The Application of Computer Technology to Clinical Practice Guideline Implementation: A Scoping Review.

Implementation of clinical practice guidelines (CPG) is a complex and challenging task. Computer technology, including artificial intelligence (AI), has been explored to promote the CPG implementation. This study has reviewed the main domains where computer technology and AI has been applied to CPG implementation. PubMed, Embase, Web of science, the Cochrane Library, China National Knowledge Infrastructure database, WanFang DATA, VIP database, and China Biology Medicine disc database were searched from inception to December 2021. Studies involving the utilization of computer technology and AI to promote the implementation of CPGs were eligible for review. A total of 10429 published articles were identified, 117 met the inclusion criteria. 21 (17.9%) focused on the utilization of AI techniques to classify or extract the relative content of CPGs, such as recommendation sentence, condition-action sentences. 47 (40.2%) focused on the utilization of computer technology to represent guideline knowledge to make it understandable by computer. 15 (12.8%) focused on the utilization of AI techniques to verify the relative content of CPGs, such as conciliation of multiple single-disease guidelines for comorbid patients. 34 (29.1%) focused on the utilization of AI techniques to integrate guideline knowledge into different resources, such as clinical decision support systems. We conclude that the application of computer technology and AI to CPG implementation mainly concentrated on the guideline content classification and extraction, guideline knowledge representation, guideline knowledge verification, and guideline knowledge integration. The AI methods used for guideline content classification and extraction were pattern-based algorithm and machine learning. In guideline knowledge representation, guideline knowledge verification, and guideline knowledge integration, computer techniques of knowledge representation were the most used.

[Experiment on Recovery of Phosphorus from Aqueous Solution by Calcium Doped Fe3O4].

Adsorption is an economical and effective method for recovering phosphate from wastewater. In order to improve the adsorption capacity of Fe3O4 for phosphate and for easy separation from water under the action of an external magnetic field, CaO2 was used in this study as an oxidant to partially oxidize Fe2+. A phosphorus recovery adsorbent, Ca doped Fe3O4 (CMIO), was prepared and was characterized by X-ray diffraction (XRD), X-ray fluorescence (XRF) and vibrating sample magnetometer (VSM) techniques. The results showed that CMIO had a Ca2+ doped Fe3O4 crystal structure with a saturation magnetization of 38.82 emu·g-1, which was easily separated from water by using an external magnetic field. The phosphorus adsorption capacity of the CMIO decreased with an increase of pH value. When pH=2 and T=25℃, the maximum adsorption capacity was 24.10 mg·g-1, which is almost five times the adsorption capacity of pure Fe3O4. The phosphorus adsorption of CMIO was in accord with the Langmuir isotherm adsorption model, and the adsorption process followed the pseudo-second order kinetic model. The complexation of phosphate occurred on the inner surface of the CMIO to form a ≡Fe-Ca-P ternary complex, which can adsorb phosphorus. Compared with other anions in the aqueous solution, CMIO had good adsorption selectivity to PO43-, and the adsorbed PO43- could be desorbed by NaOH solution.The quality loss of the CMIO was less than 4% once, and multiple recycling was possible.

Well-Dispersed Nickel- and Zinc-Tailored Electronic Structure of a Transition Metal Oxide for Highly Active Alkaline Hydrogen Evolution Reaction.

The practical scale-up of renewable energy technologies will require catalysts that are more efficient and durable than present ones. This is, however, a formidable challenge that will demand a new capability to tailor the electronic structure. Here, an original electronic structure tailoring of CoO by Ni and Zn dual doping is reported. This changes it from an inert material into one that is highly active for the hydrogen evolution reaction (HER). Based on combined density functional theory calculations and cutting-edge characterizations, it is shown that dual Ni and Zn doping is responsible for a highly significant increase in HER activity of the host oxide. That is, the Ni dopants cluster around surface oxygen vacancy of the host oxide and provide an ideal electronic surface structure for hydrogen intermediate binding, while the Zn dopants distribute inside the host oxide and modulate the bulk electronic structure to boost electrical conduction. As a result, the dual-doped Ni, Zn CoO nanorods achieve current densities of 10 and 20 mA cm-2 at overpotentials of, respectively, 53 and 79 mV. This outperforms reported state-of-the-art metal oxide, metal oxide/metal, metal sulfide, and metal phosphide catalysts.

Atomic-level structure engineering of metal oxides for high-rate oxygen intercalation pseudocapacitance.

Atomic-level structure engineering can substantially change the chemical and physical properties of materials. However, the effects of structure engineering on the capacitive properties of electrode materials at the atomic scale are poorly understood. Fast transport of ions and electrons to all active sites of electrode materials remains a grand challenge. Here, we report the radical modification of the pseudocapacitive properties of an oxide material, Zn x Co1-x O, via atomic-level structure engineering, which changes its dominant charge storage mechanism from surface redox reactions to ion intercalation into bulk material. Fast ion and electron transports are simultaneously achieved in this mixed oxide, increasing its capacity almost to the theoretical limit. The resultant Zn x Co1-x O exhibits high-rate performance with capacitance up to 450 F g-1 at a scan rate of 1 V s-1, competing with the state-of-the-art transition metal carbides. A symmetric device assembled with Zn x Co1-x O achieves an energy density of 67.3 watt-hour kg-1 at a power density of 1.67 kW kg-1, which is the highest value ever reported for symmetric pseudocapacitors. Our finding suggests that the rational design of electrode materials at the atomic scale opens a new opportunity for achieving high power/energy density electrode materials for advanced energy storage devices.

Multiscale Structural Engineering of Ni-Doped CoO Nanosheets for Zinc-Air Batteries with High Power Density.

Zinc-air batteries offer a possible solution for large-scale energy storage due to their superhigh theoretical energy density, reliable safety, low cost, and long durability. However, their widespread application is hindered by low power density. Herein, a multiscale structural engineering of Ni-doped CoO nanosheets (NSs) for zinc-air batteries with superior high power density/energy density and durability is reported for the first time. In micro- and nanoscale, robust 2D architecture together with numerous nanopores inside the nanosheets provides an advantageous micro/nanostructured surface for O2 diffusion and a high electrocatalytic active surface area. In atomic scale, Ni doping significantly enhances the intrinsic oxygen reduction reaction activity per active site. As a result of controlled multiscale structure, the primary zinc-air battery with engineered Ni-doped CoO NSs electrode shows excellent performance with a record-high discharge peak power density of 377 mW cm-2 , and works stable for >400 h at 5 mA cm-2 . Rechargeable zinc-air battery based on Ni-doped CoO NSs affords an unprecedented small charge-discharge voltage of 0.63 V, outperforming state-of-the-art Pt/C catalyst-based device. Moreover, it is shown that Ni-doped CoO NSs assembled into all-solid-state coin cells can power 17 light-emitting diodes and charge an iPhone 7 mobile phone.

Isolated Platinum Atoms Stabilized by Amorphous Tungstenic Acid: Metal-Support Interaction for Synergistic Oxygen Activation.

Oxygen activation plays a crucial role in many important chemical reactions such as oxidation of organic compounds and oxygen reduction. For developing highly active materials for oxygen activation, herein, we report an atomically dispersed Pt on WO3 nanoplates stabilized by in situ formed amorphous H2 WO4 out-layer and the mechanism for activating molecular oxygen. Experimental and theoretical studies demonstrate that the isolated Pt atoms coordinated with oxygen atoms from [WO6 ] and water of H2 WO4 , consequently leading to optimized surface electronic configuration and strong metal-support interaction (SMSI). In exemplified reactions of butanone oxidation sensing and oxygen reduction, the atomic Pt/WO3 hybrid exhibits superior activity than those of Pt nanoclusters/WO3 and bare WO3 as well as enhanced long-term durability. This work will provide insight into the origin of activity and stability for atomically dispersed materials, thus promoting the development of highly efficient and durable single atom-based catalysts.

[Effects of hypothermia plus dexamethasone on eNOS expression and spermatogenic cell apoptosis after testicular torsion reduction].

OBJECTIVE: To investigate the protective effects of hypothermia combined with dexamethasone on the testis of rats after testicular torsion reduction and on the expression of eNOS and apoptosis of spermatogenic cells. METHODS: We made unilateral testicular torsion models in 80 adolescent male Sprague-Dawley rats by 720 degrees torsion of the left testis, and then randomly divided them into four groups of equal number to be treated with normal temperature + physiological saline (group A), hypothermia + physiological saline (group B), hypothermia + dexamethasone (group C), and normal temperature + dexamethasone (group D). After 48 hours, we collected the testes, observed pathological changes of the testicular tissue by HE staining under the light microscope, determined the expression of eNOS by immunohistochemistry, and detected the apoptosis of spermatogenic cells by TUNEL. RESULTS: HE staining showed different degrees of testicular tissue injury in all the four groups of rats, most obvious in group A, while protective effect was observed in the other three groups. Immunohistochemistry revealed significantly more positive cells and higher positive staining intensity in the torsion (left) testis in group A than in B (P < 0.05), C (P < 0.01) and D (P < 0.01). The nuclei were deep brown or brown. Lots of apoptotic spermatogenic cells were seen in the torsion testis of group A, with a significantly higher apoptosis index (31.12 +/- 4.68) than in B (16.58 +/- 6.22) (P < 0.05), C (8.60 +/- 1.15) (P < 0.01) and D (13.52 +/- 3.06) (P < 0.01). CONCLUSION: Ischemia-reperfusion injury after testicular torsion reduction can increase the apoptosis of spermatogenic cells and decrease testicular reproductivity. Hypothermia combined with dexamethasone can protect the testis from injury as well as the reproductive function of the testis after testicular torsion reduction.

[Study on correlation between neuropsychological features and Chinese medical syndrome types in patients with Wilson's disease].

OBJECTIVE: To explore the correlation between neuropsychological features and Chinese medical syndrome types in Wilson's disease (WD) patients, thus providing evidence for early intervention by syndrome typing. METHODS: Totally 96 WD patients were assigned to Gan-Dan damp-heat syndrome (GDDHS, 31 cases), Gan-Shen yin deficiency syndrome (GSYDS, 47 cases), and qi-blood deficiency syndrome (QBDS, 18 cases) by syndrome typing. Three items of neuropsychological testing were performed in them, i.e., Raven's standard progressive matrices (R'SPM), Stroop color-word test (CWT), trail making test (TMT). The correlations between the integrals of Chinese medical syndrome types and results of the 3 tests were analyzed. RESULTS: (1) There was statistical difference in the total scores of R'SPM, the word interference time of CWT, and interference effects of TMT among the 3 syndrome types (P <0.01, P <0.05). There was statistical difference in the total scores of R'SPM and the word interference time of CWT in patients of QBDS, when compared with those of GDDHS and GSYDS (P <0.05). There was statistical difference in interference effects of TMT in patients of GDDHS, when compared with those of QBDS and GSYDS (P <0.05). (2) The integrals of the 3 syndrome types were negatively correlated with the total scores of R'SPM (P <0.01). The integral of GDDHS was significantly positively correlated with the interference effects of TMT (P <0.01). The integral of GSYDS was significantly positively correlated with TMT-B time consumption and interference effects of TMT (P <0. 05). The integral of QBDS was significantly positively correlated with the word interference time of CWT (P <0.05). CONCLUSIONS: There was correlation between neuropsychological changes of WD patients and Chinese medical syndrome types. The severity of asthenia syndrome was sequenced from high to low as QBDS > GSYDS > GDDHS. The severity of asthenia was higher than that of asthenia.

[Association between gestational weight gain and birth weight (2001-2009): a cohort study carried outin Kunshan city, Jiangsu province, China].

OBJECTIVE: To identify the association between gestational weight gain and birth weight over the past 9 years in Kunshan city, Jiangsu province, China. METHODS: This population-based study was conducted between 2001 to 2009. Data were retrieved from Perinatal Monitoring System of Maternal and Child Health Care Hospital of Kunshan. The study population consisted of 33 631 women and singleton live fetus. Gestational weight gain was defined as the total weight gain during the last and first prenatal care program and divided by the interval weeks. RESULTS: From 2001 to 2009, the average incidence of low birth weight was 1.86%, while the average incidence of macrosomia was a bit higher, fluctuating around 8.47%. On those underweight mothers, after adjustment for potential confounders, and stratified by the BMI levels, which were evaluated at the first prenatal care program, we found that weight gain in the 3rd and 4th intervals, could reduce the risk of low birth weight (less than 2500 g). With those mothers with normal-weight, weight gain in the 2 nd, 3 rd and 4th intervals, would reduce the risk of low birth weight. Risks in the 4th quantile among underweight and normal-weight group were prevalence odds radio (POR) 95%CI: 0.51 (0.32-0.80) and 0.58 (0.42-0.79), respectively. The risks showed a significant downward trend in underweight and normal-weight groups with increased gestational weight gain. As for macrosomia (≥4000 g), the risks increased (POR 95%CI) 4.69 (2.82-7.81) in underweight, 4.15 (3.43-5.03) in normal-weight, in overweight, 3.64 (2.62-5.06) and 1.96 (1.48-2.60) in obese mothers with increased levels of gestational weight gain. Trend tests indicated that the risks of marcosomia increased in all levels of BMI, with the increase of gestational weight gain. CONCLUSION: Findings from this population-based study suggested that gestational weight gain could reduce the risks of low birth weight among underweight and normal-weight groups, while increase the risks of macrosomia in all parturients, as compared with lowest levels of gestational weight gain.

[Epidemiological study of hepatolenticular degeneration at Hanshan County, Anhui Province].

OBJECTIVE: To identify the incidence and morbidity rates of hepatolenticular degeneration (HLD) at Hanshan County, Anhui Province. METHODS: According to the principles of age stratification, cluster and random sampling, a total of 112 810 subjects were screened by cornea slit-lamp examination during the period of November 2008 to October 2009. The subjects were from recruited from schools, factories, communities, institutions and villages at Hanshan County. And they belonged to the age group of 7 - 75 years. At the same time, each subject was evaluated by the clinical examination with regards to the presence of such clinical manifestations as brain, liver, kidney, skin and other organ damage. And the examinations of copper biochemistry and abdominal ultrasound were performed for those subjects with K-F rings or their clinical manifestations suspicious of HLD. In order to confirm or exclude HLD, the penicillamine challenge test (PCT) was performed if necessary. RESULTS: Seven HLD patients had a definite diagnosis of HLD. There were classical Wilson type (n = 1), pseudosclerosis type (n = 1), mental disorder type (n = 1), liver type (n = 1) and presymptomatic (n = 3). The incidence rate was 2.66/100 000 and the prevalence rate 6.21/100 000 at Hanshan County, Anhui Province. CONCLUSION: HLD is a common disease. In order to avoid a misdiagnosis and prevent an incorrect treatment, physicians should pay more attention to this curable disease and try their best to achieve early detection, early diagnosis and early treatment.

[Effect of gandou tablet I on neurological electrophysiology in patients of hepatolenticular degeneration].

OBJECTIVE: To observe the influence of Gandou Tablet I (GD I) on neurologic electrophysiology in patients of hepatolenticular degeneration (HLD). METHODS: Vigilance-controlled electroencephalogram (VEEG), electromyogram (EMG) and brain-stem auditory evoked potential (BAEP) in 32 cases of HLD were examined before GD I treatment, and reexamined after 4 weeks of treatment in those with abnormal neurologic electrophysiology. RESULTS: At the same time of clinical symptom improvement after treatment, the abnormal VEEG, EMG and BAEP also improved with the effective rate of 71.43%, 70% and 66.67% respectively, their constitutional ratio were different insignificantly, P > 0.05. The peak latency (PL) of III, V waves and interpeak latency (IPL) of I-III, III-V and I-V waves in patients before treatment were all greatly prolonged, compared with those in the healthy control group (P < 0.05 or 0.01), the IPL of III-V and I-V waves were markedly improved after treatment. CONCLUSION: Neurologic electrophysiologic examination was valuable for complementary diagnosis and therapeutic effect evaluation of HLD. GD I could improve the abnormal neurologic electrophysiologic parameters.

Copper-chelating therapeutic effect in Wilson disease with different clinical phenotypes and polymorphisms of ATP7B gene.

AIM:To investigate the copper-chelating therapeutic effect in Wilson disease (WD) with different clinical phenotypes and polymorphisms of ATP7B gene.METHODS:One hundred and twenty-two WD patients with different clinicalphenotypes were given DMPS intravenously and Gandou copper-chelating tablet orally for one month. The therapeutic effect was judged by modified Goldstein mothod. Exon 18 of ATP7B gene extracted from the DNA of patients and 20 healthy volunteers was amplified with PCR mutation and polymorphism were screened with SSCP technique.RESULTS:Four kinds of abnormal migration bands in PCR-SSCP were observed in 37 WD patients, mutation frequencies of three different disease phenotypes, and curative effect between mutation group and non-mutation group showed no statistically significant difference (P > 0.05), but the total effectiveness rates in patients with Wilson type or pseudosclerosis type were significantly higher than those of patients with hepatic type (X(2) = 6.17, P < 0.05).CONCLUSION:Most WD patients are compound heterozygotes, the patients with different clinical phenotypes have different response to copper-chelating therapy. Specific mutation, at least in part, plays a role in influencing the disease phenotypes and therapeutic effect.