Androgen deprivation therapy plus apalutamide as neoadjuvant therapy prior radical prostatectomy for patients with unresectable prostate cancer.

Whether neoadjuvant therapy confers a survival benefit in advanced prostate cancer (PCa) remains uncertain. The primary endpoints of previous retrospective and phase II clinical studies that used neoadjuvant therapy, including androgen deprivation therapy combined with new-generation androgen receptor signaling inhibitors or chemotherapy, were pathological downstaging, progression-free survival, prostate-specific antigen relief, and local symptom improvement. To the best of our knowledge, no studies have explored the efficacy and safety of neoadjuvant therapy in improving the surgical resection rate in cases of unresectable primary tumors of PCa. We first designed this retrospective study to evaluate the potential value of apalutamide as neoadjuvant therapy in improving the resectability rate of radical prostatectomy (RP). We initially reported 7 patients with unresectable primary lesions who underwent neoadjuvant apalutamide treatment for a median of 4 months, and all of them successfully underwent RP treatment. Our study supported apalutamide as neoadjuvant therapy, which helped improve RP's success rate and did not significantly increase perioperative complications, and the neoadjuvant therapy was controllable. Our findings' clinical value and benefit for survival still need further clinical research to confirm.

Sexual violence against women remains problematic and highly prevalent around the world.

BACKGROUND: Sexual violence is far more prevalent in most societies than is usually suspected in daily life. However, no study has systematically summarized the global prevalence rate and the major outcomes of sexual violence against women. METHODS: We directed a wide-raging search in the PubMed, Embase, and Web of Science, catalogs since the beginning to December 2022 for relevant reports about the incidence of sexual fighting touching females. The occurrence frequency was assessed with a random-effects model. The heterogeneity was estimated with I 2 values. Differences by research features were assessed over subgroup evaluation and meta-regression. RESULTS: A total of 32 cross-sectional studies were included (a total of 19,125 participants). The pooled sexual violence rate was 0.29 (95% CI = 0.25-0.34). Subgroup analyses found that there was a higher rate of sexual violence against women in 2010-2019 period (0.33, 95% CI = 0.27-0.37), developing countries (0.32, 95% CI = 0.28-0.37), and interview (0.39, 95% CI = 0.29-0.49). The analysis found that more than half of women (0.56, 95% CI = 0.37-0.75) had post-traumatic stress disorder (PTSD) after experiencing sexual violence, and only a third of women considered seeking support (0.34, 95% CI = 0.13-0.55). CONCLUSIONS: Nearly one out of every three (29%) women around the world has been a victim of sexual violence in their life. This current study investigated the status and characteristics of sexual violence against women, which could provide an important reference for police and emergency health services management.

Enhancing Circular Polarization Performance of Low-Profile Patch Antennas for Wearables Using Characteristic Mode Analysis.

A wearable antenna functioning in the 2.4 GHz band for health monitoring and sensing is proposed. It is a circularly polarized (CP) patch antenna made from textiles. Despite its low profile (3.34 mm thickness, 0.027 λ0), an enhanced 3-dB axial ratio (AR) bandwidth is achieved by introducing slit-loaded parasitic elements on top of analysis and observations within the framework of Characteristic Mode Analysis (CMA). In detail, the parasitic elements introduce higher-order modes at high frequencies that may contribute to the 3-dB AR bandwidth enhancement. More importantly, additional slit loading is investigated to preserve the higher-order modes while relaxing strong capacitive coupling invoked by the low-profile structure and the parasitic elements. As a result, unlike conventional multilayer designs, a simple single-substrate, low-profile, and low-cost structure is achieved. While compared to traditional low-profile antennas, a significantly widened CP bandwidth is realized. These merits are important for the future massive application. The realized CP bandwidth is 2.2-2.54 GHz (14.3%), which is 3-5 times that of traditional low-profile designs (thickness < 4 mm, 0.04 λ0). A prototype was fabricated and measured with good results.

Blood circulating exosomes carrying microRNA-423-5p regulates cell progression in prostate cancer via targeting FRMD3.

This study explored the role of circulating exosomal microRNA-423-5p in the progression of PCa and its molecular mechanism. First, based on the microarray analysis, microRNA-423-5p was at a high expression level in PCa peripheral blood samples. It was demonstrated that microRNA-423-5p expression in serum exosomes of PCa patients was notably higher than that in healthy people as revealed by qRT-PCR. Further studies indicated that overexpressing microRNA-423-5p promoted cell progression of PCa. Microarray analysis and luciferase gene reporter assay illustrated that FRMD3 was targeted by microRNA-423-5p, and its expression was down-regulated by microRNA-423-5p. While FEMD3 knockdown would reverse the repressive effect of silencing microRNA-423-5p on PCa cell functions. In addition, it was exhibited that exosomes carrying microRNA-423-5p could internalize into PCa cells by labeling and tracing exosomes. Cell function assays and animal experiments manifested those exosomes carrying microRNA-423-5p could enhance PCa cell proliferation, migration, and invasion in vivo. In conclusion, this study indicated that blood circulating exosomal microRNA-423-5p played important roles in PCa cell functions, and illustrated the molecular mechanism of microRNA-423-5p as an oncogene in PCa.

Patients' trust and associated factors among primary care institutions in China: a cross-sectional study.

BACKGROUND: Empirical evidence on patients' trust and the factors among primary care institutions (PCIs) in China is limited. This study aimed to investigate patients' trust and explore some associated factors among PCIs in the central region of China. METHODS: The data was collected through a multistage stratified sampling method with a structured self-administered questionnaire, which was distributed from January to March 2021 among 2,287 Chinese patients ever involved in seeking healthcare among PCIs. Patients' trust was measured with the Chinese version of the Wake Forest Physician Trust Scale (C-WFPTS). Differences in C-WFPTS scores among groups were estimated by t-tests or ANOVA analyses. Multiple linear regression analysis was used to analyze influencing factors for patients' trust in primary care physicians. RESULTS: Based on the C-WFPTS with a full score of 50, the average score of patients' trust was 34.19 (SD = 5.83). Multiple linear analyses indicated that the patients who were older aged, married, with education of higher level, living in urban regions, under better health status and with a family doctor contract reported a higher level of patients' trust. CONCLUSION: Patients' trust in primary care physicians was at a medium but slightly improved level in the central region of China. Age, marital status, education, residential area, health status, and a family doctor contract were significant predictors of patients' trust.

Synergistically Active Piezoelectrical H2 O2 Production Composite Film Achieved from a Catalytically Inert PVDF-HFP Matrix and SiO2 Fillers.

Local and decentralized H2 O2 production via a piezoelectrical process promises smart biological utilization as well as environmental benefits. However, stable, bio/environmentally safe, and easily applied H2 O2 generation materials are still lacking. Here, we report a novel flexible H2 O2 generation polymeric film composed of catalytically inert PVDF-HFP (Poly(vinylidene fluoride-co-hexafluoropropylene)) matrix and SiO2 nanoparticle fillers. The film is bio-/environmentally benign at resting states, but effectively produces H2 O2 upon ultrasonic motivation at a production rate of 492 µmol g SiO 2 - 1 in one hour. Experimental and simulation methods in combination indicate that the effective H2 O2 generation capabilities stem from the synergistic existence of piezoelectrical fields and the air-liquid-solid three-phase regions around the porous film. The chemical conversions are motivated by the adsorbed charges. The silicon hydroxyl groups properly stabilize the *OOH intermediate and facilitate the chemical conversions of 2e- ORR of ambient O2 . We expect the report to inspire H2 O2 piezoelectrical generation materials and promote the novel production strategies of H2 O2 as well as piezoelectrical functional materials.

Piezoelectric-Fenton degradation and mechanism study of Fe2O3/PVDF-HFP porous film drove by flowing water.

Piezocatalysis driven by a gentle force possesses broad application prospects for degrading organic pollutants, sterilisation, wound healing and tissue recovery. The flexible and industrially scalable poly(vinylidene fluoride) (PVDF) film is commonly used in piezocatalysis. However, under gentle force action, PVDF composite-based piezocatalysis is poor. Herein, a flexible porous film based on poly(vinylidene fluoride)-hexafluoro propylene (PVDF-HFP) is enhanced with Fenton fillers (α-Fe2O3 nanoparticles). α-Fe2O3 nanoparticles improve the piezoelectric catalysis performance of PVDF-HFP by the ß-phase enhancement and provide Fe3+ to react with H2O2 generated by the piezoelectric film itself, leading to an additional Fenton reaction. Meanwhile, the Fe3+/Fe2+ cycle in the Fenton process accelerates under the piezoelectric field, promoting the Fenton reaction for 6.9% degradation improvement. The study on Fe2O3/PVDF-HFP porous film with the piezo-Fenton reaction under flowing water may help promote new piezocatalysis designs with high efficiency for self-powered environmental purification.

Ultra-Sensitive, Deformable, and Transparent Triboelectric Tactile Sensor Based on Micro-Pyramid Patterned Ionic Hydrogel for Interactive Human-Machine Interfaces.

Rapid advances in wearable electronics and mechno-sensational human-machine interfaces impose great challenges in developing flexible and deformable tactile sensors with high efficiency, ultra-sensitivity, environment-tolerance, and self-sustainability. Herein, a tactile hydrogel sensor (THS) based on micro-pyramid-patterned double-network (DN) ionic organohydrogels to detect subtle pressure changes by measuring the variations of triboelectric output signal without an external power supply is reported. By the first time of pyramidal-patterned hydrogel fabrication method and laminated polydimethylsiloxane (PDMS) encapsulation process, the self-powered THS shows the advantages of remarkable flexibility, good transparency (≈85%), and excellent sensing performance, including extraordinary sensitivity (45.97 mV Pa-1 ), fast response (≈20 ms), very low limit of detection (50 Pa) as well as good stability (36 000 cycles). Moreover, with the LiBr immersion treatment method, the THS possesses excellent long-term hyper anti-freezing and anti-dehydrating properties, broad environmental tolerance (-20 to 60 °C), and instantaneous peak power density of 20 µW cm-2 , providing reliable contact outputs with different materials and detecting very slight human motions. By integrating the signal acquisition/process circuit, the THS with excellent self-power sensing ability is utilized as a switching button to control electric appliances and robotic hands by simulating human finger gestures, offering its great potentials for wearable and multi-functional electronic applications.

Enzyme-Mimetic Molecular Selective Catalysis via Single Zr Atom Catalysis in Chelated Cage Embedded in a Flexible Piezoelectrical Matrix.

The molecularly selective catalysis in enzyme is central to life. However, their functioning mechanism remains elusive. We propose here that the synergistic effects from (i) effective orbital hybridizing and energy gap decreasing via chelating on single Zr atom as the catalytic center, (ii) selective supramolecular encapsulation in the cage, and (iii) piezoelectrical field motivation are able to achieve the enzyme-mimetic molecular selective high performance catalysis. Metal-organic polyhedra (MOPs) are added into a piezoelectrical polymer matrix to achieve the composite structure where ultrasonic treatment motivates redox reactions in the MOP-guest complex. Encapsulated and chelated guest such as Rhodamine B (RhB) is effectively converted with ratios higher than 90 % after 100 min. In comparison, molecules inefficient in either cage encapsulation or chelating with the Zr center can not be converted. This study first proposes a synergistic plot for enzyme-mimetic catalyst realization and is expected to inspire new mentality in efficient catalyst designing.

H2O2 generation enhancement by ultrasonic nebulisation with a zinc layer for spray disinfection.

With the outbreak of COVID-19, microbial pollution has gained increasing attention as a threat to human health. Consequently, many research efforts are being devoted to the development of efficient disinfection methods. In this context, hydrogen peroxide (H2O2) stands out as a green and broad-spectrum disinfectant, which can be produced and sprayed in the air directly by cavitation in ultrasonic nebulisation. However, the yield of H2O2 obtained by ultrasonic nebulisation is too low to satisfy the requirements for disinfection by spraying and needs to be improved to achieve efficient disinfection of the air and objects. Herein, we report the introduction of a zinc layer into an ultrasonic nebuliser to improve the production of H2O2 and generate additional Zn2+ by self-corrosion, achieving good disinfecting performance. Specifically, a zinc layer was assembled on the oscillator plate of a commercial ultrasonic nebuliser, resulting in a 21-fold increase in the yield of H2O2 and the production of 4.75 µg/mL Zn2+ in the spraying droplets. When the generated water mist was used to treat a bottle polluted with Escherichia coli for 30 min, the sterilisation rate reached 93.53%. This ultrasonic nebulisation using a functional zinc layer successfully enhanced the production of H2O2 while generating Zn2+, providing a platform for the development of new methodologies of spray disinfection.

Daytime naps and depression risk: A meta-analysis of observational studies.

Background: The relationship between daytime napping and depression remains debatable. Thus, a meta-analysis in this study was conducted to evaluate the relationship between daytime napping and depression. Methods: The PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases were searched up to February 2022, and the reference lists of the included studies were also retrieved. A random-effects model was used to estimate the combined effect size. Results: Nine studies with 649,111 participants were included in the final analysis. The pooled odds ratio (OR) was 1.15 (95% confidence interval: 1.01-1.31) with a significant heterogeneity (I 2 = 91.3%, P for heterogeneity <0.001), and the results demonstrated an increased risk of depressive symptoms among daytime nappers. Visual inspection of the funnel plot and Egger's and Begg's tests identified no obvious evidence of publication bias. Conclusion: This meta-analysis indicates that daytime naps are a predictor of depression. The effects of daytime napping on depression may vary depending on the characteristics of people, the pattern of naps, and the individual's sleep experience. The findings may have significant implications for future research on depression.

Screen time and depression risk: A meta-analysis of cohort studies.

Background: The impact of screen time on mental health, including depression, has attracted increasing attention from not only children and adolescents but also the elderly. Thus, we conducted a meta-analysis of cohort studies to evaluate the association between screen time and depression risk. Methods: The PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases were searched for cohort studies up to May 2022, and the reference lists of the included studies were also retrieved. A random-effect model was used to estimate the combined effect size. Heterogeneity was assessed with the I 2 statistic. Potential publication bias was evaluated using a funnel plot and Begg's and Egger's tests. Results: The final analysis included 18 cohort studies with a combined total of 241,398 participants. The pooled risk ratio (RR) was 1.10 (95% confidence interval: 1.05-1.14), with significant heterogeneity (I 2 = 82.7%, P < 0.001). The results of subgroup analyses showed that the pooled RRs varied according to geographic locations, gender, age group, screen time in the control group, depression at the baseline, and whether the study was conducted during the COVID-19 pandemic. No obvious evidence of publication bias was found. Conclusion: This study indicates that screen time is a predictor of depressive symptoms. The effects of screen time on depression risk may vary based on the participant's age, gender, location, and screen time duration. The findings could have important implications for the prevention of depression.

An Electret/Hydrogel-Based Tactile Sensor Boosted by Micro-Patterned and Electrostatic Promoting Methods with Flexibility and Wide-Temperature Tolerance.

With the rising demand for wearable, multifunctional, and flexible electronics, plenty of efforts aiming at wearable devices have been devoted to designing sensors with greater efficiency, wide environment tolerance, and good sustainability. Herein, a thin film of double-network ionic hydrogel with a solution replacement treatment method is fabricated, which not only possesses excellent stretchability (>1100%) and good transparency (>80%), but also maintains a wide application temperature range (-10~40 °C). Moreover, the hydrogel membrane further acts as both the flexible electrode and a triboelectric layer, with a larger friction area achieved through a micro-structure pattern method. Combining this with a corona-charged fluorinated ethylene propylene (FEP) film, an electret/hydrogel-based tactile sensor (EHTS) is designed and fabricated. The output performance of the EHTS is effectively boosted by 156.3% through the hybrid of triboelectric and electrostatic effects, which achieves the open-circuit peak voltage of 12.5 V, short-circuit current of 0.5 µA, and considerable power of 4.3 µW respectively, with a mentionable size of 10 mm × 10 mm × 0.9 mm. The EHTS also demonstrates a stable output characteristic within a wide range of temperature tolerance from -10 to approximately 40 °C and can be further integrated into a mask for human breath monitoring, which could provide for a reliable healthcare service during the COVID-19 pandemic. In general, the EHTS shows excellent potential in the fields of healthcare devices and wearable electronics.

Significant Aggregation-Enhanced Carrier Separation in Nanoscopic Catalysts Heterojunction Stacks.

Nanoscopic heterojunction stacks are prevalent in nature as well as in artificial material systems, such as the nanoscopically blended components in soil or artificial catalytic layers on device surfaces. Despite the enormous attention placed on studying individual heterojunctions, the advantageous catalytic performance of heterojunction aggregates has not been recognized. In this study, we employ the ordered N-doped TiO2 nanosheets and Au nanoparticle heterojunction multilayers obtained by a layer-by-layer technique to investigate the functional merits stemmed from heterojunction aggregates. The study demonstrates that nanoscopic heterojunction stacks promote the internal electric field that stemmed from charge separation and boost carrier separations. The aggregate-enhanced carrier separation can be harnessed in chemical conversions. The enhancement effect is influenced by both the dimensions of the entire aggregates as well as the dimensions of the nanoscopic building units. We expect the study to promote the understanding of heterojunction catalysts and corresponding matter conversion from the individual particulate level to the nanoscopic aggregate level and facilitate better harnessing of the photovoltaic effects or catalytic power in nanoscopic heterojunction aggregates.

Hierarchical Honeycomb-Structured Electret/Triboelectric Nanogenerator for Biomechanical and Morphing Wing Energy Harvesting.

Flexible, compact, lightweight and sustainable power sources are indispensable for modern wearable and personal electronics and small-unmanned aerial vehicles (UAVs). Hierarchical honeycomb has the unique merits of compact mesostructures, excellent energy absorption properties and considerable weight to strength ratios. Herein, a honeycomb-inspired triboelectric nanogenerator (h-TENG) is proposed for biomechanical and UAV morphing wing energy harvesting based on contact triboelectrification wavy surface of cellular honeycomb structure. The wavy surface comprises a multilayered thin film structure (combining polyethylene terephthalate, silver nanowires and fluorinated ethylene propylene) fabricated through high-temperature thermoplastic molding and wafer-level bonding process. With superior synchronization of large amounts of energy generation units with honeycomb cells, the manufactured h-TENG prototype produces the maximum instantaneous open-circuit voltage, short-circuit current and output power of 1207 V, 68.5 µA and 12.4 mW, respectively, corresponding to a remarkable peak power density of 0.275 mW cm-3 (or 2.48 mW g-1) under hand pressing excitations. Attributed to the excellent elastic property of self-rebounding honeycomb structure, the flexible and transparent h-TENG can be easily pressed, bent and integrated into shoes for real-time insole plantar pressure mapping. The lightweight and compact h-TENG is further installed into a morphing wing of small UAVs for efficiently converting the flapping energy of ailerons into electricity for the first time. This research demonstrates this new conceptualizing single h-TENG device's versatility and viability for broad-range real-world application scenarios.

Synergistic Polarization Engineering on Bulk and Surface for Boosting CO2 Photoreduction.

Sluggish charge kinetics and low CO2 affinity seriously inhibit CO2 photoreduction. Herein, the synchronous promotion of charge separation and CO2 affinity of Bi4 Ti3 O12 is realized by coupling corona poling and surface I-grafting. Corona poling enhances ferroelectric polarization of Bi4 Ti3 O12 by aligning the domains direction, which profoundly promotes charge transfer along opposite directions across bulk. Surface I-grafting forms a surface local electric field for further separating charge carriers and provides abundant active sites to enhance CO2 adsorption. The two modifications cooperatively further increase the ferroelectric polarization of Bi4 Ti3 O12 , which maximize the separation efficiency of photogenerated charges, resulting in an enhanced CO production rate of 15.1 µmol g-1 h-1 (nearly 9 times) with no sacrificial agents or cocatalysts. This work discloses that ferroelectric polarization and surface ion grafting can promote CO2 photoreduction in a synergistic way.

Productivity change and its driving forces in Chinese healthcare sector.

Since the last medical reform in 2009, China's public hospitals have been facing the changes in the institutional environment. However, the effects of reforms have not been received enough attention to deliver evidence-based implications. In this paper, we first assess the efficiency of regional public hospitals from 2011 to 2018, employing a proposed method based on an additive indicator and an aggregate directional distance function (DDF). The method applied allows for decomposing total factor productivity (TFP) indicator into three components, including technical efficiency change (TEC), total productivity (TP) and scale efficiency change (SEC). Second, following the efficiency assessment, we carry post-efficiency analysis to identify the determinants of efficiency of the public hospitals. The results show that annual average TFP growth rate is 1.38%, which is driven mainly by TEC. Regional disparities of public hospitals' performance are expanding. Almost 75% of the regions considered show a positive TFP growth. The regression results show that the significant determinants of efficiency of regional public hospitals include the price of and demand for health services.

Technical Efficiency of Regional Public Hospitals in China Based on the Three-Stage DEA.

Many countries are facing the increasing cost of healthcare services and the low efficiency of public hospitals. These issues are also evident in China. This paper offers a comprehensive assessment of the efficiency of public hospitals operating in China's 31 regions. The impact of the third round of reform of the health system in 2009 is assessed based on the three-stage data envelopment analysis procedure. The time period from 2011 to 2018 is covered in this study. Due to different functions performed by the public hospitals and other ones, the number of patients with infectious diseases is incorporated as an output variable reflecting the social function. The outpatient visits and inpatient visits are considered to reflect the outputs related to the private functions. The results imply an increase in the mean efficiency of public hospitals from 0.927 to 0.981 after taking the impact of environmental variables and statistic noise into account. These results indicate that the efficiency of public hospitals is dependent in the operational environment. There are 11 regions whose hospitals operate on the efficiency frontier during the whole period covered. Therefore, the Chinese government should reasonably design and apply the regulatory tools to improve the efficiency of public hospitals.

Modified three-level techniques of retroperitoneal laparoscopic procedures to treat adrenal lesions for patients with BMI ≥ 25 Kg/m2.

Objective: To evaluate the modified Zhang's 'three-level' technique of retroperitoneal laparoscopic adrenalectomy (RLA) to treat adrenal lesions for patients with BMI of 25-30 Kg/m2. Methods: A retrospective analysis was performed in all patients with BMI of 25-30 Kg/m2 in our hospital from January 2014 to December 2019. Those who underwent laparoscopic adrenal surgery were divided into two groups on the basis of the technique used: the Zhang's technique (the ZT group) and the modified technique (the MT group). Results: Herein, 170 operations were included (ZT, 91 patients; MT, 79 patients). RLA was successfully performed in all of them. Compared with the ZT group patients, the MT group patients showed shorter operation time (p = 0.007), lesser intraoperative blood loss (p = 0.023), shorter operation time, earlier postoperative diet recovery (p < 0.001), shorter postoperative drainage time (p < 0.001) and shorter postoperative hospitalization period (p = 0.001). It was also worth noting that the unplanned total adrenalectomy rate was significantly less in the MT group than in the ZT group (0% vs. 10.8%, p = 0.020). There was no significant difference in the complications between the two groups (3.3% vs. 2.5%, p = 0.567). Conclusions: We found that MT was a beneficial retroperitoneal laparoscopic treatment for adrenal lesions in patients who had a BMI of 25-30 Kg/m2. It may provide a reference for the treatment of adrenal surgical diseases in such patients.

Reciprocal genomic evolution in the ant-fungus agricultural symbiosis.

The attine ant-fungus agricultural symbiosis evolved over tens of millions of years, producing complex societies with industrial-scale farming analogous to that of humans. Here we document reciprocal shifts in the genomes and transcriptomes of seven fungus-farming ant species and their fungal cultivars. We show that ant subsistence farming probably originated in the early Tertiary (55-60 MYA), followed by further transitions to the farming of fully domesticated cultivars and leaf-cutting, both arising earlier than previously estimated. Evolutionary modifications in the ants include unprecedented rates of genome-wide structural rearrangement, early loss of arginine biosynthesis and positive selection on chitinase pathways. Modifications of fungal cultivars include loss of a key ligninase domain, changes in chitin synthesis and a reduction in carbohydrate-degrading enzymes as the ants gradually transitioned to functional herbivory. In contrast to human farming, increasing dependence on a single cultivar lineage appears to have been essential to the origin of industrial-scale ant agriculture.