Enhancing colposcopy training using a widely accessible digital education tool in China.

BACKGROUND: Colposcopy is a cornerstone of cervical cancer prevention; however, there is a global shortage of colposcopists. It is challenging to train a sufficient number of colposcopists through in-person methods, which hinders our ability to adequately diagnose and manage positive cases. A digital platform is needed to make colposcopy training more efficient, scalable, and sustainable; however, current online training programs are generally based on didactic curricula that do not incorporate image analysis training. In addition, long-term assessments of online training are not readily available. Therefore, innovative digital training and an assessment of its effectiveness are needed. OBJECTIVE: This study aimed to evaluate the short- and long-term effects of DECO (an online Digital Education Tool for Colposcopy) on trainees' colposcopy competencies and confidence. STUDY DESIGN: DECO can be used both on laptops and smartphones and comprises 4 training modules (image interpretation; terminology learning; video teaching; and collection of guidelines and typical cases) and 2 test modules. DECO was tested through a pre-post study between September and November 2022. Participants were recruited in China, and DECO training lasted 12 days. Trainees initially learned basic theory before completing training using 200 image-based cases. Pretest, posttest, and follow-up testing included 20 distinct image-based questions, and was conducted on Days 0, 13, and 60. Primary outcomes were competence and confidence scores. Secondary measures were response distributions for colposcopic diagnoses, biopsies, and DECO training satisfaction. Multilevel modeling was used to determine improvement from baseline to posttraining and follow-up for the outcomes of interest. RESULTS: Among 402 participants recruited, 96.8% (n=389) completed pretesting, 84.1% (n=338) posttesting, and 75.1% (n=302) follow-up testing. Colposcopic competence and confidence increased across this study. Diagnostic scores improved on average from 55.3 (53.7-56.9) to 70.4 (68.9-71.9). The diagnostic accuracy for normal/benign lesions, low-grade squamous intraepithelial lesions, and high-grade squamous intraepithelial lesions or worse increased by 16.9%, 13.1%, and 16.9%, respectively. Mean confidence scores increased from 48.1 (45.6-50.6) to 56.2 (54.5-57.9). These improvements remained evident 2 months after training. Trainees were also satisfied with DECO overall. Most found DECO to be scientific (82.5%), easy to use (75.2%), and clinically useful (98.4%), and would recommend it to colleagues (93.2%). CONCLUSION: DECO is a useful, acceptable digital education tool that improves colposcopy competencies and confidence. DECO could make colposcopy training more efficient, scalable, and sustainable because there are no geographic or time limitations. Therefore, DECO could be used to alleviate the shortage of trained colposcopists around the world.

Low-Power Red Laser Treatment for Anisometropic Myopia Control in Children: A Contralateral Comparison Study.

BACKGROUND: There are some uncertainties about the effect of low-power red laser treatment on myopia control for anisometropic myopia in children. To evaluate the effect and safety of low-power red laser treatment on refractive development for anisometropic myopia in children, a contralateral comparison study was conducted. METHODS: The more myopic eye of child with anisometropic myopia was treated with low-power red laser treatment (LRL group), the other eye received no treatment other than the wearing of single-focus spectacles (SFS) (SFS Group). The LRL treatment was given at home under parental guidance for 3 minutes each time, twice daily with a minimal interval of 4 hours, 7 days per week, using an equipment that produces red laser of 650 nm wavelength at an illuminance range of roughly 1200-1800 lux and an energy of 0.60 mw for a 4-mm pupil (class I classification). RESULTS: Among 51 included children, 44 (86.27%) completed the 3-months study, consisting of 15 girls (34.1%) and 29 boys (65.9%). After 3-months axial length (AL) and spherical equivalent refraction (SER) progression were -0.08 mm [95% CI (confidence interval), 0.11 to 0.06 mm] and +0.23 diopter (D) (95% CI, 0.13-0.33 D) for LRL group and +0.08 mm (95% CI, 0.05-0.11 mm) and -0.07 D (95% CI, -0.16-0.03 D) for SFS group. AL and SER progression between the groups varied by 0.17 mm (95% CI, 0.13-0.20 mm) and -0.30 D (95% CI, -0.42 to -0.18 D). There was no visible structural damage on optical coherence tomography (OCT) scans. CONCLUSIONS: AL growth, myopia progression, and anisometropia of the binoculars can all be slowed down by LRL treatment. Compared to SER progression, axial elongation is more accurate and simpler to monitor. LRL treatment unrecorded functional and structural damage of binoculus.

Changes of insular function in lifelong premature ejaculation patients before and after SSRI administration.

OBJECTIVE: Lifelong premature ejaculation (PE) is regarded as one of the most common male sexual dysfunction. We aimed to detect whether insula-related brain functional networks are altered in lifelong PE patients and whether such alterations are "normalised" after selective serotonin reuptake inhibitors (SSRI) administration. METHODS: Twenty-three drug-naive lifelong PE patients and 30 healthy controls (HC) were recruited in current study. All subjects underwent resting-state functional magnetic resonance imaging (fMRI) scan at first. One hour after dapoxetine administration, all patients underwent fMRI scanning again. The degree centrality (DC), amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) analysis, and ROI-based functional connectivity (FC) analysis were applied to calculate the abnormalities in insula-related functions among three groups. RESULTS: Compared to HC group, PE patients at baseline showed significantly altered DC, ALFF, and ReHo value of the bilateral insula, which subsequently showed a "normalised" trend after dapoxetine administration. Additionally, compared to HC group, PE patients at baseline showed significantly decreased FC between insula and precentral gyrus, inferior frontal gyrus, middle/inferior temporal gyrus, and caudate, while patients after dapoxetine administration showed increased insula-related FC in anterior cingulate cortex and decreased FC in thalamus and middle/inferior temporal gyrus. The main effects of dapoxetine were located in precentral gyrus, inferior frontal gyrus, caudate, and limbic system. CONCLUSIONS: Our findings report altered brain mechanism of insula in lifelong PE patients and also indicate that dapoxetine can "normalise" the abnormal function of the insula to certain extent in lifelong PE patients.

Long-Term Performance Evolution of RIOHTrack Pavement Surface Layer Based on DMA Method.

Asphalt mixture is a typical viscoelastic material, and its road performance will change with the action of environment and load during actual service. This study conducted experimental research on the surface course asphalt mixture of three categories and six typical structures of RIOHTrack based on the Dynamic Mechanical Analysis method. Moreover, this study explored the performance evolution law of asphalt mixture under the coupling action of load and environment in the process of loading from 0 million to 54 million standard axle times. Results demonstrated that the phase transition characteristic temperature of the surface course materials of the three types of typical structures showed a trend of first increasing and then decreasing with the accumulation of load and environmental effects, indicating the presence of two stages of the dual coupling effect of environmental aging and load rolling on the asphalt mixture during service. In addition, the results suggested that the phase transition characteristic temperature, modulus, and phase angle of the surface layer materials have obvious material differences and structure dependencies.

Multivariate Pattern Analysis of Lifelong Premature Ejaculation Based on Multiple Kernel Support Vector Machine.

Objective: This study aimed to develop an effective support vector machine (SVM) classifier based on the multi-modal data for detecting the main brain networks involved in group separation of premature ejaculation (PE). Methods: A total of fifty-two patients with lifelong PE and 36 matched healthy controls were enrolled in this study. Structural MRI data, functional MRI data, and diffusion tensor imaging (DTI) data were used to process SPM12, DPABI4.5, and PANDA, respectively. A total of 12,735 features were reduced by the Mann-Whitney U test. The resilience nets method was further used to select features. Results: Finally, 36 features (3 structural MRI, 7 functional MRI, and 26 DTI) were chosen in the training dataset. We got the best SVM model with an accuracy of 97.5% and an area under the curve (AUC) of 0.986 in the training dataset as well as an accuracy of 91.4% and an AUC of 0.966 in the testing dataset. Conclusion: Our findings showed that the majority of the brain abnormalities for the classification was located within or across several networks. This study may contribute to the neural mechanisms of PE and provide new insights into the pathophysiology of patients with lifelong PE.

Evaluation of the High- and Low-Temperature Performance of Asphalt Mortar Based on the DMA Method.

Asphalt mortar is a typical temperature-sensitive material that plays a crucial role in the performance of asphalt mixture. This study evaluates the high- and low-temperature performance of asphalt mortar based on the dynamic mechanical analysis (DMA) method. Temperature-sweep tests of asphalt mortars were conducted using the DMA method under fixed strain level, frequency, and heating rate conditions. The dynamic mechanical response curves, characteristic temperature, and other indices were obtained and used to investigate the high- and low-temperature performance of asphalt mortar. The results showed that the phase transition temperatures T1, T0, and Tg can be used to evaluate the low-temperature performance of asphalt mortar. Additionally, they had a good linear relationship, and the evaluation results were consistent. Meanwhile, T2, E60, and tan(δ)max indicators can effectively evaluate the high-temperature performance of asphalt mortar. Asphalt plays a key role in the performance of asphalt mortar. Mortars with neat asphalt A70 and modified asphalt AR had the worst and best high- and low-temperature performances, respectively. Furthermore, the finer gradation improved the low-temperature performance of asphalt mortar, while the coarser gradation improved the high-temperature properties of modified asphalt mortars but had the opposite effect on neat asphalt A70.

Thalamocortical Dysconnectivity In Lifelong Premature Ejaculation: A Functional MRI Study.

OBJECTIVES: To detect seed-based functional connectivity (FC) between various cortical sub-regions and the thalamus in lifelong premature ejaculation (LPE) patients and explore whether specific thalamocortical networks are significantly altered in PE patients compared to healthy controls (HCs) METHODS: Fifty non-medicated LPE patients and 40 age-matched HCs underwent a resting-state functional MRI. FC was adopted to identify specific thalamocortical connectivity between the thalamus and 6 cortical regions of interest (i.e., the motor cortex/supplementary motor, the prefrontal cortex, the temporal lobe, the posterior parietal cortex, the somatosensory cortex and the occipital lobe). In LPE patients, regression analysis was subsequently conducted to assess relationships of thalamocortical connectivity with the Premature Ejaculation Diagnostic Tool (PEDT) score and the Intravaginal Ejaculatory Latency Time (IELT). RESULTS: LPE patients had significantly decreased FC between the motor cortex and bilateral ventral thalamus, between the prefrontal cortex and left dorsomedial thalamus, as well as between the temporal cortex and bilateral ventromedial thalamus. In LPE patients, PEDT score was significantly positively associated with the thalamus-posterior parietal cortex FC, and negatively associated with the thalamus-temporal cortex FC, while IELT was positively associated with the thalamus-temporal cortex and thalamus-motor cortex FC. CONCLUSION: These results enrich the imaging evidence for the understanding of the neurobiological mechanisms and/or consequences of LPE.

Associations between anthropometric indicators and refraction in school-age children during the post-COVID-19 era.

Purpose: To explore the associations between anthropometric indicators and refraction in school-aged children in the post-COVID-19 era. Methods: Data were collected from 25,644 children aged 7 to 12 years in 48 elementary schools in Tianjin. The comprehensive examination included height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), refraction, and calculation of BMI, with a follow-up visit after 6 months. Myopia was defined as spherical equivalent refraction (SER) ≤-0.50 diopter (D). Bivariate correlation coefficients and multiple linear regression models were used to explore the cross-sectional and longitudinal associations between anthropometric indicators (height, weight, BMI, SBP, and DBP) and refraction. Results: The mean changes in height, weight, BMI, SBP, DBP, and SER of the participants were 4.03 ± 2.18 cm, 3.10 ± 2.39 kg, 0.45 ± 1.16 kg/m2, 2.26 ± 14.74 mmHg, 2.18 ± 11.79 mmHg and -0.17 ± 0.51 D, respectively. Overall, height, weight, BMI, SBP, and DBP were all correlated with SER (r = -0.324, r = -0.234, r = -0.121, r = -0.112, r = -0.066, both p < 0.001), and changes in height and weight were correlated with changes in SER (r = -0.034, -0.031, both p < 0.001). Furthermore, multiple linear regression analysis revealed that the association of BMI, SBP, and DBP with SER was significant in myopic children but not in non-myopic children. The association between changes in weight and changes in SER was only present in non-myopic children but not in myopic children. Conclusion: Height and weight were negatively correlated with SER in both cross-sectional analysis and longitudinal changes, indicating that children's height, weight and growth rate may be used as a reference indicator for myopia risk prediction and myopia progression monitoring.

Experimental Study on the Phase Transition Characteristics of Asphalt Mixture for Stress Absorbing Membrane Interlayer.

Asphalt mixtures used in stress absorbing membrane interlayers (SAMIs) play a significant role in improving the performance of asphalt pavement. To investigate the rheological properties and phase transition characteristics of asphalt mixtures used in SAMI with temperature changes, twenty-seven candidate mixtures with different binders, gradation types and binder contents were selected in this research. During the study, dynamic mechanical analysis method was employed to evaluate their temperature-dependent properties and a series of wide-range temperature sweep tests were conducted under a sinusoidal loading. Some critical points and key indexes from the testing curves such as glass transition temperature (Tg) can be obtained. Test results show that phase transition characteristics can better reflect the rheological properties of asphalt mixtures at different temperatures. Crumb rubber modified asphalt mixtures (AR) provide a better performance at both high and low temperatures. Additionally, the range of AR asphalt mixtures' effective functioning temperature ΔT is wider, and the slope K value is greater than the others, which indicates that AR asphalt mixtures are less sensitive to temperature changes. Additionally, gradation type and asphalt content also influence the properties: finer gradation and more asphalt content have a good effect on the low-temperature performance of the asphalt mixtures; while mixtures with a coarser gradation and less asphalt content perform better at high temperature and they are less sensitive to temperature changes. Finally, AR asphalt mixture is more suitable to be applied in the SAMI due to its phase transition characteristics from this method.

Anti-tumor effects of a recombinant anti-prostate specific membrane antigen immunotoxin against prostate cancer cells.

BACKGROUND: To evaluate anti-prostate cancer effects of a chimeric tumor-targeted killer protein. METHODS: We established a novel fusion gene, immunocasp-3, composed of NH2-terminal leader sequence fused with an anti-prostate-specific membrane antigen (PSMA) antibody (J591), the furin cleavage sequences of diphtheria toxin (Fdt), and the reverse coding sequences of the large and small subunits of caspase-3 (revcaspase-3). The expressing level of the immunocasp-3 gene was evaluated by using the reverse transcription-PCR (RT-PCR) and western blot analysis. Cell viability assay and cytotoxicity assay were used to evaluate its anti-tumor effects in vitro. Apoptosis was confirmed by electron microscopy and Annexin V-FITC staining. The antitumor effects of immunocasp-3 were assessed in nude mice xenograft models containing PSMA-overexpressing LNCaP cells. RESULTS: This study shows that the immunocasp-3 proteins selectively recognized and induced apoptotic death in PSMA-overexpressing LNCaP cells in vitro, where apoptotic cells were present in 15.3% of the cells transfected with the immunocasp-3 expression vector at 48 h after the transfection, in contrast to 5.5% in the control cells. Moreover, LNCaP cells were significantly killed under the condition of the co-culture of the immunocasp-3-secreting Jurkat cells and more than 50% of the LNCaP cells died when the two cell lines were co-cultured within 5 days. In addition, The expression of immunocasp-3 also significantly suppressed tumor growth and greatly prolonged the animal survival rate in vivo. CONCLUSION: A novel fusion gene, immunocasp-3, may represent a viable approach to treating PSMA-positive prostate cancer.

[Robot-assisted laparoscopic radical prostatectomy for prostate cancer: report of 34 cases].

OBJECTIVE: To assess the feasibility and safety of robot-assisted laparoscopic radical prostatectomy (RLRP) in the treatment of prostate cancer. METHODS: Using the da Vinci robot surgical system, we performed RLRP for 34 patients with localized prostate cancer and analyzed the intraoperative and follow-up data. RESULTS: The procedures were performed successfully in all the patients, with the mean operation time of 198 min (range 135-340 min), average blood loss of 257 ml (range 50-700 ml), and 1 case of blood transfusion, but no postoperative complications. Three cases had positive surgical margins. Postoperative examination at 4 weeks showed PSA > 0.2 microg/L in 2 cases, suggestive of residual tumor, for which maximal androgen block therapy was administered. The other 32 patients were followed up for 3-10 (mean 7.5) months, during which the average level of serum tPSA remained < 0.2 microg/L. Urinary continence was found in 94% (32/34) and 97% (33/34) of the patients at 3 and 6 months, respectively, of whom 77% (26/34) and 88% (30/34) had no urinary leakage (0 pad per day). CONCLUSION: RLRP, with its advantages of less perioperative blood loss, low rate of positive margin, and good urinary continence, is a safe and effective surgical option for the treatment of prostate cancer.

The investigation of MCM-48-type and MCM-41-type mesoporous silica as oral solid dispersion carriers for water insoluble cilostazol.

OBJECTIVE: To explore the suitable application of MCM-41 (Mobil Composition of Matter number forty-one)-type and MCM-48-type mesoporous silica in the oral water insoluble drug delivery system. METHODS: Cilostazol (CLT) as a model drug was loaded into synthesized MCM-48 (Mobil Composition of Matter number forty-eight) and commercial MCM-41 by three common methods. The obtained MCM-41, MCM-48 and CLT-loaded samples were characterized by means of nitrogen adsorption, thermogravimetric analysis, ultraviolet-visible spectrophotometry, scanning electron microscopy, transmission electron microscopy, differential scanning calorimetry and powder X-ray diffractometer. RESULTS: It was found that solvent evaporation method was preferred according to the drug loading efficiency and the maximum percent cumulative drug dissolution. MCM-48 with 3D cubic pore structure and MCM-41 with 2D long tubular structure are nearly spherical particles in 300-500 nm. Nevertheless, the silica carriers with similar large specific surface areas and concentrating pore size distributions (978.66 m(2)/g, 3.8 nm for MCM-41 and 1108.04 m(2)/g, 3.6 nm for MCM-48) exhibited different adsorption behaviors for CLT. The maximum percent cumulative drug release of the two CLT/silica solid dispersion (CLT-MCM-48 and CLT-MCM-41) was 63.41% and 85.78% within 60 min, respectively; while in the subsequent 12 h release experiment, almost 100% cumulative drug release were both obtained. In the pharmacokinetics aspect, the maximum plasma concentrations of CLT-MCM-48 reached 3.63 mg/L by 0.92 h. The AUC0-∞ values of the CLT-MCM-41 and CLT-MCM-48 were 1.14-fold and 1.73-fold, respectively, compared with the commercial preparation. CONCLUSION: Our findings suggest that MCM-41-type and MCM-48-type mesoporous silica have great promise as solid dispersion carriers for sustained and immediate release separately.

Novel chitosan-functionalized spherical nanosilica matrix as an oral sustained drug delivery system for poorly water-soluble drug carvedilol.

A novel spherical nanosilica matrix (SNM) together with chitosan (CTS) encapsulated SNM (CTS-SNM) was developed in order to investigate the feasibility of using chitosan to regulate drug release rate from porous silica and obtain an oral sustained drug delivery system. To achieve this goal, we synthesized a spherical nanosilica matrix (SNM) and incorporated chitosan chains on the SNM surface. Solvent evaporation method was adopted to load the model drug carvedilol into SNM and CTS-SNM. The physicochemical properties of the drug carriers and drug-loaded composites were systematically studied using scanning electron microscopy (SEM), transmission electron microscopy (TEM), nitrogen adsorption, X-ray diffraction (XRD), differential scanning calorimetry (DSC), and thermogravimetric analysis (TGA). The structural changes in CTS-SNM in simulated gastrointestinal fluid as well as the relationships between swelling effect of chitosan and in vitro drug release behaviors were investigated. Pharmacokinetic and bioavailability aspects were also discussed. The results showed that the powerful dispersing effect of SNM and the blocking action due to the swelling of chitosan were the two main factors contributing to the sustained drug release behavior. The swelling effect of chitosan in an acidic environment together with the shrinking effect in a relatively alkaline environment allowed regulation of drug release behavior in simulated gastrointestinal fluid. An in vivo study showed that the bioavailability of CAR was improved 182% compared with that of the commercial capsule when SNM was used as the drug carrier. As for CAR-CTS-SNM, the T(max) of CAR was delayed by about 3.4 h and the bioavailability was slightly increased in comparison with the commercial capsule. We believe that SNM and CTS-SNM developed in this study will help increase the use of polymers and inorganic materials in pharmaceutical applications and stimulate the design of oral drug delivery systems for immediate or sustained release of poorly water-soluble drugs.