Optimization and inventory management under stochastic demand using metaheuristic algorithm.

This study considers multi-period inventory systems for optimizing profit and storage space under stochastic demand. A nonlinear programming model based on random demand is proposed to simulate the inventory operation. The effective inventory management system is realized using a multi-objective grey wolf optimization (MOGWO) method, reducing storage space while maximizing profit. Numerical outcomes are used to confirm the efficacy of the optimal solutions. The numerical analysis and tests for multi-objective inventory optimization are performed in the four practical scenarios. The inventory model's sensitivity analysis is performed to verify the optimal solutions further. Especially the proposed approach allows businesses to optimize profits while regulating the storage space required to operate in inventory management. The supply chain performance can be significantly enhanced using inventory management strategies and inventory management practices. Finally, the novel decision-making strategy can offer new insights into effectively managing digital supply chain networks against market volatility.

Factors That Influence the Intention of Smallholder Rice Farmers to Adopt Cleaner Production Practices: An Empirical Study of Precision Agriculture Adoption.

Sustainable agriculture is crucial for achieving SDG2 and building a resilient climate-food system. This study provides a nuanced understanding of factors that influence the adoption of precision agriculture technology by Vietnamese smallholder rice farmers as a sustainable agricultural solution. The study's objectives are: (1) to provide a nuanced understanding of factors that influence adoption of precision agriculture technology by Vietnamese smallholder rice farmers; and (2) to identify factors associated with agricultural practice in Vietnam that may impact the adoption of precision agriculture technology. The study conducted 35 semi-structured interviews with smallholder rice farmers and agriculture experts. Data were analyzed using iterative thematic analysis. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used for empirical analysis. The UTAUT constructs of Performance expectancy, Effort expectancy, Government support, and Social influence were found to be determinants of adoption. Trialability and Observability impact Effort expectancy and Performance expectancy. We also discovered that the performance of agricultural cooperatives and support of lead firms play a crucial role in facilitating agricultural technology adoption by Vietnamese smallholder rice farmers. The results confirm the applicability of UTAUT in defining smallholders' behavioural intention and predicting agricultural technology adoption. The study also provides constructive feedback on the UTAUT model by highlighting the effect of agricultural cooperatives' performance as innovation intermediaries and of the support of lead firms.

Design, synthesis and evaluation the bioactivities of novel 1,3-dimethyl-6-amino-1H-indazole derivatives as anticancer agents.

Indoleamine 2,3-dioxygenase (IDO1) is a heme-containing enzyme mainly responsible for the metabolism of tryptophan to kynurenine. To date, the IDO1 inhibitors have been developed intensively for the re-activation of the anticancer immune response. In this report, we designed, and synthesized novel 1,3-dimethyl-6-amino indazole derivatives as IDO1 inhibitors based on the structure of IDO1 active site. We further examined their anticancer activity on hypopharyngeal carcinoma cells (FaDu), squamous cell carcinoma of the oral tongue (YD-15), breast cancer cells (MCF7), and human dental pulp stem cells (HDPSC). Of them, compound N-(4-bromobenzyl)-1,3-dimethyl-1H-indazol-6-amine (7) remarkably suppressed IDO1 expression in a concentration - dependent manner. In addition, 7 was the most potential anticancer compound with inducing apoptosis activity as well as selectively activated extracellular signal-regulated kinases (ERK) in mitogen-activated protein kinase (MAPK) pathways on FaDu cells. Finally, compound 7 suppressed cell mobility in wound healing assay with the reduced expression of matrix metalloproteinase MMP9. Taken together, we believe that 7 is the most promising compound, which may be applied to treatment of hypopharyngeal carcinoma.

Double-shelling AgInS2nanocrystals with GaSx/ZnS to make them emit bright and stable excitonic luminescence.

This paper presents the successful synthesis of AgInS2nanocrystals (NCs) double-shelled with GaSxand ZnS for emitting bright and narrow excitonic luminescence from AgInS2core NCs. Additionally, the AgInS2/GaSx/ZnS NCs with a core/double-shell structure have demonstrated high chemical and photochemical stability. The AgInS2/GaSx/ZnS NCs were prepared via three steps: (i) synthesis of AgInS2core NCs by solvothermal method at 200 °C for 30 min, (ii) shelling GaSxon AgInS2core NCs at 280 °C for 60 min to produce the AgInS2/GaSxcore/shell structure, and (iii) the outermost ZnS shelling at 140 °C for 10 min. The synthesized NCs were characterized in detail by using appropriate techniques such as x-ray diffraction, transmission electron microscopy, and optical spectroscopies. The luminescence evolution of the synthesized NCs is as follows: from the broad spectrum (peaking at 756 nm) of the AgInS2core NCs to become the narrow excitonic emission (at 575 nm) prominent beside the broad one after shelling with GaSx, then only the bright excitonic luminescence (at 575 nm) without broad emission after double-shelling with GaSx/ZnS. The double-shell has made the AgInS2/GaSx/ZnS NCs not only remarkably enhance their luminescence quantum yield (QY) up to ∼60% but also maintain the narrow excitonic emission stably for a long-term storage over 12 months. The outermost ZnS shell is believed to play a key role in enhancing QY and protecting AgInS2and AgInS2/GaSxfrom certain damage.

The networked micro-decision context: a new lens on transformative urban governance.

Recent large-scale societal disruptions, from the COVID-19 pandemic to intensifying wildfires and weather events, reveal the importance of transforming governance systems so they can address complex, transboundary, and rapidly evolving crises. Yet current knowledge of the decision-making dynamics that yield transformative governance remains scant. Studies typically focus on the aggregate outputs of government decisions, while overlooking their micro-level underpinnings. This is a key oversight because drivers of policy change, such as learning or competition, are prosecuted by people rather than organizations. We respond to this knowledge gap by introducing a new analytical lens for understanding policymaking, aimed at uncovering how characteristics of decision-makers and the structure of their relationships affect their likelihood of effectuating transformative policy responses. This perspective emphasizes the need for a more dynamic and relational view on urban governance in the context of transformation.

Review of antibiotic prescriptions as part of antimicrobial stewardship programmes: results from a pilot implementation at two provincial-level hospitals in Viet Nam.

Objectives: To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam. Methods: This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. Results: The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01-0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52-40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17-322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13-10.62). Conclusions: This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.

Outcomes of endoscopic retrograde cholangiopancreatography in patients with situs inversus viscerum

Background/Aims@#Situs inversus viscerum (SIV) is a congenital condition defined by left-to-right transposition of all visceral organs. This anatomical variant has caused technical challenges in endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP in patients with SIV are limited to case reports of unknown clinical and technical success rates. This study aimed to evaluate the clinical and technical success rates of ERCP in patients with SIV. @*Methods@#Data from patients with SIV who underwent ERCP were retrospectively reviewed. The data were collected by querying the nationwide Veterans Affairs Health System database for patients diagnosed with SIV who underwent ERCP. Patient demographics and procedural characteristics were collected. @*Results@#Eight patients with SIV who underwent ERCP were included. Choledocholithiasis was the most common indication for ERCP (62.5%). The technical success rate was 63%. Subsequent ERCP with interventional radiology–assisted rendezvous has increased the technical success rate to 100%. Clinical success was achieved in 63% of cases. Among cases of subsequent rendezvous ERCP after conventional ERCP failure, clinical success was achieved in 100%. @*Conclusions@#The clinical and technical success rates of ERCP in patients with SIV were both 63%. In patients with SIV in whom ERCP fails, interventional radiology–assisted rendezvous ERCP can be considered.

Emerging from the global syndemic crucible: Finding belonging in a post corona future.

The covid-19 global syndemic has upended societies worldwide and concomitantly united the world in a shared experience of lockdowns, social distancing, and economic upheaval. In the face of great uncertainty, dystopian realities, and binding government edicts, people's everyday lives, sense of agency, actions, and interactions changed forcibly. Importantly, it has disrupted many practices and routines essential for (re)constituting a sense of belonging, an important element of personhood and individual wellbeing. Using the "Letters from the Future" method, we investigate how individuals imagine and present themselves in the future to navigate this social change. We ask "How do letter writers construct a sense of belonging in a future of their own imagining?" To answer this question, we combine discourse- and text analysis with network analysis to examine 47 letters that Greek participants wrote during the Spring 2020 lockdown. We explore how individuals present and introduce their future self, what topos this self inhabits and what expressions, values, and practices they perform and negotiate as they reflect on and navigate their relational worlds. By and large, Greek letter writers recognize that inequities and injustices paved the way for the syndemic and express a pressing need for societal transformation.

Surgical treatment of tension pneumomediastinum in patients with covid-19 at the field hospital: a case series.

BACKGROUND: Tension pneumomediastinum is one of the most serious complications in COVID-19 patients with respiratory distress requiring invasive mechanical ventilation. This complication can lead to rapid hemodynamic instability and death if it is not recognized in a timely manner and intervenes promptly. CASE PRESENTATION: We reported 7 COVID-19 patients with tension pneumomediastinum at a field hospital. All patients were critically ill with ARDS. These 7 patients, including 3 females and 4 males in this series, were aged between 39 and 70 years. Tension pneumomediastinum occurred on the first day of mechanical ventilation in 3 patients and later in the course of hospital stay, even 10 days after being intubated and ventilated. The tension pneumomediastinum caused hemodynamic instability and worsened respiratory mechanics with imminent cardiopulmonary collapse. In this series, we used two surgical techniques: (i) mediastinal decompression by suprasternal drainage with or without simultaneous pleural drainage in the first two cases and (ii) mediastinal drainage via suprasternal and subxiphoid incisions in 5 patients. The surgical procedures were feasible and reversed the pending cardiopulmonary collapse. Four patients had a favorable postprocedural period and were discharged from the intensive care center. Both patients undergoing suprasternal drainage died of failed/recurrent tension pneumomediastinum and nosocomial infection. Only one in five patients who underwent mediastinal drainage via suprasternal and subxiphoid incisions died of septic shock secondary to ventilator-associated pneumonia. CONCLUSION: Tension pneumomediastinum was a life-threatening complication in critically ill COVID-19 patients requiring mechanical ventilation. Surgical mediastinal decompression was the salvage procedure. The surgical technique of mediastinal drainage via suprasternal and subxiphoid incisions proved an advantage in tension relief, hemodynamic improvement and mortality reduction.

Triple therapy with artemether-lumefantrine plus amodiaquine versus artemether-lumefantrine alone for artemisinin-resistant, uncomplicated falciparum malaria: an open-label, randomised, multicentre trial.

BACKGROUND: Late treatment failures after artemisinin-based combination therapies (ACTs) for falciparum malaria have increased in the Greater Mekong subregion in southeast Asia. Addition of amodiaquine to artemether-lumefantrine could provide an efficacious treatment for multidrug-resistant infections. METHODS: We conducted an open-label, randomised trial at five hospitals or health centres in three locations (western Cambodia, eastern Cambodia, and Vietnam). Eligible participants were male and female patients aged 2-65 years with uncomplicated Plasmodium falciparum malaria. Patients were randomly allocated (1:1 in blocks of eight to 12) to either artemether-lumefantrine alone (dosed according to WHO guidelines) or artemether-lumefantrine plus amodiaquine (10 mg base per kg/day), both given orally as six doses over 3 days. All received a single dose of primaquine (0·25 mg/kg) 24 h after the start of study treatment to limit transmission of the parasite. Parasites were genotyped, identifying artemisinin resistance. The primary outcome was Kaplan-Meier 42-day PCR-corrected efficacy against recrudescence of the original parasite, assessed by intent-to-treat. Safety was a secondary outcome. This completed trial is registered at ClinicalTrials.gov (NCT03355664). FINDINGS: Between March 18, 2018, and Jan 30, 2020, 310 patients received randomly allocated treatment; 154 received artemether-lumefantrine alone and 156 received artemether-lumefantrine plus amodiaquine. Parasites from 305 of these patients were genotyped. 42-day PCR-corrected treatment efficacy was noted in 151 (97%, 95% CI 92-99) of 156 patients with artemether-lumefantrine plus amodiaquine versus 146 (95%, 89-97) of 154 patients with artemether-lumefantrine alone; hazard ratio (HR) for recrudescence 0·6 (95% CI 0·2-1·9, p=0·38). Of the 13 recrudescences, 12 were in 174 (57%) of 305 infections with pfkelch13 mutations indicating artemisinin resistance, for which 42-day efficacy was noted in 89 (96%) of 93 infections with artemether-lumefantrine plus amodiaquine versus 73 (90%) of 81 infections with artemether-lumefantrine alone; HR for recrudescence 0·44 (95% CI 0·14-1·40, p=0·17). Artemether-lumefantrine plus amodiaquine was generally well tolerated, but the number of mild (grade 1-2) adverse events, mainly gastrointestinal, was greater in this group compared with artemether-lumefantrine alone (vomiting, 12 [8%] with artemether-lumefantrine plus amodiaquine vs three [2%] with artemether-lumefantrine alone, p=0·03; and nausea, 11 [7%] with artemether-lumefantrine plus amodiaquine vs three [2%] with artemether-lumefantrine alone, p=0·05). Early vomiting within 1 h of treatment, requiring retreatment, occurred in no patients of 154 with artemether-lumefantrine alone versus five (3%) of 156 with artemether-lumefantrine plus amodiaquine, p=0·06. Bradycardia (≤54 beats/min) of any grade was noted in 59 (38%) of 154 patients with artemether-lumefantrine alone and 95 (61%) of 156 with artemether-lumefantrine plus amodiaquine, p=0·0001. INTERPRETATION: Artemether-lumefantrine plus amodiaquine provides an alternative to artemether-lumefantrine alone as first-line treatment for multidrug-resistant P falciparum malaria in the Greater Mekong subregion, and could prolong the therapeutic lifetime of artemether-lumefantrine in malaria-endemic populations. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust.

Rotary bi-layer ring-shaped metamaterials for reconfiguration absorbers: publisher's note.

This publisher's note corrects errors in Appl. Opt.61, 9078 (2022)APOPAI0003-693510.1364/AO.471949.

Rotary bi-layer ring-shaped metamaterials for reconfiguration absorbers.

A reconfigurable metamaterial absorber (MA) in the microwave region is numerically and experimentally demonstrated based on a multi-layered metamaterial. The proposed structure can be mechanically switched between two different configurations to obtain designated absorption behaviors. By rotating the upper ring layer by multiples of 90 deg, two separated absorption modes of the MA are created. The first configuration acts as a single-band absorber, while the second configuration performs multi-band perfect absorption. In addition, the proposed structure can be easily switched into two different configurations to obtain a designated absorption feature. Our work is expected to provide an effective approach to obtaining reconfigurable MAs, which are useful for various applications.

Endertiins A-B, two lanostane triterpenoids from the fruit bodies of the mushoom Humphreya endertii.

Two new lanostane triterpnenoids named endertiins A and B (1 and 2) together with two known compounds as ganodecalone A (3) and ergosterol (4) have been successfully isolated from the cultivated fruit bodies of the mushroom Humphreya endertii Stey (Ganodermataceae). Their structures were elucidated by a combination of HR-MS and 2 D NMR spectroscopic analyses. In addition, endertiins A and B (1 and 2) were evaluated their cytotoxicity against two cancer cell lines, MCF7 (human breast carcinoma) and LU (human lung carcinoma). The result showed that endertiin A (1) could inhibit the growth of MCF-7 cells with its IC50 value of 71.16 ± 6.25 µg/ml.

The follow-up of the robotic-assisted Soave procedure for Hirschsprung's disease in children.

Robotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung's disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung's disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5-2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1-2 defecations per day, 12 patients (21.8%) had 3-4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung's disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

Simulated Microgravity Induces the Proliferative Inhibition and Morphological Changes in Porcine Granulosa Cells.

Astronauts are always faced with serious health problems during prolonged spaceflights. Previous studies have shown that weightlessness significantly affects the physiological function of female astronauts, including a change in reproductive hormones and ovarian cells, such as granulosa and theca cells. However, the effects of microgravity on these cells have not been well characterized, especially in granulosa cells. This study aimed to investigate the effects of simulated microgravity (SMG) on the proliferation and morphology of porcine granulosa cells (pGCs). pGC proliferation from the SMG group was inhibited, demonstrated by the reduced O.D. value and cell density in the WST-1 assay and cell number counting. SMG-induced pGCs exhibited an increased ratio of cells in the G0/G1 phase and a decreased ratio of cells in the S and G2/M phase. Western blot analysis indicated a down-regulation of cyclin D1, cyclin-dependent kinase 4 (cdk4), and cyclin-dependent kinase 6 (cdk6), leading to the prevention of the G1-S transition and inducing the arrest phase. pGCs under the SMG condition showed an increase in nuclear area. This caused a reduction in nuclear shape value in pGCs under the SMG condition. SMG-induced pGCs exhibited different morphologies, including fibroblast-like shape, rhomboid shape, and pebble-like shape. These results revealed that SMG inhibited proliferation and induced morphological changes in pGCs.

Evaluation of in vitro cytotoxicity and in vivo potential toxicity of the extract from in vitro cultivated Anoectochilus roxburghii Lindl.

Anoectochilus roxburghii Lind. (A. roxburghii) has promising anti-oxidant, hyperglycemic, hepatoprotective, and immunomodulatory activities as well as anti-tumor effects. However, the pharmacological actions of in vitro cultured plants remain to be determined. Therefore, the objective of the study was to assess in vitro cytotoxicity and in vivo potential toxicity of an extract derived from in vitro cultivated A. roxburghii, termed as iARE. The total flavonoid content and predominant flavonoid compounds of extract were identified and quantitatively analyzed. The in vitro cytotoxicity of iARE was examined using several cancer and normal cell lines. The apoptotic activity and expression of apoptosis-associated genes were also examined in MCF7 cells to determine the underlying mechanisms related to anti-proliferative effects. In vivo potential toxicity of iARE was assessed following acute and subchronic oral administration in Sprague Dawley rats. Quercetin, kaempferol, and isorhamnetin were three flavonoid components identified in iARE. The extract exerted cytotoxic effects on various cancer cells but not normal fibroblasts. Apoptosis in MCF7 cells was induced by iARE in a concentration-dependent manner associated with increased Bax/Bcl-2 ratio and reduced mitochondrial membrane potential ΔΨm, leading to release of cytochrome c, activation of caspase-3/7 and caspase-9, and cleavage of PARP. In the acute oral toxicity study, no mortality or toxicological signs were observed in rats at 1000 or 5000 mg/kg. In a subchronic oral toxicity study, iARE at a dosage of up to 1000 mg/kg produced no mortality or treatment-related adverse effects on general behavior, food intake, body weight, relative organ weights. No apparent marked changes in the histopathology of the liver and kidney were detected. Data demonstrated that iARE induced in vitro cytotoxic effects in cancer cells are associated with lackof invivo toxicity. Thus, iARE was suggested to be considered as apotential therapeutic candidate for cancer treatment.

Catheter-directed intra-arterial thrombolysis in the treatment of acute thrombosis of below-the-knee arteries.

Selecting treatment options in acute arterial thrombosis of the lower extremity, which threatens limb viability, is still a challenge for vascular surgeons. Early restoration of blood flow is crucial and is conducted by surgical thrombectomies or endovascular procedures, depending on patient condition. Catheter-directed thrombolysis with or without percutaneous mechanical thrombectomy for acute limb ischemia has been widely implemented from the early 1990s. Here, we present 2 cases of acute thrombosis of below-the-knee arteries, where we successfully saved the involved limbs using catheter-directed thrombolysis and thrombus aspiration.

Global climate change, diet, and the complex relationship between human host and microbiome: Towards an integrated picture.

Dietary changes can alter the human microbiome with potential detrimental consequences for health. Given that environment, health, and evolution are interconnected, we ask: Could diet-driven microbiome perturbations have consequences that extend beyond their immediate impact on human health? We address this question in the context of the urgent health challenges posed by global climate change. Drawing on recent studies, we propose that not only can diet-driven microbiome changes lead to dysbiosis, they can also shape life-history traits and fuel human evolution. We posit that dietary shifts prompt mismatched microbiome-host genetics configurations that modulate human longevity and reproductive success. These mismatches can also induce a heritable intra-holobiont stress response, which encourages the holobiont to re-establish equilibrium within the changed nutritional environment. Thus, while mismatches between climate change-related genetic and epigenetic configurations within the holobiont increase the risk and severity of diseases, they may also affect life-history traits and facilitate adaptive responses. These propositions form a framework that can help systematize and address climate-related dietary challenges for policy and health interventions.

Remote radio control of insect flight reveals why beetles lift their legs in flight while other insects tightly fold.

In the research and development of micro air vehicles, understanding and imitating the flight mechanism of insects presents a viable way of progressing forward. While research is being conducted on the flight mechanism of insects such as flies and dragonflies, research on beetles that can carry larger loads is limited. Here, we clarified the beetle midlegs' role in the attenuation and cessation of the wingbeat. We anatomically confirmed the connection between the midlegs and the elytra. We also further clarified which pair of legs are involved in the wingbeat attenuation mechanism, and lastly demonstrated free-flight control via remote leg muscle stimulation. Observation of multiple landings using a high-speed camera revealed that the wingbeat stopped immediately after their midlegs were lowered. Moreover, the action of lowering the midleg attenuated and often stopped the wingbeat. A miniature remote stimulation device (backpack) mountable on beetles was designed and utilized for the free-flight demonstration. Beetles in free flight were remotely induced into lowering (swing down) each leg pair via electrical stimulation, and they were found to lose significant altitude only when the midlegs were stimulated. Thus, the results of this study revealed that swinging down of the midlegs played a significant role in beetle wingbeat cessation. In the future, our findings on the wingbeat attenuation and cessation mechanism are expected to be helpful in designing bioinspired micro air vehicles.

Nurse-led psychological intervention reduces anxiety symptoms and improves quality of life following percutaneous coronary intervention for stable coronary artery disease.

OBJECTIVE: To study the effect of nurse-led counselling on the anxiety symptoms and the quality of life following percutaneous coronary intervention for stable coronary artery disease. DESIGN: Randomised control trial. SETTING: Rural and remote China. PARTICIPANTS: Rural and remote patients were consecutively recruited from a medical centre located in China between January and December 2014. INTERVENTIONS: The control group received standard pre-procedure information from a ward nurse on the processes of the hospitalisation and percutaneous coronary intervention, and post-procedural care. The intervention group received a structured 30-minute counselling session the day before and 24 hours after the percutaneous coronary intervention, by nurse consultants with qualifications in psychological therapies and counselling. The health outcomes were assessed by a SF-12 scale and the Seattle Angina Questionnaire at 6 and 12 months after percutaneous coronary intervention. The anxiety and depression symptoms were evaluated by a Zung anxiety and depression questionnaire. MAIN OUTCOME MEASURES: Cardiac outcomes, quality of life and mental health status. RESULTS: Eighty patients were randomly divided into control (n = 40) and intervention groups (n = 40). There was a significant increase in the scores of the three domains of Seattle Angina Questionnaire 12 months after percutaneous coronary intervention in the intervention group (P < .01). The mental health and physical health scores also increased (P < .01). In the control group, the mean scores of Zung self-rating anxiety scale 12 months following percutaneous coronary intervention were higher than the baseline scores, and higher than in the intervention group (P < .01). CONCLUSIONS: Counselling by a clinician qualified in psychological therapies and counselling significantly reduces anxiety symptoms and improves quality of life.