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OBJECTIVE Circumferential minimally invasive surgery (cMIS) may provide incremental benefits compared with open surgery for patients with increasing frailty status by decreasing peri- and postoperative complications. METHODS Operative patients with adult spinal deformity (ASD) ≥ 18 years old with baseline and 2-year postoperative data were assessed. With propensity score matching, patients who underwent cMIS (cMIS group) were matched with similar patients who underwent open surgery (open group) based on baseline BMI, C7–S1 sagittal vertical axis, pelvic incidence to lumbar lordosis mismatch, and S1 pelvic tilt. The Passias modified ASD frailty index (mASD-FI) was used to determine patient frailty stratification as not frail, frail, or severely frail. Baseline and postoperative factors were assessed using two-way analysis of covariance (ANCOVA) and multivariate ANCOVA while controlling for baseline age, Charlson Comorbidity Index (CCI) score, and number of levels fused. RESULTS After propensity score matching, 170 ASD patients (mean age 62.71 ± 13.64 years, 75.0% female, mean BMI 29.25 ± 6.60 kg/m2) were included, split evenly between the cMIS and open groups. Surgically, patients in the open group had higher numbers of posterior levels fused (p = 0.021) and were more likely to undergo three-column osteotomies (p > 0.05). Perioperatively, cMIS patients had lower intraoperative blood loss and decreased use of cell saver across frailty groups (with adjustment for baseline age, CCI score, and levels fused), as well as fewer perioperative complications (p < 0.001). Adjusted analysis also revealed that compared to open patients, increasingly frail patients in the cMIS group were also more likely to demonstrate greater improvement in 1- and 2-year postoperative scores for the Oswestry Disability Index, SRS-36 (total), EQ-5D and SF-36 (all p < 0.05). With regard to postoperative complications, increasingly frail patients in the cMIS group were also noted to experience significantly fewer complications overall (p = 0.036) and fewer major intraoperative complications (p = 0.039). The cMIS patients were also less likely to need a reoperation than their open group counterparts (p = 0.043). CONCLUSIONS Surgery performed with a cMIS technique may offer acceptable outcomes, with diminishment of perioperative complications and mitigation of catastrophic outcomes, in increasingly frail patients who may not be candidates for surgery using traditional open techniques. However, further studies should be performed to investigate the long-term impact of less optimal alignment in this population.

The bamboo worm Omphisa fuscidentalis is a kind of popular edible insect in Indochina Peninsula, however, the genus affiliation of this insect is controversial. Previous taxonomic studies from China and Thailand using limited morphology and single mitochondrial gene evidence indicated that, those samples distributed in different areas from Asia could belong to different species in different genera. To understand its taxonomic status and phylogenetic relationship with related taxa, we first sequenced and characterised the complete mitochondrial genome (mitogenome) of the moth O. fuscidentalis’ mitogenome is 15,347 bp in size, and containing 13 protein-coding genes (PCGs), 2 rRNAs, 22 tRNAs, and a control region. Further, 23 of the 37 genes are encoded by the J-strand while 14 are encoded by the N-strand. Most of PCGs are initiated by ATN codons, but 3 of the 13 PCGs harboured the incomplete termination codon by ATT. In the gene order of O. fuscidentalis, the ancestor of Lepidoptera sequence trnI-trnQ-trnM morphed into trnM-trnI-trnQ, as observed in other Pyraloidea species. A phylogenetic tree was then constructed based on the nucleotide sequences of mitochondrial 13 PCGs from 39 Pyraloidea species and two Tortricoidea species (outgroups) using Bayesian inference and maximum likelihood, which determined that O. fuscidentalis belongs to Crambidae. Accordingly, the bamboo worm does not belong to the genus Chilo in the subfamily Crambinae, or to the subfamily Spilomelinae. This study provides fundamental data to clarify the taxonomic status and better understand the biology of this edible insect.

In early 2004 and in 2005, several unusual stranding events occurred in Taiwan during a period when large-scale naval exercises were conducted in and on nearby waters. Gross examination of the partial remains of two carcasses (a ginkgo-toothed beaked whale (Mesoplodon ginkgodens) and a pygmy killer whale (Feresa attenuata)) and an intact Risso’s dolphin (Grampus griseus) revealed that the former two had internal injuries to structures associated with or related to acoustics or diving. The several unusual stranding events and the findings of the gross post mortem examination of the only specimens that were available for study were suggestive that nearby naval exercises may have contributed to or caused the death of at least one cetacean in this region and that species other than beaked whales may also be susceptible to such activities. With an increasing number of military exercises in this region, more attention to the impacts of such activities on cetaceans is needed.

Background: Myoma removal remains a challenge hysteroscopically including for the “IBS®” Intrauterine Bigatti Shaver technique. Objective: To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. Materials and methods: This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size

Taiwan had an eventful year in 2022. Cross-Strait tensions increased dramatically after Speaker Nancy Pelosi’s visit to Taipei. China’s belligerent actions in response have invited international condemnation and triggered more official engagements between Taiwan and the global community. Amid this tension, Taiwan continued its democratic governance by holding local elections in November. A change in COVID policy led to a surge in cases, but the initial high death rate had declined by the end of the year, thanks to high inoculation rates. In a global economic slowdown, Taiwan outperformed its neighboring countries. With Beijing’s alignment to Moscow after Russia’s invasion of Ukraine, the close US–Taiwan relationship further strengthened.

OBJECTIVE Depression and anxiety are associated with inferior outcomes following spine surgery. In this study, the authors examined whether patients with cervical spondylotic myelopathy (CSM) who have both self-reported depression (SRD) and self-reported anxiety (SRA) have worse postoperative patient-reported outcomes (PROs) compared with patients who have only one or none of these comorbidities. METHODS This study is a retrospective analysis of prospectively collected data from the Quality Outcomes Database CSM cohort. Comparisons were made among patients who reported the following: 1) either SRD or SRA, 2) both SRD and SRA, or 3) neither comorbidity at baseline. PROs at 3, 12, and 24 months (scores for the visual analog scale [VAS] for neck pain and arm pain, Neck Disability Index [NDI], modified Japanese Orthopaedic Association [mJOA] scale, EQ-5D, EuroQol VAS [EQ-VAS], and North American Spine Society [NASS] patient satisfaction index) and achievement of respective PRO minimal clinically important differences (MCIDs) were compared. RESULTS Of the 1141 included patients, 199 (17.4%) had either SRD or SRA alone, 132 (11.6%) had both SRD and SRA, and 810 (71.0%) had neither. Preoperatively, patients with either SRD or SRA alone had worse scores for VAS neck pain (5.6 ± 3.1 vs 5.1 ± 3.3, p = 0.03), NDI (41.0 ± 19.3 vs 36.8 ± 20.8, p = 0.007), EQ-VAS (57.0 ± 21.0 vs 60.7 ± 21.7, p = 0.03), and EQ-5D (0.53 ± 0.23 vs 0.58 ± 0.21, p = 0.008) than patients without such disorders. Postoperatively, in multivariable adjusted analyses, baseline SRD or SRA alone was associated with inferior improvement in the VAS neck pain score and a lower rate of achieving the MCID for VAS neck pain score at 3 and 12 months, but not at 24 months. At 24 months, patients with SRD or SRA alone experienced less change in EQ-5D scores and were less likely to meet the MCID for EQ-5D than patients without SRD or SRA. Furthermore, patient self-reporting of both psychological comorbidities did not impact PROs at all measured time points compared with self-reporting of only one psychological comorbidity alone. Each cohort (SRD or SRA alone, both SRD and SRA, and neither SRD nor SRA) experienced significant improvements in mean PROs at all measured time points compared with baseline (p < 0.05). CONCLUSIONS Approximately 12% of patients who underwent surgery for CSM presented with both SRD and SRA, and 29% presented with at least one symptom. The presence of either SRD or SRA was independently associated with inferior scores for 3- and 12-month neck pain following surgery, but this difference was not significant at 24 months. However, at long-term follow-up, patients with SRD or SRA experienced lower quality of life than patients without SRD or SRA. The comorbid presence of both depression and anxiety was not associated with worse patient outcomes than either diagnosis alone.

The purpose of this article is to analyze the role of virtual simulation in teaching Chinese medicine pharmacology experiments. Starting from the current situation of teaching Chinese medicine pharmacology experiments, this article analyzes the advantages of virtual simulation technology in experiment teaching under the concept of “student-centered” and its application effect. The analysis of students’ learning effects after the actual application of virtual simulation teaching in our school shows that virtual simulation experiment teaching can enhance students’ interest in active learning, improve their practical ability, and improve the overall level of experiments. It shows that virtual simulation technology has a wide application prospect in teaching Chinese medicine pharmacology experiments.

This study compared the dosimetric parameters of field-in-field forward intensity-modulated radiotherapy (FIF-IMRT) and fixed-field inversely optimized intensity-modulated radiotherapy (FFIO-IMRT) for the whole-breast irradiation of patients undergoing right-breast lumpectomy.A total of 30 patients with pT1-2N0M0 right-breast invasive ductal carcinoma were enrolled in this study. Two different treatment plans, i.e., FIF-IMRT and FFIO-IMRT, were designed for each patient. The dosimetric parameters of the two treatment plans were compared including ipsilateral lung and heart, conformity index (CI), and the homogeneity index (HI) of the planning target volume (PTV).Fixed-field inversely optimized intensity-modulated radiotherapy was found to significantly improve CI (83.302% vs. 60.146%) and HI (11.837% vs. 19.280%), and significantly reduced VRegardless of improving the conformity and homogeneity of PTV and reducing the ipsilateral lung irradiation volume at high doses, FFIO-IMRT significantly raised the ipsilateral lung irradiated volume at low doses, as well as the irradiation volume and mean radiation doses to the heart. This limits its use in patients with early-stage right breast cancer.

Sm-doped YBa2Cu3O7–δ samples were prepared by conventional solid state reaction method in air. The studies of X-ray photoemission spectroscopy and X-ray absorption spectroscopy indicate that the extra electrons fill the holes in CuO2 planes, so that the hole carrier concentration decrease under Sm substitution. The X-ray absorption spectroscopy of Cu L-edge and O K-edge demonstrates that the hybridization strength between Cu 3 d and O 2 p decreases with increasing content of Sm, but the hybridization strength between Y 4 d, Ba 5 d, Sm 4 f and O 2 p increases with the increasing of Sm content, while the superconductivity of the Sm-doped YBa2Cu3O7–δ samples is suppressed, i.e., the superconducting transition temperature of the samples was lowered. Thus, our experimental results suggest a close relationship between the superconductivity and orbital hybridization.

OBJECTIVE Return to work (RTW) is an important surgical outcome for patients who are employed, yet a significant number of patients with cervical spondylotic myelopathy (CSM) who are employed undergo cervical spine surgery and fail to RTW. In this study, the authors investigated factors associated with failure to RTW in the CSM population who underwent cervical spine surgery and who were considered to have a good surgical outcome yet failed to RTW. METHODS This study retrospectively analyzed prospectively collected data from the cervical myelopathy module of a national spine registry, the Quality Outcomes Database. The CSM data set of the Quality Outcomes Database was queried for patients who were employed at the time of surgery and planned to RTW postoperatively. Distinct multivariable logistic regression models were fitted with 3-month RTW as an outcome for the overall population to identify risk factors for failure to RTW. Good outcomes were defined as patients who had no adverse events (readmissions or complications), who had achieved 30% improvement in Neck Disability Index score, and who were satisfied (North American Spine Society satisfaction score of 1 or 2) at 3 months postsurgery. RESULTS Of the 409 patients who underwent surgery, 80% (n = 327) did RTW at 3 months after surgery. At 3 months, 56.9% of patients met the criteria for a good surgical outcome, and patients with a good outcome were more likely to RTW (88.1% vs 69.2%, p < 0.01). Of patients with a good outcome, 11.9% failed to RTW at 3 months. Risk factors for failing to RTW despite a good outcome included preoperative short-term disability or leave status (OR 3.03 [95% CI 1.66–7.90], p = 0.02); a higher baseline Neck Disability Index score (OR 1.41 [95% CI 1.09–1.84], p < 0.01); and higher neck pain score at 3 months postoperatively (OR 0.81 [95% CI 0.66–0.99], p = 0.04). CONCLUSIONS Most patients with CSM who undergo spine surgery reenter the workforce within 3 months from surgery, with RTW rates being higher among patients who experience good outcomes. Among patients with good outcomes who were employed, failure to RTW was associated with being on preoperative short-term disability or leave status prior to surgery as well as higher neck pain scores at baseline and at 3 months postoperatively.

The global public health crisis of antibiotic resistance is being driven in part by over prescription of antibiotics. We aimed to assess the relative weight of patient expectations, clinical uncertainty, and past behaviour on hospital-based physicians' antibiotic prescribing decisions.A discrete choice experiment was administered among hospital-based physicians in Tuscany, Italy. Respondents were asked to choose in which of two clinical scenarios they would be more likely to prescribe antibiotics, with the two cases differing in levels of clinical uncertainty, patient expectations, and the physician's past behaviour. We fitted a conditional logistic regression.Respondents included 1,436 hospital-based physicians. Results show that the odds of prescribing antibiotics decrease when a patient requests it (OR=0.80, 95%CI [0.72,0.89]) and increase when the physician has prescribed antibiotics to a patient under similar circumstances previously (OR=1.15, 95%CI [1.03,1.27]). We found no significant effect of clinical uncertainty on the odds of prescribing antibiotics (OR=0.96, 95%CI [0.87, 1.07]).We show that patient expectation has a significant negative association with antibiotic prescribing among hospital-based physicians. Our findings speak to the importance of cultural context in shaping the physician's disposition when confronted with patient expectations. We suggest shared decision-making to improve prudent prescribing without compromising on patient satisfaction.

Recent randomised controlled trials have failed to show a benefit in mortality by using processed electroencephalography (pEEG) to guide lighter anaesthesia. We performed a meta-analysis of mortality data from randomised trials of pEEG monitoring to assess the evidence of any protective effect of pEEG-guided light anaesthesia compared with deep anaesthesia in adults aged ≥18 yr.Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. In February 2022, we searched three databases (Cochrane CENTRAL, OVID Medline, EMBASE) for RCTs of pEEG monitoring that provided mortality data at 30 days, 90 days, and/or 1 yr or longer.We included 16 articles from 12 RCTs with 48 827 total participants. We observed no statistically significant mortality reduction with light anaesthesia compared with deep anaesthesia in patients aged ≥18 yr when all studies were pooled (odds ratio [OR]=0.99; 95% confidence interval (CI), 0.92-1.08). This result did not change significantly when analysing mortality at 30 days, 90 days, 1 yr or longer. We observed no mortality benefit for pEEG monitoring compared with usual care (OR=1.02; 95% CI, 0.89-1.18), targeting higher pEEG index values compared with lower values (OR=0.89; 95% CI, 0.60-1.32), or low pEEG index value alerts compared with no alerts (OR=1.02; 95% CI, 0.41-2.52).pEEG-guided lighter anaesthesia does not appear to reduce the risk of postoperative mortality. The absence of a plausible rationale for why deeper anaesthesia should increase mortality has hampered appropriate design of definitive clinical trials.CRD42022285195 (PROSPERO).

The outlet blade angle is a key geometrical parameter that governs how the impeller directly influences centrifugal pump performance. Therefore, a reasonable angle selection is crucial. To investigate the effects of the outlet blade angle on centrifugal pump internal flow field characteristics under cavitation conditions, this study employs a combination of a modified SST k-ω turbulent model with a Zwart-Gerber-Belamri cavitation model to perform transient flow simulations. Outlet blade angles of 15°, 20°, 25°, 30°, and 35° were tested. The results indicated that as the outlet blade angle increased, the relative liquid flow angle, vapor volume, and corresponding fraction first increased, then decreased, and finally increased again. Meanwhile, the distribution scope of each stall vortex on the suction surface became smaller, then larger, and smaller again, whereas the scopes of the pressure surfaces grew constantly as the outlet blade angle increased. Pressure fluctuations at all monitored points in the volute became weaker over time, and variations in the pressure fluctuations alternated with the outlet blade angle. The main frequency amplitude increased and the frequency doubling decreased as the outlet blade angle increased. Although the energy corresponding to the main frequency was unstable, it consistently held the dominant position. The duration that cavitation compliance was less than 0 first decreased and then increased as the outlet blade angle increased. For the impeller with an outlet blade angle of 25°, stall vortices accounted for the smallest regions, and the duration of negative cavitation compliance was minimized. In this case, the overall performance of the centrifugal pump was optimal.