Aqueous aluminum ion batteries(AAIBs)have garnered extensive attention due to their environmental friendliness,high theoretical capacity,and low cost.However,the sluggish reaction kinetics and severe structural collap...Aqueous aluminum ion batteries(AAIBs)have garnered extensive attention due to their environmental friendliness,high theoretical capacity,and low cost.However,the sluggish reaction kinetics and severe structural collapse of the cathode material,especially manganese oxide,during the cycling process have hindered its further application.Herein,Cu^(2+)pre-interca la ted layeredδ-MnO_(2)was synthesized via a hydrothermal method.The pre-intercalated Cu^(2+)ions not only improve the conductivity of MnO_(2)cathode but also stabilize the structure to enhance stability.X-ray absorption fine structure(XAFS)combined with density functional theory(DFT)calculations confirm the formation of the covalent bond between Cu and O,increasing the electronegativity of O atoms and enhancing the H^(+)adsorption energy.Moreover,ex-situ measurements not only elucidate the Al^(3+)/H^(+)co-insertion energy storage mechanism but also demonstrate the high reversibility of the Cu-MnO_(2)cathode during cycling.This work provides a promising modification approach for the application of manganese oxides in AAIBs.展开更多
[Objective]To construct an Escherichia coli mutant strain that accumulates pyruvate by genetic modification guided by the genome-scale metabolic network model.[Methods]Using a genome-scale metabolic network model as a...[Objective]To construct an Escherichia coli mutant strain that accumulates pyruvate by genetic modification guided by the genome-scale metabolic network model.[Methods]Using a genome-scale metabolic network model as a guide,we simulated pyruvate production of E.coli,screened key genes in metabolic pathways,and developed gene editing procedures accordingly.We knocked out the acetate kinase gene ackA,phosphate acetyltransferase gene pta,alcohol dehydrogenase adhE,glycogen synthase gene glgA,glycogen phosphorylase gene glgP,phosphoribosyl pyrophosphate(PRPP)synthase gene prs,ribose 1,5-bisphosphate phosphokinase gene phnN,and transporter encoding gene proP.Furthermore,we knocked in the transporter encoding gene ompC,flavonoid toxin gene fldA,and D-serine ammonia lyase gene dsdA.[Results]A shake flask process with the genetically edited mutant strain MG1655-6-2 under anaerobic conditions produced pyruvate at a titer of 10.46 g/L and a yield of 0.69 g/g.Metabolomic analysis revealed a significant increase in the pyruvate level in the fermentation broth,accompanied by notable decreases in the levels of certain related metabolic byproducts.Through 5 L fed-batch fermentation and an adaptive laboratory evolution,the strain finally achieved a pyruvate titer of 45.86 g/L.[Conclusion]This study illustrated the efficacy of a gene editing strategy predicted by a genome-scale metabolic network model in enhancing pyruvate accumulation in E.coli under anaerobic conditions and provided novel insights for microbial metabolic engineering.展开更多
BACKGROUND Primary biliary cholangitis(PBC)is a chronic autoimmune-mediated cholestatic liver disease.Nanoparticles encapsulating rapamycin(ImmTOR)suppress adaptive immune responses and induce the hepatic tolerogenic ...BACKGROUND Primary biliary cholangitis(PBC)is a chronic autoimmune-mediated cholestatic liver disease.Nanoparticles encapsulating rapamycin(ImmTOR)suppress adaptive immune responses and induce the hepatic tolerogenic immune response.AIM To investigate the effects of ImmTOR in PBC mouse models.METHODS PBC models were induced in C57BL/6 mice by two immunizations of 2-octynoic acid-coupled bovine serum albumin at two-week intervals,and polycytidylic acid every three days.The PBC mouse models were separated into the treatment group and the control group.The levels of alkaline phosphatase(ALP)and alanine aminotransferase in the mice were detected using an automatic biochemical analyzer.Liver and spleen mononuclear cells were analyzed by flow cytometry,and serum anti-mitochondrial antibodies(AMA)and the related cytokines were analyzed by enzyme-linked immunosorbent assay.Liver histopathology was examined by hematoxylin and eosin staining and scored.RESULTS After treatment with ImmTOR,the ALP level was significantly decreased(189.60 U/L±27.25 U/L vs 156.00 U/L±17.21 U/L,P<0.05),the level of AMA was reduced(1.28 ng/mL±0.27 ng/mL vs 0.56 ng/mL±0.07 ng/mL,P<0.001)and the expression levels of interferon gamma and tumor necrosis factorαwere significantly decreased(48.29 pg/mL±10.84 pg/mL vs 25.01 pg/mL±1.49 pg/mL,P<0.0001)and(84.24 pg/mL±23.47 pg/mL vs 40.66 pg/mL±14.65 pg/mL,P<0.001).The CD4+T lymphocytes,CD8+T lymphocytes and B lymphocytes in the liver were significantly reduced,with statistically significant differences(24.21%±6.55%vs 15.98%±3.03%,P<0.05;9.09%±1.91%vs 5.49%±1.00%,P<0.001;80.51%±2.96%vs 75.31%±4.34%,P<0.05).The expression of CD8+T lymphocytes and B lymphocytes in the ImmTOR treatment group also decreased(9.09%±1.91%vs 5.49%±1.00%,P<0.001;80.51%±2.96%vs 75.31%±4.34%,P<0.05).The liver pathology of PBC mice in the treatment group showed reduced inflammation and a decreased total pathology score,and the difference in the scores was statistically significant(4.50±2.88 vs 1.75±1.28,P<0.05).CONCLUSION ImmTOR can improve biochemistry and pathology of liver obvious by inhibiting the expression of CD8+T cells and B cells,and reducing the titer of AMA.展开更多
The preparation of immobilized enzyme with excellent performance is one of the difficulties that restrict the application of enzyme catalysis technology.Here,Candida rugosa lipase(CRL)was firstly adsorbed on the surfa...The preparation of immobilized enzyme with excellent performance is one of the difficulties that restrict the application of enzyme catalysis technology.Here,Candida rugosa lipase(CRL)was firstly adsorbed on the surface of magnetic zeolitic imidazolate framework-8(ZIF-8)nanospheres,which was further encapsulated with a mesoporous SiO_(2)nano-membrane formed by tetraethyl orthosilicate(TEOS)polycondensation.Consequently,lipase could be firmly immobilized on carrier surface by physical binding rather than chemical binding,which did not damage the active conformation of enzyme.There were mesopores on the silica nano-membrane,which could improve the accessibility of enzyme and its apparent catalytic activity.Moreover,silica membrane encapsulation could also improve the stability of enzyme,suggesting an effective enzyme immobilization strategy.It showed that TEOS amount and the encapsulation time had significant effects on the thickness of silica membrane and the enzyme activity.The analysis in enzyme activity and protein secondary structure showed that lipase encapsulated in silica membrane retained the active conformation to the greatest extent.Compared with the adsorbed lipase,the encapsulated lipase increased its thermostability by 3 times and resistance to chemical denaturants by 7 times.The relative enzyme activity remained around 80%after 8 repetitions,while the adsorbed lipase only remained at7.3%.展开更多
Utilizing data from 5,481 village-level service stations(VS)in Baoding,China,this study empirically investigates the impact of digital inclusive finance(DIF)and VS infrastructure on rural e-commerce(RE)development.Res...Utilizing data from 5,481 village-level service stations(VS)in Baoding,China,this study empirically investigates the impact of digital inclusive finance(DIF)and VS infrastructure on rural e-commerce(RE)development.Results demonstrate that DIF significantly promotes RE by reducing transaction and financing costs(β=0.783,P<0.01).VS as physical infrastructure significantly drives RE growth(β=0.654,P<0.01).Crucially,DIF and VS exhibit synergistic effects(interactionβ=0.421,P<0.01),producing a“1+1>2”enhancement.Regional economic development,population density,and education levels positively influence RE.Current challenges include financial misallocation,infrastructure deficits,and skill gaps.We propose a“One Core,Three Wings”framework—Core:Develop tailored financial products for specialty industries(luggage,textiles,mushrooms);Wings:(1)Upgrade digital infrastructure,(2)Optimize policy synergy,(3)Enhance inclusive capacity through elderly-friendly technologies and training.Implementation strategies include establishing risk-sharing mechanisms,expanding VS functionality,and creating DIF-RE-VS alliances to foster sustainable rural revitalization.展开更多
Objective:To explore the effect of comprehensive nursing on relieving psychological pressure in patients with pulmonary micro-nodules.Methods:One hundred and twenty patients with pulmonary micro-nodules who received d...Objective:To explore the effect of comprehensive nursing on relieving psychological pressure in patients with pulmonary micro-nodules.Methods:One hundred and twenty patients with pulmonary micro-nodules who received diagnosis and treatment in our hospital from January 2024 to December 2024 were randomly divided into control and observation groups.The control group received routine nursing,while the observation group received comprehensive nursing.The Self-Rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were used to evaluate the patients’psychological states before and after nursing.Patient satisfaction with nursing was analyzed using a nursing satisfaction survey scale.Results:After nursing,the SAS and SDS scores of the observation group were significantly lower than those of the control group(P<0.05).The nursing satisfaction rates of the observation and control groups were 98.33%and 83.33%,respectively,with statistically significant differences(P<0.05).Conclusion:Comprehensive nursing intervention for patients with pulmonary micro-nodules can effectively relieve their psychological pressure and improve nursing satisfaction,demonstrating clinical value.展开更多
BACKGROUND The efficacy of laparoscopic surgery for the treatment of T3-T4a colon cancer remains a subject of debate in the medical community.AIM To explore the surgical techniques,perioperative outcomes,follow-up res...BACKGROUND The efficacy of laparoscopic surgery for the treatment of T3-T4a colon cancer remains a subject of debate in the medical community.AIM To explore the surgical techniques,perioperative outcomes,follow-up results,patient prognosis,and survival status associated with laparoscopic surgery for T3-T4a colon cancer.METHODS A total of 202 patients with T3-T4a colon cancer treated at the Affiliated Hospital of Hebei University between January 2020 and December 2024 were selected for this study and divided into two groups based on the type of surgery:Open surgery group(101 cases)and laparoscopic surgery group(LAP group,101 cases).Perioperative indicators(surgical time,postoperative drainage,first flatus,hospital stay,intraoperative blood loss,and number of lymph nodes removed),disease-free survival,and overall survival at 1-year and 3-year follow-ups,as well as the incidence of complications,were compared between the two groups.RESULTS The LAP group had longer surgical times and a greater number of lymph nodes removed compared to the open surgery group(P<0.05).The LAP group also had less blood loss,shorter drainage time,faster time to flatus,and a lower incidence of complications compared to the open surgery group(P<0.05).There was no significant difference in hospital stay,disease-free survival,or overall survival between the two groups during the follow-up period,and this remained true even after adjusting for subgroups based on left-sided colon,right-sided colon,and T4a stage(P>0.05).CONCLUSION The long-term outcomes of laparoscopic radical surgery for T3-T4a colon cancer are comparable to those of open surgery and can accelerate patient recovery and reduce the risk of short-term complications,offering better immediate outcomes.展开更多
As the cornerstone of sterile instrument maintenance in endoscopy centers,the quality of endoscope cleaning directly impacts hospital infection control effectiveness.The traceability system for endoscopy centers utili...As the cornerstone of sterile instrument maintenance in endoscopy centers,the quality of endoscope cleaning directly impacts hospital infection control effectiveness.The traceability system for endoscopy centers utilizes digital means to document the entire cleaning process,enabling real-time monitoring and precise quality control.This paper analyzes current quality control practices in endoscope cleaning and addresses existing challenges.It explores how traceability systems standardize procedures,enhance monitoring,and improve management efficiency.The study proposes optimization strategies for traceability system implementation,clarifying its core value in endoscope cleaning quality control.These findings provide theoretical foundations and practical guidance for hospitals to refine management of endoscopy centers,ensure diagnostic safety,and reduce infection risks,ultimately advancing endoscope cleaning quality control toward standardized and informatized development.展开更多
As the core department in medical institutions responsible for cleaning,disinfecting,sterilizing,and supplying reusable medical devices,instruments,and items,the quality of work in the disinfection supply center direc...As the core department in medical institutions responsible for cleaning,disinfecting,sterilizing,and supplying reusable medical devices,instruments,and items,the quality of work in the disinfection supply center directly impacts medical safety and infection control effectiveness.Professional protective training for personnel is crucial to ensure operational quality in this department.Systematic training enhances staff awareness of occupational exposure risks,standardizes protective measures in procedures,reduces cross-infection risks caused by improper operations,and ultimately lowers infection transmission risks.This paper analyzes the core content,implementation approaches,and practical role of professional protective training for disinfection supply center personnel in infection control.It aims to clarify the significant value of such training,providing references for medical institutions to optimize disinfection center management and strengthen infection control systems,thereby contributing to improved overall medical safety standards.展开更多
Manganese dioxide is widely used as a cathode material in aqueous zinc-ion batteries,and the cathode material is a key factor limiting the performance of these batteries.In this study,β-manganese dioxide was used as ...Manganese dioxide is widely used as a cathode material in aqueous zinc-ion batteries,and the cathode material is a key factor limiting the performance of these batteries.In this study,β-manganese dioxide was used as the base material to synthesize two hybrid materials,i.e.manganese dioxide-3D graphene carbon nanotube hybrids(MnO_(2)@3D-GPE/CNT)and manganese dioxide-3D-graphene hybrids(MnO_(2)@3D-GPE),via intermittent highenergy vibration ball milling.Electrochemical tests revealed that the CNT-containing hybrid materials exhibited a higher specific capacity of 480 mAh g^(-1)and superior cycling stability,maintaining over 80%of its initial capacity after 1000 cycles at 500 mA g^(-1)with a Coulombic efficiency close to 100%.MnO_(2)@3D-GPE/CNT had a smaller particle size distribution and a larger specific surface area than MnO_(2)@3D-GPE,explaining its enhanced electrochemical performance.Additionally,MnO_(2)@3D-GPE/CNT exhibited lower electrode impedance,further supporting its efficacy as a cathode material.展开更多
Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a seri...Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a serious threat to the life and health of newborns.This paper systematically reviews the core pathogenesis of HMD,focusing on the abnormal metabolism of pulmonary surfactant(PS),genetic factors,immature lung development,and the synergistic effects of inflammatory oxidative stress.It highlights the advances in non-invasive ventilation(NIV)therapy for HMD,including the mechanisms of action,clinical application effects,and optimization strategies of mainstream modalities such as nasal continuous positive airway pressure ventilation(NCPAP),nasal intermittent positive pressure ventilation(NIPPV),and heated humidified high-flow nasal cannula ventilation(HHHFNC).The aim is to provide references for standardized clinical treatment.展开更多
Objective:This study investigates the preventive and therapeutic effects of medical radiation protection spray(Bergmann)compared to triethanolamine cream in patients undergoing radiotherapy following breast cancer sur...Objective:This study investigates the preventive and therapeutic effects of medical radiation protection spray(Bergmann)compared to triethanolamine cream in patients undergoing radiotherapy following breast cancer surgery.Methods:Ninety patients with breast cancer who received postoperative radiotherapy between July 2018 and July 2021 were randomly divided into the Bergmann treatment(experimental)group and the triethanolamine cream treatment(control)group,with 45 patients in each group.Radiodermatitis severity was assessed using the RTOG radiodermatitis grading standards.Results:The radiation dose required to develop grade I radiodermatitis was significantly higher in the experimental group compared to the control group,at(36.13±1.17 Gy)and(25.38±0.63 Gy),respectively.At a radiation dose of 30 Gy,the proportion of grade I radiodermatitis cases in the experimental group was significantly lower than in the control group(P=0.002).At radiation doses of 40 Gy and 50 Gy,the proportion of grade II radiodermatitis cases in the experimental group was also significantly lower than in the control group(P<0.001).No cases of grade III or higher radiodermatitis were observed in the experimental group,while three cases of grade III radiodermatitis occurred in the control group,although the difference was not statistically significant.No patients in the experimental group discontinued treatment due to radiodermatitis or mucosal reactions,whereas two patients in the control group interrupted treatment due to these reactions but eventually completed therapy.Conclusion:Bergmann spray effectively prevents radiodermatitis in patients undergoing radiotherapy after breast cancer surgery and is more effective than triethanolamine cream in treating skin lesions.Its ease of use improves the quality of life for patients undergoing radiotherapy and ensures successful treatment completion.Bergmann is suitable for clinical promotion and application.展开更多
Microneedles(MNs)are an innovative and viable option for drug delivery that offer the distinct advantages of minimal invasiveness,painlessness,stable drug loading,efficient drug permeation,and biocompatibility.MNs wer...Microneedles(MNs)are an innovative and viable option for drug delivery that offer the distinct advantages of minimal invasiveness,painlessness,stable drug loading,efficient drug permeation,and biocompatibility.MNs were first used to penetrate the skin surface and facilitate transcutaneous drug delivery with great success.Recent applications of MNs have extended to non-transdermal drug delivery,specifically,to various tissues and organs.This review captures the fabrication methods for MNs,discusses advanced design strategies for achieving controlled drug release,and summarizes current MN applications in delivering multiple therapeutic agents to the cardiovascular,digestive(e.g.,oral cavity),reproductive,and central nervous systems.The findings in this review would contribute toward the improved designs of MN systems that can be modified according to purpose,including material selection,structural design,choice of fabrication methods,and tissue considerations,to determine the optimal therapeutic regimen for the target treatment area.展开更多
Lung cancer is among the most prevalent cancers and has the highest mortality rate globally.The diagnosis,pathohistological classification,and molecular testing of lung cancer primarily rely on tissue biopsy or surgic...Lung cancer is among the most prevalent cancers and has the highest mortality rate globally.The diagnosis,pathohistological classification,and molecular testing of lung cancer primarily rely on tissue biopsy or surgical resection.These methods are invasive and associated with limitations,including sample quantity and quality,as well as patient tolerance.Radiomics,an emerging technology,enables the extraction of high-throughput quantitative information from medical images,providing radiomic features applicable to clinical diagnosis and treatment.Significant advancements have been made in the application of radiomics to the diagnosis,molecular detection,efficacy prediction,and prognosis of lung cancer.This review examines the progress in radiomics for individualized and precise diagnosis and treatment of lung cancer in recent years.展开更多
Nipple confusion,a term that accurately describes the confusion that occurs between the mother’s nipple and the artificial teat during feeding in newborns.Specifically,it refers to the fact that babies develop specif...Nipple confusion,a term that accurately describes the confusion that occurs between the mother’s nipple and the artificial teat during feeding in newborns.Specifically,it refers to the fact that babies develop specific breastfeeding habits after birth,based on their initial feeding experience.For babies who are accustomed to their mother’s nipple,they tend to show resistance to bottle feeding;on the contrary,those who have adapted to bottle feeding may refuse to accept their mother’s nipple.This confusion is particularly common among mixed-feeding babies.展开更多
Addressing the challenges of difficult early diagnosis and the incomplete prognosis evaluation system for Autoimmune Encephalitis(AE),this study comprehensively reviews the relevant indicators for early diagnosis and ...Addressing the challenges of difficult early diagnosis and the incomplete prognosis evaluation system for Autoimmune Encephalitis(AE),this study comprehensively reviews the relevant indicators for early diagnosis and prognosis evaluation of AE.The analysis reveals that multiple indicators currently exhibit unique value in the diagnosis and treatment of AE,but each has its limitations.This article aims to systematically review these indicators and clarify their current application in clinical practice,to help improve the accuracy of early diagnosis and prognosis evaluation of AE,and provide a theoretical basis for clinicians to develop more effective treatment strategies.展开更多
In the context of power generation companies, vast amounts of specialized data and expert knowledge have been accumulated. However, challenges such as data silos and fragmented knowledge hinder the effective utilizati...In the context of power generation companies, vast amounts of specialized data and expert knowledge have been accumulated. However, challenges such as data silos and fragmented knowledge hinder the effective utilization of this information. This study proposes a novel framework for intelligent Question-and-Answer (Q&A) systems based on Retrieval-Augmented Generation (RAG) to address these issues. The system efficiently acquires domain-specific knowledge by leveraging external databases, including Relational Databases (RDBs) and graph databases, without additional fine-tuning for Large Language Models (LLMs). Crucially, the framework integrates a Dynamic Knowledge Base Updating Mechanism (DKBUM) and a Weighted Context-Aware Similarity (WCAS) method to enhance retrieval accuracy and mitigate inherent limitations of LLMs, such as hallucinations and lack of specialization. Additionally, the proposed DKBUM dynamically adjusts knowledge weights within the database, ensuring that the most recent and relevant information is utilized, while WCAS refines the alignment between queries and knowledge items by enhanced context understanding. Experimental validation demonstrates that the system can generate timely, accurate, and context-sensitive responses, making it a robust solution for managing complex business logic in specialized industries.展开更多
Peroxymonosulfate(PMS)is commonly used in advanced oxidation processes to degrade organic pollutants in wastewater.In this work,to obtain better PMS activation efficiency,Bi_(4)O_(5)Br_(2)/BCZT(BBT)piezoelectric photo...Peroxymonosulfate(PMS)is commonly used in advanced oxidation processes to degrade organic pollutants in wastewater.In this work,to obtain better PMS activation efficiency,Bi_(4)O_(5)Br_(2)/BCZT(BBT)piezoelectric photocatalyst was designed.Abundant active radicals produced by BBT under visible light irradiation and ultrasonic vibration were used to activate PMS,thereby achieving rapid degradation of high concentration pollutants.With the introduction of BCZT,the catalyst has a strong internal electric field and three-dimensional lamellar structure,which promotes the separation and transfer of electrons and holes.It is worth noting that under optimal reaction conditions,the degradation rate of ARB reached 93%by BBT15 within 10 min.The catalytic experiment combined with the piezoelectric performance test results revealed the key role of piezoelectric photocatalytic reaction in PMS activation.This provides an important prospect for PMS to effectively deal with the degradation of high concentrations of organic pollutants.展开更多
Chinese cabbage(Brassica rapa subsp.pekinensis)is a widely cultivated vegetable crop in Asia with significant economic importance(Li et al.,2024;Yu et al.,2024).As a potyvirus with the broad host range,turnip mosaic v...Chinese cabbage(Brassica rapa subsp.pekinensis)is a widely cultivated vegetable crop in Asia with significant economic importance(Li et al.,2024;Yu et al.,2024).As a potyvirus with the broad host range,turnip mosaic virus(TuMV)is a major pathogen affecting Chinese cabbages,leading to severe yield losses(Li et al.,2019).Traditional control measures have shown limited efficacy,and the long-term use of chemical pesticides has led to significant issues such as environmental pollution and pathogen resistance(Samara et al.,2021;Lu et al.,2022).Biologicallyderived pesticides have garnered considerable attention owing to their eco-friendly attributes(Ayilara et al.,2023).γ-Aminobutyric acid(GABA),initially discovered in potato tubers,has been proven to regulate immune responses and enhance resistance to fungal and bacterial pathogens by modulating reactive oxygen species and stress-related hormone signals(Tarkowski et al.,2020;Wang et al.,2025).But biologically-derived agents typically face challenges such as large particle size and instability,which limit their practical application and bioavailability(Daraban et al.,2023).展开更多
Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the ea...Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the early diagnosis and treatment of patients with such tumors,and thus improving their prognosis.Methods:Seventy-two patients with rectal neuroendocrine tumors who underwent surgical treatment in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method,each with 36 cases.In the control group,traditional foreign body forceps combined with laparoscopic resection were performed,and in the observation group,modified EMR and ESD were performed as needed.The mass resection rate,histologically intact resection rate,postoperative serum vascular endothelial growth factors(VEGFA,VEGFB,VEGFC levels)in the postoperative period of 7d,and indicators of the rate of related complications of the two groups of patients were compared.Results:The mass resection rate of 91.67%and histological complete resection rate of 94.44%in the observation group were significantly higher than those of 72.22%and 66.67%in the control group;the VEGFA,VEGFB,and VEGFC levels of the observation group were 82.08±7.94 ng/ml,168.89±16.53 ng/ml,and 121.07±10.75 ng/ml,respectively,in the postoperative period of 7 d after surgery;the levels were significantly higher than those of the control group:68.39±6.82 ng/ml,141.06±14.12 ng/ml,and 98.45±9.87 ng/ml,respectively,and the difference was statistically significant(P<0.05);the patients in the observation group had a lower rate of surgical complications than those in the control group(2.78%vs 8.33%),the difference was not statistically significant(P>0.05).Conclusion:Modified EMR and ESD in rectal neuroendocrine tumors are effective,not only can it effectively improve the rate of mass resection and histological integrity of the resection rate,but it can also further improve the level of serum vascular endothelial growth factor(VEGFA,VEGFB,VEGFC);thus,it is recommended to be promoted for use in clinical practice.展开更多
基金financially supported by the National Natural Science Foundation of China(52102233)Science and Technology Project of Hebei Education Department(QN2023019)。
文摘Aqueous aluminum ion batteries(AAIBs)have garnered extensive attention due to their environmental friendliness,high theoretical capacity,and low cost.However,the sluggish reaction kinetics and severe structural collapse of the cathode material,especially manganese oxide,during the cycling process have hindered its further application.Herein,Cu^(2+)pre-interca la ted layeredδ-MnO_(2)was synthesized via a hydrothermal method.The pre-intercalated Cu^(2+)ions not only improve the conductivity of MnO_(2)cathode but also stabilize the structure to enhance stability.X-ray absorption fine structure(XAFS)combined with density functional theory(DFT)calculations confirm the formation of the covalent bond between Cu and O,increasing the electronegativity of O atoms and enhancing the H^(+)adsorption energy.Moreover,ex-situ measurements not only elucidate the Al^(3+)/H^(+)co-insertion energy storage mechanism but also demonstrate the high reversibility of the Cu-MnO_(2)cathode during cycling.This work provides a promising modification approach for the application of manganese oxides in AAIBs.
基金supported by the Hebei Provincial Key Research and Development Project(21372803D)。
文摘[Objective]To construct an Escherichia coli mutant strain that accumulates pyruvate by genetic modification guided by the genome-scale metabolic network model.[Methods]Using a genome-scale metabolic network model as a guide,we simulated pyruvate production of E.coli,screened key genes in metabolic pathways,and developed gene editing procedures accordingly.We knocked out the acetate kinase gene ackA,phosphate acetyltransferase gene pta,alcohol dehydrogenase adhE,glycogen synthase gene glgA,glycogen phosphorylase gene glgP,phosphoribosyl pyrophosphate(PRPP)synthase gene prs,ribose 1,5-bisphosphate phosphokinase gene phnN,and transporter encoding gene proP.Furthermore,we knocked in the transporter encoding gene ompC,flavonoid toxin gene fldA,and D-serine ammonia lyase gene dsdA.[Results]A shake flask process with the genetically edited mutant strain MG1655-6-2 under anaerobic conditions produced pyruvate at a titer of 10.46 g/L and a yield of 0.69 g/g.Metabolomic analysis revealed a significant increase in the pyruvate level in the fermentation broth,accompanied by notable decreases in the levels of certain related metabolic byproducts.Through 5 L fed-batch fermentation and an adaptive laboratory evolution,the strain finally achieved a pyruvate titer of 45.86 g/L.[Conclusion]This study illustrated the efficacy of a gene editing strategy predicted by a genome-scale metabolic network model in enhancing pyruvate accumulation in E.coli under anaerobic conditions and provided novel insights for microbial metabolic engineering.
基金Supported by Cultivation Project of Hebei Natural Science Foundation-Precision Medicine Joint Fund,No.H2021206239.
文摘BACKGROUND Primary biliary cholangitis(PBC)is a chronic autoimmune-mediated cholestatic liver disease.Nanoparticles encapsulating rapamycin(ImmTOR)suppress adaptive immune responses and induce the hepatic tolerogenic immune response.AIM To investigate the effects of ImmTOR in PBC mouse models.METHODS PBC models were induced in C57BL/6 mice by two immunizations of 2-octynoic acid-coupled bovine serum albumin at two-week intervals,and polycytidylic acid every three days.The PBC mouse models were separated into the treatment group and the control group.The levels of alkaline phosphatase(ALP)and alanine aminotransferase in the mice were detected using an automatic biochemical analyzer.Liver and spleen mononuclear cells were analyzed by flow cytometry,and serum anti-mitochondrial antibodies(AMA)and the related cytokines were analyzed by enzyme-linked immunosorbent assay.Liver histopathology was examined by hematoxylin and eosin staining and scored.RESULTS After treatment with ImmTOR,the ALP level was significantly decreased(189.60 U/L±27.25 U/L vs 156.00 U/L±17.21 U/L,P<0.05),the level of AMA was reduced(1.28 ng/mL±0.27 ng/mL vs 0.56 ng/mL±0.07 ng/mL,P<0.001)and the expression levels of interferon gamma and tumor necrosis factorαwere significantly decreased(48.29 pg/mL±10.84 pg/mL vs 25.01 pg/mL±1.49 pg/mL,P<0.0001)and(84.24 pg/mL±23.47 pg/mL vs 40.66 pg/mL±14.65 pg/mL,P<0.001).The CD4+T lymphocytes,CD8+T lymphocytes and B lymphocytes in the liver were significantly reduced,with statistically significant differences(24.21%±6.55%vs 15.98%±3.03%,P<0.05;9.09%±1.91%vs 5.49%±1.00%,P<0.001;80.51%±2.96%vs 75.31%±4.34%,P<0.05).The expression of CD8+T lymphocytes and B lymphocytes in the ImmTOR treatment group also decreased(9.09%±1.91%vs 5.49%±1.00%,P<0.001;80.51%±2.96%vs 75.31%±4.34%,P<0.05).The liver pathology of PBC mice in the treatment group showed reduced inflammation and a decreased total pathology score,and the difference in the scores was statistically significant(4.50±2.88 vs 1.75±1.28,P<0.05).CONCLUSION ImmTOR can improve biochemistry and pathology of liver obvious by inhibiting the expression of CD8+T cells and B cells,and reducing the titer of AMA.
基金the financial supports from the National Natural Science Foundation of China(Nos.22378093,21878065)Natural Science Foundation of Hebei Province,China(No.E2022201100)+2 种基金the Science and Technology Support Plan of Baoding City(No.2241ZF111)the Medical Science Foundation of Hebei University(No.2021A09)the Foundation of Affiliated Hospital of Hebei University(No.2021Z003)。
文摘The preparation of immobilized enzyme with excellent performance is one of the difficulties that restrict the application of enzyme catalysis technology.Here,Candida rugosa lipase(CRL)was firstly adsorbed on the surface of magnetic zeolitic imidazolate framework-8(ZIF-8)nanospheres,which was further encapsulated with a mesoporous SiO_(2)nano-membrane formed by tetraethyl orthosilicate(TEOS)polycondensation.Consequently,lipase could be firmly immobilized on carrier surface by physical binding rather than chemical binding,which did not damage the active conformation of enzyme.There were mesopores on the silica nano-membrane,which could improve the accessibility of enzyme and its apparent catalytic activity.Moreover,silica membrane encapsulation could also improve the stability of enzyme,suggesting an effective enzyme immobilization strategy.It showed that TEOS amount and the encapsulation time had significant effects on the thickness of silica membrane and the enzyme activity.The analysis in enzyme activity and protein secondary structure showed that lipase encapsulated in silica membrane retained the active conformation to the greatest extent.Compared with the adsorbed lipase,the encapsulated lipase increased its thermostability by 3 times and resistance to chemical denaturants by 7 times.The relative enzyme activity remained around 80%after 8 repetitions,while the adsorbed lipase only remained at7.3%.
文摘Utilizing data from 5,481 village-level service stations(VS)in Baoding,China,this study empirically investigates the impact of digital inclusive finance(DIF)and VS infrastructure on rural e-commerce(RE)development.Results demonstrate that DIF significantly promotes RE by reducing transaction and financing costs(β=0.783,P<0.01).VS as physical infrastructure significantly drives RE growth(β=0.654,P<0.01).Crucially,DIF and VS exhibit synergistic effects(interactionβ=0.421,P<0.01),producing a“1+1>2”enhancement.Regional economic development,population density,and education levels positively influence RE.Current challenges include financial misallocation,infrastructure deficits,and skill gaps.We propose a“One Core,Three Wings”framework—Core:Develop tailored financial products for specialty industries(luggage,textiles,mushrooms);Wings:(1)Upgrade digital infrastructure,(2)Optimize policy synergy,(3)Enhance inclusive capacity through elderly-friendly technologies and training.Implementation strategies include establishing risk-sharing mechanisms,expanding VS functionality,and creating DIF-RE-VS alliances to foster sustainable rural revitalization.
基金Science and Technology Support Program of Baoding City,Hebei Province(Project No.:2241ZF326)。
文摘Objective:To explore the effect of comprehensive nursing on relieving psychological pressure in patients with pulmonary micro-nodules.Methods:One hundred and twenty patients with pulmonary micro-nodules who received diagnosis and treatment in our hospital from January 2024 to December 2024 were randomly divided into control and observation groups.The control group received routine nursing,while the observation group received comprehensive nursing.The Self-Rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were used to evaluate the patients’psychological states before and after nursing.Patient satisfaction with nursing was analyzed using a nursing satisfaction survey scale.Results:After nursing,the SAS and SDS scores of the observation group were significantly lower than those of the control group(P<0.05).The nursing satisfaction rates of the observation and control groups were 98.33%and 83.33%,respectively,with statistically significant differences(P<0.05).Conclusion:Comprehensive nursing intervention for patients with pulmonary micro-nodules can effectively relieve their psychological pressure and improve nursing satisfaction,demonstrating clinical value.
基金Supported by 2024 Medical Research Program of Hebei Province,No.20240457and 2024 Medically Applicable Technology Track Project of Hebei Province,No.GZ2024099.
文摘BACKGROUND The efficacy of laparoscopic surgery for the treatment of T3-T4a colon cancer remains a subject of debate in the medical community.AIM To explore the surgical techniques,perioperative outcomes,follow-up results,patient prognosis,and survival status associated with laparoscopic surgery for T3-T4a colon cancer.METHODS A total of 202 patients with T3-T4a colon cancer treated at the Affiliated Hospital of Hebei University between January 2020 and December 2024 were selected for this study and divided into two groups based on the type of surgery:Open surgery group(101 cases)and laparoscopic surgery group(LAP group,101 cases).Perioperative indicators(surgical time,postoperative drainage,first flatus,hospital stay,intraoperative blood loss,and number of lymph nodes removed),disease-free survival,and overall survival at 1-year and 3-year follow-ups,as well as the incidence of complications,were compared between the two groups.RESULTS The LAP group had longer surgical times and a greater number of lymph nodes removed compared to the open surgery group(P<0.05).The LAP group also had less blood loss,shorter drainage time,faster time to flatus,and a lower incidence of complications compared to the open surgery group(P<0.05).There was no significant difference in hospital stay,disease-free survival,or overall survival between the two groups during the follow-up period,and this remained true even after adjusting for subgroups based on left-sided colon,right-sided colon,and T4a stage(P>0.05).CONCLUSION The long-term outcomes of laparoscopic radical surgery for T3-T4a colon cancer are comparable to those of open surgery and can accelerate patient recovery and reduce the risk of short-term complications,offering better immediate outcomes.
文摘As the cornerstone of sterile instrument maintenance in endoscopy centers,the quality of endoscope cleaning directly impacts hospital infection control effectiveness.The traceability system for endoscopy centers utilizes digital means to document the entire cleaning process,enabling real-time monitoring and precise quality control.This paper analyzes current quality control practices in endoscope cleaning and addresses existing challenges.It explores how traceability systems standardize procedures,enhance monitoring,and improve management efficiency.The study proposes optimization strategies for traceability system implementation,clarifying its core value in endoscope cleaning quality control.These findings provide theoretical foundations and practical guidance for hospitals to refine management of endoscopy centers,ensure diagnostic safety,and reduce infection risks,ultimately advancing endoscope cleaning quality control toward standardized and informatized development.
文摘As the core department in medical institutions responsible for cleaning,disinfecting,sterilizing,and supplying reusable medical devices,instruments,and items,the quality of work in the disinfection supply center directly impacts medical safety and infection control effectiveness.Professional protective training for personnel is crucial to ensure operational quality in this department.Systematic training enhances staff awareness of occupational exposure risks,standardizes protective measures in procedures,reduces cross-infection risks caused by improper operations,and ultimately lowers infection transmission risks.This paper analyzes the core content,implementation approaches,and practical role of professional protective training for disinfection supply center personnel in infection control.It aims to clarify the significant value of such training,providing references for medical institutions to optimize disinfection center management and strengthen infection control systems,thereby contributing to improved overall medical safety standards.
基金2024 Hebei College students Innovation and Entrepreneurship Training Program project(S202410075065)2025 Hebei College students Innovation and Entrepreneurship Training Program project(DC2005444)Horizontal project 20230048,20230049.
文摘Manganese dioxide is widely used as a cathode material in aqueous zinc-ion batteries,and the cathode material is a key factor limiting the performance of these batteries.In this study,β-manganese dioxide was used as the base material to synthesize two hybrid materials,i.e.manganese dioxide-3D graphene carbon nanotube hybrids(MnO_(2)@3D-GPE/CNT)and manganese dioxide-3D-graphene hybrids(MnO_(2)@3D-GPE),via intermittent highenergy vibration ball milling.Electrochemical tests revealed that the CNT-containing hybrid materials exhibited a higher specific capacity of 480 mAh g^(-1)and superior cycling stability,maintaining over 80%of its initial capacity after 1000 cycles at 500 mA g^(-1)with a Coulombic efficiency close to 100%.MnO_(2)@3D-GPE/CNT had a smaller particle size distribution and a larger specific surface area than MnO_(2)@3D-GPE,explaining its enhanced electrochemical performance.Additionally,MnO_(2)@3D-GPE/CNT exhibited lower electrode impedance,further supporting its efficacy as a cathode material.
文摘Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a serious threat to the life and health of newborns.This paper systematically reviews the core pathogenesis of HMD,focusing on the abnormal metabolism of pulmonary surfactant(PS),genetic factors,immature lung development,and the synergistic effects of inflammatory oxidative stress.It highlights the advances in non-invasive ventilation(NIV)therapy for HMD,including the mechanisms of action,clinical application effects,and optimization strategies of mainstream modalities such as nasal continuous positive airway pressure ventilation(NCPAP),nasal intermittent positive pressure ventilation(NIPPV),and heated humidified high-flow nasal cannula ventilation(HHHFNC).The aim is to provide references for standardized clinical treatment.
基金supported by the Baoding City Self-Financed Fund Project(Project No.2241ZF339).
文摘Objective:This study investigates the preventive and therapeutic effects of medical radiation protection spray(Bergmann)compared to triethanolamine cream in patients undergoing radiotherapy following breast cancer surgery.Methods:Ninety patients with breast cancer who received postoperative radiotherapy between July 2018 and July 2021 were randomly divided into the Bergmann treatment(experimental)group and the triethanolamine cream treatment(control)group,with 45 patients in each group.Radiodermatitis severity was assessed using the RTOG radiodermatitis grading standards.Results:The radiation dose required to develop grade I radiodermatitis was significantly higher in the experimental group compared to the control group,at(36.13±1.17 Gy)and(25.38±0.63 Gy),respectively.At a radiation dose of 30 Gy,the proportion of grade I radiodermatitis cases in the experimental group was significantly lower than in the control group(P=0.002).At radiation doses of 40 Gy and 50 Gy,the proportion of grade II radiodermatitis cases in the experimental group was also significantly lower than in the control group(P<0.001).No cases of grade III or higher radiodermatitis were observed in the experimental group,while three cases of grade III radiodermatitis occurred in the control group,although the difference was not statistically significant.No patients in the experimental group discontinued treatment due to radiodermatitis or mucosal reactions,whereas two patients in the control group interrupted treatment due to these reactions but eventually completed therapy.Conclusion:Bergmann spray effectively prevents radiodermatitis in patients undergoing radiotherapy after breast cancer surgery and is more effective than triethanolamine cream in treating skin lesions.Its ease of use improves the quality of life for patients undergoing radiotherapy and ensures successful treatment completion.Bergmann is suitable for clinical promotion and application.
基金financial support from the Beijing Natural Science Foundation(No.L234020)the National Natural Science Foundation of China(Nos.12472325 and 12272032)the 111 Project(No.B13003).
文摘Microneedles(MNs)are an innovative and viable option for drug delivery that offer the distinct advantages of minimal invasiveness,painlessness,stable drug loading,efficient drug permeation,and biocompatibility.MNs were first used to penetrate the skin surface and facilitate transcutaneous drug delivery with great success.Recent applications of MNs have extended to non-transdermal drug delivery,specifically,to various tissues and organs.This review captures the fabrication methods for MNs,discusses advanced design strategies for achieving controlled drug release,and summarizes current MN applications in delivering multiple therapeutic agents to the cardiovascular,digestive(e.g.,oral cavity),reproductive,and central nervous systems.The findings in this review would contribute toward the improved designs of MN systems that can be modified according to purpose,including material selection,structural design,choice of fabrication methods,and tissue considerations,to determine the optimal therapeutic regimen for the target treatment area.
文摘Lung cancer is among the most prevalent cancers and has the highest mortality rate globally.The diagnosis,pathohistological classification,and molecular testing of lung cancer primarily rely on tissue biopsy or surgical resection.These methods are invasive and associated with limitations,including sample quantity and quality,as well as patient tolerance.Radiomics,an emerging technology,enables the extraction of high-throughput quantitative information from medical images,providing radiomic features applicable to clinical diagnosis and treatment.Significant advancements have been made in the application of radiomics to the diagnosis,molecular detection,efficacy prediction,and prognosis of lung cancer.This review examines the progress in radiomics for individualized and precise diagnosis and treatment of lung cancer in recent years.
文摘Nipple confusion,a term that accurately describes the confusion that occurs between the mother’s nipple and the artificial teat during feeding in newborns.Specifically,it refers to the fact that babies develop specific breastfeeding habits after birth,based on their initial feeding experience.For babies who are accustomed to their mother’s nipple,they tend to show resistance to bottle feeding;on the contrary,those who have adapted to bottle feeding may refuse to accept their mother’s nipple.This confusion is particularly common among mixed-feeding babies.
文摘Addressing the challenges of difficult early diagnosis and the incomplete prognosis evaluation system for Autoimmune Encephalitis(AE),this study comprehensively reviews the relevant indicators for early diagnosis and prognosis evaluation of AE.The analysis reveals that multiple indicators currently exhibit unique value in the diagnosis and treatment of AE,but each has its limitations.This article aims to systematically review these indicators and clarify their current application in clinical practice,to help improve the accuracy of early diagnosis and prognosis evaluation of AE,and provide a theoretical basis for clinicians to develop more effective treatment strategies.
文摘In the context of power generation companies, vast amounts of specialized data and expert knowledge have been accumulated. However, challenges such as data silos and fragmented knowledge hinder the effective utilization of this information. This study proposes a novel framework for intelligent Question-and-Answer (Q&A) systems based on Retrieval-Augmented Generation (RAG) to address these issues. The system efficiently acquires domain-specific knowledge by leveraging external databases, including Relational Databases (RDBs) and graph databases, without additional fine-tuning for Large Language Models (LLMs). Crucially, the framework integrates a Dynamic Knowledge Base Updating Mechanism (DKBUM) and a Weighted Context-Aware Similarity (WCAS) method to enhance retrieval accuracy and mitigate inherent limitations of LLMs, such as hallucinations and lack of specialization. Additionally, the proposed DKBUM dynamically adjusts knowledge weights within the database, ensuring that the most recent and relevant information is utilized, while WCAS refines the alignment between queries and knowledge items by enhanced context understanding. Experimental validation demonstrates that the system can generate timely, accurate, and context-sensitive responses, making it a robust solution for managing complex business logic in specialized industries.
基金financially supported by the National Natural Science Foundation of China(No.51302061)Natural Science Foundation of Hebei Province(No.E2020201021 and E2023201019)+4 种基金Industry-University-Research Cooperation Major Projects of Shijiazhuang(No.241130477A)Research Innovation Team of College of Chemistry and Environmental Science of Hebei University(No.hxkytd2102)Industry-University-research Cooperation Project of Colleges and Universities in Hebei Province(No.CXZX2025016)Hebei Province Innovation Capability Enhancement Plan Project(No.22567620H)Bintuan Science and Technology Program(Nos.2020DB002 and 2022DB009)。
文摘Peroxymonosulfate(PMS)is commonly used in advanced oxidation processes to degrade organic pollutants in wastewater.In this work,to obtain better PMS activation efficiency,Bi_(4)O_(5)Br_(2)/BCZT(BBT)piezoelectric photocatalyst was designed.Abundant active radicals produced by BBT under visible light irradiation and ultrasonic vibration were used to activate PMS,thereby achieving rapid degradation of high concentration pollutants.With the introduction of BCZT,the catalyst has a strong internal electric field and three-dimensional lamellar structure,which promotes the separation and transfer of electrons and holes.It is worth noting that under optimal reaction conditions,the degradation rate of ARB reached 93%by BBT15 within 10 min.The catalytic experiment combined with the piezoelectric performance test results revealed the key role of piezoelectric photocatalytic reaction in PMS activation.This provides an important prospect for PMS to effectively deal with the degradation of high concentrations of organic pollutants.
基金supported by the National Natural Science Foundation of China(Grant Nos.32402564,32330096,32372631)Hebei Natural Science Foundation(Grant No.C2024204246)+1 种基金the Pinduoduo-China Agricultural University Research Fund(Grant No.PC2023B02018)the 2115 Talent Development Program of China Agricultural University.
文摘Chinese cabbage(Brassica rapa subsp.pekinensis)is a widely cultivated vegetable crop in Asia with significant economic importance(Li et al.,2024;Yu et al.,2024).As a potyvirus with the broad host range,turnip mosaic virus(TuMV)is a major pathogen affecting Chinese cabbages,leading to severe yield losses(Li et al.,2019).Traditional control measures have shown limited efficacy,and the long-term use of chemical pesticides has led to significant issues such as environmental pollution and pathogen resistance(Samara et al.,2021;Lu et al.,2022).Biologicallyderived pesticides have garnered considerable attention owing to their eco-friendly attributes(Ayilara et al.,2023).γ-Aminobutyric acid(GABA),initially discovered in potato tubers,has been proven to regulate immune responses and enhance resistance to fungal and bacterial pathogens by modulating reactive oxygen species and stress-related hormone signals(Tarkowski et al.,2020;Wang et al.,2025).But biologically-derived agents typically face challenges such as large particle size and instability,which limit their practical application and bioavailability(Daraban et al.,2023).
基金Clinical Study on Endoscopic Resection of Colorectal Submucosal Tumors Using Underwater Combined with Metal Clip-Assisted Snare,China(Grant No.2441ZF271)。
文摘Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the early diagnosis and treatment of patients with such tumors,and thus improving their prognosis.Methods:Seventy-two patients with rectal neuroendocrine tumors who underwent surgical treatment in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method,each with 36 cases.In the control group,traditional foreign body forceps combined with laparoscopic resection were performed,and in the observation group,modified EMR and ESD were performed as needed.The mass resection rate,histologically intact resection rate,postoperative serum vascular endothelial growth factors(VEGFA,VEGFB,VEGFC levels)in the postoperative period of 7d,and indicators of the rate of related complications of the two groups of patients were compared.Results:The mass resection rate of 91.67%and histological complete resection rate of 94.44%in the observation group were significantly higher than those of 72.22%and 66.67%in the control group;the VEGFA,VEGFB,and VEGFC levels of the observation group were 82.08±7.94 ng/ml,168.89±16.53 ng/ml,and 121.07±10.75 ng/ml,respectively,in the postoperative period of 7 d after surgery;the levels were significantly higher than those of the control group:68.39±6.82 ng/ml,141.06±14.12 ng/ml,and 98.45±9.87 ng/ml,respectively,and the difference was statistically significant(P<0.05);the patients in the observation group had a lower rate of surgical complications than those in the control group(2.78%vs 8.33%),the difference was not statistically significant(P>0.05).Conclusion:Modified EMR and ESD in rectal neuroendocrine tumors are effective,not only can it effectively improve the rate of mass resection and histological integrity of the resection rate,but it can also further improve the level of serum vascular endothelial growth factor(VEGFA,VEGFB,VEGFC);thus,it is recommended to be promoted for use in clinical practice.
