Differential pulse-position modulation(DP PM)can achieve a good compromise between power and bandwidth requirements.However,the output sequence has undetectable insertions and deletions.This paper proposes a successiv...Differential pulse-position modulation(DP PM)can achieve a good compromise between power and bandwidth requirements.However,the output sequence has undetectable insertions and deletions.This paper proposes a successive cancellation(SC)decoding scheme based on the weighted levenshtein distance(WLD)of polar codes for correcting insertions/deletions in DPPM systems.In this method,the WLD is used to calculate the transfer probabilities recursively to obtain likelihood ratios,and the low-complexity SC decoding method is built according to the error characteristics to match the DPPM system.Additionally,the proposed SC decoding scheme is extended to list decoding,which can further improve error correction performance.Simulation results show that the proposed scheme can effectively correct insertions/deletions in the DPPM system,which enhances its reliability and performance.展开更多
BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carri...BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.展开更多
An efficient TfOH-catalyzed O—H insertion reaction of α-aryl diazoesters with carboxylic acids is reported.This metal-free protocol provides an operationally simple method for a one-pot assembly of diverse α-acylox...An efficient TfOH-catalyzed O—H insertion reaction of α-aryl diazoesters with carboxylic acids is reported.This metal-free protocol provides an operationally simple method for a one-pot assembly of diverse α-acyloxy esters in moderate to high yields with a broad substrate scope.All starting materials are readily available,and the reactions can be conducted in the open air at room temperature.展开更多
A blue light-induced formal insertion reaction ofα-siloxy carbene into the C—H bond of 1,3-diketones has been reported.Under the irradiation of blue light,acylsilane converts toα-siloxy carbene,which then undergoes...A blue light-induced formal insertion reaction ofα-siloxy carbene into the C—H bond of 1,3-diketones has been reported.Under the irradiation of blue light,acylsilane converts toα-siloxy carbene,which then undergoes formal C—H bond insertion reaction with the enol form of 1,3-diketone.This method uses readily available and relative stable acylsilane as car-bene precursor,which features a simple and metal-free approach under mild conditions.Moreover,the synthetic potential of this protocol has been demonstrated by performing the reaction on a gram scale with comparable high yield.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are crucial for patients requiring long-term intravenous therapy,especially within digestive surgery under bundled care protocols.AIM To evaluate and compare th...BACKGROUND Peripherally inserted central catheters(PICCs)are crucial for patients requiring long-term intravenous therapy,especially within digestive surgery under bundled care protocols.AIM To evaluate and compare the efficacy,safety,and patient-reported outcomes of single-lumen vs double-lumen PICCs among patients undergoing digestive surgery within a structured bundled care framework.METHODS This retrospective cohort study analyzed data from 249 patients who underwent digestive surgery and utilized either single-lumen(n=117)or double-lumen(n=132)PICCs between January 2021 and June 2024.Clinical outcomes,patient satisfaction,catheterization duration,and complication rates were compared using statistical analysis via SPSS(version 29.0).The bundled care protocol was consistently applied,focusing on standardized procedures,staff training,and patient support.RESULTS Single-lumen PICCs were associated with a significantly lower thrombosis rate(0.85%)than double-lumen PICCs(6.82%,P=0.039).The single-lumen group experienced shorter catheterization durations(12.5±3.14 days vs 13.6±4.50 days,P=0.025)and higher successful infusion rates(92.7%±5.32%vs 90.4%±6.60%,P=0.003).This group also reported higher comfort scores(8.40±1.20 vs 7.90±1.50,P=0.004)and lower pain levels(2.90±0.70 vs 3.20±0.80,P=0.002).Aside from thrombosis,complication rates showed no significant difference between the groups.CONCLUSION Within bundled care context,single-lumen PICCs demonstrated advantages in reducing thrombosis risk,procedural efficiency,patient comfort,and satisfaction compared with double-lumen PICCs.The findings underscore the importance of considering patient-specific needs and clinical scenarios in catheter choice.展开更多
The switchable cross-coupling of indoles and pyridotriazoles through carbene insertion at C_(2)-or C_(3)-positon has been developed in this paper.This highly site-selective C-H carbenoid functionalization is determine...The switchable cross-coupling of indoles and pyridotriazoles through carbene insertion at C_(2)-or C_(3)-positon has been developed in this paper.This highly site-selective C-H carbenoid functionalization is determined by both the Rh-catalyst species and auxiliary groups.[Cp∗RhCl_(2)]_(2) and coordinating pyrimidyl group direct the C-H carbenoid functionalization to occur at the C_(2)-position,while Rh2OAc4 and noncoordinating benzyl group lead the reaction to occur at the C_(3)-position of the indoles.This regioselective C−H functionalization strategy is of significant importance for the discovery of indole drugs.展开更多
BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdr...BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdrawal durations based on different insertion times.METHODS We retrospectively analyzed 830 cases using logistic regression and identified four key factors,validated in a prospective cohort of 5699 patients.Their importance was confirmed using random forest(RF),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Attempts to determine targetachieving withdrawal time by grouping cases based on insertion time and Cox regression were inconclusive.Using the 5699-case dataset,we developed a predictive model combining support vector machine(SVM)with XGBoost.We built a Shiny app using this model for clinical application.RESULTS Multivariate logistic regression identified age[odds ratio(OR)=1.05;95%confidence interval(CI):1.03-1.08;P<0.001],male(OR=1.79;95%CI:1.32-2.41;P=0.005),higher endoscopist experience(OR=1.79;95%CI:1.20-2.68;P=0.005),and longer withdrawal time(P<0.001)as independent risk factors for colorectal adenoma.A nomogram demonstrated strong discrimination[area under the curve(AUC)=0.720],with robust calibration and decision-curve performance.Feature importance via RF,XGBoost,and LightGBM confirmed key predictors.A hybrid model combining SVM regression for withdrawal-time estimation and XGBoost classification achieved stable results,with XGBoost reporting AUCs of 0.640 in training and 0.610 in testing,and similar validation outcomes.Deployed via a Shiny app for clinical use.However,model discrimination was modest(AUC:0.61-0.64),suggesting that clinical utility requires further refinement.CONCLUSION A hybrid SVM-XGBoost model using four key endoscopic factors was independently validated and is available as a Shiny app,delivering real-time decision support to streamline endoscopy and enhance clinical outcomes.展开更多
Uronic acids are prevalent components of crucial glycoconjugates,pivotal in various biological processes.In nature,NDP-uronic acids,the nucleosides-activated uronic acids,serve as glycosylation donors catalyzed by uro...Uronic acids are prevalent components of crucial glycoconjugates,pivotal in various biological processes.In nature,NDP-uronic acids,the nucleosides-activated uronic acids,serve as glycosylation donors catalyzed by uronosyltransferases(UATs)to construct glycans containing uronic acids.Despite their biological importance,the synthesis of naturally occurring NDP-uronic acids on a large scale remains challenging.Here,we developed an oxidation reaction insertion strategy for the efficient synthesis of NDP-uronic acids,and 11 NDP-uronic acids were successfully prepared in good yield and on a large scale.The prepared NDP-uronic acids can be used to explore new uronosyltransferases and synthesize uronic acids containing carbohydrates for fundamental research.展开更多
Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC...Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC).Methods:For one ovarian cancer patient with PICC malposition in the coronary sinus(CS)due to PLSVC,multimodal imaging techniques were integrated to accurately locate the catheter tip.The catheter position was adjusted based on evidence(withdrawing 5 cm),and a standardized nursing process was established,including personalized health education,catheter fixation and displacement monitoring,complication monitoring,establishment of a specialized disease information archive system,and formulation of a follow-up plan.Results:The catheter tip was successfully withdrawn from the coronary sinus(at the T8 level)to the middle and lower part of the PLSVC(at the T6 vertebral level),and the catheter functioned normally after adjustment.No complications such as arrhythmia or thrombosis occurred during the 332-day chemotherapy period.Conclusion:The PICC tip in PLSVC patients should be positioned in the middle and lower part of the PLSVC(at the T5–T7 vertebral level).This new standard can effectively avoid CS-related complications.The integration of multi-modal imaging techniques and evidence-based nursing management are key to ensuring safe infusion.展开更多
There is nonradiative recombination in waveguide region owing to severe carrier leakage,which in turn reduces output power and wall-plug efficiency.In this paper,we designed a novel epitaxial structure,which suppresse...There is nonradiative recombination in waveguide region owing to severe carrier leakage,which in turn reduces output power and wall-plug efficiency.In this paper,we designed a novel epitaxial structure,which suppresses carrier leakage by inserting n-Ga_(0.55)In_(0.45)P and p-GaAs_(0.6)P_(0.4) between barriers and waveguide layers,respectively,to modulate the energy band structure and to increase the height of barrier.The results show that the leakage current density reduces by 87.71%,compared to traditional structure.The nonradiative recombination current density of novel structure reduces to 37.411 A/cm^(2),and the output power reaches 12.80 W with wall-plug efficiency of 78.24%at an injection current density 5 A/cm^(2) at room temperature.In addition,the temperature drift coefficient of center wavelength is 0.206 nm/℃at the temperature range from 5℃to 65℃,and the slope of fitted straight line of threshold current with temperature variation is 0.00113.The novel epitaxial structure provides a theoretical basis for achieving high-power laser diode.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are widely used for administering chemotherapy to breast cancer patients due to their long-term indwelling capability,versatility in drug administration,and fle...BACKGROUND Peripherally inserted central catheters(PICCs)are widely used for administering chemotherapy to breast cancer patients due to their long-term indwelling capability,versatility in drug administration,and flexibility.PICCs infection are a relatively common occurrence,yet there were no reported instances that it can metastasise to the lumbar spine.CASE SUMMARY This case report describes a breast cancer patient who developed a methicillinresistant Staphylococcus aureus lumbar vertebral infection secondary to a PICCrelated infection during chemotherapy.Following PICC removal,bacterial culture confirmed the presence of highly virulent methicillin-resistant Staphylococcus aureus.The patient presented with fever and severe lumbar pain.Lumbar magnetic resonance imaging revealed paraspinal muscle edema from L1 to L3 with abnormal signal intensity in the affected regions,suggestive of vertebral osteomyelitis.Prompt initiation of appropriate antibiotic therapy based on the culture results led to significant improvement in the patient’s lumbar pain.CONCLUSION This case highlights the importance of vigilant infection prevention and control measures to minimize the risk of PICC-related complications,such as bloodstream infections and subsequent metastatic infections.展开更多
Objective:Patients after radical gastrectomy often require medium-to long-term intravenous therapy.However,traditional central venous catheters(CVCs)have issues such as high infection risk and poor comfort.This study ...Objective:Patients after radical gastrectomy often require medium-to long-term intravenous therapy.However,traditional central venous catheters(CVCs)have issues such as high infection risk and poor comfort.This study aims to deeply explore the clinical application value of peripherally inserted central catheters(PICCs)after radical gastrectomy,providing a scientific basis for optimizing intravenous access selection.Methods:Fifty patients requiring catheterization after radical gastrectomy at the Friendship Hospital of Ili Kazak Autonomous Prefecture from December 2022 to May 2024 were selected.Catheterization site selection was based on patients’preferences,dividing them into two groups:the experimental group receiving PICCs and the control group receiving CVCs,with 25 patients in each group.Multi-dimensional comparative analysis was conducted,including catheterization operation time,catheter indwelling time,success rates of first and second catheterizations,and complication rates.Statistical methods such as t-tests and chi-square tests were used for in-depth analysis.Results:Compared to the control group,the experimental group had longer catheterization operations and catheter indwelling times,and a higher success rate of first catheterization(P<0.05).The incidence of catheterization complications in the experimental group was 12.00%,lower than the 40.00%in the control group(P<0.05).Conclusion:Although PICC catheterization after radical gastrectomy has relatively longer catheterization operation and indwelling times,it has a high success rate of first catheterization and a low complication rate,demonstrating high clinical application value and worth promoting in clinical practice.展开更多
BACKGROUND Ultrasound-guided peripherally inserted central catheter(PICC)placement is vital for cancer therapy,but lidocaine infiltration faces limitations like puncture pain and vasospasm.AIM To assess the clinical e...BACKGROUND Ultrasound-guided peripherally inserted central catheter(PICC)placement is vital for cancer therapy,but lidocaine infiltration faces limitations like puncture pain and vasospasm.AIM To assess the clinical efficacy of a no-pain intervention-combining compound lidocaine cream with warm compress-in reducing pain during ultrasound-guided PICC placement in cancer patients.METHODS A retrospective cohort study analyzed 88 cancer patients undergoing PICC placement(Shanghai Fourth People’s Hospital,2024).Patients were divided into control(lidocaine infiltration,n=44)and intervention(cream+warm compress,n=44)groups.Primary outcomes:Pain scores(numerical rating scale),procedural time,complications;secondary outcome:Satisfaction.RESULTS The intervention group showed significantly lower pain scores(1.2±0.4 vs 3.8±1.2,P=0.012)with comparable first-attempt success(95.5%vs 90.9%)and safety(P=0.672).Thermal activation of transient receptor potential vanilloid 1 channel enhanced drug penetration,achieving anesthesia within 8-10 minutes.Patient satisfaction reached 97.7%.CONCLUSION The combination of compound lidocaine cream with warm compress significantly alleviates procedural pain and enhances patient satisfaction during ultrasound-guided PICC placement in cancer patients,supporting its clinical application.展开更多
Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance tre...Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance treatment.Methods:Eighty-six patients with acute leukemia admitted to the First Affiliated Hospital of Baotou Medical College from July 2022 to March 2023 were randomly divided into the IIN group and the PICC group,with 43 patients in each group.Results:Significant differences were observed between the two groups in terms of the number of punctures and puncture time(P<0.05).Although the intubation cost was lower in the IIN group than in the PICC group,the maintenance treatment duration was shorter in the IIN group(P<0.05).There were no significant differences between the two groups in terms of disease symptoms,treatment-related toxicity,and side effects(P>0.05).However,anxiety,treatment compliance,and patient satisfaction were significantly lower in IIN group compared to the PICC group(P<0.05).Additionally,the incidence of vein-related complications in the IIN group was higher than in the PICC group(P<0.05).Conclusion:Compared with intravenous indwelling needles,PICCs demonstrate superior application outcomes.Although the cost of PICC placement is relatively high,its ability to prolong maintenance treatment,alleviate patient anxiety,reduce vein-related complications,and improve treatment compliance makes it a valuable method worth promoting.展开更多
BACKGROUND Peripherally inserted central catheter(PICC)is the preferred intravenous route for chemotherapy in patients with cancer,but its complications,especially deep vein thrombosis(DVT),are becoming increasingly p...BACKGROUND Peripherally inserted central catheter(PICC)is the preferred intravenous route for chemotherapy in patients with cancer,but its complications,especially deep vein thrombosis(DVT),are becoming increasingly prevalent.Medical staff proficient in intubation and maintenance techniques can reduce complications.The multivariate integration teaching model applies the integration of“teaching learning application”to medical training,which helps shift the prevention of complications from“passive management of complications”to“active construction of risk immunity”,thereby ensuring foundational competency for PICC in patients with cancer.AIM To investigate the efficacy of the multivariate integration teaching model in patients with gastric cancer and concurrent DVT after PICC intubation and analyze its effect on patients’quality of life index(QLI)and satisfaction.METHODS A retrospective analysis of medical records of 100 patients with gastric cancer and PICC treated at Zhejiang Provincial People’s Hospital from May 2019 to November 2020 was conducted.According to the different treatment methods and teaching modes received by medical staff,they were divided into a control group and an experimental group,with 50 cases in each group.The routine clinical teaching model and the multivariate integration teaching model were administered to the medical staff for the control group and the experimental group,respectively,to compare the incidence rates of DVT and other adverse reactions,QLI scores,Karnofsky Performance Scale scores,Mental Status Scale in Non-Psychiatric Settings scores,patient satisfaction,medical staff’s test marks,and satisfaction evaluation of the teaching model.RESULTS Compared with the control group,the experimental group exhibited significantly lower incidence rates of DVT and other adverse reactions and MSSNS scores but significantly higher QLI scores,KPS scores,patient satisfaction,medical staff’s test marks,and their satisfaction evaluations of the teaching model(P<0.05).CONCLUSION In a single-center practice,performing the multivariate integration teaching model for medical staff may effectively improve the patients’QLI and satisfaction and may have certain application value in preventing DVT in patients with gastric cancer and PICC.展开更多
BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intr...BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intraoperative strategies.AIM To evaluate the predictive performance of machine learning(ML)algorithms for DCI by comparing three modeling approaches,identify factors influencing DCI,and develop a preoperative prediction model using ML algorithms to enhance colonoscopy quality and efficiency.METHODS This cross-sectional study enrolled 712 patients who underwent colonoscopy at a tertiary hospital between June 2020 and May 2021.Demographic data,past medical history,medication use,and psychological status were collected.The endoscopist assessed DCI using the visual analogue scale.After univariate screening,predictive models were developed using multivariable logistic regression,least absolute shrinkage and selection operator(LASSO)regression,and random forest(RF)algorithms.Model performance was evaluated based on discrimination,calibration,and decision curve analysis(DCA),and results were visualized using nomograms.RESULTS A total of 712 patients(53.8%male;mean age 54.5 years±12.9 years)were included.Logistic regression analysis identified constipation[odds ratio(OR)=2.254,95%confidence interval(CI):1.289-3.931],abdominal circumference(AC)(77.5–91.9 cm,OR=1.895,95%CI:1.065-3.350;AC≥92 cm,OR=1.271,95%CI:0.730-2.188),and anxiety(OR=1.071,95%CI:1.044-1.100)as predictive factors for DCI,validated by LASSO and RF methods.Model performance revealed training/validation sensitivities of 0.826/0.925,0.924/0.868,and 1.000/0.981;specificities of 0.602/0.511,0.510/0.562,and 0.977/0.526;and corresponding area under the receiver operating characteristic curves(AUCs)of 0.780(0.737-0.823)/0.726(0.654-0.799),0.754(0.710-0.798)/0.723(0.656-0.791),and 1.000(1.000-1.000)/0.754(0.688-0.820),respectively.DCA indicated optimal net benefit within probability thresholds of 0-0.9 and 0.05-0.37.The RF model demonstrated superior diagnostic accuracy,reflected by perfect training sensitivity(1.000)and highest validation AUC(0.754),outperforming other methods in clinical applicability.CONCLUSION The RF-based model exhibited superior predictive accuracy for DCI compared to multivariable logistic and LASSO regression models.This approach supports individualized preoperative optimization,enhancing colonoscopy quality through targeted risk stratification.展开更多
基金supported by National Natural Science Foundation of China(No.61801327).
文摘Differential pulse-position modulation(DP PM)can achieve a good compromise between power and bandwidth requirements.However,the output sequence has undetectable insertions and deletions.This paper proposes a successive cancellation(SC)decoding scheme based on the weighted levenshtein distance(WLD)of polar codes for correcting insertions/deletions in DPPM systems.In this method,the WLD is used to calculate the transfer probabilities recursively to obtain likelihood ratios,and the low-complexity SC decoding method is built according to the error characteristics to match the DPPM system.Additionally,the proposed SC decoding scheme is extended to list decoding,which can further improve error correction performance.Simulation results show that the proposed scheme can effectively correct insertions/deletions in the DPPM system,which enhances its reliability and performance.
文摘BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.
文摘An efficient TfOH-catalyzed O—H insertion reaction of α-aryl diazoesters with carboxylic acids is reported.This metal-free protocol provides an operationally simple method for a one-pot assembly of diverse α-acyloxy esters in moderate to high yields with a broad substrate scope.All starting materials are readily available,and the reactions can be conducted in the open air at room temperature.
文摘A blue light-induced formal insertion reaction ofα-siloxy carbene into the C—H bond of 1,3-diketones has been reported.Under the irradiation of blue light,acylsilane converts toα-siloxy carbene,which then undergoes formal C—H bond insertion reaction with the enol form of 1,3-diketone.This method uses readily available and relative stable acylsilane as car-bene precursor,which features a simple and metal-free approach under mild conditions.Moreover,the synthetic potential of this protocol has been demonstrated by performing the reaction on a gram scale with comparable high yield.
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are crucial for patients requiring long-term intravenous therapy,especially within digestive surgery under bundled care protocols.AIM To evaluate and compare the efficacy,safety,and patient-reported outcomes of single-lumen vs double-lumen PICCs among patients undergoing digestive surgery within a structured bundled care framework.METHODS This retrospective cohort study analyzed data from 249 patients who underwent digestive surgery and utilized either single-lumen(n=117)or double-lumen(n=132)PICCs between January 2021 and June 2024.Clinical outcomes,patient satisfaction,catheterization duration,and complication rates were compared using statistical analysis via SPSS(version 29.0).The bundled care protocol was consistently applied,focusing on standardized procedures,staff training,and patient support.RESULTS Single-lumen PICCs were associated with a significantly lower thrombosis rate(0.85%)than double-lumen PICCs(6.82%,P=0.039).The single-lumen group experienced shorter catheterization durations(12.5±3.14 days vs 13.6±4.50 days,P=0.025)and higher successful infusion rates(92.7%±5.32%vs 90.4%±6.60%,P=0.003).This group also reported higher comfort scores(8.40±1.20 vs 7.90±1.50,P=0.004)and lower pain levels(2.90±0.70 vs 3.20±0.80,P=0.002).Aside from thrombosis,complication rates showed no significant difference between the groups.CONCLUSION Within bundled care context,single-lumen PICCs demonstrated advantages in reducing thrombosis risk,procedural efficiency,patient comfort,and satisfaction compared with double-lumen PICCs.The findings underscore the importance of considering patient-specific needs and clinical scenarios in catheter choice.
基金CAMS Innovation Fund for Medical Sciences(CIFMS)(Nos.2022-I2M-1-013,2022-I2M-1-014,2022-I2M-2-002).
文摘The switchable cross-coupling of indoles and pyridotriazoles through carbene insertion at C_(2)-or C_(3)-positon has been developed in this paper.This highly site-selective C-H carbenoid functionalization is determined by both the Rh-catalyst species and auxiliary groups.[Cp∗RhCl_(2)]_(2) and coordinating pyrimidyl group direct the C-H carbenoid functionalization to occur at the C_(2)-position,while Rh2OAc4 and noncoordinating benzyl group lead the reaction to occur at the C_(3)-position of the indoles.This regioselective C−H functionalization strategy is of significant importance for the discovery of indole drugs.
基金Supported by the Young and Middle-Aged Talents Program of Wuxi Health Commission,No.BJ2020011Cohort Research Program of Wuxi Medical Center,Nanjing Medical University,No.WMCC202314Wuxi People’s Hospital 2024“Wild Goose Array Talent”Reserve Discipline Leader,No.2024-YZ-HBDTR-YC-2024.
文摘BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdrawal durations based on different insertion times.METHODS We retrospectively analyzed 830 cases using logistic regression and identified four key factors,validated in a prospective cohort of 5699 patients.Their importance was confirmed using random forest(RF),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Attempts to determine targetachieving withdrawal time by grouping cases based on insertion time and Cox regression were inconclusive.Using the 5699-case dataset,we developed a predictive model combining support vector machine(SVM)with XGBoost.We built a Shiny app using this model for clinical application.RESULTS Multivariate logistic regression identified age[odds ratio(OR)=1.05;95%confidence interval(CI):1.03-1.08;P<0.001],male(OR=1.79;95%CI:1.32-2.41;P=0.005),higher endoscopist experience(OR=1.79;95%CI:1.20-2.68;P=0.005),and longer withdrawal time(P<0.001)as independent risk factors for colorectal adenoma.A nomogram demonstrated strong discrimination[area under the curve(AUC)=0.720],with robust calibration and decision-curve performance.Feature importance via RF,XGBoost,and LightGBM confirmed key predictors.A hybrid model combining SVM regression for withdrawal-time estimation and XGBoost classification achieved stable results,with XGBoost reporting AUCs of 0.640 in training and 0.610 in testing,and similar validation outcomes.Deployed via a Shiny app for clinical use.However,model discrimination was modest(AUC:0.61-0.64),suggesting that clinical utility requires further refinement.CONCLUSION A hybrid SVM-XGBoost model using four key endoscopic factors was independently validated and is available as a Shiny app,delivering real-time decision support to streamline endoscopy and enhance clinical outcomes.
基金financially supported by National Natural Science Foundation of China(No.22207113 to J.Zhang)Guangdong Basic and Applied Basic Research Foundation(No.2021A1515110588to J.Zhang)Natural Science Foundation of Shanghai Municipality(No.22ZR1474000 to L.Wen)。
文摘Uronic acids are prevalent components of crucial glycoconjugates,pivotal in various biological processes.In nature,NDP-uronic acids,the nucleosides-activated uronic acids,serve as glycosylation donors catalyzed by uronosyltransferases(UATs)to construct glycans containing uronic acids.Despite their biological importance,the synthesis of naturally occurring NDP-uronic acids on a large scale remains challenging.Here,we developed an oxidation reaction insertion strategy for the efficient synthesis of NDP-uronic acids,and 11 NDP-uronic acids were successfully prepared in good yield and on a large scale.The prepared NDP-uronic acids can be used to explore new uronosyltransferases and synthesize uronic acids containing carbohydrates for fundamental research.
文摘Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC).Methods:For one ovarian cancer patient with PICC malposition in the coronary sinus(CS)due to PLSVC,multimodal imaging techniques were integrated to accurately locate the catheter tip.The catheter position was adjusted based on evidence(withdrawing 5 cm),and a standardized nursing process was established,including personalized health education,catheter fixation and displacement monitoring,complication monitoring,establishment of a specialized disease information archive system,and formulation of a follow-up plan.Results:The catheter tip was successfully withdrawn from the coronary sinus(at the T8 level)to the middle and lower part of the PLSVC(at the T6 vertebral level),and the catheter functioned normally after adjustment.No complications such as arrhythmia or thrombosis occurred during the 332-day chemotherapy period.Conclusion:The PICC tip in PLSVC patients should be positioned in the middle and lower part of the PLSVC(at the T5–T7 vertebral level).This new standard can effectively avoid CS-related complications.The integration of multi-modal imaging techniques and evidence-based nursing management are key to ensuring safe infusion.
文摘There is nonradiative recombination in waveguide region owing to severe carrier leakage,which in turn reduces output power and wall-plug efficiency.In this paper,we designed a novel epitaxial structure,which suppresses carrier leakage by inserting n-Ga_(0.55)In_(0.45)P and p-GaAs_(0.6)P_(0.4) between barriers and waveguide layers,respectively,to modulate the energy band structure and to increase the height of barrier.The results show that the leakage current density reduces by 87.71%,compared to traditional structure.The nonradiative recombination current density of novel structure reduces to 37.411 A/cm^(2),and the output power reaches 12.80 W with wall-plug efficiency of 78.24%at an injection current density 5 A/cm^(2) at room temperature.In addition,the temperature drift coefficient of center wavelength is 0.206 nm/℃at the temperature range from 5℃to 65℃,and the slope of fitted straight line of threshold current with temperature variation is 0.00113.The novel epitaxial structure provides a theoretical basis for achieving high-power laser diode.
基金Supported by the Shandong Province Medical and Health Technology Development Plan,No.202204011069.
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are widely used for administering chemotherapy to breast cancer patients due to their long-term indwelling capability,versatility in drug administration,and flexibility.PICCs infection are a relatively common occurrence,yet there were no reported instances that it can metastasise to the lumbar spine.CASE SUMMARY This case report describes a breast cancer patient who developed a methicillinresistant Staphylococcus aureus lumbar vertebral infection secondary to a PICCrelated infection during chemotherapy.Following PICC removal,bacterial culture confirmed the presence of highly virulent methicillin-resistant Staphylococcus aureus.The patient presented with fever and severe lumbar pain.Lumbar magnetic resonance imaging revealed paraspinal muscle edema from L1 to L3 with abnormal signal intensity in the affected regions,suggestive of vertebral osteomyelitis.Prompt initiation of appropriate antibiotic therapy based on the culture results led to significant improvement in the patient’s lumbar pain.CONCLUSION This case highlights the importance of vigilant infection prevention and control measures to minimize the risk of PICC-related complications,such as bloodstream infections and subsequent metastatic infections.
基金The Ili Kazakh Autonomous Prefecture Science and Technology Plan Project(Project No.:YJC2023A28)。
文摘Objective:Patients after radical gastrectomy often require medium-to long-term intravenous therapy.However,traditional central venous catheters(CVCs)have issues such as high infection risk and poor comfort.This study aims to deeply explore the clinical application value of peripherally inserted central catheters(PICCs)after radical gastrectomy,providing a scientific basis for optimizing intravenous access selection.Methods:Fifty patients requiring catheterization after radical gastrectomy at the Friendship Hospital of Ili Kazak Autonomous Prefecture from December 2022 to May 2024 were selected.Catheterization site selection was based on patients’preferences,dividing them into two groups:the experimental group receiving PICCs and the control group receiving CVCs,with 25 patients in each group.Multi-dimensional comparative analysis was conducted,including catheterization operation time,catheter indwelling time,success rates of first and second catheterizations,and complication rates.Statistical methods such as t-tests and chi-square tests were used for in-depth analysis.Results:Compared to the control group,the experimental group had longer catheterization operations and catheter indwelling times,and a higher success rate of first catheterization(P<0.05).The incidence of catheterization complications in the experimental group was 12.00%,lower than the 40.00%in the control group(P<0.05).Conclusion:Although PICC catheterization after radical gastrectomy has relatively longer catheterization operation and indwelling times,it has a high success rate of first catheterization and a low complication rate,demonstrating high clinical application value and worth promoting in clinical practice.
基金Supported by the Discipline Promotion Program of Shanghai Fourth People’s Hospital,No.SY-XKZT-2021-2006.
文摘BACKGROUND Ultrasound-guided peripherally inserted central catheter(PICC)placement is vital for cancer therapy,but lidocaine infiltration faces limitations like puncture pain and vasospasm.AIM To assess the clinical efficacy of a no-pain intervention-combining compound lidocaine cream with warm compress-in reducing pain during ultrasound-guided PICC placement in cancer patients.METHODS A retrospective cohort study analyzed 88 cancer patients undergoing PICC placement(Shanghai Fourth People’s Hospital,2024).Patients were divided into control(lidocaine infiltration,n=44)and intervention(cream+warm compress,n=44)groups.Primary outcomes:Pain scores(numerical rating scale),procedural time,complications;secondary outcome:Satisfaction.RESULTS The intervention group showed significantly lower pain scores(1.2±0.4 vs 3.8±1.2,P=0.012)with comparable first-attempt success(95.5%vs 90.9%)and safety(P=0.672).Thermal activation of transient receptor potential vanilloid 1 channel enhanced drug penetration,achieving anesthesia within 8-10 minutes.Patient satisfaction reached 97.7%.CONCLUSION The combination of compound lidocaine cream with warm compress significantly alleviates procedural pain and enhances patient satisfaction during ultrasound-guided PICC placement in cancer patients,supporting its clinical application.
基金supported by the Medical and Health Science and Technology Plan Project of Health and Health Commission of Inner Mongolia Autonomous Region(202201427).
文摘Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance treatment.Methods:Eighty-six patients with acute leukemia admitted to the First Affiliated Hospital of Baotou Medical College from July 2022 to March 2023 were randomly divided into the IIN group and the PICC group,with 43 patients in each group.Results:Significant differences were observed between the two groups in terms of the number of punctures and puncture time(P<0.05).Although the intubation cost was lower in the IIN group than in the PICC group,the maintenance treatment duration was shorter in the IIN group(P<0.05).There were no significant differences between the two groups in terms of disease symptoms,treatment-related toxicity,and side effects(P>0.05).However,anxiety,treatment compliance,and patient satisfaction were significantly lower in IIN group compared to the PICC group(P<0.05).Additionally,the incidence of vein-related complications in the IIN group was higher than in the PICC group(P<0.05).Conclusion:Compared with intravenous indwelling needles,PICCs demonstrate superior application outcomes.Although the cost of PICC placement is relatively high,its ability to prolong maintenance treatment,alleviate patient anxiety,reduce vein-related complications,and improve treatment compliance makes it a valuable method worth promoting.
文摘BACKGROUND Peripherally inserted central catheter(PICC)is the preferred intravenous route for chemotherapy in patients with cancer,but its complications,especially deep vein thrombosis(DVT),are becoming increasingly prevalent.Medical staff proficient in intubation and maintenance techniques can reduce complications.The multivariate integration teaching model applies the integration of“teaching learning application”to medical training,which helps shift the prevention of complications from“passive management of complications”to“active construction of risk immunity”,thereby ensuring foundational competency for PICC in patients with cancer.AIM To investigate the efficacy of the multivariate integration teaching model in patients with gastric cancer and concurrent DVT after PICC intubation and analyze its effect on patients’quality of life index(QLI)and satisfaction.METHODS A retrospective analysis of medical records of 100 patients with gastric cancer and PICC treated at Zhejiang Provincial People’s Hospital from May 2019 to November 2020 was conducted.According to the different treatment methods and teaching modes received by medical staff,they were divided into a control group and an experimental group,with 50 cases in each group.The routine clinical teaching model and the multivariate integration teaching model were administered to the medical staff for the control group and the experimental group,respectively,to compare the incidence rates of DVT and other adverse reactions,QLI scores,Karnofsky Performance Scale scores,Mental Status Scale in Non-Psychiatric Settings scores,patient satisfaction,medical staff’s test marks,and satisfaction evaluation of the teaching model.RESULTS Compared with the control group,the experimental group exhibited significantly lower incidence rates of DVT and other adverse reactions and MSSNS scores but significantly higher QLI scores,KPS scores,patient satisfaction,medical staff’s test marks,and their satisfaction evaluations of the teaching model(P<0.05).CONCLUSION In a single-center practice,performing the multivariate integration teaching model for medical staff may effectively improve the patients’QLI and satisfaction and may have certain application value in preventing DVT in patients with gastric cancer and PICC.
基金the Chinese Clinical Trial Registry(No.ChiCTR2000040109)approved by the Hospital Ethics Committee(No.20210130017).
文摘BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intraoperative strategies.AIM To evaluate the predictive performance of machine learning(ML)algorithms for DCI by comparing three modeling approaches,identify factors influencing DCI,and develop a preoperative prediction model using ML algorithms to enhance colonoscopy quality and efficiency.METHODS This cross-sectional study enrolled 712 patients who underwent colonoscopy at a tertiary hospital between June 2020 and May 2021.Demographic data,past medical history,medication use,and psychological status were collected.The endoscopist assessed DCI using the visual analogue scale.After univariate screening,predictive models were developed using multivariable logistic regression,least absolute shrinkage and selection operator(LASSO)regression,and random forest(RF)algorithms.Model performance was evaluated based on discrimination,calibration,and decision curve analysis(DCA),and results were visualized using nomograms.RESULTS A total of 712 patients(53.8%male;mean age 54.5 years±12.9 years)were included.Logistic regression analysis identified constipation[odds ratio(OR)=2.254,95%confidence interval(CI):1.289-3.931],abdominal circumference(AC)(77.5–91.9 cm,OR=1.895,95%CI:1.065-3.350;AC≥92 cm,OR=1.271,95%CI:0.730-2.188),and anxiety(OR=1.071,95%CI:1.044-1.100)as predictive factors for DCI,validated by LASSO and RF methods.Model performance revealed training/validation sensitivities of 0.826/0.925,0.924/0.868,and 1.000/0.981;specificities of 0.602/0.511,0.510/0.562,and 0.977/0.526;and corresponding area under the receiver operating characteristic curves(AUCs)of 0.780(0.737-0.823)/0.726(0.654-0.799),0.754(0.710-0.798)/0.723(0.656-0.791),and 1.000(1.000-1.000)/0.754(0.688-0.820),respectively.DCA indicated optimal net benefit within probability thresholds of 0-0.9 and 0.05-0.37.The RF model demonstrated superior diagnostic accuracy,reflected by perfect training sensitivity(1.000)and highest validation AUC(0.754),outperforming other methods in clinical applicability.CONCLUSION The RF-based model exhibited superior predictive accuracy for DCI compared to multivariable logistic and LASSO regression models.This approach supports individualized preoperative optimization,enhancing colonoscopy quality through targeted risk stratification.
