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Terminal cancer patients often endure significant distress, impacting their quality of life. Spiritual well-being provides peace and meaning during this challenging period.
Objectives. This study explored the spiritual well-being of terminally ill patients and their next-of-kin caregivers in hospice care, focusing on factors influencing their spiritual experiences.
Methods
This mixed-methods study included 30 terminally ill patients and 17 next-of-kin caregivers in hospice care. Spiritual well-being was assessed using the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale (FACIT-Sp-12), and symptom distress with the Edmonton Symptom Assessment Scale. Qualitative data were collected through semi-structured interviews at baseline, 1 week, and 1 month. Data were analyzed using quantitative methods and thematic analysis.
Results
Patients showed a significant improvement in spiritual well-being over time, with FACIT-Sp-12 scores increasing from 28.6 at baseline to 31.3 at 1 month (p < .01). Symptoms such as shortness of breath (β = –1.19, p < .001), drowsiness (β = –1.27, p = .01), and anxiety (β = –0.60, p = .03) were negatively associated with spiritual well-being. Caregiver spiritual well-being positively influenced patient scores, especially with female caregivers (β = 0.26, p < .001). Qualitative findings supported these results, revealing themes of spiritual adjustment, the impact of physical symptoms on spiritual well-being, and the crucial role of caregivers in providing emotional and spiritual support.
Significance of results
Early palliative care facilitates spiritual adjustment in terminally ill patients. A holistic approach addressing physical symptoms and psychological distress is essential. Supporting caregivers, particularly female ones, positively impacts patient spiritual well-being. Tailored interventions considering the unique needs of patients and caregivers are recommended to enhance palliative care quality.
This paper provides an overview of the current status of ultrafast and ultra-intense lasers with peak powers exceeding 100 TW and examines the research activities in high-energy-density physics within China. Currently, 10 high-intensity lasers with powers over 100 TW are operational, and about 10 additional lasers are being constructed at various institutes and universities. These facilities operate either independently or are combined with one another, thereby offering substantial support for both Chinese and international research and development efforts in high-energy-density physics.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used due to their profound efficacy in glycemic control and weight management. Real-world observations have revealed potential neuropsychiatric adverse events (AEs) associated with GLP-1RAs. This study aimed to comprehensively investigate and characterize these neuropsychiatric AEs with GLP-1RAs.
Methods
We analyzed GLP-1RA adverse reaction reports using the FDA Adverse Event Reporting System database. Disproportionality analysis using reporting odds ratio (ROR) identified eight categories of neuropsychiatric AEs associated with GLP-1RAs. We conducted descriptive and time-to-onset (TTO) analyses and explored neuropsychiatric AE signals among individual GLP-1RAs for weight loss and diabetes mellitus (DM) indications.
Results
We identified 25,110 cases of GLP-1RA-related neuropsychiatric AEs. GLP-1RAs showed an association with headache (ROR 1.74, 95% confidence interval [CI] 1.65–1.84), migraine (ROR 1.28, 95%CI 1.06–1.55), and olfactory and sensory nerve abnormalities (ROR 2.44, 95%CI 1.83–3.25; ROR 1.69, 95%CI 1.54–1.85). Semaglutide showed a moderate suicide-related AEs signal in the weight loss population (ROR 2.55, 95%CI 1.97–3.31). The median TTO was 16 days (interquartile range: 3–66 days).
Conclusions
In this study, we identified eight potential neuropsychiatric adverse events (AEs) associated with GLP-1RAs and, for the first time, detected positive signals for migraine, olfactory abnormalities, and sensory abnormalities. We also observed positive suicide-related signals of semaglutide, in weight loss population. This study provides a reliable basis for further investigation of GLP-1RA-related neuropsychiatric AEs. However, as an exploratory study, our findings require confirmation through large-scale prospective studies.
For the pulse shaping system of the SG-II-up facility, we propose a U-shaped convolutional neural network that integrates multi-scale feature extraction capabilities, an attention mechanism and long short-term memory units, which effectively facilitates real-time denoising of diverse shaping pulses. We train the model using simulated datasets and evaluate it on both the simulated and experimental temporal waveforms. During the evaluation of simulated waveforms, we achieve high-precision denoising, resulting in great performance for temporal waveforms with frequency modulation-to-amplitude modulation conversion (FM-to-AM) exceeding 50%, exceedingly high contrast of over 300:1 and multi-step structures. The errors are less than 1% for both root mean square error and contrast, and there is a remarkable improvement in the signal-to-noise ratio by over 50%. During the evaluation of experimental waveforms, the model can obtain different denoised waveforms with contrast greater than 200:1. The stability of the model is verified using temporal waveforms with identical pulse widths and contrast, ensuring that while achieving smooth temporal profiles, the intricate details of the signals are preserved. The results demonstrate that the denoising model, trained utilizing the simulation dataset, is capable of efficiently processing complex temporal waveforms in real-time for experiments and mitigating the influence of electronic noise and FM-to-AM on the time–power curve.
Smart agriculture is based on latest technologies in communication, big data analysis, high-performance sensors, and automatic machinery to improve the effectiveness of agriculture industry. China is looking forward to achieve modernization of its agriculture industry through smart agriculture. But its unique climate, landscape, diversity in crops, and large population make this task more challenging compared to other counties. Herein, we present the current achievements regarding policies made to guide and support the development of smart agriculture, the promotion of smart techniques and smart equipment, and the cultivation of specialists in smart agriculture. Then we discussed the existing challenges that hinder further development of smart agriculture industry and proposed several feasible solutions to solve or ease the problem, including the pertinent development of smart agriculture in provinces with different resources, enrich modes of online technical support and specialist cultivation, and set a series of standards to guide research and development of novel smart systems.
Choline and betaine are important in the body, from cell membrane components to methyl donors. We aimed to investigate trends in dietary intake and food sources of total choline, individual choline forms and betaine in Chinese adults using data from the China Health and Nutrition Survey (CHNS) 1991–2011, a prospective cohort with a multistage, random cluster design. Dietary intake was estimated using three consecutive 24-h dietary recalls in combination with a household food inventory. Linear mixed-effect models were constructed using R software. A total of 11 188 men and 12 279 women aged 18 years or older were included. Between 1991 and 2011, total choline intake increased from 219·3 (95 % CI 215·1, 223·4) mg/d to 269·0 (95 % CI 265·6, 272·5) mg/d in men and from 195·6 (95 % CI 191·8, 199·4) mg/d to 240·4 (95 % CI 237·4, 243·5) mg/d in women (both P-trends < 0·001). Phosphatidylcholine was the major form of dietary choline, and its contribution to total choline increased from 46·9 % in 1991 to 58·8 % in 2011. Cereals were the primary food source of total choline before 2000, while eggs had ranked at the top since 2004. Dietary betaine intake was relatively steady over time with a range of 134·0–151·5 mg/d in men (P-trend < 0·001) and 111·7–125·3 mg/d in women (P-trend > 0·05). Chinese adults experienced a significant increase in dietary intake of choline, particularly phosphatidylcholine during 1991–2011 and animal-derived foods have replaced plant-based foods as the main food sources of choline. Betaine intake remained relatively stable over time. Future efforts should address the health effects of these changes.
MicroRNAs (miRNAs) are endogenous, non-coding RNAs, which are functional in a variety of biological processes through post-transcriptional regulation of gene expression. However, the role of miRNAs in the interaction between Bacillus thuringiensis and insects remains unclear. In this study, small RNA libraries were constructed for B. thuringiensis-infected (Bt) and uninfected (CK) Spodoptera exigua larvae (treated with double-distilled water) using Illumina sequencing. Utilising the miRDeep2 and Randfold, a total of 233 known and 726 novel miRNAs were identified, among which 16 up-regulated and 34 down-regulated differentially expressed (DE) miRNAs were identified compared to the CK. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that potential target genes of DE miRNAs were associated with ABC transporters, fatty acid metabolism and MAPK signalling pathway which are related to the development, reproduction and immunity. Moreover, two miRNA core genes, SeDicer1 and SeAgo1 were identified. The phylogenetic tree showed that lepidopteran Dicer1 clustered into one branch, with SeDicer1 in the position closest to Spodoptera litura Dicer1. A similar phylogenetic relationship was observed in the Ago1 protein. Expression of SeDicer1 increased at 72 h post infection (hpi) with B. thuringiensis; however, expression of SeDicer1 and SeAgo1 decreased at 96 hpi. The RNAi results showed that the knockdown of SeDicer1 directly caused the down-regulation of miRNAs and promoted the mortality of S. exigua infected by B. thuringiensis GS57. In conclusion, our study is crucial to understand the relationship between miRNAs and various biological processes caused by B. thuringiensis infection, and develop an integrated pest management strategy for S. exigua via miRNAs.
Persistent cognitive deficits and functional impairments are associated with bipolar disorder (BD), even during the euthymic phase. The dysfunction of default mode network (DMN) is critical for self-referential and emotional mental processes and is implicated in BD. The current study aims to explore the balance of excitatory and inhibitory neurotransmitters, i.e. glutamate and γ-aminobutyric acid (GABA), in hubs of the DMN during the euthymic patients with BD (euBD).
Method
Thirty-four euBD and 55 healthy controls (HC) were recruited to the study. Using proton magnetic resonance spectroscopy (1H-MRS), glutamate (with PRESS sequence) and GABA levels (with MEGAPRESS sequence) were measured in the medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and the posterior cingulate gyrus (PCC). Measured concentrations of excitatory glutamate/glutamine (Glx) and inhibitory GABA were used to calculate the excitatory/inhibitory (E/I) ratio. Executive and attentional functions were respectively assessed using the Wisconsin card-sorting test and continuous performance test.
Results
euBD performed worse on attentional function than controls (p = 0.001). Compared to controls, euBD had higher E/I ratios in the PCC (p = 0.023), mainly driven by a higher Glx level in the PCC of euBD (p = 0.002). Only in the BD group, a marginally significant negative association between the mPFC E/I ratio (Glx/GABA) and executive function was observed (p = 0.068).
Conclusions
Disturbed E/I balance, particularly elevated Glx/GABA ratio in PCC is observed in euBD. The E/I balance in hubs of DMN may serve as potential biomarkers for euBD, which may also contribute to their poorer executive function.
Depression is a significant mental health concern affecting the overall well-being of adolescents and young adults. Recently, the prevalence of depression has increased among young people. Nonetheless, there is little research delving into the longitudinal epidemiology of adolescent depression over time.
Aims
To investigate the longitudinal epidemiology of depression among adolescents and young adults aged 10–24 years.
Method
Our research focused on young people (aged 10–24 years) with depression, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We explored the age-standardised prevalence, incidence and disability-adjusted life-years (DALYs) of depression in different groups, including various regions, ages, genders and sociodemographic indices, from 1990 to 2019.
Results
The prevalence, incidence and DALYs of depression in young people increased globally between 1990 and 2019. Regionally, higher-income regions like High-Income North America and Australasia recorded rising age-standardised prevalence and incidence rates, whereas low- or middle-income regions mostly saw reductions. Nationally, countries such as Greenland, the USA and Palestine reported the highest age-standardised prevalence and incidence rates in 2019, whereas Qatar witnessed the largest growth over time. The burden disproportionately affected females across age groups and world regions. The most prominent age effect on incidence and prevalence rates was in those aged 20–24 years. The depression burden showed an unfavourable trend in younger cohorts born after 1980, with females reporting a higher cohort risk than males.
Conclusions
Between 1990 and 2019, the general pattern of depression among adolescents varied according to age, gender, time period and generational cohort, across regions and nations.
Malignant vasovagal syncope in children seriously affects their physical and mental health. Our study aimed to explore the efficacy of catheter ablation in ganglionated plexus with malignant vasovagal syncope children.
Conclusion:
Catheter ablation of ganglionated plexus was safe and effective in children with malignant vasovagal syncope and can be used as a treatment option for these children.
Methods:
A total of 20 children diagnosed with malignant vasovagal syncope were enrolled in Beijing Children’s Hospital, affiliated with Capital Medical University. All underwent catheter ablation treatment of ganglionated plexus. Ganglionated plexuses of the left atrium were identified by high-frequency stimulation and/or anatomic landmarks being targeted by radiofrequency catheter ablation. The efficacy of the treatment was evaluated by comparing the remission rate of post-operative syncopal symptoms and the rate of negative head-up tilt results. Safety and adverse events were evaluated.
Results:
After follow-up for 2.5 (0.6–5) years, the syncope symptom scores were decreased significantly compared with before treatment [3 (2–4) versus 5 (3–8) scores, P < 0.01]. Eighty-five per cent (17/20) children no longer experienced syncope, whilst 80% (16/20) children showed negative head-up tilt test after treatment. No adverse effects such as cardiac arrhythmia occurred in the children.
Stress affects executive functions and exploring the association between stress-induced physiological reactivity and executive functions could highlight the potential mechanism of the stress-cognitive function link. Our study examined the linear and nonlinear associations between cardiovascular stress reactivity and cool and hot executive functions among adolescents. In November 2021 (T1), 273 Chinese adolescents between 11 and 14 (Mage = 12.93, SDage = 0.79) underwent a speech task during which their cardiovascular data were recorded, and they completed a Flanker task and an Emotional Stroop task. In May 2023 (T2), 253 adolescents again completed the Flanker and Emotional Stroop tasks. Cool and hot executive functions were assessed using the intra-individual reaction time variability of the Flanker task and Emotional Stroop task, respectively. Results showed that cardiovascular stress reactivity was positively linearly associated with cool executive functions at T1 and quadratically (inverted U-shaped) associated with cool executive functions at T1 and hot executive functions at T1 and T2. These findings suggest that compared to very high and very low cardiovascular reactivity, moderate to high cardiovascular reactivity to a structured social challenge is associated with better cool and hot executive functions.
Accurately predicting neurosyphilis prior to a lumbar puncture (LP) is critical for the prompt management of neurosyphilis. However, a valid and reliable model for this purpose is still lacking. This study aimed to develop a nomogram for the accurate identification of neurosyphilis in patients with syphilis. The training cohort included 9,504 syphilis patients who underwent initial neurosyphilis evaluation between 2009 and 2020, while the validation cohort comprised 526 patients whose data were prospectively collected from January 2021 to September 2021. Neurosyphilis was observed in 35.8% (3,400/9,504) of the training cohort and 37.6% (198/526) of the validation cohort. The nomogram incorporated factors such as age, male gender, neurological and psychiatric symptoms, serum RPR, a mucous plaque of the larynx and nose, a history of other STD infections, and co-diabetes. The model exhibited good performance with concordance indexes of 0.84 (95% CI, 0.83–0.85) and 0.82 (95% CI, 0.78–0.86) in the training and validation cohorts, respectively, along with well-fitted calibration curves. This study developed a precise nomogram to predict neurosyphilis risk in syphilis patients, with potential implications for early detection prior to an LP.
Few studies have evaluated the joint effect of trace elements on spontaneous preterm birth (SPTB). This study aimed to examine the relationships between the individual or mixed maternal serum concentrations of Fe, Cu, Zn, Se, Sr and Mo during pregnancy, and risk of SPTB. Inductively coupled plasma MS was employed to determine maternal serum concentrations of the six trace elements in 192 cases with SPTB and 282 controls with full-term delivery. Multivariate logistic regression, weighted quantile sum regression (WQSR) and Bayesian kernel machine regression (BKMR) were used to evaluate the individual and joint effects of trace elements on SPTB. The median concentrations of Sr and Mo were significantly higher in controls than in SPTB group (P < 0·05). In multivariate logistic regression analysis, compared with the lowest quartile levels of individual trace elements, the third- and fourth-quartile Sr or Mo concentrations were significantly associated with reduced risk of SPTB with adjusted OR (aOR) of 0·432 (95 CI < 0·05). In multivariate logistic regression analysis, compared with the lowest quartile levels of individual trace elements, the third- and fourth-quartile Sr or Mo concentrations were significantly associated with reduced risk of SPTB with adjusted aOR of 0·432 (95 % CI 0·247, 0·756), 0·386 (95 % CI 0·213, 0·701), 0·512 (95 % CI 0·297, 0·883) and 0·559 (95 % CI 0·321, 0·972), respectively. WQSR revealed the inverse combined effect of the trace elements mixture on SPTB (aOR = 0·368, 95 % CI 0·228, 0·593). BKMR analysis confirmed the overall mixture of the trace elements was inversely associated with the risk of SPTB, and the independent effect of Sr and Mo was significant. Our findings suggest that the risk of SPTB decreased with concentrations of the six trace elements, with Sr and Mo being the major contributors.
A compact high-power ultra-wideband bipolar pulse generator based on a modified Marx circuit is designed, which is mainly composed of a primary power supply, Marx generator, sharpening and cutoff subnanosecond spark gap switches, and coaxial transmission lines. The Marx generator with modified circuit structure has thirty-two stages and is composed of eight disk-like modules. Each module consists of four capacitors, two spark gap switches, four charging inductors, and a mechanical support. To simplify the design of the charging structure and reduce the number of switches, four groups of inductors are used to charge the capacitors of the Marx generator, two of which are used for positive voltage charging and the other two for negative voltage charging. When the capacitor of each stage is charged to 35 kV, the maximum output peak voltage can reach 1 MV when the Marx generator is open circuit. The high-voltage pulse generated by the Marx generator charges the transmission line and forms a bipolar pulse through sharpening and cutoff switches. All transmission lines used for bipolar pulse generation have an impedance of 10 Ω. When the 950 kV pulse voltage generated by the Marx generator is fed into the transmission line, the bipolar pulse peak voltage can reach 390 kV, the center frequency of the pulse is about 400 MHz, and the output peak power is about 15.2 GW.
In order to establish a compact all-optical Thomson scattering source, experimental studies were conducted on the 45 TW Ti: sapphire laser facility. By including a steel wafer, mixed gas, and plasma mirror into a double-exit jet, several mechanisms, such as shock-assisted ionization injection, ionization injection, and driving laser reflection, were integrated into one source. So, the source of complexity was remarkably reduced. Electron bunches with central energy fluctuating from 90 to 160 MeV can be produced. Plasma mirrors were used to reflect the driving laser. The scattering of the reflected laser on the electron bunches led to the generation of X-ray photons. Through comparing the X-ray spots under different experimental conditions, it is confirmed that the X-ray photons are generated by Thomson scattering. For further application, the energy spectra and source size of the Thomson scattering source were measured. The unfolded spectrum contains a large amount of low-energy photons besides a peak near 67 keV. Through importing the electron energy spectrum into the Monte Carlo simulation code, the different contributions of the photons with small and large emitting angles can be used to explain the origin of the unfolded spectrum. The maximum photon energy extended to about 500 keV. The total photon production was 107/pulse. The FWHM source size was about 12 μm.
Heart rate variability (HRV) can be an indicator of the flexibility of the central and autonomic nervous systems. Heart rate variability biofeedback (HRV-BF) has been shown to validate the neuro-peripheral relationship and enhance the interaction between top-down and bottom-up processes. Few previous studies have focused on the treatment outcomes of HRV-BF in traumatic brain injury, and such studies have been mostly limited to pilot studies or case reports. The purpose of this study is to investigate the efficacy of HRV-BF for neuropsychological functioning in patients with mild traumatic brain injury (mTBI).
Participants and Methods:
Forty-one patients with mTBI were referred from the neurosurgery outpatient program and randomly assigned to a psychoeducation group or a HRV-BF intervention group. The psychoeducation group received standard medical care and one 60-minute psychoeducation session after brain injury. The HRV-BF group received standard medical care and one 60-minute session of the HRV-BF intervention weekly for 10 weeks. All participants received performance-based and self-reported neuropsychological measures of memory, executive function, mood, and information processing at week 1 of injury (pretest) and week 12 (posttest).
Results:
Participants in HRV-BF improved significantly after the intervention compared with the psychoeducation group on the Verbal Learning Test, Frontal Assessment Battery, Verbal Fluency Test, Paced Auditory Serial Addition Test, Trail Making Test, Dysexecutive Questionnaire, Depression Inventory, and Checklist of Post-concussion Symptoms.
Conclusions:
HRV-BF was found to be an efficacious and efficient intervention for improving neuropsychological functioning in patients with mTBI and a potential candidate for mTBI rehabilitation.
Manipulation of T cells has revolutionized cancer immunotherapy. Notably, the use of T cells carrying engineered T cell receptors (TCR-T) offers a favourable therapeutic pathway, particularly in the treatment of solid tumours. However, major challenges such as limited clinical response efficacy, off-target effects and tumour immunosuppressive microenvironment have hindered the clinical translation of this approach. In this review, we mainly want to guide TCR-T investigators on several major issues they face in the treatment of solid tumours after obtaining specific TCR sequences: (1) whether we have to undergo affinity maturation or not, and what parameter we should use as a criterion for being more effective. (2) What modifications can be added to counteract the tumour inhibitory microenvironment to make our specific T cells to be more effective and what is the safety profile of such modifications? (3) What are the new forms and possibilities for TCR-T cell therapy in the future?
Frequency modulation (FM)-to-amplitude modulation (AM) conversion is an important factor that affects the time–power curve of inertial confinement fusion (ICF) high-power laser facilities. This conversion can impact uniform compression and increase the risk of damage to optics. However, the dispersive grating used in the smoothing by spectral dispersion technology will introduce a temporal delay and can spatially smooth the target. The combined effect of the dispersive grating and the focusing lens is equivalent to a Gaussian low-pass filter, which is equivalent to 8 GHz bandwidth and can reduce the intensity modulation on the target to below 5% with 0.3 nm @ 3 GHz + 20 GHz spectrum phase modulation. The results play an important role in the testing and evaluating of the FM-to-AM on the final optics and the target, which is beneficial for comprehensively evaluating the load capacity of the facility and isentropic compression experiment for ICF.
An online pattern recognition method of lower limb movements is proposed based on the personalized surface electromyography (sEMG) signals, and the corresponding experimental researches are performed in the rehabilitation training. Further, a wireless wearable acquisition instrument is used. Based on this instrument, a host computer for the personal online recognition and real-time control of rehabilitation training is developed. Three time-domain features and two features in the nonlinear dynamics are selected as the joint set of the characteristic values for the sEMG signals. Then a particle swarm optimization (PSO) algorithm is used to optimize the feature channels, and a k-nearest neighbor (KNN) algorithm and the extreme learning machine (ELM) algorithm are combined to classify and recognize individual sample data. Based on the multi-pose lower limb rehabilitation robot, the real-time motion recognition and the corresponding rehabilitation training are carried out by using the online personalized classifier. The experimental results of eight subjects indicate that it takes only 6 min to build an online personalized classifier for the four types of the lower limb movements. The recognition between switches of different rehabilitation training movements is timely and accurate, with an average recognition accuracy of more than 95%. These results demonstrate that this system has a strong practicability.