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Aim: This study aimed to determine the psychosocial markers associated with pre‐hospital delay among patients with diabetic foot (DF). Design: This study has a cross‐sectional design. Methods: The participants completed a questionnaire including pre‐hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale‐14. Bivariate and multivariate analyses were conducted to explore independent associations with pre‐hospital delay. Results: Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. Implications for the Profession and/or Patient Care: Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self‐management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. Patient or Public Contribution: This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China. [ABSTRACT FROM AUTHOR]

Introduction: Although the prevalence of Asian chronic lymphocytic leukemia (CLL) patients is not as high as that of Caucasians, there are more atypical CLLs in Asia whose genetic characteristics and their clinical significance are distinct and remain unclear. Methods: A retrospective analysis of 85 CLL samples in our center was conducted from 2019 to 2022. We used next‐generation sequencing with a 172 gene panel to explore the multi‐gene mutational data and the mutational status of immunoglobulin heavy variable (IGHV) gene. Results: MYD88 (20.0%) was the most frequently mutated gene, much higher than in Europe, followed in order by TP53 (18.8%), NOTCH1 (14.1%), IGLL5 (11.8%), and DNMT3A (8.2%). In addition, the incidence of ATM and SF3B1 mutations was relatively lower in our centre compared to Europe. Mutated (M)‐IGHV patients were more likely to have a cooccurrence of MYD88 mutation, while complex karyotype and DNMT3A mutation were more common in the unmutated (U)‐IGHV group. MYD88 mutated CLL was characterized by prevalence in young males in high‐risk staging, with isolated 13q deletion and concomitant mutation of IGLL5. CLL patients with MYD88 and TP53 mutation showed an unfavorable prognosis. Conclusion: These results would be valuable in helping to understand the characteristics and significance of cytogenetic genetics in Chinese patients with CLL. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effects of laparoscopic repeat liver resection (LRLR) and open repeat liver resection (ORLR) on surgical site wound infection and pain in recurrent hepatocellular carcinoma. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were systematically searched for studies comparing LRLR with ORLR for the treatment of recurrent hepatocellular carcinoma, with a search timeframe from their inception to December 2022. Two investigators independently screened the literature, extracted information, and evaluated the quality of the studies according to the inclusion and exclusion criteria. This study was performed using RevMan 5.4 software. A total of 20 publications with 4380 patients were included, with 1108 and 3289 patients in the LRLR and ORLR groups, respectively. The results showed that LRLR significantly reduced surgical site wound infection rate (1.71% vs. 5.16%, odds ratio [OR]:0.32, 95% confidence interval [CI]: 0.18‐0.56, P <.001), superficial wound infection rate (1.29% vs. 4.92%, OR: 0.29, 95% CI: 0.14‐0.58, P <.001), bile leakage (3.34% vs. 6.05%, OR: 0.59, 95% CI: 0.39‐0.90, P =.01), organ/space wound infection rate (0.4% vs. 5.11%, OR: 0.23, 95% CI: 0.07‐0.81, P =.02), and surgical site wound pain (mean difference: −2.00, 95% CI: −2.99 to −1.02, P <.001). Thus, the findings of this study showed that LRLR for recurrent hepatocellular carcinoma significantly reduced wound infection rates and improved postoperative wound pain. [ABSTRACT FROM AUTHOR]

Aim: Periodontitis (PD) is the sixth most prevalent disease around the world and is involved in the development and progression of multiple systemic diseases. Previous studies have reported that PD may aggravate liver injuries. The objective of this study was to investigate whether and how PD affects liver fibrosis. Materials and Methods: Ligature‐induced PD (LIP) was induced in male C57/B6J mice, and sub‐gingival plaques (PL) from patients with PD were applied to mouse teeth. Liver fibrosis was induced by carbon tetrachloride (CCl4) injection. The mice were randomly divided into six groups: Oil, Oil+LIP, Oil+LIP+PL, CCl4, CCl4+LIP, and CCl4+LIP+PL. Alveolar bone resorption was evaluated by methylene blue staining. Hepatic function was analysed by serum alanine aminotransferase and hepatic hydroxyproline. Picrosirius red and α‐smooth muscle actin (SMA) staining were used to evaluate the fibrotic area. RNA sequencing and quantitative RT‐PCR were used to measure gene expression. Western blotting was used to measure protein levels. Flow cytometry was used to analyse the accumulation of immune cells. Mouse microbiota were analysed using 16S rRNA gene sequencing. Results: Mice in the CCl4+LIP+PL group displayed higher serum alanine aminotransferase and hepatic hydroxyproline as well as more Picrosirius red‐positive and α‐SMA‐positive areas in liver samples than those of the CCl4 group, suggesting that PD (LIP+PL) aggravated CCl4‐induced hepatic dysfunction and liver fibrosis. Consistently, the expression of fibro‐genic genes and the protein levels of transforming growth factor β were much higher in the CCl4+LIP+PL group than in the CCl4 group. Flow cytometry revealed that PD increased the accumulation of immune cells, including Kupffer cells, B cells, and Th17 cells, in the liver of mice with CCl4 treatment. PD also increased the expression of inflammatory genes and activated pro‐inflammatory nuclear factor‐kappa B pathway in the livers of CCl4‐injected mice. Moreover, PD altered both oral and liver microbiota in CCl4‐injected mice. Conclusions: PD aggravates CCl4‐induced hepatic dysfunction and fibrosis in mice, likely through the increase of inflammation and alteration of microbiota in the liver. [ABSTRACT FROM AUTHOR]

Background: Engineering programs have increasingly incorporated design challenges into courses. These design challenges vary in the degree to which they present complex, ill‐structured, and relevant problems, and therefore may vary in the degree to which they support students to learn to frame design problems. Purpose/Hypothesis: We characterized how first‐year engineering students with little formal design training approach problem framing. We developed design challenges informed by funds of knowledge. We compared the development of problem framing skills in first‐year students who completed these challenges to students who completed more traditional challenges and to students in capstone design. Design/Method: Students completed a pre/post performance‐based assessment of problem framing skills. We analyzed student responses in terms of design requirements, design practices, and design styles. We used descriptive statistics and correlations to characterize how students initially approached problem framing and repeated‐measures ANOVA to compare groups of students. Results: First‐year students approached framing a design problem in one of four primary ways. Compared to students in the original course, they showed growth in attending to an underlying need, considering contexts of use, and depicting design function. Compared to capstone students, they also showed growth in considering stakeholder roles and planning the next steps. Conclusions: Funds of knowledge can provide a means to evaluate possible design challenges as authentic yet accessible for first‐year students, in turn, providing opportunities to support the development of the design problem framing ability. [ABSTRACT FROM AUTHOR]

Objectives: Typically, prognostic capability of gene expression profiling (GEP) is studied in the context of clinical trials, for which 50%‐80% of patients are not eligible, possibly limiting the generalizability of findings to routine practice. Here, we evaluate GEP analysis outside clinical trials, aiming to improve clinical risk assessment of multiple myeloma (MM) patients. Methods: A total of 155 bone marrow samples from MM patients were collected from which RNA was analyzed by microarray. Sixteen previously developed GEP‐based markers were evaluated, combined with survival data, and studied using Cox proportional hazard regression. Results: Gene expression profiling‐based markers SKY92 and the PR‐cluster were shown to be independent prognostic factors for survival, with hazard ratios and 95% confidence interval of 3.6 [2.0‐6.8] (P <.001) and 5.8 [2.7‐12.7] (P <.01) for overall survival (OS). A multivariate model proved only SKY92 and the PR‐cluster to be independent prognostic factors compared to cytogenetic high‐risk patients, the International Staging System (ISS), and revised ISS. A substantial number of high‐risk individuals could be further identified when SKY92 was added to the cytogenetic, ISS, or R‐ISS. In the cytogenetic standard‐risk group, ISS I/II, and R‐ISS I/II, 13%, 23%, and 23% of patients with adverse survivals were identified. Conclusions: For the first time, this study confirmed the prognostic value of GEP markers outside clinical trials. Conventional prognostic models to define high‐risk MM are improved by the incorporation of GEP markers. [ABSTRACT FROM AUTHOR]

Existing research has established that openness to experience can enhance dispositional awe. For the first time, the current study examines whether subjective socioeconomic status (SSES) moderates and a Zhong‐Yong thinking style mediates this effect. A sample of 2,377 Chinese undergraduates (mean age 20.7, ranging from 18 to 26) was recruited. As shown in previous research, openness was found to be positively associated with dispositional awe. As predicted, the relationship was moderated by familial and school SSES. The positive correlation was significantly larger in cases of lower familial and school SSES. The mediating effect of Zhong‐Yong thinking style was also supported in the relationship between openness and dispositional awe, as was the moderating effect of familial SSES; however, a suppressive effect was found for school SSES. The implications of this study are discussed herein. [ABSTRACT FROM AUTHOR]

Objective: This study aims to develop an artificial intelligence‐based method to screen patients with left ventricular ejection fraction (LVEF) of 50% or lesser using electrocardiogram (ECG) data alone. Methods: Convolutional neural network (CNN) is a class of deep neural networks, which has been widely used in medical image recognition. We collected standard 12‐lead ECG and transthoracic echocardiogram (TTE) data including the LVEF value. Then, we paired the ECG and TTE data from the same individual. For multiple ECG‐TTE pairs from a single individual, only the earliest data pair was included. All the ECG‐TTE pairs were randomly divided into the training, validation, or testing data set in a ratio of 9:1:1 to create or evaluate the CNN model. Finally, we assessed the screening performance by overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: We retrospectively enrolled a total of 26 786 ECG‐TTE pairs and randomly divided them into training (n = 21 732), validation (n = 2 530), and testing data set (n = 2 530). In the testing set, the CNN algorithm showed an overall accuracy of 73.9%, sensitivity of 69.2%, specificity of 70.5%, positive predictive value of 70.1%, and negative predictive value of 69.9%. Conclusion: Our results demonstrate that a well‐trained CNN algorithm may be used as a low‐cost and noninvasive method to identify patients with left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Background: H7N9 avian influenza is an infection of public health concern, in part because of its high mortality rate and pandemic potential. Aims: To describe the clinical features of H7N9 avian influenza and the response to treatment. Methods: Clinical, radiological and histopathological data, and treatment‐related of H7N9‐infected patients hospitalised during 2014–2017 were extracted and analysed. Results: A total of 17 H7N9 patients (three females; mean age, 58.4 ± 13.7 years) was identified; of these six died. All patients presented with fever and productive cough; four patients had haemoptysis and 13 had chest distress and/or shortness of breath. Early subnormal white blood cell count and elevation of serum liver enzymes were common. Multilobar patchy shadows, rapid progression to ground‐glass opacities, air bronchograms and consolidation were the most common imaging findings. Histopathological examination of lung tissue of three patients who died showed severe alveolar epithelial cell damage, with inflammatory exudation into the alveolar space and hyaline membrane formation; widened alveolar septae, prominent inflammatory cell infiltration; and hyperplasia of pneumocytes. Viral inclusions were found in the lung tissue of two patients. All patients received antiviral drugs (oseltamivir ± peramivir). Four patients carried the rs12252‐C/C interferon‐induced transmembrane protein‐3 (IFITM3) genotype, while the others had the C/T genotype. Conclusions: H7N9 virus infection causes human influenza‐like symptoms, but may rapidly progress to severe pneumonia and even death. Clinicians should be alert to the possibility of H7N9 infection in high‐risk patients. The presence of the IFITM3 rs12252‐C genotype may predict severe illness. [ABSTRACT FROM AUTHOR]

Background: The safety and efficacy of superior vena cava (SVC) isolation using second‐generation cryoballoon (CB) ablation remain unknown. Methods: A total of 26 (3.2%) patients with SVC‐related paroxysmal atrial fibrillation (AF) from a consecutive series of 806 patients who underwent second‐generation CB were included. Pulmonary vein isolation was initially achieved by CB ablation. If the SVC trigger was determined, the electrical isolation of SVC isolation was performed using the second‐generation CB. Results: Real‐time SVC potential was observed in all patients. Isolation of the SVC was successfully accomplished in 21 (80.8%) patients. The mean number of freeze cycles in each patient was 2.1 ± 1.1. The mean time to isolation and ablation duration were 22.5 ± 14.2 seconds and 94.5 ± 22.3 seconds, respectively. A transient phrenic nerve (PN) injury was observed in five patients (19.2%). There were two patients (7.7%) experienced reversible sinus node injury during the first application. During a mean follow‐up period of 13.2 ± 5.8 months, four patients (15.4%) had atrial arrhythmia recurrences. Conclusion: Isolation of SVC using the second‐generation 28‐mm CB is feasible when SVC driver during AF is identified. Vigilant monitoring of PN function during CB ablation of SVC is needed to avoid PN injury. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons. The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta‐analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients. Methods: A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies‐2. Country, study design, setting, blinding, and characteristics of included studies were extracted. Results: Eleven full‐text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87‐0.91; I2 = 94.9%, P =.0000) and 0.28 (95% CI, 0.27‐0.29; I2 = 99.2%, P =.0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09‐9.68). The overall weighted AUC was 0.7812 ± 0.0331 (95% CI: 0.7163‐0.8461) and the Q* value was 0.7196 ± 0.0283 (95% CI: 0.6641‐0.7751). Significant heterogeneity was noted among the included studies. Meta‐regression analysis showed that there was no heterogeneity in blinding (P =.074), study design (P =.679), or cut‐off value (P =.821). Conclusions: This meta‐analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations. Relevance to clinical practice: The first step in prevention of PU is risk assessment. In this meta‐analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice. [ABSTRACT FROM AUTHOR]

Understanding the factors affecting activities of daily living (ADL) is important in Alzheimer's disease (AD), because decline in ADL contributes to many poor health outcomes. Existing studies often investigate the factors in isolation without a theoretical framework. The purpose of the present study was to provide preliminary results on how cognition, physical performance, and behavioral and psychological symptoms of dementia mediate the relationship of aerobic fitness and ADL in AD. A cross‐sectional analysis was used (n = 28: average age 78 [8] years, education 16 (3) years, Mini‐Mental State Examination scores 20 [4]). The results showed that aerobic fitness is not linked to ADL directly, and its association with ADL was mediated by physical performance and global cognition. Our findings provide preliminary support for aerobic fitness as a potential therapeutic target, as enhanced aerobic fitness could simultaneously modify other factors affecting ADL. Nurses are in a unique position for coordinating exercise safety assessment and prescription and educating older adults with AD about exercise participation. [ABSTRACT FROM AUTHOR]