinical traits. The subsystem-level analysis showed that the second gradient scores of the default mode networks and frontoparietal network in patients with ASD were relatively compressed compared to adolescent HCs. Adult patients with ASD showed an overall compression gradient of 1 in the ventral attention networks. In addition, the gray density and volumes of the subnetworks showed no significant differences between the ASD and HC groups at the adolescent stage. However, adults with ASD showed decreased gray density in the limbic network. Moreover, numerous functional gradient parameters, but not VBM parameters, in adolescents with ASD were considerably correlated with clinical traits in contrast to those in adults with ASD. Our findings proved that the atypical changes in adolescent ASD mainly involve the brain functional network, while in adult ASD, the changes are more related to brain structure, including gray density and volume. These changes in functional gradients or structures are markedly correlated with clinical traits in patients with ASD. Our study provides a novel understanding of the pathophysiology of the structure-function hierarchy in ASD.

Lymphocyte Levels and Morbidity and Mortality in Cardiovascular Surgery With Cardiopulmonary Bypass.

A year ago, in a sample of 113 patients, our research group found that a high number of lymphocytes in the immediate postoperative period was correlated to a poor prognosis in cardiovascular surgeries. This study is an expansion of the initial study in order to confirm this finding. We analyzed the data of 338 consecutive patients submitted to cardiovascular surgeries with cardiopulmonary bypass performed at Hospital Universitário Ciências Médicas (Belo Horizonte/Brazil) from 2015 to 2017. We analyzed 39 variables with the outcomes death, hospital stay, and intensive care unit stay. The value of lymphocytes in the immediate postoperative period > 2175.0/mm³ was an indicator of poor prognosis in this sample (P<0.001). The variables female sex, age, high level of European System for Cardiac Operative Risk Evaluation II, increased stay in the intensive care unit and in the ward, elevation of creatinine in the preoperative period and at intensive care unit discharge, elevation of the percentage of immediate postoperative period segmented neutrophils, high immediate postoperative period neutrophil/lymphocyte ratio, fasting hyperglycemia, preoperative critical condition, reintubation, mild or transient acute renal failure, surgical infection, cardiopulmonary bypass, and aortic cross-clamping and mechanical ventilation durations also had an impact on the mortality outcome. The value of lymphocytes in the immediate postoperative period > 2175.0/mm3 was an indicator of poor prognosis in cardiovascular surgery with cardiopulmonary bypass.

DLS homemade setup: reviewing first and second-order coherence and autocorrelation concepts of a light source in the context of nanoparticle sizes synthesized by PLAL

Abstract The size of the nanoparticles (NP) is one of the most important and essential characteristics to know the properties of the synthesized nanostructures. The most common characterization procedures are related to Scanning Electronic Microscopy (SEM), Transmission Electronic Microscopy (TEM), and Atomic Force Microscopy (AFM). Unfortunately, from a practical point of view, they represent a time-consuming procedure and require expensive equipment, which limits its application to specialized research groups. Significant attention has been paid to Dynamic Light Scattering (DLS) as a simple, fast, and reproducible method for sizing nanoparticles. However, inadequate representation of the fundamental principles of DLS and data interpretation represents two of the most important challenges related to this technique. In this work we try to provide the fundamental principles of the DLS technique, the fundamental mathematical treatment of data obtained during the optical scattering studies and provide the MATLAB code to configure non-commercial DLS equipment. Additionally, analyzes of nanoparticles obtained by pulsed laser ablation of Ag, Au, Si and W and commercial Au nanoparticles were carried out. The particle size results are compared with SEM images to calculate the percentage error of the DLS measurements. The results show an error of 5%, 3.8%, 2.1% for the Ag, Au and Si nanoparticles respectively, which proves to be an excellent approximation to the real values of nanoparticle diameter. Meanwhile, the error in size for W nanoparticles by the same technique and commercial Au nanoparticle is 29% and 12%, which shows the effect of the hydrodynamic diameter of the nanoparticles. This work ends with the analysis of the concentration of nanoparticles and its importance in reliable results of DLS measurements.&amp;#xD;

Adherence to Guidelines for Diagnosis, Staging, and Treatment for Gastric Cancer in Italy According to the View of Surgeons and Patients

Background: Despite the strong declining trends in incidence and mortality over the last decades, gastric cancer (GC) is still burdened with high mortality, even in high-income countries. To improve GC prognosis, several guidelines have been increasingly published with indications about the most appropriate GC management. The Italian Society of Digestive System Pathology (SIPAD) and Gastric Cancer Italian Research Group (GIRCG) designed a survey for both surgeons and patients with the purpose of evaluating the degree of application and adherence to guidelines in GC management in Italy. Materials and Methods: Between January and May 2022, a questionnaire has been administered to a sample of Italian surgeons and, in a simplified version, to members of the Patient Association “Vivere Senza Stomaco” (patients surgically treated for GC between 2008 and 2021) to investigate the diagnosis, staging, and treatment issues. Results: The survey has been completed by 125 surgeons and 125 patients. Abdominal CT with gastric hydro-distension before treatment was not widespread in both groups (47% and 42%, respectively). The rate of surgeons stating that they do not usually perform minimally invasive gastrectomy was 15%, but the rate of patients who underwent a minimally invasive approach was 22% (between 2011 and 2022). The percentage of surgeons declaring to perform extended lymphadenectomy (&gt;D2) was 97%, although a limited lymph node dissection rate was observed in about 35% of patients. Conclusions: This survey shows several important discrepancies from surgical attitudes declared by surgeons and real data derived from the reports available to the patients, suggesting heterogeneous management in clinical practice and, thus, a not rigorous adherence to the guidelines.

Effect of the postoperative pain management model on the psychological status and quality of life of patients in the advanced intensive care unit

Objectiveit was to explore the influence of the postoperative pain management mode on the psychological state, quality of life (QOL), and nursing satisfaction of late patients in the intensive care unit (ICU) and improve the nursing effect of late patients in the ICU.Methodsseventy patients who were admitted to the postoperative ICU for gastric cancer and received treatment in our hospital from March 2021 to May 2022 were selected. The patients were assigned into a research group and a control (Ctrl) group according to a random number table, with 70 cases in each group. The Ctrl group received routine nursing intervention, while research group received nursing intervention based on routine nursing intervention with postoperative pain management mode and received psychological care. Good communication was established with the patients, and the postoperative pain assessment was well conducted. The general information, state-trait anxiety (STAI) score, World Health Organization’s Quality of Life Instrument (WHO QOL-BREF) score, and care satisfaction were compared.Resultsthe general information differed slightly, such as sex, age, and ward type, between groups, with comparability (P > 0.05). S-AI scores (13.15 ± 1.53 vs. 16.23 ± 1.24) and T-AI scores (14.73 ± 3.12 vs. 18.73 ± 3.16) in research group were inferior to those in Ctrl group (P < 0.05). The scores of patients in research group in the physiological field (78.9 ± 6.1 points vs. 72.3 ± 5.6 points), social relationship field (76.9 ± 4.5 points vs. 71.3 ± 4.8 points), psychological field (78.6 ± 6.2 points vs. 72.4 ± 5.3 points), environmental field (78.6 ± 6.7 points vs. 73.5 ± 6.4 points), and total QOL (79.5 ± 7.4 points vs. 71.6 ± 5.4 points) were higher than those in Ctrl group (P < 0.05). The total satisfaction rate with nursing care in research group (82.85%) was dramatically superior to that in Ctrl group (62.85%) (P < 0.05).Conclusionthe adoption of a postoperative pain management model in postoperative nursing interventions for patients in advanced ICUs can alleviate anxiety and depression, improve patients’ QOL and nursing satisfaction, and have clinical promotion value.

Astragalus mongholicus bunge and panax notoginseng formula (A&P) improves renal fibrosis in UUO mice via inhibiting the long non-coding RNA A330074K22Rik and downregulating ferroptosis signaling

BackgroundChronic kidney disease (CKD) and its associated end-stage renal disease (ESRD) are significant health problems that pose a threat to human well-being. Renal fibrosis is a common feature and ultimate pathological outcome of various CKD leading to ESRD. The Astragalus mongholicus Bunge and Panax notoginseng formula (A&P) is a refined compound formulated by our research group, which has been clinically administered for over a decade and has demonstrated the ability to improve the inflammatory state of various acute or chronic kidney diseases. However, the underlying mechanism by which A&P ameliorates renal fibrosis remains unclear.MethodsWe established a mouse model by surgically ligating the unilateral ureter to induce renal injury in vivo. And we utilized renal in situ electroporation of a plasmid with low LncRNA A33 expression to establish the unilateral ureteral obstruction(UUO)mouse model. In vitro, we stimulated primary tubular epithelial cells(pTEC) injury using TGF-β1, siRNA-A33, and pcDNA3.1-A33 plasmids were transfected into pTECs to respectively knockdown and overexpress LncRNA A33, and both in vitro and in vivo models were intervened with A&P.ResultsThe results demonstrated that A&P effectively alleviated renal fibrosis in mice. Subsequent findings indicated high expression of LncRNA A33 in the kidneys of UUO mice and TGF-β1-induced renal tubular cells. In situ, renal electroporation of a plasmid with reduced LncRNA A33 expression revealed that inhibiting LncRNA A33 significantly improved renal fibrosis in UUO mice. Moreover, A&P effectively suppressed LncRNA A33 expression both in vitro and in vivo. Subsequent downregulation of LncRNA A33 in renal tubular epithelial cells resulted in the downregulation of numerous fibrotic markers, a significant inhibition of LncRNA A33, and a notable reduction in downstream ferroptosis signaling. Cell experiments demonstrated that A&P improved renal fibrosis in UUO mice by inhibiting LncRNA A33 and downregulating ferroptosis signaling.ConclusionThrough the inhibition of LncRNA A33 and subsequent downregulation of ferroptosis signaling, A&P showed potential as a therapeutic approach for improving renal fibrosis in UUO mice, providing a potential treatment avenue for CKD.

Evolution of underwater noise emission prediction technology for ship-propulsor combinations in an industry environment

ABSTRACT The prediction of underwater noise emissions by marine vessels has evolved significantly over the last decade as the interest shifted from exclusive military to civil use as a result of environmental concerns. Among different research groups, the best practices for the estimation with high-fidelity simulation methods based on hydrodynamic sound emissions are developed considering the complete vessel and propulsor. Here the current state-of-the-art computational fluid dynamics (CFD) approach, centered around propulsion units, is worked out in steps leading to the application for vessels. This consists of incompressible finite volume method flow simulations with large eddy turbulence modelling and volume-of-fluid phase capturing with a Schnerr-Sauer cavitation model in combination with an added permeable surface Ffowcs-Williams-Hawkings method for far-field acoustics. Many mechanistic arguments support it and the final validation cases lead to acceptable accuracy and enrich simulation data acquisition, however, few technical limitations reveal weaknesses compared to traditional approaches.

Exploring the Darobactin Class of Antibiotics: A Comprehensive Review from Discovery to Recent Advancements.

The prevalence of antimicrobial resistance in Gram-negative bacteria poses a greater challenge due to their intrinsic resistance to many antibiotics. Recently, darobactins have emerged as a novel class of antibiotics originating from previously unexplored Gram-negative bacterial species such as Photorhabdus, Vibrio, Pseudoalteromonas and Yersinia. Darobactins belong to the ribosomally synthesized and post-translationally modified peptide (RiPP) class of antibiotics, exhibiting selective activity against Gram-negative bacteria. They target the β-barrel assembly machinery (BAM), which is crucial for the maturation and insertion of outer membrane proteins in Gram-negative bacteria. The dar operon in the producer's genome encodes for the synthesis of darobactins, which are characterized by a fused ring system connected via an alkyl-aryl ether linkage (C-O-C) and a C-C cross-link. The enzyme DarE, using the radical S-adenosyl-l-methionine (rSAM), facilitates the formation of these bonds. Biosynthetic manipulation of the darobactin gene cluster, along with its expression in a surrogate host, has enabled access to diverse darobactin analogues with variable antibiotic activities. Recently, two independent research groups successfully achieved the total synthesis of darobactin, employing Larock heteroannulation to construct the bicyclic structure. This paper presents a comprehensive review of darobactins, encompassing their discovery through to the most recent advancements.

Characteristics, consent patterns, and challenges of randomized trials using the Trials within Cohorts (TwiCs) design A scoping review

ObjectiveTrials within Cohorts (TwiCs) is a pragmatic design approach that may overcome frequent challenges of traditional randomized trials such as slow recruitment, burdensome consent procedures, or limited external validity. This scoping review aims to identify all randomized controlled trials using the TwiCs design and to summarize their design characteristics, ways to obtain informed consent, output, reported challenges and mitigation strategies. Study design and settingSystematic search of Medline, Embase, Cochrane, trial registries and citation tracking up to December 2022. TwiCs were defined as randomized trials embedded in a cohort with post-randomization consent for the intervention group and no specific post-randomization consent for the usual care control group. Information from identified TwiCs were extracted in duplicate from protocols, publications, and registry entries. We analyzed the information descriptively and qualitatively to highlight methodological challenges and solutions related to non-uptake of interventions and informed consent procedure. ResultsWe identified a total of 46 TwiCs conducted between 2005 and 2022 in 14 different countries by a handful of research groups. The most common medical fields were oncology (11/46; 24%), infectious diseases (8/46;17%), and mental health (7/46; 15%). A typical TwiCs was investigator-initiated (46/46;100%), publicly funded (36/46; 78%), and recruited outpatients (27/46; 59%). Excluding eight pilot trials, only 16/38 (42%) TwiCs adjusted their calculated sample size for non-uptake of the intervention, anticipating a median non-uptake of 25% (interquartile range 10%-32%) in the experimental arm. Seventeen TwiCs (45%) planned analyses to adjust effect estimates for non-uptake. Regarding informed consent, we observed three patterns: 1) three separate consents for cohort participation, randomization, and intervention (17/46; 37%); 2) combined consent for cohort participation and randomization and a separate intervention consent (10/46; 22%); and 3) consent only for cohort participation and intervention (randomization consent not mentioned; 19/46; 41%). ConclusionsExisting TwiCs are globally scattered across a few research groups covering a wide range of medical fields and interventions. Despite the potential advantages, the number of TwiCs remains small. The variability in consent procedures and the possibility of substantial non-uptake of the intervention warrants further research to guide the planning, implementation, and analysis of TwiCs.

Towards overcoming barriers to the clinical deployment of mixed reality image-guided navigation systems supporting percutaneous ablation of liver focal lesions

In recent years, we have observed a rise in the popularity of minimally invasive procedures for treating liver tumours, with percutaneous thermoablation being one of them, conducted using image-guided navigation systems with mixed reality technology. However, the application of this method requires adequate training in using the employed system. In our study, we assessed which skills pose the greatest challenges in performing such procedures. The article proposes a training module characterized by an innovative approach: the possibility of practicing the diagnosis, planning, execution stages and the physical possibility of performing the execution stage on the radiological phantom of the abdominal cavity. The proposed approach was evaluated by designing a set of 4 exercises corresponding to the 3 phases mentioned. To the research group included 10 radiologists and 5 residents in the study. Based on 20 clinical cases of liver tumors subjected to percutaneous thermoablation, we developed assessment tasks evaluating four skill categories: head-mounted display (HMD), ultrasound (US)/computed tomography (CT) image fusion interpretation, tracking system use, and the ability to insert a needle. The results were presented using the Likert scale. The results of our study indicate that the most challenging aspect for radiology specialists is adapting to HMD gesture control, while residents point to intraoperative images of fusion and respiratory movements in the liver as the most problematic. In terms of improving the ability to perform procedures on new patients, the module also allows you to create a new hologram for a different clinical case.

Physicians’ perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

ObjectivesParents’ decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians’ perspectives on COVID-19 vaccinations for...

Spanish translation of the Expert Recommendations for Implementing Change (ERIC) compilation

BackgroundMost implementation science resources (e.g., taxonomies) are published in English. Linguistic inaccessibility creates a barrier to the conduct of implementation research among non-English-speaking populations, so translation of resources is needed. Translation into Spanish can facilitate widespread reach, given the large proportion of Spanish speakers around the world. This research aimed to systematically translate the Expert Recommendations for Implementation Change (ERIC) compilation into Spanish as an exemplar for the linguistic translation process.MethodsUsing the World Health Organization guidelines, this work translated the ERIC compilation strategy names, short definitions, and thematic clusters through a three-step process: 1) forward translation into Spanish by a native Spanish-speaking implementation scientist, 2) back-translation into English by a bilingual global health researcher, and 3) piloting via virtual focus group discussions with bilingual researchers not conducting implementation research. To achieve a generalizable translation, recruitment targeted a multicultural group of Spanish-speaking researchers. At the conclusion of each step, the transdisciplinary research team (N = 7) met to discuss discrepancies and refine translations. The Spanish version of the ERIC compilation was finalized through group consensus. Reflections from research team meetings and focus group discussions were synthesized qualitatively.ResultsGiven that dialectical nuances exist between Spanish-speaking regions, efforts prioritized universally accepted terminology. Team discussions focused on difficult translations, word choice, and clarity of concepts. Seven researchers participated in two focus groups, where discussion surrounded clarity of concepts, alternative word choice for Spanish translations, linguistic formality, grammar, and conciseness. Translation difficulties highlighted lack of precision in implementation science terminology, and the lack of conceptual clarity of words underscored limitations in the application of the compilation.ConclusionsThe work demonstrated the feasibility of translating implementation science resources. As one of the first systematic efforts to translate implementation resources, this study can serve as a model for additional efforts, including translation into other languages and the expansion to conceptual modifications. Further, this work yielded insights into the need to provide conceptual clarity in implementation science terminology. Importantly, the development of Spanish resources will increase access to conduct implementation research among Spanish-speaking populations.

Big ideas that changed the world of disability: Exploring theory with self‐advocates

AbstractBackgroundInclusive research has sidelined discussion of theoretical issues with researchers with intellectual/learning disabilities. This is a situation which the Big Ideas initiative sought to change. Between 2021 and 2023, the Open University, Leipzig University and the University of Koblenz organised nine workshops to explore influential theories in disability research. The objective was to share a theory (Big Idea) that sheds light on disability with self‐advocates and discuss how it relates to their experience. By making theories accessible and discussing how they relate to lived experience, we aimed to inform self‐advocates and activist researchers about key concepts in disability, deepen their capacity for research and campaigning, and better equip them to activate for change.MethodsThe online workshops were evaluated by observers. These observations were used by an inclusive group of activist researchers as the basis for an overall evaluation of the project.FindingsPeople with learning disabilities can engage with complex theories if these are presented accessibly alongside opportunities for reflective discussion. Input from self‐advocates helps to broaden and deepen theoretical understanding.An unanticipated but important finding was that the Big Ideas workshops created a new space in which academics and self‐advocates could learn together as equals.ConclusionsMaking theory accessible and easier to understand is both possible and valuable.

On Perceiving Molecular Time: Computational Chemical Simulations and the Moving Image

The perception of time undergoes a radical shift between the human scale and the nanoscale. In an age of rapidly evolving media and scientific technologies, we need to understand how these impact human perception and visual culture. This essay explores computational molecular simulations through the lenses of temporal media theory and moving image practice. Emerging from a creative fellowship with a physical chemistry research group, I focus on two moving image works that depict crystalline structures. One is a nanoscale computational simulation of soot formation and the other is a durational video artwork showing the dissolution of sugar. Computational molecular simulations are shown to produce a feeling of time by smearing an extremely short duration across a longer perceptible duration. This analysis uncovers how the awareness of media as a construct troubles our chronoception (perception of time), while unexpectedly, the screen becomes complicit in scientists’ expert temporal understanding. The videos present vastly different spatial and temporal scales and have different chronoceptive effects: one gives a sense of being within time, the other across time. Ultimately, computational simulations emerge as isomorphic media that have explicit aesthetic properties that connect us to the implicit, abstract energetics of chemical reactivity.

Threats to Journalism Practice in South America Due to Lack of Trauma Literacy in Professional Training: Results of a Survey in Brazil and Colombia

This discussion is part of the work of the Research Group on Education in Journalism and Trauma (JETREG), focusing on the exposure of Brazilian and Colombian journalists to risks in the exercise of their profession. The article analyzes responses of 50 Brazilian and Colombian professors who participated in the web survey on traumatic coverage and the inclusion of this topic in journalism teaching. The method involves survey. The fact that in Colombia and Brazil most journalism schools are private results in avoiding talking about risks of traumatic situations that the profession involves, as this can affect the demand of young people who want to graduate for this job and have great impact on already offering and distributing dispersed classes in the curriculum. The study pointed: i) gender attacks; ii) coverage of human rights; and iii) attacks on press freedom.

Dataset of Post-Event Survey of the 2024 Noto Peninsula Earthquake Tsunami in Japan

An earthquake with a moment magnitude of 7.5 (Mw) struck the northern Noto Peninsula, Ishikawa Prefecture, Japan, at 16:10 local time on January 1, 2024. This earthquake triggered a tsunami that propagated along the coastline of Ishikawa, Toyama, and Niigata Prefectures facing the Sea of Japan and significantly damaged coastal communities and infrastructure. Approximately 70 researchers from 23 universities or other institutes throughout Japan formed a joint research group to conduct a post-tsunami survey along a 340 km stretch of the coast. Based on the watermarks and traces of the tsunami, the inundation and run-up heights were surveyed using total stations, automatic optical levels, laser range finders, and a real-time kinematic (RTK) Global Navigation Satellite System (GNSS). The tidal correction was adjusted using astronomical tidal tables. In total, 303 survey records have been compiled, generating the NP2024TS (Noto Peninsula 2024 Tsunami Survey) dataset. This dataset provides comprehensive information on the inundation and run-up heights of the tsunami, which is useful for understanding tsunami characteristics and validating numerical tsunami models.

Meaning-making and transformative engagement – notes on Gunther Kress’s social semiotic and multimodal approach to learning

Abstract Against the background of a longstanding collaboration between Gunther Kress’s research group in London and my own research group in Stockholm, I reflect, in this paper, on the role of Kress’s ideas in our joint development of a social semiotic, multimodal, and design-oriented approach to learning, an approach which sees learning as performative, and as an activity in which learners create their own learning paths. I first discuss how, for Kress, this path has three elements, the affordances of the learning resources available to the learner, the learner’s ‘interest’ which turns aspects of these resources into ‘prompts’ for learning, and the learner’s active interpretation and transformation of these aspects, the results of which can then be recognized and valued as ‘signs of learning’. However, recognizing learning also needs to take account of the dimension of time, so as to make it possible to assess whether learners have gained knowledges and skills they did not have at an earlier stage. I then discuss the role of context in Kress’s thinking about learning. For Kress, context is another vital aspect of a social semiotic theory of learning. On the one hand, Kress focuses here on the specific, unique contexts in which individual learners create their own learning paths. On the other hand, he recognizes that signs will always carry social and political relations. Reflecting on the dynamic relation between individual learners and the way institutions regulate ways of learning, I discuss both the continued role of institutional learning contexts and their hidden curricula, and the way emerging technologies facilitate individual learning paths and interactive, participatory forms of learning.

Quality of life and survival analyses of breast cancer cases treated with integrated traditional Chinese and Western medicine.

Breast cancer (BC) is the second leading cause of tumor-related mortality after lung cancer. Chemotherapy resistance remains a major challenge to progress in BC treatment, warranting further exploration of feasible and effective alternative therapies. To analyzed the quality of life (QoL) and survival of patients with BC treated with integrated traditional Chinese and Western medicine (TCM-WM). This study included 226 patients with BC admitted to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine between February 2018 and February 2023, including 100 who received conventional Western medicine treatment (control group) and 126 who received TCM-WM treatment (research group). The total effective rate, side effects (alopecia, nausea and vomiting, hepatorenal toxicity, and myelosuppression), QoL assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), 1-year overall survival (OS), recurrence and metastasis rates, and serum inflammatory factors [interleukin (IL)-6, IL-10, and tumor necrosis factor alpha] were comparatively analyzed. The research group showed statistically better overall efficacy, EORTC QoL-C30 scores, and 1-year OS than the control group, with markedly lower side effects and 1-year recurrence and metastasis rates. Moreover, the posttreatment levels of serum inflammatory in the research group were significantly lower than the baseline and those in the control group. Overall, TCM-WM demonstrated significantly improved therapeutic efficacy while ensuring drug safety in BC, which not only improved patients' QoL and prolonged survival, but also significantly inhibited the inflammatory response.

Use of Cannabinoids by People Who Consume Kratom in the United States.

To estimate lifetime, past-year, and past-month prevalence of kratom, cannabis, and cannabidiol-only product use among adults 18 years and older in the United States, using 2 independent datasets. Utilizing (a) the 2022 National Survey on Drug Use and Health (NSDUH) and (b) a 2022 online national convenience sample of adults who use kratom regularly (from our research group at the National Institute on Drug Abuse [NIDA]), we examined key demographic information as well as lifetime, past-year, and past-month substance use and preferences. Among the full sample of adults from the 2022 NSDUH, the prevalence of lifetime use was 49.69% for cannabis, 34.09% for cannabidiol-only products, and 1.93% for kratom. When solely examining participants who have used kratom, both independent datasets showed higher proportions of cannabis use over the lifetime-92.81% (95% confidence interval: 90.31-95.31) in the NSDUH subset and 92.16% (95% confidence interval: 89.37-94.95) in our NIDA sample. Our study demonstrates that people are co-using kratom with cannabis and/or cannabidiol-only products at the same time or during the same time period, though more research is needed to understand people's motivations and practices for such co-use. Co-use might result in herb-herb interactions that may impact research findings and clinical outcomes for people who use kratom.