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Jing Han Yang,1,* Ye Sun,1,* Yi Ran Yang,1 Ling Na Qi,1 Wan Yao Li,1 Xiang Zheng Qin2 1School of Medicine, Yanbian University, Yanji City, Jilin Province, 136200, People’s Republic of China; 2Department of Human Histology and Anatomy, Yanbian University, Yanji City, Jilin Province, 136200, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang Zheng Qin, Department of Human Histology and Anatomy, Yanbian University, Park Street, Yanji City, Jilin Province, 136200, People’s Republic of China, Email 0000003978@ybu.edu.cnAbstract: Now, the erector spinae plane block (ESPB) is widely used in various thoracolumbar surgeries. It has unique advantages: simple and convenient operation, low safety risks, and reduced opioid use. The ESPB is used in thoracic surgery, abdominal surgery, and spinal surgery. There are also relevant research reports on postoperative analgesia during general anesthesia surgery. This article searches the PubMed and Web of Science databases to find and screen relevant studies on ESPB since 2019 and retrospectively summarizes the current indications of ESPB. The methodological quality of the included studies was assessed using the Cochrane bias risk tool. The results showed that the current research on ESPB generally provides low-level clinical evidence. The complex anatomy of the erector spinae muscles is both responsible for its unique advantages and restricts its development. Few anatomical studies have clearly and completely demonstrated the diffusion relationship of local anesthetics among the anatomical structures of the erector spinal muscles. The uncontrollability of the diffusion plane prevents ESPB from being applied on a wider scale with a high level of evidence. To further clarify the scope of application of ESPB and achieve the best analgesic effect, in the future, we should focus on the unique anatomical course and distribution of the erector spinal muscles and their fascia and nerves. It is necessary to combine anatomical, imaging, and histological methods to obtain high-quality evidence to guide clinical application.Keywords: erector spinae plane block, fascial plane block, anatomy, regional anesthesia, pain, nerve block

Tao Sun,1,* Xian-Hong Huang,1,* Shu-E Zhang,2,* Hong-Yan Yin,3 Qing-Lin Li,2 Lei Gao,2 Ye Li,2 Li Li,4 Bing Cao,5 Jin-Hong Yang,6 Bei Liu7 1Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China; 2Department of Health Management, School of Health Management, Harbin Medical University, Harbin, 150081, People’s Republic of China; 3Department of Humanities and Social Sciences, Harbin Medical University (Daqing), Daqing, 163319, People’s Republic of China; 4Department of Administration, School of Law, Zhejiang University City College, Hangzhou, 310015, People’s Republic of China; 5Department of Oncology, Weifang People’s Hospital, Weifang, 261000, People’s Republic of China; 6Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, People’s Republic of China; 7Global Center for Infectious Disease and Policy Research, Peking University, Beijing, 100191, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bei Liu, Global Center for Infectious Disease and Policy Research, Peking University, Beijing, 100191, People’s Republic of China, Email 18827380717@163.comAim: To clarify the mediating role of burnout and the moderating role of turnover intention in the association between fatigue and job satisfaction among Chinese nurses in intensive care units (ICU) during the COVID-19 pandemic.Methods: A cross-sectional survey of fifteen provinces in China was conducted, using an online questionnaire, from December 2020 to January 2021, during the COVID-19 pandemic. A total of 374 ICU nurses (effective response rate: 71.37%) provided sufficient responses. Sociodemographic factors, job demographic factors, fatigue, burnout, job satisfaction, and turnover intention were assessed using questionnaires. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive modeling (GAM) were performed to examine all the considered research hypotheses.Results: Fatigue was found to be negatively and significantly associated with job satisfaction. Moreover, burnout played a partial mediating role and turnover intention played a moderating role in the relationship between fatigue and job satisfaction.Conclusion: Over time, a state of physical and mental exhaustion and work weariness among Chinese ICU nurses potentially results in job burnout and consequently promotes the level of job dissatisfaction. The results also found that turnover intention played a moderating role in the relationship between burnout and job satisfaction. Specific policies could be considered to eliminate nurses’ fatigue and negative attitudes during times of public health emergencies.Keywords: ICU nurses, fatigue, burnout, job satisfaction, turnover intention, COVID-19 pandemic

Jing-Hua Yang,1 Zuohui Zhao,2 Wanting Niu,3 Han-Pil Choi,3 Kazem M Azadzoi4 1Department of Surgery, Boston University School of Medicine and Proteomics Laboratory, VA Boston Healthcare System, Boston, MA, USA; 2Department of Urology, Boston University School of Medicine, Boston, MA, USA; 3Research Department, VA Boston Healthcare System, Boston, MA, USA; 4Departments of Urology and Pathology, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USACorrespondence: Kazem M Azadzoi, VA Boston Healthcare System, Building 1A, Room 317 (151), 150 South Huntington Avenue, Boston, MA, 02130, USA, Tel +1 857-364-5602, Email kazadzoi@bu.eduPurpose: Growing evidence suggests that ischemia provokes detrusor overactivity and degenerative responses in the bladder. Underlying mechanisms appear to involve modification of smooth muscle contractile rudiments by hypoxia, redox, cellular stress and cell survival signaling. Downstream pathways of cellular stress and stress response molecules eliciting bladder dysfunction in ischemia remain largely elusive. Our goal was to define the role of double stranded RNA (dsRNA), a stress response molecule provoked by redox, in ischemia mediated bladder dysfunction.Methods: A rat model of pelvic ischemia along with a cell culture hypoxia model were used to investigate the expression levels, functional consequences, structural aspects, and regulatory mechanisms of dsRNA in the bladder. Gene and protein expression were examined by reverse transcription polymerase chain reaction (RT-PCR), dot blot, and Western blotting, respectively. Tissue structure and function were assessed using histological staining and organ bath. Regulatory mechanisms were analyzed in cultured bladder smooth muscle cells.Results: The data presented here provide the first evidence of the formation of dsRNA in the overactive bladder. dsRNA is a cellular stress response molecule that sensitizes smooth muscle and regulates inflammatory and degenerative rejoinders. Our data suggest that the production of dsRNA in the bladder is provoked by ischemia. Formation of dsRNA appears to augment bladder smooth muscle contractions and provoke fibrotic and apoptotic responses. Downstream actions of dsRNA in the bladder may involve upregulation of dsRNA-activated protein kinase R (PKR) and caspase-3, the executioner of apoptosis.Conclusion: Activation of dsRNA/PKR pathway may play a role in sensitization of bladder smooth muscle cells to contractile stimuli, whereas dsRNA and caspase-3 crosstalk appear to modulate cellular stress and instigate degenerative responses in bladder ischemia. These observations suggest the role of dsRNA in bladder dysfunction and may open new perspectives to overcome overactive smooth muscle contractions and structural damage in the bladder.Keywords: bladder, ischemia, overactivity, dsRNA, contraction, degeneration

Ming Li,1,&ast; Da-Ming Xu,1,&ast; Shu-Bin Lin,1 Zheng-Liang Yang,1 Teng-Yu Xu,1 Jin-Huan Yang,1 Ze-Xin Lin,1 Ze-Kai Huang,1 Jun Yin2,3 1Division of Urological Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China; 2Division of Hematology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China; 3Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun YinDepartment of Clinical Laboratory Medicine and Division of Hematology, The Second Affiliated Hospital of Shantou University Medical College, Dongxia Road North, Shantou, Guangdong Province, 515041, People’s Republic of ChinaTel +86 754 8891 5950Email jyin@stu.edu.cnObjective: To investigate the immune profiles in benign prostatic hyperplasia, changes in the absolute number of lymphocyte subsets and the proportion of T lymphocyte subsets were detected.Methods: Absolute value of lymphocyte subsets in peripheral blood (T, B and NK cells) and the proportion of T lymphocyte (native CD4+ T cell, memory CD4+ T cell, CD8+CD28+ T cell, CD8+CDDR+ T cells and CD8+CD38+ T cell) were measured by flow cytometry.Results: The absolute values of CD3+ T cell (972.55± 330.31 vs 1757.99± 439.38), CD4+ T cell (656.43± 252.39 vs 899.30± 262.10), and CD8+ T cell (301.97± 147.76 vs 728.45± 230.34) in patients with benign prostatic hyperplasia were significantly reduced (all P< 0.05). There was no significant difference in NK cell (285.58± 182.84 vs 528.92± 208.17) and B cell (186.66± 86.62 vs 334.17± 130.46). The proportion of naive CD4+ T cell (3.75± 0.50 vs 8.54± 1.61) in T lymphocyte subsets in patients with BPH was significantly reduced (P< 0.05). There was no significant difference in memory CD4+ T cell (87.9± 6.37 vs 92.63± 5.94), CD8+CD28+ T cell (60.52± 13.86 vs 64.32± 12.78), CD8+CDDR+ T cell (36.58± 12.87 vs 31.92± 8.54) and CD8+CD38+ T cell (2.1± 1.90 vs 2.55± 2.01).Conclusion: Immune dysfunction raised the risk of viral infection, inflammatory stimulation, and tumor induction in prostate cells, leading to hyperplasia, and immune non-response was potentially a key factor in the transformation of BPH into prostate cancer.Keywords: benign prostatic hyperplasia, lymphocyte subsets, pathogenesis, flow cytometry

Jing-Hua Yang,1 Mike B Siroky,1 Subbarao V Yalla,2 Kazem M Azadzoi3,4 1Department of Urology, VA Boston Healthcare System, Boston University School of Medicine, 2Department of Urology, VA Boston Healthcare System, Harvard Medical School, 3Department of Urology, 4Department of Pathology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA Purpose: Detrusor overactivity contributes to bothersome constellation of lower urinary tract symptoms (LUTS) in men and women as they age. However, the underlying mechanisms of non-obstructive detrusor overactivity and LUTS remain largely unknown. Growing evidence suggests that ischemia may be an independent factor in the development of non-obstructive bladder dysfunction. Our goal was to determine the effects of ischemia on detrusor function and voiding behavior and define redox-mediated cellular stress and cell survival signaling in the ischemic bladder. Materials and methods: Male Sprague Dawley rats were randomly divided into treatment (n=8) and control (n=8) groups. In the treatment group, iliac artery atherosclerosis and chronic bladder ischemia were induced. At 8 weeks after bladder ischemia, voiding patterns were examined in metabolic cages, cystometrograms were recorded in conscious animals, and then bladder blood flow was measured under general anesthesia. Bladder tissues were processed for assessment of transcription factors, markers of cellular and mitochondrial stress, mitochondrial respiration, and cell survival signaling pathway.Results: Atherosclerotic occlusive disease spread from the common iliac arteries to the internal iliac and vesical arteries and produced sustained bladder ischemia. Studies in metabolic cages showed increased micturition frequency and decreased voided volume in bladder ischemia. Conscious cystometrograms produced consistent data showing significant increase in micturition frequency and decreased voided volume and bladder capacity. Voiding behavior and cystometric changes in bladder ischemia were associated with significant decrease in DNA binding activity of Nrf2, significant increase in cellular levels of stress protein Hsp70 and mitochondrial stress protein GRP75, and significant decrease in mitochondrial oxygen consumption and upregulation of PI3K and Akt expression. Conclusion: Chronic bladder ischemia may be a mediating variable in the development of detrusor overactivity in the non-obstructive bladder. The mechanism may involve ischemia-induced cellular stress, Nrf2 functional deficit, depression of mitochondrial respiration, and upregulation of PI3K/Akt cell survival signaling pathway. Keywords: atherosclerosis, blood flow, redox, cellular stress, detrusor overactivity, survival signaling

Deng-GuangYu1, Li-Min Zhu2, Christopher J Branford-White3, Jun-He Yang1, Xia Wang1, Ying Li1, Wei Qian11School of Materials Science and Engineering, University of Shanghai for Science and Technology; 2College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, People's Republic of China; 3Faculty of Life Sciences, London Metropolitan University, London, United KingdomBackground: The objective of this investigation was to develop a new type of solid dispersion in the form of core-sheath nanofibers using coaxial electrospinning for poorly water-soluble drugs. Different functional ingredients can be placed in various parts of core-sheath nanofibers to improve synergistically the dissolution and permeation properties of encapsulated drugs and to enable drugs to exert their actions.Methods: Using acyclovir as a model drug, polyvinylpyrrolidone as the hydrophilic filament-forming polymer matrix, sodium dodecyl sulfate as a transmembrane enhancer, and sucralose as a sweetener, core-sheath nanofibers were successfully prepared, with the sheath part consisting of polyvinylpyrrolidone, sodium dodecyl sulfate, and sucralose, and the core part composed of polyvinylpyrrolidone and acyclovir.Results: The core-sheath nanofibers had an average diameter of 410 ± 94 nm with a uniform structure and smooth surface. Differential scanning calorimetry and x-ray diffraction results demonstrated that acyclovir, sodium dodecyl sulfate, and sucralose were well distributed in the polyvinylpyrrolidone matrix in an amorphous state due to favoring of second-order interactions. In vitro dissolution and permeation studies showed that the core-sheath nanofiber solid dispersions could rapidly release acyclovir within one minute, with an over six-fold increased permeation rate across the sublingual mucosa compared with that of crude acyclovir particles.Conclusion: The study reported here provides an example of the systematic design, preparation, characterization, and application of a novel type of solid dispersion consisting of multiple components and structural characteristics.Keywords: core-sheath nanofibers, solid dispersion, coaxial electrospinning, poorly water-soluble drug, dissolution, permeation

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system that causes significant disability and healthcare burden. The treatment of MS has evolved over the past three decades with development of new, high efficacy disease modifying therapies targeting various mechanisms including immune modulation, immune cell suppression or depletion and enhanced immune cell sequestration. Emerging therapies include CNS-penetrant Bruton's tyrosine kinase inhibitors and autologous hematopoietic stem cell transplantation as well as therapies aimed at remyelination or neuroprotection. Therapy development for progressive MS has been more challenging with limited efficacy of current approved agents for inactive disease and older patients with MS. The aim of this review is to provide a broad overview of the current therapeutic landscape for MS.

Introduction: The 2019e2020 coronavirus pandemic has had a significant impact on all aspects of health care. Decrease in clinical and operative volume and limitations for conferences has drastically decreased educational opportunities for resident trainees. We describe the formation and initial success of the Collaborative Online Video Didactics lecture series, a multi-institutional online video didactics collaboration. Methods: Zoom data extraction and postlecture evaluation surveys were used to collect data on the impact of the pandemic on local educational activities as well as feedback about the lecture series. Lectures are being given by faculty from 35 institutions. The twice daily, hour-long webinar averages more than 470 live viewers per session with an average of 33.5 questions per session and has over 7,000 YouTube views of the recordings after the first 2 weeks. Results: Viewers reported significant decreases in outpatient (75.2%), inpatient (64.9%) and operating room (77.7%) volumes at local programs, and only half (52.7%) of the survey responders indicated an increase in didactics locally. The lectures have been well-received, with over 90% of respondents giving the lecturers and series above average or excellent ratings. A significant majority of responders indicated that the lecture series has allowed for ongoing education opportunities during the pandemic (95.0%), helped to access faculty experts from other institutions (92.3%) and provided a sense of community connectedness during this period of social isolation (81.7%). Conclusions: We strongly encourage other institutions and trainees to participate in the didactic series and hope that this series can continue to evolve and be of benefit beyond the pandemic.

The oxygen stacking of O3-type layered sodium transition metal oxides (O3-NaTMO2) changes dynamically upon topotactic Na extraction and reinsertion. While the phase transition from octahedral to prismatic Na coordination that occurs at intermediate desodiation by transition metal slab gliding is well understood, the structural evolution at high desodiation, crucial to achieve high reversible capacity, remains mostly uncharted. In this work, the phase transitions of O3-type layered NaTMO2 at high voltage are investigated by combining experimental and computational approaches. An OP2-type phase that consists of alternating octahedral and prismatic Na layers is directly observed by in situ X-ray diffraction and high-resolution scanning transmission electron microscopy. The origin of this peculiar phase is explained by atomic interactions involving Jahn–Teller active Fe4+ and distortion tolerant Ti4+ that stabilize the local Na environment. The path-dependent desodiation and resodiation pathways are also rationalized in this material through the different kinetics of the prismatic and octahedral layers, presenting a comprehensive picture about the structural stability of the layered materials upon Na intercalation.

The ability of first-principles computational methods to reproduce ground-state crystal structure selection is key to their application in the discovery of new materials, and yet presents a formidable challenge due to the low-energy scale of the problem and lack of systematic error cancellation. The recently developed Strongly Constrained and Appropriately Normed (SCAN) functional is notable for accurately calculating physical properties such as formation energies and in particular, correctly predicting ground-state structures. Here, we attempt to rationalize the improved structure prediction accuracy in SCAN by investigating the relationship between preferred coordination environments, the description of attractive van der Waals (vdW) interactions, and the overall ground-state prediction in bulk main-group solids. We observe a systematic undercoordination error in the traditional Perdew, Burke, and Ernzerhof (PBE) functional which is not present in SCAN results and find that semiempirical dispersion corrections in the form of PBE+D3 fail to correct this error in a consistent or physical manner. We conclude that the medium-range vdW interaction is correctly parametrized in SCAN and yields meaningful relative energies between coordination environments.

Chen et al. recently carried out self-assembled growth of epitaxial sub-10 nm erbium disilicide (C32, hP3) nanowires on Si(001). They pointed out that the success of this self-assembly process is due to asymmetric lattice mismatches in the two orthogonal crystallographic directions of the two materials, i.e. [0001]ErSi2/[110]si,+6.5% and [1120] RESi2/[110]si,-1.3%. In this paper, we have established experimentally that (Er1-xGdx)Si2 and (Er 1-xSmx)Si2 exist with values of x from 0 to 1 and that their lattice parameters follow Vegard's law. Since the binary GdSi2 and SmSi2 end members in each of these ternary systems have a and c unit cell parameters greater than those of the ErSi 2 end member, we have determined that an optimal lattice mismatch can be achieved with the Si substrate at a composition of (Er 0.45Gd0.55)Si2 and (Er0.62Sm 0.38)Si2. It is reasonable to expect a higher quality of self-assembled nanowire growth on Si by employing these ternary silicides. A review of the atomic sizes of the rare earth metal elements of the lanthanide series indicates that many of the binary disilicides, when exhibiting the C32 structure, should have a tendency to form ternary and higher-order disilicides. These materials would offer many possibilities for the growth of suicide nanowires with interesting electronic, magnetic and optical properties.