Microsyringe-based slug-flow microextraction for rapid and accurate determination of antibiotics in highly saline seawater.

BACKGROUND: Extensive use of antibiotics leads to widespread environmental pollution, endangering ecosystems, and human health. It is particularly concerning, posing global threats requiring urgent attention and action. In this regard, the shift to mass spectrometry in determining antibiotics is highly desirable. Significant progress has been made in analyzing and optimizing the sensitivity of high-salt samples. However, the persistence of cumbersome operational procedures presents a significant challenge to this shift. Thus, the persistence of complex operational procedures needs to be addressed. RESULTS: In this study, a rapid and direct method for determining antibiotics in highly saline environmental water samples using microsyringe-based slug-flow microextraction (MSFME)-droplet spray ionization (DSI) mass spectrometry (MS) has been described. The proposed method successfully detected clarithromycin, ofloxacin, and sulfadimidine in seawater within a linear range of 1-1200 ng mL-1, with low limits of detection of 0.19 ng mL-1, 0.17 ng mL-1, and 0.20 ng mL-1, respectively (Signal/Noise = 3). Additionally, spiked real seawater samples of all three antibiotics demonstrated satisfactory recoveries (95.1-107.5%) and precision (RSD≤8.8%). The MSFME-treated high-salt sample (3.5 wt%) showed a mass spectral response intensity 4-5 orders of magnitude higher than the untreated medium-salt sample (0.35 wt%). Furthermore, exploration of the applicability of MSFME showed that it is suitable not only for high-salinity (3.5 wt%) samples but also for salt-free or low-salt and hard water samples rich in calcium and magnesium ions. SIGNIFICANCE: Comparisons with other methods, complex laboratory setups for sample processing are now simplified to a single step, completing the entire process, including desalination and detection, MSFME-DSI-MS provides faster results in less than 1 min while maintaining sensitivity comparable to that of other detection methods. In conclusion, this advancement provides an exceptionally simplified protocol for the rapid, highly sensitive, and quantitative determination of antibiotics in environmental water samples.

Research on dependent evidence combination based on principal component analysis.

Dempster-Shafer evidence theory, as a generalization of probability theory, is a powerful tool for dealing with a variety of uncertainties, such as incompleteness, ambiguity, and conflict. Because of its advantages in information fusion compared with traditional probability theory, it is widely used in various fields. However, the classic Dempster's combination rule assumes that evidences are independent of each other, which is difficult to satisfy in real life. Ignoring the dependence among the evidences will lead to unreasonable fusion results, and even wrong conclusions. Considering the limitations of D-S evidence theory, this paper proposed a new evidence fusion model based on principal component analysis (PCA) to deal with the dependence among evidences. First, the approximate independent principal components of each information source were obtained based on principal component analysis. Second, the principal component data set was used as a new information source for evidence theory. Third, the basic belief assignments (BBAs) were constructed. As the fundamental construct of evidence theory, a BBA is a probabilistic function corresponding to each hypothesis, quantifying the belief assigned based on the evidence at hand. This function facilitates the synthesis of disparate evidence sources into a mathematically coherent and unified belief structure. After constructing the BBAs, the BBAs were fused and a conclusion was drawn. The case study verified that the proposed method is more robust than several traditional methods and can deal with redundant information effectively to obtain more stable results.

One-step online analysis of antibiotics in highly saline seawater by nano-based slug-flow microextraction.

The transition to mass spectrometry (MS) in the analysis of antibiotics in the marine environment is highly desirable, particularly in the enhancement of sensitivity for high-salinity (3.5 wt%) seawater samples. However, the persistence of complex operational procedures poses substantial challenges to this transition. In this study, a rapid method for the online analysis of antibiotics in seawater samples via nano-electrospray ionization (nESI) MS based on slug-flow microextraction (SFME) has been proposed. Comparisons with other methods, complex laboratory setups for sample processing are now seamlessly integrated into a single online step, completing the entire process, including desalination and detection, SFME-nESI-MS provides faster results in less than 2 min while maintaining sensitivity comparable to that of other detection methods. Using SFME-nESI, six antibiotics in high-salinity (3.5 wt%) seawater samples have been determined in both positive and negative ion modes. The proposed method successfully detected clarithromycin, ofloxacin, and sulfadimidine in seawater within a linear range of 1-1000 ng mL-1 and limit of detection (LOD) of 0.23, 0.06, and 0.28 ng mL-1, respectively. The method recovery was from 92.8% to 107.3%, and the relative standard deviation was less than 7.5%. In addition, the response intensity of SFME-nESI-treated high-salinity (3.5 wt%) samples surpassed that of untreated medium-salinity (0.35 wt%) samples by two to five orders of magnitude. This advancement provides an exceptionally simplified protocol for the online rapid, highly sensitive, and quantitative determination of antibiotics in high-salinity (3.5 wt%) seawater.

Cathodic electrochemiluminescence of L012 and its application in antioxidant detection.

Cathodic electrochemiluminescence (ECL) of a luminol (or its analogues)-dissolved oxygen (O2) system is an ideal alternative to ECL of the traditional luminol-hydrogen peroxide (H2O2) system, which can efficiently avoid the self-decomposition of H2O2 at room temperature. However, the mechanism for the generation of cathodic ECL by the luminol (or its analogues)-O2 system is still ambiguous. Herein, we report the study of cathodic ECL generation by the L012-O2 system at a glassy carbon electrode (GCE). The types of reactive oxygen species (ROS) involved generated during ECL reactions were verified. A possible reaction mechanism for the system was proposed and the rate constants of related reactions were estimated. Furthermore, several intermediates of L012 involved in the proposed pathways were validated by electrochemistry-coupled mass spectrometry. Finally, the cathodic ECL system was successfully used for measuring the antioxidant capacity of commercial juice with Trolox as a standard.

Connecting through clicks: A longitudinal examination of internet use and depressive symptoms among middle- and old-aged Chinese.

AIM: While prior investigations into the influence of internet engagement on depressive symptoms in middle-aged and older individuals have largely been favorable, concerns persist. Some research posits that internet use may detract from direct interpersonal interactions, elevating depression risks. Here, we scrutinize these contrasting views, endeavoring to delineate the relationship between internet use, social participation, and the ensuing depressive manifestations. METHODS: We analyzed nationally representative data from three consecutive waves (2013-T1, 2015-T2, 2018-T3) of the China Health and Retirement Longitudinal Study survey. Measures of social participation encompassed formal social participation (i.e., attending clubs for mahjong, chess, sports, or other activities; participation in community organizations, volunteering, or enrolling in training courses) and informal social participation (i.e., interactions with friends or extending assistance to relatives, friends, or neighbors). Structural equation modeling was used to evaluate a focused longitudinal mediation model. RESULTS: Our dataset comprised 13 671 individuals aged 45 years or older. Baseline internet use was associated with a decrease in depressive symptoms by T3 ( c ' = -0.143, SE = 0.055). The longitudinal association between internet use and the alleviation of depressive symptoms was partially mediated by enhanced formal social participation (indirect effect a 1 × b 1 = -0.023, SE = 0.011). CONCLUSIONS: For developing nations such as China, grappling with a rapidly aging demographic and scarce mental health infrastructure, pioneering initiatives that merge digital and formal social participation might be a valuable component in a multifaceted approach to alleviate late-life depression. Geriatr Gerontol Int 2024; 24: 218-224.

The Impact of Everyday ICT Use on Depressive Symptoms Among Older Adults in China: A Subjective Social Status Perspective.

OBJECTIVES: While numerous studies have highlighted the positive effects of everyday information and communication technology (EICT) use among older adults, emerging evidence signals potential detriments to mental health, particularly among younger demographics. This study aims to examine the effect of EICT on depressive symptoms among Chinese older adults. We hypothesize that EICT use among older adults will contribute to higher amounts of depressive symptoms, mediated by a decline in subjective social status. METHODS: We conducted a longitudinal mediation analysis with data from the China Family Panel Studies (CFPS), a nationally representative survey. A total of 3,234 older adults aged 60 years and older were selected from Wave 2016 (T1), Wave 2018 (T2), and Wave 2020 (T3) of the CFPS. Structural equation modeling was used to construct complete longitudinal path model. RESULTS: EICT use at T1 predicted a decline in subjective social status at T2 (ß = -0.215, p = .001), which in turn predicted higher depressive symptoms at T3 (ß = -0.375, p = .005). The mediating effect of subjective social status was statistically supported (indirect effect 0.081, p = .042). DISCUSSION: We reveal the potential negative impact of EICT use among older adults and its underlying mechanism. It lays the groundwork for the formulation of relevant public health initiatives, critical for stemming and mitigating the burgeoning incidence of depressive symptoms within China's aging population.

Randomized phase III study comparing the first-line chemotherapy regimens in patients with driver mutation-negative advanced non-small cell lung cancer and poor performance status complicated with chronic obstructive pulmonary disease.

BACKGROUND: Patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) with poor performance status (PS) are common in clinical practice with few related studies. Present studies have found that weekly low-dose docetaxel or gemcitabine combined with platinum is suitable for elderly or poor PS patients with advanced NSCLC. METHODS: Untreated advanced driver mutation-negative NSCLC patients with COPD and PS ≥2 were enrolled in this double-blind randomized trial. Both groups controlled their COPD symptoms according to the GOLD guidelines. The anti-tumor regimens included docetaxel (37.5 mg/m2, D1, D8)/carboplatin (AUC 5.0) (DC group) and gemcitabine (1,000 mg/m2, D1, D8)/carboplatin (AUC 5.0) (GC group) were used every 3 weeks with continuous chemotherapy for 4-6 cycles or until disease progression. The primary endpoints were progression-free survival (PFS), and overall survival (OS). RESULTS: Among the 52 patients (DC, n=25; GC, n=27), the median follow-up time was 12.3 months. There was no significant difference in tumor overall response rate (ORR; DC, 20.0% vs. GC, 22.2%, P=0.845) and disease control rate (DCR; DC, 72.0% vs. GC, 74.1%, P=0.064) between the 2 groups. The median PFS (GC, 6.5 vs. DC, 5.5 months; P=0.296) and the median OS (GC, 14.9 vs. DC, 12.3 months; P=0.548) of the GC group was slightly longer than the DC group. The main adverse reactions were myelosuppression and there were few adverse reactions of grade 3-4. Compared with the anti-tumor therapy only group in previous literature, the median PFS in this study was longer (6.2 months, 95% CI: 3.533-6.733 vs. 3.5 months, 95% CI: 2.432-4.568; P=0.589). There was also no significant difference in median OS and median PFS between the 2 groups (14.0 vs. 15.0 months, P=0.718). Chemotherapy cycle (P<0.001) was an independent prognostic factor for PFS, while chemotherapy cycle (P=0.011) and PS (P=0.041) were independent prognostic factors for OS. CONCLUSIONS: Weekly low-dose docetaxel or gemcitabine combined with carboplatin chemotherapy regimens can yield survival benefits and a tolerable safety profile in patients with driver mutation-negative advanced NSCLC and poor PS complicated with COPD, with no significant difference between the two regimens. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-15006164.

Erratum to risk factors and predictors associated with the severity of COVID-19 in China: a systematic review, meta-analysis, and meta-regression.

[This corrects the article DOI: 10.21037/jtd-20-1743.].

Patient Questions and Physician Responses in a Chinese Health Q&A Website: Content Analysis.

BACKGROUND: Since the turn of this century, the internet has become an invaluable resource for people seeking health information and answers to health-related queries. Health question and answer websites have grown in popularity in recent years as a means for patients to obtain health information from medical professionals. For patients suffering from chronic illnesses, it is vital that health care providers become better acquainted with patients' information needs and learn how they express them in text format. OBJECTIVE: The aims of this study were to: (1) explore whether patients can accurately and adequately express their information needs on health question and answer websites, (2) identify what types of problems are of most concern to those suffering from chronic illnesses, and (3) determine the relationship between question characteristics and the number of answers received. METHODS: Questions were collected from a leading Chinese health question and answer website called "All questions will be answered" in January 2018. We focused on questions relating to diabetes and hepatitis, including those that were free and those that were financially rewarded. Content analysis was completed on a total of 7068 (diabetes) and 6685 (hepatitis) textual questions. Correlations between the characteristics of questions (number of words per question, value of reward) and the number of answers received were evaluated using linear regression analysis. RESULTS: The majority of patients are able to accurately express their problem in text format, while some patients may require minor social support. The questions posted were related to three main topics: (1) prevention and examination, (2) diagnosis, and (3) treatment. Patients with diabetes were most concerned with the treatment received, whereas patients with hepatitis focused on the diagnosis results. The number of words per question and the value of the reward were negatively correlated with the number of answers. The number of words per question and the value of the reward were negatively correlated with the number of answers. CONCLUSIONS: This study provides valuable insights into the ability of patients suffering from chronic illnesses to make an understandable request on health question and answer websites. Health topics relating to diabetes and hepatitis were classified to address the health information needs of chronically ill patients. Furthermore, identification of the factors affecting the number of answers received per question can help users of these websites to better frame their questions to obtain more valuable answers.

Risk factors and predictors associated with the severity of COVID-19 in China: a systematic review, meta-analysis, and meta-regression.

Since December 2019, the pneumonia cases infected with 2019 novel coronavirus have appeared, posing a critical threat to global health. In this study, we performed a meta-analysis to discover the different clinical characteristics between severe and non-severe patients with COVID-19 to find the potential risk factors and predictors of this disease's severity, as well as to serve as a guidance for subsequent epidemic prevention and control work. PubMed, Cochrane Library, Medline, Embase and other databases were searched to collect studies on the difference of clinical characteristics of severe and non-severe patients. Meta-analysis was performed using RevMan 5.3 software, and the funnel plots could be made to evaluate the publication bias. P>0.05 means no statistical significance. Furthermore, a meta-regression analysis was performed by using Stata 15.0 to find the potential factors of the high degree of heterogeneity (I2>50%). Sixteen studies have been included, with 1,172 severe patients and 2,803 non-severe patients. Compared with non-severe patients, severe patients were more likely to have the symptoms of dyspnea, hemoptysis, and the complications of ARDS, shock, secondary infection, acute kidney injury, and acute cardiac injury. Interestingly, the former smokers were more prevalent in severe cases as compared to non-severe cases, but there was no difference between the two groups of 'current smokers'. Except for chronic liver disease and chronic kidney disease, the underlying comorbidities of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), malignancy, cerebrovascular disease, and HIV can make the disease worse. In terms of laboratory indicators, the decreased lymphocyte and platelet count, and the increased levels of white blood cell (WBC), D-dimer, creatine kinase, lactate dehydrogenase, procalcitonin, alanine aminotransferase, aspartate aminotransferase, and C-reactive protein were more prevalent in severe patients. Meta-regression analysis showed that patient age, gender, and proportion of severe cases did not significantly impact on the outcomes of any clinical indexes that showed high degree of heterogeneity in the meta-analysis. In conclusion, the severity of COVID-19 could be evaluated by, radiologic finding, some symptoms like dyspnea and hemoptysis, some laboratory indicators, and smoking history, especially the ex-smokers. Compared with non-severe patients, severe patients were more likely to have complications and comorbidities including hypertension, cardiovascular disease etc., which were the risk factors for the disease to be severer, but the chronic liver disease and chronic kidney disease were not associated the severity of COVID-19 in China.

The Effect of Online Effort and Reputation of Physicians on Patients' Choice: 3-Wave Data Analysis of China's Good Doctor Website.

BACKGROUND: Nowadays, patients are seeking physician information more frequently via the internet. Physician-rating websites (PRWs) have been recognized as the most convenient way to gain insight and detailed information about specific physicians before receiving consultation. However, little is known about how the information provided on PRWs may affect patients' decisions to seek medical advice. OBJECTIVE: This study aimed to examine whether the physicians' online efforts and their reputation have a relationship with patients' choice of physician on PRWs. METHODS: A model, based on social exchange theory, was developed to analyze the factors associated with the number of online patients. A 3-wave data collection exercise, covering 4037 physicians on China's Good Doctor website, was conducted during the months of February, April, and June 2017. Increases in consultation in a 60-day period were used as the dependent variable, whereas 2 series of data were analyzed using linear regression modeling. The fixed-effect model was used to analyze the 3-wave data. RESULTS: The adjusted R2 value in the linear regression models were 0.28 and 0.27, whereas in the fixed-effect model, it was .30. Both the linear regression and fixed-effect models yielded a good fit. A positive effect of physicians' effort on the aggregated number of online patients was identified in all models (R2=0.30 and R2=0.37 in 2 regression models; R2=0.23 in fixed effect model; P<.001). The proxies of physicians' reputations indicated different results, with total number of page views of physicians' homepages (R2=0.43 and R2=0.46; R2=0.16; P<.001) and number of votes received (R2=0.33 and R2=0.27; R2=0.43; P<.001) being seen as positive. Virtual gifts were not significant in all models, whereas thank-you messages were only significant in the fixed-effect model (R2=0.11; P=.02). The effort made by physicians online is positively associated with their aggregated number of patients consulted, whereas the effect of a physician's reputation remains uncertain. The control effect of a physician's title and hospital's level was not significant in all linear regressions. CONCLUSIONS: Both the effort and reputation of physicians online contribute to the increased number of online patients' consultation; however, the influence of a physician's reputation varies. This may imply that physicians' online effort and reputation are critical in attracting patients and that strategic manipulation of physician profiles is worthy of study. Practical insights are also discussed.

Health information in the digital age: an empirical study of the perceived benefits and costs of seeking and using health information from online sources.

OBJECTIVE: This paper aims to explore the determinants of the online health information seeking (OHIS) and usage (OHIU) behaviours of consumers based on the perceived benefits and costs of such activities. METHODS: This study applies questionnaires and empirical research methods. A questionnaire is designed according to the hypothesis model. A total of 282 questionnaires are obtained from patients and their accompanying families in two large hospitals, and the SPSS 17.0 and AMOS 17.0 (IBM, Almond, NY, USA) software are used to analyse the sample data and to test the research models. RESULTS: Three key findings are obtained from the analysis. Firstly, functional, learning, social and personal integrative benefits positively affect the OHIS intent of consumers. Secondly, cognitive costs negatively influence the OHIU behaviour of consumers. Thirdly, personal integrative benefits and OHIS behaviour significantly influence the OHIU behaviour of consumers. CONCLUSION: This paper highlights the differences between OHIS and OHIU based on their impact factors and applies social exchange theory to understand such factors. Online health information providers must improve the ease of use of their websites or applications, enhance the quality of their health information and focus on their functionality.

Examining factors affecting patients trust in online healthcare services in China: The moderating role of the purpose of use.

With the development of Web 2.0 technologies, an increasing number of websites are providing online healthcare services, and they have potential to alleviate problems of overloaded medical resources in China. However, some patients are reluctant to trust and continue using online healthcare services, partly due to the immature development of healthcare websites. Previous research has argued that online trust is significantly associated with the risk or benefit perceived by users. This study aims to extend prior research and examine how perceptual factors influence patients' online trust and intention to continue using online healthcare services. We developed a model with the moderating role of purpose of use and tested it with data collected from 283 participants. The results support the validity of the model and most hypotheses. The moderating role of purpose of use between the perceived benefits/risks and patients' online trust is also highlighted. Theoretical and practical implications are also discussed.

What Predicts Patients' Adoption Intention Toward mHealth Services in China: Empirical Study.

BACKGROUND: With the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients' willingness to use mHealth is considered critical because its success depends on the adoption of patients. OBJECTIVE: The objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks. METHODS: We conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling. RESULTS: The results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients' trust and adoption intention toward mHealth services. In addition, patients' age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively. CONCLUSIONS: We concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients.

Unhappy Patients Are Not Alike: Content Analysis of the Negative Comments from China's Good Doctor Website.

BACKGROUND: With the rise in popularity of Web 2.0 technologies, the sharing of patient experiences about physicians on online forums and medical websites has become a common practice. However, negative comments posted by patients are considered to be more influential by other patients and physicians than those that are satisfactory. OBJECTIVE: The aim of this study was to analyze negative comments posted online about physicians and to identify possible solutions to improve patient satisfaction, as well as their relationship with physicians. METHODS: A Java-based program was developed to collect patient comments on the Good Doctor website, one of the most popular online health communities in China. A total of 3012 negative comments concerning 1029 physicians (mean 2.93 [SD 4.14]) from 5 highly ranked hospitals in Beijing were extracted for content analysis. An initial coding framework was constructed with 2 research assistants involved in the codification. RESULTS: Analysis, based on the collected 3012 negative comments, revealed that unhappy patients are not alike and that their complaints cover a wide range of issues experienced throughout the whole process of medical consultation. Among them, physicians in Obstetrics and Gynecology (606/3012, 20.12%; P=.001) and Internal Medicine (487/3012, 16.17%; P=.80) received the most negative comments. For negative comments per physician, Dermatology and Sexually Transmitted Diseases (mean 5.72, P<.001) and Andrology (mean 5, P=.02) ranked the highest. Complaints relating to insufficient medical consultation duration (577/3012, 19.16%), physician impatience (527/3012, 17.50%), and perceived poor therapeutic effect (370/3012, 12.28%) received the highest number of negative comments. Specific groups of people, such as those accompanying older patients or children, traveling patients, or very important person registrants, were shown to demonstrate little tolerance for poor medical service. CONCLUSIONS: Analysis of online patient complaints provides an innovative approach to understand factors associated with patient dissatisfaction. The outcomes of this study could be of benefit to hospitals or physicians seeking to improve their delivery of patient-centered services. Patients are expected to be more understanding of overloaded physicians' workloads, which are impacted by China's stretched medical resources, as efforts are made to build more harmonious physician-patient relationships.