Objective:To systematically integrate domestic and international qualitative studies on the experiences of cardiac rehabilitation in patients with coronary heart disease (CHD), providing a reference for the development of cardiac rehabilitation in China.Methods:A systematic search was conducted for qualitative studies focusing on the theme or the sub-theme of cardiac rehabilitation experiences in CHD patients. The databases searched included China Biology Medicine disc, China National Knowledge Infrastructure, VIP, Wanfang Data, PubMed, Scopus, Embase, Web of Science, CINAHL, and the Cochrane Library, covering the period from their inception to November 1, 2022. The included literature underwent quality assessment and was subjected to Meta-synthesis using an aggregative integration approach.Results:Seventeen articles were ultimately included, yielding 71 distinct and clear research findings. These were categorized into 11 new categories, forming three integrated results: diverse attitudes, facilitating factors, and hindering factors.Conclusions:Currently, there is insufficient health education on cardiac rehabilitation by medical personnel, affecting patients' participation in cardiac rehabilitation programs. Medical staff should expedite the construction of cardiac rehabilitation centers to meet the rehabilitation needs of patients.

The current linear economy model relies on fossil energy and increases CO₂ emissions, which contributes to global warming and environmental pollution. Therefore, there is an urgent need to develop and deploy technologies for carbon capture and utilization to establish a circular economy. The use of acetogens for C1-gas (CO and CO₂) conversion is a promising technology due to high metabolic flexibility, product selectivity, and diversity of the products including chemicals and fuels. This review focuses on the physiological and metabolic mechanisms, genetic and metabolic engineering modifications, fermentation process optimization, and carbon atom economy in the process of C1-gas conversion by acetogens, with the aim to facilitate the industrial scale-up and carbon negative production through acetogen gas fermentation.
Fermentation ; Gases/metabolism* ; Carbon Dioxide/metabolism* ; Metabolic Engineering ; Carbon/metabolism*

Objective:To retrieve evidence on nutritional management in patients with chronic heart failure and summarize the best evidence.Methods:Based on the search terms "heart failure" and "nutrition", the evidence on nutritional management in patients with chronic heart failure including guidelines, evidence summary, expert consensus, recommended practices, systematic reviews, and original studies closely related to the topic were searched through computer on British Medical Journal (BMJ) Best Practice, UpToDate, Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database in Australia, Scottish Intercollegiate Guidelines Network, Guidelines International Network, Cochrane Library, PubMed, China National Knowledge Infrastructure, and other websites and databases. The search period was from the establishment of the database to February 25, 2022. Two researchers evaluated the quality of the included literature and extracted evidence from the literature that met the quality standards.Results:A total of 15 articles were included, including 5 guidelines, 5 expert consensus, and 5 systematic reviews. Finally, 24 best pieces of evidence were summarized, covering 7 aspects, including multidisciplinary team building, nutritional screening and evaluation, nutritional needs, nutrient recommendation, liquid intake management, weight management, and nutritional intervention.Conclusions:This study summarizes the best evidence for nutritional management in patients with chronic heart failure from 7 aspects. Clinical medical and nursing staff can implement evidence conversion applications based on the patient's wishes and clinical actual situation.

IL-34 can promote osteoclast differentiation and activation, which may contribute to steroidinduced osteonecrosis of the femoral head (ONFH). Animal model was constructed in both BALB/c and IL-34 deficient mice to detect the relative expression of inflammation cytokines. Micro-CT was utilized to reveal the internal structure. In vitro differentiated osteoclast was induced by culturing bone marrow-derived macrophages with IL-34 conditioned medium or M-CSF. The relative expression of pro-inflammation cytokines, osteoclast marker genes, and relevant pathways molecules was detected with quantitative real-time RT-PCR, ELISA, and Western blot. Up-regulated IL-34 expression could be detected in the serum of ONFH patients and femoral heads of ONFH mice. IL-34 deficient mice showed the resistance to ONFH induction with the up-regulated trabecular number, trabecular thickness, bone value fraction, and down-regulated trabecular separation. On the other hand, inflammatory cytokines, such as TNF-α, IFN-γ, IL-6, IL-12, IL-2, and IL-17A, showed diminished expression in IL-34 deficient ONFH induced mice. IL-34 alone or works in coordination with M-CSF to promote osteoclastogenesis and activate ERK, STAT3, and non-canonical NF-κB pathways. These data demonstrate that IL-34 can promote the differentiation of osteoclast through ERK, STAT3, and non-canonical NF-κB pathways to aggravate steroid-induced ONFH, and IL-34 can be considered as a treatment target.

Objective:To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods:The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed. The average age was 67.9 (40-87) years old, and the average body mass index was 24.56 (15.12-35.94) kg/m 2. The average PSA was 41.07 ng/ml, including 48 cases<10 ng/ml, 98 cases 10-20 ng/ml, and 412 cases>20 ng/ml. There were 123, 214, 118, 89, and 14 cases with biopsy Gleason 6-10 score, respectively. The clinical stage : 90 cases in ≤T 2b, 273 cases in T 2c, and 195 cases in ≥T 3 . 558 cases underwent radical prostatectomy, including 528 robotic-assisted laparoscopic surgery, 25 laparoscopic surgery, and 5 open-surgery. The risk factors for postoperative biochemical recurrence were analyzed by Cox regression. Results:A total of 63 patients had postoperative pathological stage pT 2a, 32 patients had pT 2b, 241 patients had pT 2c, and 222 patients had ≥pT 3. A total of 210 cases developed biochemical recurrence after surgery, and the mean time to biochemical recurrence was 33.3 (3-127) months after the radical prostatectomy. The biochemical recurrence rates at 1, 3, and 5 years were 9.7% (54/558), 21.5% (120/558), and 31.7% (177/558), respectively. Among pT 2a and pT 2b patients, 7 (11.1%) and 4 (12.5%) cases developed biochemical recurrence, respectively. Among pT 2c stage patients, 145 (60.17%) cases had positive cut margins, treated with androgen-deprivation therapy (ADT) after surgery. 68 (28.21%) cases of pT 2c stage patients had biochemical recurrence at mean 36.1 (3-106)months after the radical prostatectomy. Among ≥pT 3 patients, 147 patients with positive margins, perineural invasion, seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy (ADT) + radiotherapy. 98 of 147 patients (66.67%) had biochemical recurrence, and the average time to biochemical recurrence was 30.6 (24-98) months.75 patients of ≥pT 3 without positive margins, perineural invasion, seminal vesicle invasion or positive pelvic lymph nodes, were treated with postoperative ADT. 33 of them (44%) had biochemical recurrence, and the average time to biochemical recurrence was 32.5 (21-106) months. 5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05% (187/210) and 78.09% (164/210) respectively, 5- and 10-year tumor-specific survival rates were 92.57% and 87.69%, respectively. 46 of 210 cases died, of which 31 (67.39%) died from prostate cancer, and 15 cases (32.61%) died from cardiovascular and cerebrovascular diseases. Multifactorial Cox regression analysis showed that patient's age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7 were independent risk factors for biochemical recurrence. Conclusions:After radical prostatectomy, patients were treated according to their pathological stage and surgical margins. Patients with positive margins have a higher risk of biochemical recurrence. The independent risk factors for biochemical recurrence included age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7.

Objective:To establish an artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning optical coherence tomography (OCT) and evaluate its application value.Methods:Diagnostic test studies. From 2016 to 2019, 25 000 OCT images of 25 000 patients treated at the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were used as training sets and validation sets for the fundus intelligent assisted diagnosis system. Among them, macular epiretinal membrane (MERM), macular edema, macular hole, choroidal neovascularization (CNV), and age-related macular degeneration (AMD) were 5 000 sheets each. The training set and the verification set are 18 124 and 6 876 sheets, respectively. Through the transfer learning Attention ResNet structure algorithm, the OCT image was characterized by lesion identification, the disease feature was extracted by a specific procedure, and the given image was distinguished from other types of disease according to the statistical characteristics of the target lesion. The model algorithms of MERM, macular edema, macular hole, CNV and AMD were initially formed, and the fundus intelligent auxiliary diagnosis system of five models was established. The performance of each model-assisted diagnosis in the fundus intelligent auxiliary diagnostic system was evaluated by applying the subject working characteristic curve, area under the curve (AUC), sensitivity, and specificity.Results:With the intelligent auxiliary diagnosis system, the diagnostic sensitivity of the MERM was 93.5%, the specificity was 99.23%, and AUC was 0.983 7; the diagnostic sensitivity of macular edema was 99.02%, the specificity was 98.17%, and AUC was 0.994 6; the diagnostic sensitivity of macular hole was 98.91%, the specificity was 99.91%, AUC was 0.996 2; the diagnostic sensitivity of CNV was 97.54%, the specificity was 94.71%, AUC was 0.987 5; the diagnostic sensitivity of AMD was 95.12%, the specificity was 97.09%, AUC was 0.985 3.Conclusions:The artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning for OCT images has accurate and efficient diagnostic performance for assisting the diagnosis of MERM, macular edema, macular hole, CNV, and AMD.

We retrospectively analyzed the clinical characteristic of one patient with metastatic prostate cancer and the relative literatures were reviewed. A 40-year-old man was admitted and diagnosed as prostate cancer on March 20, 2018(T 4N 1M 1a) with prostate-specific antigen (PSA) at 47.99 ng/ml. The first 68Ga-PSMA PET/CT showed multiple nodular lesions in the bilateral peripheral bands of the prostate, multiple nodular lesions in the right apex, abnormal uptake of nuclides in multiple lymph nodes in the abdominal aortic wandering zone, the abdominal aortic bifurcation zone, and the bilateral iliac artery wandering zone at the level of the lumbar 2-5 vertebral body, and metastasis was considered. The patient was treated with six cycles of drug castration combined with antiandrogenic treatment and pre-operative system chemotherapy(docetaxel). Six months later, the PSA decreased to 0.225ng/ml. Robot-assisted laparoscopic prostatectomy and expanded pelvic lymph node dissection was performed. Postoperative total androgen blocking therapy was maintained, and PSA slowly increased. Ten months after operation, salvage radiotherapy for enlarged lymph nodes was performed in pelvic extension field, prostate tumor bed area and pelvic cavity. PSA remained stable for 7 months postradiotherapy, and then increased. The patient developed castration-resistant prostate cancer and was treated with triptorelin combined with abiraterone. PSA was decreased, and local radiotherapy was performed for new lymph node metastases in the neck. 68Ga-PSMA PET/CT could provide a decision-making basis for accurate clinical staging, therapeutic effect evaluation and distant metastatic lesions location with guiding value for the formulation of individualized treatment plans.

Hormone-sensitive prostate cancer with visceral metastasis is a difficulty in clinical diagnosis and treatment. We treated a patient with hormone-sensitive prostate cancer with visceral metastasis and managed it under the multi-disciplinary treatment model (MDT). A 55-year-old man presented to the hospital complaining of increased prostate-specific antigen (PSA) found in the physical examination for 2 days. At admission, the PSA was 389.2ng/ml, and 68Ga-PSMA PET/CT showed metastatic malignant lesions of the prostate, with lymph node metastasis, lumbar vertebral metastases and liver tubercles. Transrectal prostate puncture biopsy: prostate adenocarcinoma, Gleason score of 4+ 5=9. The patient has no history of androgen deprivation therapy (ADT) and diagnosed as metastatic hormone-sensitive prostate cancer (mHSPC). Then the patient received total androgen blockade therapy (CAB regimen). After MDT discussion, metastatic prostate cancer was diagnosed based on the liver histopathology of percutaneous biopsy. After the second MDT discussion, the regimen was changed to abirone plus ADT. After 6 months, the blood PSA was controlled at a level between 0.003 to 0.006 ng/ml, and the testosterone was less than 2.5ng/dl. Re-examination of 68Ga-PSMA PET/CT showed that lower signal of radionuclide in all lesions, especially no more abnormal uptake lesions were identified in the liver.

Objective:To investigate the normal range of exhaled nitric oxide (FeNO) in 6-18-year-old children in China, so as to provide a data base for the establishment of FeNO standards for Chinese children.Methods:A multi-center study was conducted on 5 949 children aged 6-18 (3 101 males and 2 848 females) in 16 pro-vinces of 7 administrative districts in China.According to the technical standard recommended by American Thoracic Society/European Respiratory Association, FeNO was measured, and the relationship of FeNO with the sex, age, height, weight, body mass index and region was discussed.Results:The geometric mean FeNO value of Chinese children aged 6-18 was 14.1 ppb, and its 95% confidence interval (skewness distribution) was 1.0-38.2 ppb.The geometric mean FeNO values of children aged 6-11 and 12-18 were 13.1 ppb and 15.7 ppb, respectively, and their 95% confidence intervals (skewness distribution) were 1.0-38.1 ppb and 2.0-38.2 ppb.For children at and under 11 years old, FeNO decreased with age, with a mean decline of 1 ppb per year.The multiple linear regression results suggested that there was a significant correlation between FeNO and age for children aged 6-11, and FeNO of children aged 12-18 was significantly correlated with the gender, height, and region(all P<0.01). Conclusions:FeNO values of Chinese children and adolescents in this study are higher than those obtained by the previous study conducted from 2010 to 2012.For children aged 12-18, 16 ppb is recommended as the clinical cut-off point.For children at or under 11 years old, the influence of age on FeNO should be considered, and the cut-off point of FeNO decreases by 1 ppb as the age is reduced by one year.

Objective: To investigate the prevalence of biting pencils among pupils living in Harbin, Guangzhou, and Beijing and to compare the differences among these cases. Methods: Stratified sampling method was used to select four elementary schools in Harbin and Guangzhou from April 2015 to April 2016. Firstly, Simple random sampling method was used in every grade (grade 1-grade 5) to select 3 or 4 classes (71 classes in total).After the sample selection, questionnaire surveys were conducted among pupils and their guardians (anyone of their guardians) who belonged to these classes. Secondly, the study extracted part of these pupils to conduct a field survey. Every school was classified by grade, and every grade adopted the method of random sampling to select one classes (20 classes in total). Meanwhile, the study randomly selected pupils from 10 classes in 2 elementary schools in Beijing. All together, 1 627 pupils participated in the field survey. The questionnaire included general information about the students and their guardians, the situation of biting pencils, the awareness of the harm of biting pencils, etc.; the field survey considered if participates' pencils have tooth marks and the severity of the marks, etc. χ² was applied to test and compare the differences among pupils of different genders and different cities. The comparison focused on the proportion of students who bited pencils, the proportion of pencils with tooth marks and the proportion of students and guardians already awared of the harm of biting pencils, etc. Results: The number of the valid questionnaires in Harbin and Guangzhou were 1 842, and 1 210, respectively. The occurrence rate of pupils biting pencils in Harbin (18.0% (333/1 842)) was higher than that in Guangzhou (11.3% (137/1 210)) (χ²=29.16, P=0.001). Specifically, in Harbin, the rate of boys biting pencils was 21.9% (212/965), which was higher than girls (13.8% (121/877)) (χ²=27.04, P=0.001). Similarly, in Guangzhou, the rate of boys biting pencils was 14.5% (92/632), which was also higher than girls (7.7% (45/578)) (χ²=15.34, P=0.001). The awareness rate of the harm of biting pencils among students from these two cities were 88.5% (1 611/1 819), and 90.8% (1 098/1 208), respectively, and the difference was statistically significant as well (χ²=4.39, P= 0.020). Compared with these data, the awareness rate of the harm of biting pencils among guardians from these two cities were 74.7% (1 339/1 791), and 79.4% (832/1 047), respectively as well as the statistically significant difference appeared (χ²=9.83, P=0.007). The result of field survey showed the rate of tooth-marked pencils in Harbin, Guangzhou and Beijing was 30.5% (187/613), 14.8% (79/534), and 28.3% (136/480), respectively. The difference was also statistically significant (χ²=42.68, P=0.001). The degree of tooth marks was mainly mild, while the percentage of mild degree in Guangzhou (54.4%(43/79)) and Beijing (41.2% (56/136)) was apparently higher than that of Harbin (39.0% (73/187)). The difference was not statistically significant (χ²=7.01, P=0.136). Conclusion The behavior of biting pencils existed universally among pupils in Harbin, Guangzhou, and Beijing , which the situation of pupils biting pencils in Harbin and Beijing was more serious than that in Guangzhou. Pupils, parents and teachers should pay attention to such a behavior.