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Chih-Yen Hsiao,1 Yi-Chien Lee,2,3 Douglas JH Shyu,4 Che-Ping Su,5 Man-Yi Lin,5 Nai-Yu Guo,6 Cheng-Lun Chiang,1 Yih-Yuan Chen5 1Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; 2Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; 3School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; 4Department of Biological Science and Technology, National Pingtung University of Science and Technology, Neipu, Pingtung, Taiwan; 5Department of Biochemical Science and Technology, National Chiayi University, Chiayi, Taiwan; 6Department of Respiratory Care, Chang-Gung University of Science and Technology, Chiayi, TaiwanCorrespondence: Yih-Yuan Chen, Department of Biochemical Science and Technology, National Chiayi University, Chiayi, Taiwan, Tel +886-5-271-7795, Email yychen@mail.ncyu.edu.twObjective: The most common extraintestinal pathogen and infection site is uropathogenic Escherichia coli (UPEC), which causes urinary tract infections (UTIs). UPEC is also a common pathogen in bloodstream infections; in severe cases, it can lead to death. Although host and bacterial virulence factors have been demonstrated to be associated with UTI pathogenesis, the role of the related contributing factors in UTI and urinary source bacteremia is not yet fully understood. This study aimed to compare and analyze the factors contributing to urinary bacteremia in patients with UTI.Methods: A total of 171 E. coli strains collected from patients with UTI and urinary source bacteremia at Chiayi Christian Hospital were used. Phylogenetic groups and virulence factors were determined using PCR. Drug resistance patterns were determined using the disk diffusion assay.Results: Previous studies have demonstrated that fimbriae and papGII may be associated with first-step infections and severe UTIs, respectively. As expected, highly virulent E. coli strains (belonging to the phylogenetic B2 and D groups) were dominant in the bacteremic UTI (90%) and UTI (86.27%) groups. However, our results showed that the UTI group had a significantly higher prevalence of sfa/focDE (belonging to the S and FIC fimbriae) than the bacteremic UTI group (29.4% vs 12.5%; p=0.008). In the bacteremic group, we found that sfa/focDE was only detected in highly virulent strains. The bacteremic UTI group had a significantly higher prevalence of papGII (belonging to P fimbriae) than the UTI group (55.8% vs 37.3%; p=0.026). In addition, the P fimbriae gene cluster, including papC, papEF, and papGII, was predominant in highly virulent strains. Notably, our results show that multidrug-resistant (MDR) strains were significantly less virulent than non MDR strains.Conclusion: Taken together, our results provide insights into the contributing factors in patients with UTI and urinary bacteremia.Keywords: Escherichia coli, urinary tract infection, urinary source bacteremia, virulence factors, multidrug resistance

Proton exchange membrane (PEM) electrolysis holds great promise for green hydrogen production, but suffering from high loading of platinum-group metals (PGM) for large-scale deployment. Anchoring PGM-based materials on supports can not only improve the atomic utilization of active sites but also enhance the intrinsic activity. However, in practical PEM electrolysis, it is still challenging to mediate hydrogen adsorption/desorption pathways with high coverage of hydrogen intermediates over catalyst surface. Here, operando generated stable palladium (Pd) hydride nanoclusters anchored on tungsten carbide (WC x ) supports were constructed for hydrogen evolution in PEM electrolysis. Under PEM operando conditions, hydrogen intercalation induces formation of Pd hydrides (PdH x ) featuring weakened hydrogen binding energy (HBE), thus triggering reverse hydrogen spillover from WC x (strong HBE) supports to PdH x sites, which have been evidenced by operando characterizations, electrochemical results and theoretical studies. This PdH x -WC x material can be directly utilized as cathode electrocatalysts in PEM electrolysis with ultralow Pd loading of 0.022 mg cm -2 , delivering the current density of 1 A cm -2 at the cell voltage of ~1.66 V and continuously running for 200 hours without obvious degradation. This innovative strategy via tuning the operando characteristics to mediate reverse hydrogen spillover provide new insights for designing high-performance supported PGM-based electrocatalysts., (© 2024 Wiley-VCH GmbH.)

Objective: Kidney failure manifests in various forms, from sudden occurrences such as Acute Kidney Injury (AKI) to progressive like Chronic Kidney Disease (CKD). Given its intricate nature, marked by overlapping comorbidities and clinical similarities-including treatment modalities like dialysis-we sought to design and validate an end-to-end framework for clustering kidney failure subtypes., Materials and Methods: Our emphasis was on dialysis, utilizing a comprehensive dataset from the UK Biobank (UKB). We transformed raw Electronic Health Record (EHR) data into standardized matrices that incorporate patient demographics, clinical visit data, and the innovative feature of visit time-gaps. This matrix structure was achieved using a unique data cutting method. Latent space transformation was facilitated using a convolution autoencoder (ConvAE) model, which was then subjected to clustering using Principal Component Analysis (PCA) and K-means algorithms., Results: Our transformation model effectively reduced data dimensionality, thereby accelerating computational processes. The derived latent space demonstrated remarkable clustering capacities. Through cluster analysis, two distinct groups were identified: CKD-majority (cluster 1) and a mixed group of non-CKD and some CKD subtypes (cluster 0). Cluster 1 exhibited notably low survival probability, suggesting it predominantly represented severe CKD. In contrast, cluster 0, with substantially higher survival probability, likely to include milder CKD forms and severe AKI. Our end-to-end framework effectively differentiates kidney failure subtypes using the UKB dataset, offering potential for nuanced therapeutic interventions., Conclusions: This innovative approach integrates diverse data sources, providing a holistic understanding of kidney failure, which is imperative for patient management and targeted therapeutic interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose of Review: With only 12% of the human population living in cities meeting the air quality standards set by the WHO guidelines, there is a critical need for coordinated strategies to meet the requirements of a healthy society. One pivotal mechanism for addressing societal expectations on air pollution and human health is to employ strategic modeling within the urban planning process. This review synthesizes research to inform coordinated strategies for a healthy society. Through strategic modeling in urban planning, we seek to uncover integrated solutions that mitigate air pollution, enhance public health, and create sustainable urban environments., Recent Findings: Successful urban planning can help reduce air pollution by optimizing city design with regard to transportation systems. As one specific example, ventilation corridors i.e. aim to introduce natural wind into urban areas to improve thermal comfort and air quality, and they can be effective if well-designed and managed. However, physical barriers such as sound walls and vegetation must be carefully selected following design criteria with significant trade-offs that must be modeled quantitatively. These tradeoffs often involve balancing effectiveness, cost, aesthetics, and environmental impact. For instance, sound walls are highly effective at reducing noise, provide immediate impact, and are long-lasting. However, they are expensive to construct, visually unappealing, and may block views and sunlight. To address the costly issue of sound walls, a potential solution is implementing vegetation with a high leaf area index or leaf area density. This alternative is also an effective method for air pollution reduction with varying land-use potential. Ultimately, emission regulations are a key aspect of all such considerations. Given the broad range of developments, concerns, and considerations spanning city management, ventilation corridors, physical barriers, and transportation planning, this review aims to summarize the effect of a range of urban planning methods on air pollution considerations., Competing Interests: Declarations. Conflict of Interest: The authors declare no competing interests. Human and Animal Rights: This article does not contain any studies with human or animal subjects performed by the authors., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: To compare the degree of myopic regression after myopia correction with either femtosecond laser-assisted in situ keratomileusis (FS-LASIK) or small-incision lenticule extraction (SMILE) over 18 months., Methods: Patients undergoing FS-LASIK or SMILE surgery for myopia correction were retrospectively recruited. The propensity scores were used to match patients by age and preoperative manifest spherical equivalent (SEQ) from these 2 groups. Myopic regression was analyzed using the Cox proportional hazard model., Results: A total of 416 eyes of 416 patients undergoing FS-LASIK and 416 eyes of 416 patients undergoing SMILE were matched. Using 1-month SEQ as baseline, the SEQ regression values after FS-LASIK were 0D, -0.17 ± 0.69D, -0.24 ± 0.65D, -0.31 ± 0.65D, -0.32 ± 0.63D, and -0.33 ± 0.62D and the SEQ regression values after SMILE were 0D, -0.07 ± 0.75D, -0.18 ± 0.77D, -0.23 ± 0.82 D, -0.21 ± 0.77D, and -0.24 ± 0.68D at 1, 3, 6, 9, 12, and 18 months, respectively. The Cox proportional hazard model showed that preoperative manifest SEQ ( P = 0.021) and designed optical zone ( P = 0.048) are significant predictors. The selected surgical procedure had no significant effect on predicting myopic regression ( P = 0.470). The cumulative survival rates of myopic regression were 54.74% and 42.10% in the FS-LASIK group and 58.66% and 43.83% in the SMILE group, at 12 and 18 months, respectively (log-rank test, P = 0.11)., Conclusions: After matching based on age and preoperative manifest SEQ, we found that higher myopia and a smaller optical zone contribute significantly to the development of myopic regression after undergoing FS-LASIK or SMILE surgery at 18 months. The selected surgical procedure, however, does not affect the likelihood of myopic regression., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To investigate the relationship between physician-hospital integration within accountable care organizations (ACOs) and inpatient care utilization and expenditure., Data Sources: The primary data were Massachusetts All-Payer Claims Database (2009-2013)., Study Setting: Fifteen provider organizations that entered a commercial ACO contract with a major private payer in Massachusetts between 2009 and 2013., Study Design: Using an instrumental variable approach, the study compared inpatient care delivery between patients of ACOs demonstrating high versus low integration. We measured physician-hospital integration within ACOs by the proportion of primary care physicians in an ACO who billed for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. The study sample comprised non-elderly adults who had continuous insurance coverage and were attributed to one of the 15 ACOs. Outcomes of interest included total medical expenditure during an episode of inpatient care, length of stay (LOS) of the index hospitalization, and 30-day readmission. An inpatient episode was defined as 30, 45, and 60 days from the admission date., Data Collection/extraction Methods: Not applicable., Principal Findings: The study examined 33,535 admissions from patients served by the 15 ACOs. Average medical expenditure within 30 days of admission was $24,601, within 45 days was $26,447, and within 60 days was $28,043. Average LOS was 3.5 days, and 5.4% of patients were readmitted within 30 days. Physician-hospital integration was associated with a 10.6% reduction in 30-day expenditure (95% CI, -15.1% to -5.9%). Corresponding estimates for 45 and 60 days were - 9.7% (95%CI, -14.2% to -4.9%) and - 9.6% (95%CI, -14.3% to -4.7%). Integration was associated with a 15.7% decrease in LOS (95%CI, -22.6% to -8.2%) but unrelated to 30-day readmission rate., Conclusions: Our instrumental variable analysis shows physician-hospital integration with ACOs was associated with reduced inpatient spending and LOS, with no evidence of elevated readmission rates., (© 2024 Health Research and Educational Trust.)

Introduction: Chronic kidney disease is related to neurodegeneration and structural changes in the brain which might lead to cognitive decline. The Fazekas scale used for assessing white matter hyperintensities (WMHs) was associated with poor cognitive performance. Therefore, this study investigated the associations between the mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), and Fazekas scale in patients under hemodialysis (HD)., Methods: The periventricular (PV) WMHs and deep WMHs (DWMHs) in brain magnetic resonance images of 59 patients under dialysis were graded using the Fazekas scale. Three cognition function tests were also performed, then multivariable ordinal regression and logistic regression were used to identify the associations between cognitive performance and the Fazekas scale., Results: There were inverse associations between the three cognitive function tests across the Fazekas scale of PVWMHs ( p  = .037, .006, and .008 for MMSE, MoCA, and CASI, respectively), but the associations were attenuated in the DWMHs group. In CASI, significant differences were identified in short-term memory, mental manipulation, abstract thinking, language, spatial construction, and name fluency in the PVWMHs group. However, DWMHs were only significantly correlated with abstract thinking and short-term memory., Conclusion: An inverse correlation existed between the Fazekas scale, predominantly in PVWMHs, and cognition in patients undergoing HD. The PVWMHs were associated with cognitive performance assessed by MMSE, MoCA, and CASI, as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.

Purpose: In Taiwan, the incidence of urothelial carcinoma of the upper urinary tract (UTUC) is high and intravesical recurrence is approximately 22%-47%. Thus, postoperative cystoscopy and urine cytology follow-up, which require experienced cytologists, are needed. The AIxURO system aligns with The Paris System (TPS) guidelines for reporting urinary cytology. This study assessed the benefit of early detection of intravesical recurrence after nephroureterectomy using the AIxURO system., Methods: Urine cytology slides (n = 296) from 113 patients with UTUC were retrieved and patient data, pre-operative and postoperative cytology, pathology, and follow-up series for the intravesical recurrence group were collected. Cytology slides were digitized and independently assessed by the AIxURO system, and the results were compared to cytology reports., Results: From January 2022 to August 2023, 113 patients with UTUC underwent nephroureterectomy. Eighty-eight patients (88/113, 77.8%) received 1 or 2 cytology examinations pre-operatively, 44 slides (44/204, 21.5%) were positive and 34 patients (34/113, 30.1%) were diagnosed with UTUC. Postoperative intravesical recurrence was detected in 27 patients (27/113, 23%) at an average of 190.62 days. Thirty-four slides (34/56, 60.7%) were negative for UTUC. Eight patients (8/27, 29.6%) met the criteria for early diagnosis of intravesical recurrence. The AIxURO system identified two more patients (10/27, 37.0%) with early intravesical recurrence., Conclusion: The AIxURO system enhanced postoperative urine cytology reporting confidence and could identify some underdiagnosed slides to enhance the early detection of UTUC with intravesical recurrence. AIxURO may be used for post-nephroureterectomy follow-up and reduce the necessity for cystoscopy., (© 2024. The Author(s).)

Aim: To assess the effects of virtual reality training on the cognitive, affective and psychomotor domains in nursing education among nursing students., Background: The use of virtual reality in nursing education immerses students in realistic and interactive environments, greatly enhancing their learning experiences. However, research on its effectiveness in nursing education has shown inconsistent results, particularly regarding its impact on learner emotions related to clinical skills., Design: Systematic review and meta-analysis., Method: Related studies were sourced from PubMed, Cochrane, Web of Science and Embase databases from their inception until October 3, 2024. Comprehensive Meta-Analysis software was used for data analysis and the risk of bias was assessed using the Risk of Bias Tools., Results: Eight randomized controlled trials met our inclusion criteria. The results revealed that virtual reality training significantly enhanced the development of clinical skills, having a positive impact on the cognitive, affective and psychomotor learning domains in nursing students. The following effect sizes were obtained: (1) knowledge: 0.237 (95 % CI: 0.054-0.421, p = 0.011); (2) skill: 0.682 (95 % CI: 0.299-1.064, p < 0.001); (3) self-confidence: 0.287 (95 % CI: 0.008-0.567, p = 0.044); and (4) learning satisfaction: 0.458 (95 % CI: 0.256-0.661, p < 0.001)., Conclusion: Virtual reality nursing training enriches students' cognitive, emotional and psychomotor skills; provides a secure setting for honing critical skills, thus boosting student confidence; and increases students' overall learning satisfaction, but shows limited impact on improving self-efficacy. Integrating virtual reality into pre-departure nursing technology education and training can enhance students' understanding of the nursing process, improve the accuracy of technical operations and promote overall learning effectiveness., Competing Interests: Declaration of Competing Interest "The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.", (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Labyrinthitis significantly reduces quality of life due to prolonged vestibular symptoms in patients experiencing sudden sensorineural hearing loss with vertigo (SSNHLV). This study employed a novel coherence analysis in the video head impulse test (vHIT) to explore vertigo outcomes in SSNHLV patients., Methods: A retrospective review was conducted on 48 SSNHLV patients who completed high-dose steroid treatment between December 2016 and April 2023. Additionally, 38 healthy volunteers were prospectively enrolled from November 2022 to April 2023 at our academic tertiary referral center. The magnitude-squared wavelet coherence between eye and head velocities during the vHIT was measured to assess correlations across frequency bands. Recovery from vertigo, determined by a visual analog scale (VAS) score of 0 at both 2 weeks and 2 months, was analyzed using multivariable Cox regression., Results: The mean VAS for patients with SSNHLV was 5.73±2.45. Higher coherent frequencies in the horizontal semicircular canal (SCC), posterior SCC, and the mean and minimal coherent frequencies of all three SCCs combined were significantly associated with early complete remission of vertigo 2 weeks posttreatment. In the multivariate analysis, the minimal coherent frequency among the three SCCs emerged as an independent factor (hazard ratio, 2.040; 95% CI, 1.776-2.304). Two months posttreatment, in addition to the previously significant parameters, abnormalities in the vestibulo-ocular reflex (VOR) in the posterior SCC, gains in the horizontal and posterior SCCs, total and overt saccades in the horizontal SCC, coherent frequency in the anterior SCC, and mean VOR gain of all three SCCs combined were also statistically significantly related to total relief from vertigo., Conclusion: The highest minimal coherent frequency among the three SCCs significantly contributed to earlier vertigo relief in patients with SSNHLV. Coherence analysis in vHIT may offer greater sensitivity than time series analysis for predicting the prognosis of vertigo.

Background/aim: To evaluate efficacy of the AIxURO system, a deep learning-based artificial intelligence (AI) tool, in enhancing the accuracy and reliability of urine cytology for diagnosing upper urinary tract cancers., Materials and Methods: One hundred and eighty-five cytology samples of upper urine tract were collected and categorized according to The Paris System for Reporting Urinary Cytology (TPS), yielding 168 negative for High-Grade Urothelial Carcinoma (NHGUC), 14 atypical urothelial cells (AUC), 2 suspicious for high-grade urothelial carcinoma (SHGUC), and 1 high-grade urothelial carcinoma (HGUC). The AIxURO system, trained on annotated cytology images, was employed to analyze these samples. Independent assessments by a cytotechnologist and a cytopathologist were conducted to validate the initial AIxURO assessment., Results: AIxURO identified discrepancies in 37 of the 185 cases, resulting in a 20% discrepancy rate. The cytotechnologist achieved an accuracy of 85% for NHGUC and 21.4% for AUC, whereas the cytopathologist attained accuracies of 95% for NHGUC and 85.7% for AUC. The cytotechnologist exhibited overcall rates of roughly 15% and undercall rates of greater than 50%, while the cytopathologist showed profoundly lower miscall rates from both undercall and overcall. AIxURO significantly enhanced diagnostic accuracy and consistency, particularly in complex cases involving atypical cells., Conclusion: AIxURO can improve the accuracy and reliability of cytology diagnosis for upper urine tract urothelial carcinomas by providing precise detection on atypical urothelial cells and reducing subjectivity in assessments. The integration of AIxURO into clinical practice can significantly ameliorate diagnostic outcomes, highlighting the synergistic potential of AI technology and human expertise in cytology., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is highly accurate for diagnosing pancreatic mass. However, making diagnosis is challenging in 5-20% of patients. This study investigated the challenging features associated with reduced diagnostic performance in EUS-FNB and potential rescue methods that can improve the diagnostic rate., Methods: This single-center retrospective study included patients with solid pancreatic tumors who underwent EUS-FNB between January 1, 2019, and December 12, 2021. Patients without a computed tomography (CT) scan or definite diagnosis were excluded. Challenging features were features that reduced diagnostic accuracy in EUS-FNB, as determined through multivariate analysis. Rescue methods were methods that assisted operators in assessing lesions in patients with challenging features., Results: Of 332 enrolled patients, an accurate diagnosis obtained using EUS-FNB was achieved in 286 (86.1%). Univariable analysis revealed that the diagnostic accuracy was lower in cases of pancreatic tumors with isoattenuation in CT images (77.3% vs. 89.8%, odds ratio [OR]: 0.39, p = 0.003), an ill-defined margin on EUS (61.2% vs. 92.5%, OR: 0.13, p < 0.001), or tumor size < 20 mm (65.5% vs. 88.1%, OR: 0.26, p = 0.002). However, only ill-defined margins on EUS (OR: 0.14, p < 0.001) and tumor size < 20 mm (OR: 0.25, p = 0.005) were independent predictors of inconclusive EUS-FNB in the multivariate analysis. The use of contrast (OR: 4.46, p = 0.026) and a highly experienced endosonographer (> 5cases/month; OR: 3.25, p = 0.034) improved diagnostic performance in difficult cases., Conclusions: Pancreatic tumors with ill-defined tumor margins on EUS or size < 20 mm are challenging features in EUS-FNB. The use of contrast and a highly experienced endosonographer can improve diagnostic performance in difficult cases., Competing Interests: Declarations Conflict of interest The authors have no conflicts of interest to declare. Consent for publication The consent for publication was obtained. Ethical approval The study was approved by the Institutional Review Board of the National Cheng Kung University Hospital (B-ER-110-374)., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Importance: Prompt and accurate diagnosis of arteritic anterior ischemic optic neuropathy (AAION) from giant cell arteritis and other systemic vasculitis can contribute to preventing irreversible vision loss from these conditions. Its clinical distinction from nonarteritic anterior ischemic optic neuropathy (NAION) can be challenging, especially when systemic symptoms are lacking or laboratory markers of the disease are not reliable., Objective: To develop, train, and test a deep learning system (DLS) to discriminate AAION from NAION on color fundus images during the acute phase., Design, Setting, and Participants: This was an international study including color fundus images of 961 eyes of 802 patients with confirmed AAION and NAION. Training was performed using images from 21 expert neuro-ophthalmology centers in 16 countries, while external testing was performed in a cohort from 5 expert neuro-ophthalmology centers in the US and Europe. Data for training and external testing were collected from August 2018 to January 2023. A mix of deidentified images of 2 fields of view (optic disc centered and macula centered) were used. For training and internal validation, images were from 16 fundus camera models with fields of 30° to 55°. For external testing, images were from 5 fundus cameras with fields of 30° to 50°. Data were analyzed from January 2023 to January 2024., Main Outcomes and Measures: The performance of the DLS was measured using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy., Results: In the training and validation sets, 374 (54.9%) of patients were female, 301 (44.2%) were male, and 6 (0.9%) were of unknown sex; the median (range) age was 66 (23-96) years. When tested on the external dataset including 121 patients (35 [28.9%] female, 44 [36.4%] male, and 42 [34.7%] of unknown sex; median [range] age, 69 [37-89] years), the DLS achieved an AUC of 0.97 (95% CI, 0.95-0.99), a sensitivity of 91.1% (95% CI, 85.2-96.9), a specificity of 93.4% (95% CI, 91.1-98.2), and an accuracy of 92.6% (95% CI, 90.5-96.6). The accuracy of the 2 experts for classification of the same dataset was 74.3% (95% CI, 66.7-81.9) and 81.6% (95% CI, 74.8-88.4), respectively., Conclusions and Relevance: A DLS showing disease-specific averaged class-activation maps had greater than 90% accuracy at discriminating between acute AAION from NAION on color fundus images, at the eye level, without any clinical or biomarker information. A DLS that identifies AAION could improve clinical decision-making, potentially reducing the risk of misdiagnosis and improving patient outcomes.

Background: The light spectrum of intense pulsed light (IPL) comprises visible to near-infrared light. It has been widely employed in the field of aesthetics for approximately 30 years. However, several studies have demonstrated the appearance of various undesirable biomarkers on the skin after IPL irradiation, which remain elucidated., Methods: We reviewed the evolving concepts and explored the potentially harmful effects of IPL that may have been neglected in the past., Results: Increased levels of reactive oxidative stress, p53, p16, proliferating cell nuclear antigen, interleukin-6, C-reactive protein, and cleaved caspase 3 and decreased albumin levels in human or mouse skin have been observed after IPL treatment. Visible and infrared light can exert harmful and beneficial effects on human skin., Conclusion: If perform improperly, IPL treatment may lead to cellular senescence, photoaging, photocarcinogenesis, thermal aging, and inflammaging. Further studies are required to verify the significance of the changes in the relevant biomarkers. The selection of treatment candidates, optimal parameters, and standardized protocols for IPL therapy are necessary., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: This study evaluated the diagnostic effectiveness of the AIxURO platform, an artificial intelligence-based tool, to support urine cytology for bladder cancer management, which typically requires experienced cytopathologists and substantial diagnosis time., Methods: One cytopathologist and two cytotechnologists reviewed 116 urine cytology slides and corresponding whole-slide images (WSIs) from urology patients. They used three diagnostic modalities: microscopy, WSI review, and AIxURO, per The Paris System for Reporting Urinary Cytology (TPS) criteria. Performance metrics, including TPS-guided and binary diagnosis, inter- and intraobserver agreement, and screening time, were compared across all methods and reviewers., Results: AIxURO improved diagnostic accuracy by increasing sensitivity (from 25.0%-30.6% to 63.9%), positive predictive value (PPV; from 21.6%-24.3% to 31.1%), and negative predictive value (NPV; from 91.3%-91.6% to 95.3%) for atypical urothelial cell (AUC) cases. For suspicious for high-grade urothelial carcinoma (SHGUC) cases, it improved sensitivity (from 15.2%-27.3% to 33.3%), PPV (from 31.3%-47.4% to 61.1%), and NPV (from 91.6%-92.7% to 93.3%). Binary diagnoses exhibited an improvement in sensitivity (from 77.8%-82.2% to 90.0%) and NPV (from 91.7%-93.4% to 95.8%). Interobserver agreement across all methods showed moderate consistency (κ = 0.57-0.61), with the cytopathologist demonstrating higher intraobserver agreement than the two cytotechnologists across the methods (κ = 0.75-0.88). AIxURO significantly reduced screening time by 52.3%-83.2% from microscopy and 43.6%-86.7% from WSI review across all reviewers. Screening-positive (AUC+) cases required more time than negative cases across all methods and reviewers., Conclusions: AIxURO demonstrates the potential to improve both sensitivity and efficiency in bladder cancer diagnostics via urine cytology. Its integration into the cytopathological screening workflow could markedly decrease screening times, which would improve overall diagnostic processes., (© 2024 The Author(s). Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Purpose: This study aimed to investigate the hearing outcomes in patients with sudden sensorineural hearing loss without vertigo (SSNHLwoV)., Methods: Patients with SSNHLwoV managed from December 2016 to March 2020 were prospectively enrolled in an academic tertiary referral center. Fifty-one patients with SSNHLwoV who completed high-dose steroid treatment. The hearing prognosis was analyzed using a multivariate Cox regression model., Results: The rates of complete, partial, and no hearing recovery were 52.9%, 17.6%, and 29.4% in patients with SSNHLwoV, respectively. The video head impulse test (vHIT) of the posterior semicircular canal (PSC), high-tone hearing loss (4-8 kHz) ≥ 30 dB, and average hearing threshold (0.5-1-2-4 kHz) were significantly associated with incomplete recovery of hearing after treatment. In multivariate analysis, the vHIT of the PSC (hazard ratio [HR], 14.502; 95% confidence interval [CI], 1.371-153.355) and high-tone hearing loss ≥ 30 dB (HR, 9.170; 95% CI, 2.283-36.830) remained robust., Conclusions: Abnormal vestibular function tests were performed in 80.4% of the patients with SSNHLwoV. Abnormal vHIT of the PSC and high-tone hearing loss ≥ 30 dB were independent factors resulting in incomplete recovery of hearing in patients with SSNHLwoV. In the SSNHLwoV cohort, the caloric test was not significantly associated with hearing prognosis, and vHIT was a feasible predictor of treatment outcome., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Tuberculosis (TB) poses a significant global health challenge. While the incidence of breast TB (BTB) is relatively low, it can easily be mistaken for breast cancer or breast granulomatous lobulitis, potentially delaying timely intervention. The gold standard for diagnosis consists of Mycobacterium TB culture and Ziehl-Neelsen staining. Treatment typically consists of a combination of anti-TB therapy and surgical intervention., Case Description: Our research group recently reported a case of BTB accompanied by rib bone destruction. Initially, imaging examinations suggested breast cancer with bone metastasis. However, subsequent real-time ultrasound-guided biopsy revealed chronic inflammation with granulomatous inflammation and extensive necrosis, which led to the diagnosis of BTB. Further T cells spot test (T-SPOT) testing predicted the likelihood of the presence of TB infection, and magnetic resonance imaging (MRI) indicated a high likelihood of TB. A biopsy of the breast lesions was performed and subsequent polymerase chain reaction (PCR) analysis of the aspirated specimens confirmed the presence of DNA from the Mycobacterium TB complex, as well as genes associated with rifampicin resistance. These findings led to the definitive diagnosis of BTB complicated by bone destruction. The patient underwent a 4-month course of anti-TB medication, followed by surgical intervention and an additional regimen of anti-TB drugs. Nine months post-surgery, the patient exhibited no indications of recurrence., Conclusions: The diagnosis of BTB with bone destruction is challenging, and clinicians need to be vigilant not to misdiagnose it as breast cancer or granulomatous lobulitis., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-185/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

The male of the little-known species Aulaconotus incorrugatus Gressitt, 1939 is reported for the first time, and its male genitalia compared with the most similar congener, A. semiaulaconotus (Hayashi, 1974). A few new provincial records for A. incorrugatus are given. A new species closely related to the above taxa, A. yangi Bi & Lin sp. nov., is described from southeastern China. Illustrations of the habitus and major diagnostic characters, including endophallic structure, of these three species are provided.

The genus Mecynippus Bates, 1884 is investigated and considered a monotypic genus. Falsomecynippus Bi, Chen & Lin, gen. nov., is established for Monohammus ciliatus Gahan, 1888 which was previously placed in Mecynippus. One new subgenus is described based on Falsomecynippus (Tuberculhammus) superbus Bi, Chen & Lin, subgen. nov. & sp. nov. from China and Laos. Illustrations of the habitus, endophallic structures, and major diagnostic features for all involved taxa are provided.

The diversity of the genus Anoplophora Hope, 1839 of Nanling Priority Area for Biodiversity Conservation is surveyed, with the discovery of one new species, A. xuei Lin & Wen, sp. nov. This species is described from Guangxi and Guizhou, China. Illustrations of the habitus and male genitalia of A. xuei Lin & Wen, sp. nov. and the similar A. leechi (Gahan) are provided. Additional locality data for A. leechi is provided.

Objective: This study aimed to investigate the prevalence and distribution of carcinoma in the liver margin (LM) of resected perihilar cholangiocarcinoma (pCCA) and establish a method for LM examination., Background: LM is the largest margin in resected pCCA with undefined status and assessment method., Methods: 227 pCCA cases underwent major hepatectomy were divided into a discovery cohort (n=101) assessed using serial whole-mount digital large sections (WDLS) combined with small sections, and a control cohort (n=126) assessed using only small sections., Results: The LM R1 resection rate was 38.6% (39/101) in the discovery cohort and 5.6% (7/126) in the control cohort. WDLS identified more LM R1 cases compared to the small section in the discovery cohort (38.6% vs. 5.9%, P<0.001). R0 patients in the discovery cohort had better overall survival and recurrence-free survival than those in the control cohort (both P<0.05). Additionally, 95% of carcinoma was found within 20 mm of the proximal ductal margin (DM). A proximal DM distance of<5 mm was an independent risk factor for LM R1 resection. Patients with which are more likely to experience R1 compared to those with ≥ 5 mm (P<0.001)., Conclusions: Positive LM was the significant cause for R1 resection of pCCA and the utilization of WDLS improved the diagnostic accuracy of LM. An examination methodology was established, highlighting the necessity of examining LM within a 20 mm radius around the proximal DM, especially in patients with a proximal DM of<5 mm., Competing Interests: Conflicts of interest and source of funding: All authors have no conflicts of interest to declare. This study was supported by the National Natural Science Foundation of China (No. 82090053, No. 82090054, No. 81930119, and No. 82090050), Tsinghua University Initiative Scientific Research Program of Precision Medicine (No.10001020123, No.2022TS014), Beijing Physician Scientist Training Project (BJPSTP-2024-23), Beijing Hospitals Authority Clinical Medicine Development of special funding support (YGLX202329) and Beijing Tsinghua Changgung Hospital Fund (Grant No. 12023C01004)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Admission and discharge screening of patients for asymptomatic gut colonization with multidrug-resistant organisms (MDROs) is a common approach to active surveillance, but its sensitivity for detecting colonization is uncertain., Methods: Daily rectal or fecal swab samples and associated clinical data were collected over 12 months from patients in one 25-bed medical intensive care unit (ICU) in Chicago, IL and tested for the following MDROs: vancomycin-resistant enterococci; third-generation cephalosporin-resistant Enterobacterales, including extended-spectrum β-lactamase-producing Enterobacterales; and carbapenem-resistant Enterobacterales. MDRO detection by (1) admission and discharge surveillance cultures or (2) clinical cultures were compared to daily surveillance cultures. Samples underwent 16S rRNA gene sequencing to measure the relative abundance of operational taxonomic units (OTUs) corresponding to each MDRO., Results: Compared with daily surveillance cultures, admission/discharge cultures detected 91% of prevalent MDRO colonization and 63% of MDRO acquisitions among medical ICU patients. Few (7%) MDRO carriers were identified by clinical cultures alone. Higher relative abundance of MDRO-associated OTUs and specific antibiotic exposures were independently associated with higher probability of MDRO detection by culture., Conclusions: Admission and discharge surveillance cultures underestimated MDRO acquisitions in an ICU. These limitations should be considered when designing sampling strategies for epidemiologic studies that use culture-based surveillance., Competing Interests: Potential conflicts of interest. M. K. H. reported conducting studies for which participating healthcare facilities received contributed antiseptic and cleaning products from Stryker (formerly Sage), Molnlycke, and Clorox outside of the submitted work. M. Y. L. reported conducting studies for which participating healthcare facilities received laboratory testing at no charge from OpGen and contributed antiseptic products from Stryker (formerly Sage) outside of the submitted work. V. B. Y. serves as a consultant to Vedanta Biosciences and Debiopharm; and has received an honorarium from Aimmune. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: Weaning is an essential issue in critical care. This study explores the efficacy of multitask learning models in predicting successful weaning in critically ill ventilated patients using the Medical Information Mart for Intensive Care (MIMIC) IV database., Methods: We employed a multitask learning framework with a shared bottom network to facilitate common knowledge extraction across all tasks. We used the Shapley additive explanations (SHAP) plot and partial dependence plot (PDP) for model explainability. Furthermore, we conducted an error analysis to assess the strength and limitation of the model. Area under receiver operating characteristic curve (AUROC), calibration plot and decision curve analysis were used to determine the performance of the model., Results: A total of 7758 critically ill patients were included in the analyses, and 78.5% of them were successfully weaned. Multitask learning combined with spontaneous breath trial achieved a higher performance to predict successful weaning compared with multitask learning combined with shock and mortality (area under receiver operating characteristic curve, AUROC, 0.820 ± 0.002 vs 0.817 ± 0.001, p  < 0.001). We assessed the performance of the model using calibration and decision curve analyses and further interpreted the model through SHAP and PDP plots. The error analysis identified a relatively high error rate among those with low disease severities, including low mean airway pressure and high enteral feeding., Conclusion: We demonstrated that multitask machine learning increased predictive accuracy for successful weaning through combining tasks with a high inter-task relationship. The model explainability and error analysis should enhance trust in the model., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: A mismatch between biological and social time, often referred to as social jetlag (SJL), can lead to inadequate sleep and activities or taking meals at times that do not align with our biological rhythms, increasing the risk of metabolic abnormalities. Although the association between sleep and metabolic syndrome (MetS) is well established, the effects of SJL on MetS and the components of MetS in adults remain unclear., Purpose: This study was designed to explore the relationship between SJL and MetS components in adults., Methods: A systematic review and meta-analysis was conducted on studies registered in PubMed, Cochrane, Web of Science, and Embase between the inception of each database until November 15, 2023. We focused on studies designed to evaluate the relationship between SJL and either MetS or its components. Only studies using cross-sectional, prospective, or retrospective designs were considered for inclusion. The relationship between SJL and MetS was depicted as an odds ratio with a corresponding 95% confidence interval (CI). We determined the mean differences and 95% CIs to estimate the associations between SJL and MetS components. The Joanna Briggs Institute Critical Appraisal Checklist was used to evaluate the methodological rigor of the selected studies. Data were analyzed using RevMan software Version 5.4., Results: The systematic review included 16 studies, with five analyzed via a meta-analysis covering four outcomes, each based on two to three studies. When comparing SJL of less than 1 hour with SJL of 2 hours or more, the latter showed a higher likelihood of MetS (pooled odds ratio: 1.52). Although a significant decrease in systolic blood pressure (pooled mean differences = -3.52 mmHg, 95% CI [-6.41, -0.64]) and a significant increase in waist circumference (pooled mean differences = 2.17 cm, 95% CI [0.61, 3.73]) were observed, the correlation between SJL and diastolic blood pressure failed to reach statistical significance., Conclusions/implications for Practice: The meta-analysis conducted in this study found an association between SJL and MetS. Healthcare practitioners should prioritize the management of sleep quality and duration, especially for individuals exhibiting substantial SJL. Improving sleep can aid in controlling blood pressure and managing weight and should form part of MetS management strategies., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Inefficient active site utilization of oxygen evolution reaction (OER) catalysts have limited the energy efficiency of proton exchange membrane (PEM) water electrolysis. Here, an atomic grid structure is demonstrated composed of high-density Ir sites (≈10 atoms per nm 2 ) on reactive MnO 2-x support which mediates oxygen coverage-enhanced OER process. Experimental characterizations verify the low-valent Mn species with decreased oxygen coordination in MnO 2-x exert a pivotal impact in the enriched oxygen coverage on the surface during OER process, and the distributed Ir atomic grids, where highly electrophilic Ir─O (II-δ)- bonds proceed rapidly, render intense nucleophilic attack of oxygen radicals. Thereby, this metal-support cooperation achieves ultra-low overpotentials of 166 mV at 10 mA cm -2 and 283 mV at 500 mA cm -2 , together with a striking mass activity which is 380 times higher than commercial IrO 2 at 1.53 V. Moreover, its high OER performance also markedly surpasses the commercial Ir black catalyst in PEM electrolyzers with long-term stability., (© 2024 Wiley‐VCH GmbH.)

Background : Pompe disease is a rare metabolic myopathy caused by the lack or deficiency of the lysosomal acid alpha-glucosidase, resulting in skeletal muscle weakness and cardiomyopathy. The disease varies by onset age and genetic mutations and is categorized into infantile-onset and late-onset Pompe disease. Respiratory muscle weakness may persist regardless enzyme replacement therapy. This systemic review and meta-analysis aim to assess the effect of respiratory muscle training (RMT) on respiratory muscle strength, functional endurance, and pulmonary function in patient with Pompe disease. Methods : PubMed, EMBASE, and Cochrane databases were searched up until Aug 2024. Studies examining the therapeutic effects of RMT in patients with Pompe disease were included. Outcome measures included the change in maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), six-minute walking test (6MWT), pulmonary function before after RMT, quality of life and adverse events. Results : The meta-analysis consisted of 5 single-arm studies, including 31 patients in total. Regarding inspiratory muscle strength, RMT has significantly improving MIP (8.71 cmH 2 O; 95% CI, 6.23-11.19, p < 0.001) and MEP (12.15 cmH 2 O; 95% CI, 10.55-13.74, p < 0.001) in both types of Pompe disease. However, no significant change regarding 6MWT. No serious adverse events were reported. Conclusions : Our meta-analysis revealed that RMT may increase inspiratory muscle and expiratory muscle strength, but may not have an effect on 6MWT in patients with Pompe disease. RMT has potential to be integrated into the cardioplulmonary rehabilitation for patients with Pompe disease. Further large randomized controlled trials are needed to verify the efficacy and safety of RMT in patients with Pompe disease., Competing Interests: The authors declare no conflicts of interest.

Electrochemical binders used to immobilize electrocatalysts on electrodes are essential in all fields of electrochemistry. However, conventional organic-based binders like Nafion generally suffer from oxidative decomposition at high potentials on anodic electrodes and have high charge transport resistivity. This work proposes the use of acidic redox-assisted deposition to form cobalt manganese oxyhydroxides (CMOH) as a solid-state inorganic binder. CMOH remains stable under high oxidative currents and ensures catalyst adhesion even under significant peel-off stress as shown by experiments involving the alkaline oxygen evolution reaction (OER) using RuO 2 as a catalyst immobilized on a rotating disc electrode. While the molecular structure of Nafion decays significantly after 45 minutes under OER conditions at 3.86 V, the CMOH binder is able to support the powder catalysts (RuO 2 and NiO x ) showing stability around 1000 mA cm -2 without significant current decay over 24 hours. The robust catalyst adhesion is a result of the formation of chemical bonds between the electrode and the binder and it can be further improved by increasing the applied loading of CMOH. Unlike Nafion, both the OER activity and the diffusion kinetics are not significantly affected by the CMOH binder. It has also been shown that using CMOH as a binder leads to lower charge transfer resistances R ct and higher electrochemical surface areas compared to systems using Nafion. This is partially due to the presence of metal sites in different oxidation states which has been shown to increase intrinsic conductivity, facilitating the charge hopping at the binder/electrocatalyst interface. With this, the present work provides a proof-of-concept for inorganic metal oxides as promising solid-state binders for a wide range of applications in electrochemistry, demonstrating CMOH's outstanding characteristic of strong adhesion to support other highly active but adhesion-weak electrocatalysts., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

The frequency of percutaneous transluminal angioplasty (PTA) procedures has substantially increased, but its effect on vascular access recreation (VAR) remains inconclusive. We conducted a population-based retrospective analysis of Taiwan hemodialysis (HD) centers from 2004 to 2012. Data was accumulated into center-level characteristics, including patients' demographics, baseline characteristics, PTA procedures, and VAR. Center-level characteristics were summarized annually using appropriate measures. A mixed model assessed the association between PTA frequency and VAR rates, considering within-center correlation and adjusting for potential confounders. A total of 82,005 patients (mean age 62.7 ± 13.9 years, 50.5% male, 48.5% with diabetes mellitus) from 820 HD centers were analyzed. From 2004 to 2012, PTA frequency significantly increased from 1.24 to 3.23 per 1000 HD sessions, while VAR rates did not decline as expected (0.5-0.8 per 1000 HD sessions). Compared with the HD centers of infrequent use of PTA (annual lowest quartile, range 0.39-1.20 per 1000 HD sessions), the ones of frequent use (annual highest quartile, range 2.52-5.10 per 1000 HD sessions) didn't have lower VAR (range 0.54-0.99 vs. 0.50-0.91 per 1000 HD sessions, respectively). After controlling the potential confounders, the HD centers' PTA rates were not significantly associated with lower VAR rates (- 2.6, 95% confidence interval: - 30.3; 25.0, p = 0.85). Frequent use of PTA does not seem to improve VA patency at the center level, with no significant association identified with lower VAR. The indication of PTA in daily practice should be re-evaluated in terms of its efficiency in lowering VAR., (© 2024. The Author(s).)

Background: Oral squamous cell carcinoma (OSCC) is a frequently occurring type of head and neck cancer with a high mortality and morbidity rate. Rhopaloic acid A (RA), a terpenoid derived from sponges, has demonstrated a promising anti-tumor activity, but its effectiveness for treating OSCC remains unknown., Purpose: The aim of this study was to investigate whether RA inhibits the growth of OSCC., Methods: Cell viability was evaluated using CCK-8 assays in OSCC cells (Ca9-22, HSC-3 and SAS) and in normal cells (HGF-1) treated with RA. DAPI staining, AO staining, JC-1 staining and immunofluorescence were used to determine apoptosis, mitochondrial membrane potential and autophagy in RA-treated OSCC cells. Protein expression levels were determined by western blotting. Furthermore, the anti-tumor effect of RA was confirmed in vivo using a zebrafish oral cancer xenotransplantation model., Results: OSCC cells had a significantly reduced viability after RA treatment, but normal cells were not affected. Treatment with RA caused chromatin condensation in OSCC cells, which increased their expression of autophagy- and apoptosis-related proteins. Furthermore, RA caused mitochondrial damage and increased autophagosome formation. Mitophagy was also induced by RA through the JNK/BNIP3/Nix/LC3B pathway. The JNK inhibitor SP600125 prevented both RA-mediated cell death and mitophagy of OSCC cells. A zebrafish xenograft model demonstrated that RA inhibits OSCC growth., Conclusion: In conclusion, RA showed a potent anticancer activity in in vitro and in in vivo oral cancer models by promoting mitochondrial damage-induced apoptosis and mitophagy, which suggests that RA may be useful as a novel and effective treatment for OSCC., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Introduction: Pulmonary metastasectomy has been clarified in improving long-term survival in most primary malignancies with pulmonary metastasis, while the role of additional lymph node dissection remained controversial. We aimed to investigate the prognosis of lymph node involvement and identify the role of lymph node dissection during pulmonary metastasectomy in a real-world cohort., Methods: We identified patients diagnosed with pulmonary metastases with ≤3 cm in size and received pulmonary metastasectomy between 2004 and 2017 in the Surveillance, Epidemiology, and End Results database. We compared the survival via Kaplan-Meier analysis and propensity score matching method, and the multivariable analysis was conducted by cox regression analysis., Results: A total of 3452 patients were included, of which 2268(65.7%) received lymph node dissection, and the incidence of node-positive was 11.3%(256/2268). In total, the median overall survival was 62.8 months(interquartile range, 28.6-118.9 months), and the lymph node involvement was referred to an impaired survival compared to node-negative diseases(5-year overall survival rate, 58.0% versus 38.6%), with comparable survival between N1 and N2 diseases(P = 0.774). Lymph node dissection was associated with improved survival(HR = 0.80; 95%CI, 0.71-0.90; P < 0.001), and the survival benefits remained regardless of age, sex, the number of metastases, and surgical procedures, even in those with node-negative diseases. At least eight LNDs might lead to a significant improvement in survival, and additional survival benefits might be limited with additional dissected lymph nodes., Conclusions: Lymph node involvement was associated with impaired survival, and lymph node dissection during pulmonary metastasectomy could improve long-term survival and more accurate staging., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.)

Competing Interests: The authors report no conflicts of interest.

Aims: Hypopharyngeal cancer (HPC) is associated with the worst prognosis of all head and neck cancers and is typically identified in an advanced stage at the time of diagnosis. While oxidative stress might contribute to the onset of HPC in patients using tobacco or alcohol, the extent of this influence and the characteristics of HPC cells in advanced stage remain to be investigated. In this study, we explored whether HPC cells survived from necrotic xenograft tumors at late stage would display increased tumor resistance along with altered tolerance to oxidative stress. Results: The remnant living HPC cells isolated from a late-stage xenograft tumor, named FaDu ex vivo cells, showed stronger chemo- and radioresistance, tumorigenesis, and invasiveness compared with parental FaDu cells. FaDu ex vivo cells also displayed increased angiogenic ability after re-transplantation in mice visualized by in vivo near infrared-II fluorescence imaging modality. Moreover, FaDu ex vivo cells exhibited significant tumor-initiating cell (TIC)-related properties accompanied by a reduction of the level of reactive oxygen species, which was associated with the upregulation of transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2). Interestingly, inhibition of Nrf2 by the RNA interference and the chemical inhibitor could reduce the TIC-related properties of FaDu ex vivo cells. Innovation: Oxidative stress potentially initiates HPC, but elevation of Nrf2-associated antioxidant mechanisms would be essential to mitigate this effect for promoting and sustaining the stemness of HPC at the advanced stage. Conclusion: Present data suggest that the antioxidant potency of advanced HPC would be a therapeutic target for the design of adjuvant treatment. Antioxid. Redox Signal. 41, 505-521.

Background: Taiwan became an aged society in March 2018, and it is expected to become a super-aged society by 2025. The trend of increasing proportions of older adults continuing to work is inevitable. However, few studies have been conducted to investigate the effects of employment on the mental health of older adults. Therefore, we longitudinally explored the relationship between employment status and depressive symptoms in Taiwanese older adults., Methods: The study included 5,131 individuals aged 50 and above, of which 55.6% were men, who had participated in the national-wide Taiwan Longitudinal Study of Aging in 1996, 1999, 2003, and 2007. Of them, 1,091 older adults had completed all four surveys. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression scale; the total score on this scale ranges from 0 to 30. Employment status was assessed during each survey wave. Logistic regression was performed using a cross-sectional design. The effects of unemployment on depressive symptoms were analyzed using a generalized estimating equation model with a repeated measures design., Results: In each survey wave, employed older adults exhibited better mental health than did unemployed ones. After adjustments for potential confounders, unemployment was found to exert a significant adverse effect on depressive symptoms. The repeated measures analysis revealed that employment protected against depressive symptoms, as noted in the subsequent surveys conducted after 3 to 4 years (aOR [95% CI] = 0.679 [0.465-0.989])., Conclusion: Employment may reduce the risk of depressive symptoms in community-dwelling older adults in Taiwan., (© 2024. The Author(s).)

Background: Optic disc drusen (ODD) represent an important differential diagnosis of papilledema caused by intracranial hypertension, but their distinction may be difficult in clinical practice. The aim of this study was to train, validate, and test a dedicated deep learning system (DLS) for binary classification of ODD vs papilledema (including various subgroups within each category), on conventional mydriatic digital ocular fundus photographs collected in a large international multiethnic population., Methods: This retrospective study included 4,508 color fundus images in 2,180 patients from 30 neuro-ophthalmology centers (19 countries) participating in the Brain and Optic Nerve Study with Artificial Intelligence (BONSAI) Group. For training and internal validation, we used 857 ODD images and 3,230 papilledema images, in 1,959 patients. External testing was performed on an independent data set (221 patients), including 207 images with ODD (96 visible and 111 buried), provided by 3 centers of the Optic Disc Drusen Studies Consortium, and 214 images of papilledema (92 mild-to-moderate and 122 severe) from a previously validated study., Results: The DLS could accurately distinguish between all ODD and papilledema (all severities included): area under the receiver operating characteristic curve (AUC) 0.97 (95% confidence interval [CI], 0.96-0.98), accuracy 90.5% (95% CI, 88.0%-92.9%), sensitivity 86.0% (95% CI, 82.1%-90.1%), and specificity 94.9% (95% CI, 92.3%-97.6%). The performance of the DLS remained high for discrimination of buried ODD from mild-to-moderate papilledema: AUC 0.93 (95% CI, 0.90-0.96), accuracy 84.2% (95% CI, 80.2%-88.6%), sensitivity 78.4% (95% CI, 72.2%-84.7%), and specificity 91.3% (95% CI, 87.0%-96.4%)., Conclusions: A dedicated DLS can accurately distinguish between ODD and papilledema caused by intracranial hypertension, even when considering buried ODD vs mild-to-moderate papilledema., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by North American Neuro-Ophthalmology Society.)

Postoperative acute kidney injury (AKI) is a common complication that is associated with chronic kidney disease, early postsurgical mortality, and prolonged hospital stays. Preterm neonates who undergo surgery are at risk factors for AKI due to underdeveloped kidneys. To date, little is known about the incidence and perioperative risk factors for AKI in preterm neonates undergoing noncardiac surgery. Preterm neonates who underwent noncardiac surgery between January May 1, 2020, and February 28, 2023, were enrolled in the trial according to the inclusion criteria. Both multivariable and logistic regression analyses were used to analyze the associations between characteristic data and AKI. In total, 106 preterm neonates met the inclusion criteria, and 25 preterm neonates (23.6%) developed postoperative AKI. Multivariate analysis revealed that the factors associated with AKI were gestational age < 32 weeks [OR: 4.88; 95% CI (1.23-19.42)], preoperative sepsis [OR: 3.98; 95% CI (1.29-12.28)], and intraoperative hypotension [OR: 3.75; 95% CI (1.26-11.15)]. Preterm neonates who developed AKI were more likely to have longer hospital length of stays (38 [18,69] days vs. 21[12,46]) and higher medical costs (93,181.6 [620450.0,173,219.0] ￥ vs. 58,134.6 [31015.1,97,224,1) ￥ than neonates who did not develop AKI. Preterm neonates who underwent noncardiac surgery had a high incidence of AKI. Independent risk factors for AKI in preterm neonates who underwent noncardiac surgery were low gestational age, preoperative sepsis, and intraoperative hypotension. Preterm neonates who developed AKI were more likely to have longer hospital stays and higher medical costs., (© 2024. The Author(s).)

Objective: Microglia in the central nervous system regulate neuroinflammation that leads to a wide range of neuropathological alterations. The present study investigated the anti-neuroinflammatory properties of nobiletin (Nob) derivative, 5-acetoxy-6,7,8,3',4'-pentamethoxyflavone (5-Ac-Nob), in lipopolysaccharide (LPS)-activated BV2 microglia., Materials and Methods: By using the MTT assay, Griess method, flow cytometry, and enzyme-linked immunosorbent assay (ELISA), we determined the cell viability, the levels of nitric oxide (NO), reactive oxygen species (ROS), and pro-inflammatory factors (interleukin 1 beta; IL-1β, interleukin 6; IL-6, tumor necrosis factor alpha; TNF-α and prostaglandin E2; PGE2) in LPS-stimulated BV2 microglia. Toll-like receptor 4 (TLR4)-mediated myeloid differentiation primary response gene 88 (MyD88)/nuclear factor-kappa B (NF-κB), mitogen-activated protein kinase (MAPK) signaling pathway and signal transducer and activator of transcription 3 (STAT3) were measured by western blotting. Analysis of NO generation and mRNA of pro-inflammatory cytokines was confirmed in the zebrafish model., Results: 5-Ac-Nob reduced cell death, the levels of NO, ROS, inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), and pro-inflammatory factors in LPS-activated BV-2 microglial cells. TLR4-mediated MyD88/NF-κB and MAPK pathway (p38, ERK and JNK) after exposure to 5-Ac-Nob was also suppressed. Moreover, 5-Ac-Nob inhibited phosphorylated STAT3 proteins expression in LPS-induced BV-2 microglial cells. Furthermore, we confirmed that 5-Ac-Nob decreased LPS-induced NO generation and mRNA of pro-inflammatory cytokines in the zebrafish model., Conclusions: Our findings suggest that 5-Ac-Nob represses neuroinflammatory responses by inhibiting TLR4-mediated signaling pathway and STAT3. As a result of these findings, 5-Ac-Nob has potential as an anti-inflammatory agent against microglia-mediated neuroinflammatory disorders.

Context: Type 2 diabetes (T2D) is the major contributor to chronic kidney disease and end-stage kidney disease (ESKD). The influence of trimethylamine N-oxide (TMAO) on kidney outcomes in T2D remains unclear., Objective: To examine the association between fasting serum TMAO levels and adverse kidney outcomes in patients with T2D., Methods: Between October 2016 and June 2020, patients with T2D were recruited and monitored every 3 months until December 2021. Serum TMAO levels were assessed using liquid chromatography-mass spectrometry. The primary kidney outcomes were doubling of serum creatinine levels or progression to ESKD necessitating dialysis; the secondary kidney outcome was a rapid 30% decline in estimated glomerular filtration rate within 2 years. All-cause mortality was also evaluated., Results: Among the 440 enrolled patients with T2D, those in the highest serum TMAO tertile (≥0.88 μM) were older, had a longer diabetes duration, elevated blood urea nitrogen, and lower estimated glomerular filtration rate. Over a median follow-up period of 4 years, 26 patients (5.9%) had a doubling of serum creatinine level or progression to ESKD. After propensity score weighting, the patients in the highest serum TMAO tertile had a 6.45-fold increase in the risk of doubling of serum creatinine levels or progression to ESKD and 5.86-fold elevated risk of rapid decline in kidney function compared with those in the lowest tertile. Additionally, the stepwise increase in serum TMAO was associated with all-cause mortality., Conclusion: Patients with T2D with elevated circulating TMAO levels are at higher risk of doubling serum creatinine, progressing to ESKD, and mortality. TMAO is a potential biomarker for kidney function progression and mortality in patients with T2D., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

The worldwide prevalence and incidence rates of end-stage renal disease have been increasing, and the trend is pronounced in Taiwan. This is especially evident in southern Taiwan, where the wet-bulb globe temperature (WBGT) is consistently higher than in other regions. The association between kidney function and WBGT has not been fully investigated. Therefore, the aim of this study was to evaluate the association between estimated glomerular filtration rate (eGFR) and WBGT and variations in this association across different geographic regions in Taiwan. We used the Taiwan Biobank (TWB) to obtain data on community-dwelling individuals, linked these data with WBGT data obtained from the Central Weather Bureau and then processed the data using a machine learning model. WBGT data were recorded during the working period of the day from 8:00 a.m. to 5:00 p.m. These data were then compiled as 1-year, 3-year and 5-year averages, recorded prior to the survey year of the TWB of each participant. We identified 114 483 participants who had WBGT data during 2012-2020. Multivariable analysis showed that, in northern Taiwan, increases in 1- and 3-year averages of WBGT during the working period (β = -0.092, P  = .043 and β = -0.193, P  < .001, respectively) were significantly associated with low eGFR. In southern Taiwan, increases in 1-, 3- and 5-year averages of WBGT during the working period (β = -0.518, P  < .001; β = -0.690, P  < .001; and β = -0.386, P  = .001, respectively) were gnificantly associated with low eGFR. These findings highlight the importance of heat protection for people working outdoors or in high-temperature environments as a measure to prevent negative impacts on kidney function. Moreover, we observed that in southern Taiwan, every 1°C increase in WBGT had a greater impact on the decrease in eGFR compared with other regions in Taiwan., Competing Interests: The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

The fundamental value of universal nomenclatural systems in biology is that they enable unambiguous scientific communication. However, the stability of these systems is threatened by recent discussions asking for a fairer nomenclature, raising the possibility of bulk revision processes for "inappropriate" names. It is evident that such proposals come from very deep feelings, but we show how they can irreparably damage the foundation of biological communication and, in turn, the sciences that depend on it. There are four essential consequences of objective codes of nomenclature: universality, stability, neutrality, and transculturality. These codes provide fair and impartial guides to the principles governing biological nomenclature and allow unambiguous universal communication in biology. Accordingly, no subjective proposals should be allowed to undermine them., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Institute of Biological Sciences.)

Cytokine release syndrome (CRS) is a frequently observed side effect of chimeric antigen receptor (CAR)-T cell therapy. Here, we report self-regulating T cells that reduce CRS severity by secreting inhibitors of cytokines associated with CRS. With a humanized NSG-SGM3 mouse model, we show reduced CRS-related toxicity in mice treated with CAR-T cells secreting tocilizumab-derived single-chain variable fragment (Toci), yielding a safety profile superior to that of single-dose systemic tocilizumab administration. Unexpectedly, Toci-secreting CD19 CAR-T cells exhibit superior in vivo antitumor efficacy compared with conventional CD19 CAR-T cells. scRNA-seq analysis of immune cells recovered from tumor-bearing humanized mice revealed treatment with Toci-secreting CD19 CAR-T cells enriches for cytotoxic T cells while retaining memory T-cell phenotype, suggesting Toci secretion not only reduces toxicity but also significantly alters the overall T-cell composition. This approach of engineering T cells to self-regulate inflammatory cytokine production is a clinically compatible strategy with the potential to simultaneously enhance safety and efficacy of CAR-T cell therapy for cancer., (© 2024 Lin et al.)

Introduction: This study aimed to examine changes in emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) among uninsured or Medicaid-covered Black, Hispanic, and White adults aged 26-64 in the first 5 years of the Affordable Care Act Medicaid expansion., Methods: Using 2010-2018 inpatient and ED discharge data from nine expansion and five nonexpansion states, an event study difference-in-differences regression model was used to estimate changes in number of annual ACSC ED visits per 100 adults ("ACSC ED rate") associated with the 2014 Medicaid expansion, overall and by race/ethnicity. A secondary outcome was the proportion of ACSC ED visits out of all ED visits ("ACSC ED share"). Analyses were conducted in 2022-2023., Results: Medicaid expansion was associated with no change in ACSC ED rates among all, Black, Hispanic, or White adults. When excluding California, where most counties expanded Medicaid before 2014, expansion was associated with a decrease in ACSC ED rate among all, Black, Hispanic, and White adults. Expansion was also associated with a decrease in ACSC ED share among all, Black, and White adults. White adults experienced the largest reductions in ACSC ED rate and share., Conclusions: Medicaid expansion was associated with reductions in ACSC ED rates in some expansion states and reductions in ACSC ED share in all expansion states combined, with some heterogeneity by race/ethnicity. Expansion should be coupled with policy efforts to better link newly insured Black and Hispanic patients to non-ED outpatient care, alongside targeted outreach and expanded primary care capacity, which may reduce disparities in ACSC ED visits., (Copyright © 2024 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The main purpose of this paper is to introduce a method that can accurately locate the posterior capsule of the lens to facilitate a relatively complete resection of the anterior vitreous body., Methods: A total of 51 patients in the experimental group and control group were enrolled in this study. Phacoemulsification combined with vitrectomy was performed in all cases. After the cataract procedure was completed in the control group, the surgeon performed a conventional anterior vitrectomy with the operative eye. In the experimental group, anterior vitrectomy was performed according to the threadiness corrugation of the posterior capsule of the lens. During the operation, with the help of triamcinolone, two surgeons confirmed the resection of the anterior vitreous cortex; the best corrected visual acuity and intraocular pressure of all patients were recorded at 1 week, 1 month and 3 months after surgery., Results: Fifty patients underwent phacoemulsification combined with vitrectomy, except one patient in the experimental group who was lost to follow-up. After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. There was no significant difference in preoperative visual acuity between the two groups (t = 0.83, P = 0.25). Both groups had varying degrees of improvement in best corrected visual acuity at 1 week, 1 month and 3 months after surgery. Moreover, there was no significant difference in BCVA between the two groups at the three follow-up time points (t=-1.15, -1.65, -1.09, P = 0.53, 0.21, 0.23). After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. Incomplete resection of the anterior vitreous cortex was observed in 2 patients in each group, but there was no significant difference (χ 2  = 7.81, P > 0.05)., Conclusion: In the process of cataract surgery combined with vitrectomy, thready corrugation appears in the posterior capsule of the lens and is an important sign of its localization. Anterior vitrectomy can be accomplished safely and effectively with the help of thread-like corrugation, and the surgical effect is almost the same as that of traditional surgery. Especially suitable for beginners in vitreous surgery., (© 2024. The Author(s).)

Marine antimicrobial peptides have been demonstrated in numerous studies to possess anti-cancer properties. This research investigation aimed to explore the fundamental molecular mechanisms underlying the antitumor activity of Tilapia piscidin 4 (TP4), an antimicrobial peptide, in human bladder cancer. TP4 exhibited a remarkable inhibitory effect on the proliferation of bladder cancer cells through cell cycle arrest at the G2/M phase. Additionally, TP4 upregulated the expression of cleaved caspase-3, caspase-9, and PARP, leading to the activation of apoptotic pathways in bladder cancer cells. TP4 exhibit a marked rise in mitochondria reactive oxygen species, leading to the subsequent loss of potential for the mitochondrial membrane. Furthermore, the inhibition of mitochondrial oxidative phosphorylation resulted in a decrease in downstream ATP production. Meanwhile, TP4-treated bladder cancer cells showed an increase in Bax and ERK but a decrease in SIRT1, PGC-1α, and Bcl2. ERK activation, SIRT1/PGC-1α-axis, and TP4-induced apoptosis were all significantly reversed by the ERK inhibitor SCH772984. Finally, the inhibitory effect of TP4 on tumor growth has been confirmed in a zebrafish bladder cancer xenotransplantation model. These findings suggest that TP4 may be a potential agents for human bladder cancer through apoptosis induction, ERK activation, and the promotion of SIRT1-mediated signaling pathways., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To characterize the relationship between chlorhexidine gluconate (CHG) skin concentration and skin microbial colonization., Design: Serial cross-sectional study., Setting/participants: Adult patients in medical intensive care units (ICUs) from 7 hospitals; from 1 hospital, additional patients colonized with carbapenemase-producing Enterobacterales (CPE) from both ICU and non-ICU settings. All hospitals performed routine CHG bathing in the ICU., Methods: Skin swab samples were collected from adjacent areas of the neck, axilla, and inguinal region for microbial culture and CHG skin concentration measurement using a semiquantitative colorimetric assay. We used linear mixed effects multilevel models to analyze the relationship between CHG concentration and microbial detection. We explored threshold effects using additional models., Results: We collected samples from 736 of 759 (97%) eligible ICU patients and 68 patients colonized with CPE. On skin, gram-positive bacteria were cultured most frequently (93% of patients), followed by Candida species (26%) and gram-negative bacteria (20%). The adjusted odds of microbial recovery for every twofold increase in CHG skin concentration were 0.84 (95% CI, 0.80-0.87; P < .001) for gram-positive bacteria, 0.93 (95% CI, 0.89-0.98; P = .008) for Candida species, 0.96 (95% CI, 0.91-1.02; P = .17) for gram-negative bacteria, and 0.94 (95% CI, 0.84-1.06; P = .33) for CPE. A threshold CHG skin concentration for reduced microbial detection was not observed., Conclusions: On a cross-sectional basis, higher CHG skin concentrations were associated with less detection of gram-positive bacteria and Candida species on the skin, but not gram-negative bacteria, including CPE. For infection prevention, targeting higher CHG skin concentrations may improve control of certain pathogens.

Background: Hypoxemia represents the most prevalent adverse event during flexible bronchoscopy procedures aimed at foreign body retrieval in pediatric patients; if not expeditiously managed, it carries the potential for cardiac or respiratory arrest. The specific risk factors contributing to the occurrence of hypoxemia during foreign body FB removal via bronchoscopy have yet to be definitively established., Methods: This retrospective study included a cohort of 266 pediatric subjects from January 1, 2015, to December 31, 2022, who underwent flexible bronchoscopy for the purpose of FB extraction. In this cohort, the supraglottic airway was used to connect the anesthesia apparatus during the removal procedure., Results: In total, 45 of the pediatric patients (16.9%) experienced episodes of hypoxemia during the FB removal procedure. Multivariate analysis revealed that the following factors were significantly associated with the occurrence of hypoxemia: an operation time exceeding 60 min (odds ratio [OR] 8.55; 95% confidence interval [CI] 3.82-19.13), a maximum diameter exceeding 7 mm (OR 5.03; 95% CI, 2.24-11.29), and the presence of radiological evidence indicating pneumonia (OR 2.69; 95% CI, 1.27-5.69)., Conclusion: During flexible bronchoscopy procedures aimed at FB removal in pediatric patients, there is an increased susceptibility to hypoxemia. Factors including extended operation duration, larger FB dimensions, and radiographic evidence suggestive of pneumonia significantly contribute to a heightened risk of hypoxemia., (© 2024. The Author(s).)

Importance: Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections., Objective: To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths., Design, Setting, and Participants: This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California., Exposures: Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP)., Main Outcomes and Measures: Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs)., Results: Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%)., Conclusions and Relevance: A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.

Background: Detection and containment of hospital outbreaks currently depend on variable and personnel-intensive surveillance methods. Whether automated statistical surveillance for outbreaks of health care-associated pathogens allows earlier containment efforts that would reduce the size of outbreaks is unknown., Methods: We conducted a cluster-randomized trial in 82 community hospitals within a larger health care system. All hospitals followed an outbreak response protocol when outbreaks were detected by their infection prevention programs. Half of the hospitals additionally used statistical surveillance of microbiology data, which alerted infection prevention programs to outbreaks. Statistical surveillance was also applied to microbiology data from control hospitals without alerting their infection prevention programs. The primary outcome was the number of additional cases occurring after outbreak detection. Analyses assessed differences between the intervention period (July 2019 to January 2022) versus baseline period (February 2017 to January 2019) between randomized groups. A post hoc analysis separately assessed pre-coronavirus disease 2019 (Covid-19) and Covid-19 pandemic intervention periods., Results: Real-time alerts did not significantly reduce the number of additional outbreak cases (intervention period versus baseline: statistical surveillance relative rate [RR]=1.41, control RR=1.81; difference-in-differences, 0.78; 95% confidence interval [CI], 0.40 to 1.52; P=0.46). Comparing only the prepandemic intervention with baseline periods, the statistical outbreak surveillance group was associated with a 64.1% reduction in additional cases (statistical surveillance RR=0.78, control RR=2.19; difference-in-differences, 0.36; 95% CI, 0.13 to 0.99). There was no similarly observed association between the pandemic versus baseline periods (statistical surveillance RR=1.56, control RR=1.66; difference-in-differences, 0.94; 95% CI, 0.46 to 1.92)., Conclusions: Automated detection of hospital outbreaks using statistical surveillance did not reduce overall outbreak size in the context of an ongoing pandemic. (Funded by the Centers for Disease Control and Prevention; ClinicalTrials.gov number, NCT04053075. Support for HCA Healthcare's participation in the study was provided in kind by HCA.).

Purpose: The Fundus photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) studies showed that ED providers poorly recognized funduscopic findings in patients in the ED. We tested a modified version of the Brain and Optic Nerve Study Artificial Intelligence (BONSAI) deep learning system on nonmydriatic fundus photographs from the FOTO-ED studies to determine if the deep learning system could have improved the detection of papilledema had it been available to ED providers as a real-time diagnostic aid., Design: Retrospective secondary analysis of a cohort of patients included in the FOTO-ED studies., Methods: The testing data set included 1608 photographs obtained from 828 patients in the FOTO-ED studies. Photographs were reclassified according to the optic disc classification system used by the deep learning system ("normal optic discs," "papilledema," and "other optic disc abnormalities"). The system's performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity using a 1-vs-rest strategy, with reference to expert neuro-ophthalmologists., Results: The BONSAI deep learning system successfully distinguished normal from abnormal optic discs (AUC 0.92 [95% confidence interval {CI} 0.90-0.93]; sensitivity 75.6% [73.7%-77.5%] and specificity 89.6% [86.3%-92.8%]), and papilledema from normal and others (AUC 0.97 [0.95-0.99]; sensitivity 84.0% [75.0%-92.6%] and specificity 98.9% [98.5%-99.4%]). Six patients with missed papilledema in 1 eye were correctly identified by the deep learning system as having papilledema in the other eye., Conclusions: The BONSAI deep learning system was able to reliably identify papilledema and normal optic discs on nonmydriatic photographs obtained in the FOTO-ED studies. Our deep learning system has excellent potential as a diagnostic aid in EDs and non-ophthalmology clinics equipped with nonmydriatic fundus cameras. NOTE: Publication of this article is sponsored by the American Ophthalmological Society., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Clinical Relevance: Acute anterior uveitis (AAU) can lead to the thickening of the peripapillary retinal nerve fibre layer (pRNFL) and induce refractive changes during its active phase., Background: AAU is a common form of uveitis characterised by inflammation in the anterior chamber. A notable prevalence of optical coherence tomography - defined pRNFL thickening was observed among patients with AAU. The alterations in pRNFL thickness and their associations with other relevant ocular parameters in patients with AAU were investigated., Methods: A retrospective, consecutive case series was conducted at a specialised uveitis referral clinic in Taiwan. This study gathered data on various demographic characteristics and various ocular parameters, namely anterior chamber cell grading, refractive error, best-corrected visual acuity, intraocular pressure, and optical coherence tomography measurements. A comparative analysis of baseline and subsequent follow-up data was conducted. Additionally, this study examined the correlations between alterations in pRNFL thickness and various ocular parameters. Twenty-one patients with AAU (21 affected eyes/21 unaffected eyes) were examined., Results: Initial measurements revealed pRNFL thickening in 20 patients. Treatment led to significant improvements in best-corrected visual acuity, intraocular pressure recovery, and pRNFL thickening ( p  < 0.01). The correlation between changes in pRNFL thickness and best-corrected visual acuity was weak ( r  = 0.20, p  = 0.41). By contrast, a significant negative correlation was identified between changes in pRNFL thickness and refractive error alterations ( r  =  -0.71, p  = 0.01)., Conclusion: This study demonstrated that AAU is associated with pRNFL thickening, which in turn is inversely correlated with changes in refractive error alterations throughout the disease course. Monitoring changes in pRNFL thickness can be effective in assessing ocular inflammation status.

Polar materials with spontaneous polarization (P s ) have emerged as highly promising photocatalysts for efficient photocatalytic H 2 evolution owing to the P s -enhanced photogenerated carrier separation. However, traditional inorganic polar materials often suffer from limitations such as wide band gaps and poor carrier transport, which hinders their photocatalytic H 2 evolution efficiency. Here, we rationally synthesized a series of isostructural two-dimensional (2D) aromatic Dion-Jacobson (DJ) perovskites, namely (2-(2-Aminoethyl)pyridinium)PbI 4 (2-APDPI), (3-(2-Aminoethyl)pyridinium)PbI 4 (3-APDPI), and (4-(2-Aminoethyl)pyridinium)PbI 4 (4-APDPI), where 2-APDPI and 4-APDPI crystalize in polar space groups with piezoelectric constants (d 33 ) of approximately 40 pm V -1 and 3-APDPI adopts a centrosymmetric structure. Strikingly, owing to the P s -facilitated separation of photogenerated carriers, polar 2-APDPI and 4-APDPI exhibit a 3.9- and 2.8-fold increase, respectively, in photocatalytic H 2 evolution compared to the centrosymmetric 3-APDPI. As a pioneering study, this work provides an efficient approach for exploring new polar photocatalysts and highlights their potential in promoting photocatalytic H 2 evolution., (© 2024 Wiley‐VCH GmbH.)