Effectiveness of Educational Interventions for Health Workers on Antibiotic Prescribing in Outpatient Settings in China: A Systematic Review and Meta-Analysis

Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before-after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed

High-resolution vessel wall imaging for quantitatively and qualitatively evaluating in-stent stenosis of intracranial aneurysms

BackgroundIt is critical to accurately and noninvasively evaluate the stented parent artery of intracranial aneurysms (IAs) with endovascular treatment.ObjectiveTo investigate high-resolution vessel wall imaging (HR-VWI) for quantitative and qualitative evaluation of in-stent stenosis (ISS) in IAs treated with stent placement (SP).MethodsFifty-five patients (58 aneurysms) underwent HR-VWI, contrast-enhanced (CE)-HR-VWI, CE-MR angiography (MRA), time-of-flight (TOF)-MRA, and digital subtraction angiography (DSA) six months after SP, and the reliability of quantitative stent lumen measurements was evaluated by intraclass correlation coefficient (ICC) analysis. Agreement and correlation of quantitative evaluation were estimated by comparing the four MR imaging modalities with DSA. The diagnostic performance for >0%, ≥25%, and ≥50% of ISS degrees and overall diagnostic accuracy for the ISS degrees of the four MR imaging modalities were calculated to qualitative evaluation.ResultsThe reliability of CE-HR-VWI and HR-VWI for ISS quantitative measurements was excellent (ICC 0.955–0.989). The agreement and correlation of CE-HR-VWI, HR-VWI versus DSA for ISS quantitative measurements were better than those of CE-MRA and TOF-MRA (p < 0.05). The diagnostic performance for distinguishing the degree of ISS >0%, ≥25%, and ≥50% by CE-HR-VWI and HR-VWI was superior to CE-MRA and TOF-MRA, and their overall diagnostic accuracy was 96.55 and 94.83%, respectively. HR-VWI and CE-HR-VWI were not statistically significant in the quantitative and qualitative evaluation of ISS performance (p > 0.05).ConclusionHR-VWI and CE-HR-VWI have similar performance and value in the quantitative and qualitative evaluation of ISS, and HR-VWI without contrast media could be used as an ideal long-term follow-up approach after SP treatment for IAs

Effects of exercise interventions on negative emotions, cognitive performance and drug craving in methamphetamine addiction

IntroductionMethamphetamine is currently one of the most commonly used addictive substances with strong addiction and a high relapse rate. This systematic review aims to examine the effectiveness of physical activity in improving negative emotions, cognitive impairment, and drug craving in people with methamphetamine use disorder (MUD).MethodsA total of 17 studies out of 133 found from Embase and PubMed were identified, reporting results from 1836 participants from MUD populations. Original research using clearly described physical activity as interventions and reporting quantifiable outcomes of negative mood, cognitive function and drug craving level in people with MUD were eligible for inclusion. We included prospective studies, randomized controlled trials, or intervention studies, focusing on the neurological effects of physical activity on MUD.ResultsTaken together, the available clinical evidence showed that physical activity-based interventions may be effective in managing MUD-related withdrawal symptoms.DiscussionPhysical exercise may improve drug rehabilitation efficiency by improving negative emotions, cognitive behaviors, and drug cravings.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024530359

Two-stage robust planning method for distribution network energy storage based on load forecasting

A two-stage robust planning method for energy storage in distribution networks based on load prediction is proposed to address the uncertainty of active load in energy storage planning. First, considering the uncertainty of active load, a short-term load forecasting model combining the mutual information method and BiLSTM is established based on k-means++ clustering. Second, based on the results of load forecasting, a comprehensive norm-constrained uncertainty set is constructed, and a two-stage robust model for distribution network energy storage planning is established. The first stage aims to minimize the annual investment cost of the energy storage system, while the second stage aims to minimize the daily operating cost of the distribution network. At the same time, a second-order cone relaxation transformation model with non-convex constraints is introduced to ultimately achieve the optimal economy of the distribution network in energy storage planning. Finally, the effectiveness of the proposed method and model is validated on the IEEE 33-node distribution network model using the MATLAB platform

Prognosis of HIV Patients Receiving Antiretroviral Therapy According to CD4 Counts: A Long-term Follow-up study in Yunnan, China

We aim to evaluate the overall survival and associated risk factors for HIV-infected Chinese patients on antiretroviral therapy (ART). 2517 patients receiving ART between 2006 and 2016 were prospectively enrolled in Yunnan province. Kaplan-Meier analyses and Cox proportional hazard regression analyses were performed. 216/2517 patients died during a median 17.5 (interquartile range [IQR] 6.8-33.2) months of follow-up. 82/216 occurred within 6 months of starting ART. Adjusted hazard ratios were10.69 (95%CI 2.38-48.02, p = 0.002) for old age, 1.94 (95%CI 1.40-2.69, p < 0.0001) for advanced WHO stage, and 0.42 (95%CI 0.27-0.63, p < 0.0001) for heterosexual transmission compared to injecting drug users. Surprisingly, adjusted hazard ratios comparing low CD4 counts group (<50 cells/μl) with high CD4 counts group (≥500 cells/μl) within six months after starting ART was 20.17 (95%CI 4.62-87.95, p < 0.0001) and it declined to 3.57 (95%CI 1.10-11.58, p = 0.034) afterwards. Age, WHO stage, transmission route are significantly independent risk factors for ART treated HIV patients. Importantly, baseline CD4 counts is strongly inversely associated with survival in the first six months; whereas it becomes a weak prognostic factor after six months of starting ART

Negative Elongation Factor Controls Energy Homeostasis in Cardiomyocytes

SummaryNegative elongation factor (NELF) is known to enforce promoter-proximal pausing of RNA polymerase II (Pol II), a pervasive phenomenon observed across multicellular genomes. However, the physiological impact of NELF on tissue homeostasis remains unclear. Here, we show that whole-body conditional deletion of the B subunit of NELF (NELF-B) in adult mice results in cardiomyopathy and impaired response to cardiac stress. Tissue-specific knockout of NELF-B confirms its cell-autonomous function in cardiomyocytes. NELF directly supports transcription of those genes encoding rate-limiting enzymes in fatty acid oxidation (FAO) and the tricarboxylic acid (TCA) cycle. NELF also shares extensively transcriptional target genes with peroxisome proliferator-activated receptor α (PPARα), a master regulator of energy metabolism in the myocardium. Mechanistically, NELF helps stabilize the transcription initiation complex at the metabolism-related genes. Our findings strongly indicate that NELF is part of the PPARα-mediated transcription regulatory network that maintains metabolic homeostasis in cardiomyocytes

A correlation analysis of HHV infection and its predictive factors in an HIV-seropositive population in Yunnan, China

Human herpesviruses (HHVs) have a particularly high prevalence in certain high-risk populations and cause increased morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS). Screening and treating subclinical HHV infections reduce human immunodeficiency virus (HIV) infection incidence, disease progression, and transmission. However, there are few studies on HHVs, HIV coinfection rates, and their related risk factors. We aimed to clarify the prevalence of all eight HHVs in peripheral blood samples collected from HIV-positive patients, and explore the association of HHV infection in HIV-positive patients in an HIV-seropositive population in Yunnan. We recruited 121 HIV-positive patients with highly active antiretroviral therapy (HAART) and 45 healthy individuals. All the eight HHVs were detected using polymerase chain reaction and their epidemiological information and clinical data were collected and statistically analyzed. A high prevalence of HHVs (89.3%) was observed in individuals with HIV infections and with herpes simplex virus (HSV)-2 (65.3%), and HSV-1 (59.5%) being the most common. Coinfection with more than two different HHVs was more common in patients with HIV infections receiving HAART (72.7%) than in healthy controls. Older age, being married, higher HIV-1 plasma viral loads, and use of antiviral protease inhibitors were independently correlated with an increased frequency of HHVs, but we found no association with CD4 count, WHO HIV clinical stage, and HIV infection duration. Our findings are of great significance for the prevention of HHV opportunistic infection in patients with AIDS and their clinical treatment

Modeling Rett Syndrome Using TALEN-Edited MECP2 Mutant Cynomolgus Monkeys

Gene-editing technologies have made it feasible to create nonhuman primate models for human genetic disorders. Here, we report detailed genotypes and phenotypes of TALEN-edited MECP2 mutant cynomolgus monkeys serving as a model for a neurodevelopmental disorder, Rett syndrome (RTT), which is caused by loss-of-function mutations in the human MECP2 gene. Male mutant monkeys were embryonic lethal, reiterating that RTT is a disease of females. Through a battery of behavioral analyses, including primate-unique eye-tracking tests, in combination with brain imaging via MRI, we found a series of physiological, behavioral, and structural abnormalities resembling clinical manifestations of RTT. Moreover, blood transcriptome profiling revealed that mutant monkeys resembled RTT patients in immune gene dysregulation. Taken together, the stark similarity in phenotype and/or endophenotype between monkeys and patients suggested that gene-edited RTT founder monkeys would be of value for disease mechanistic studies as well as development of potential therapeutic interventions for RTT

Risk prediction model for postoperative cognitive dysfunction after total knee replacement based on Bayesian network algorithm

Objective To establish a prediction model of risk for postoperative cognitive dysfunction (POCD) after total knee replacement (TKR) by Bayesian network (BN) algorithm and investigate its predictive performance. Methods A case-control trial was conducted on 1 260 inpatients who underwent TKR from January 2017 to December 2021 in the Department of Joint Surgery of our hospital. Their main diagnosis of inclusion was severe osteoarthritis of left/right knee joint. They were 240 cases of male (19.0%) and 1 020 cases of female (81.0%), at an average age of 66.73±8.46 (23~79) years and a mean body mass index (BMI) of 25.08±5.08 kg/m2. The POCD patients (n=71) after surgery (from the end of surgery to discharge) were randomly divided into A1 group and B1 group at a ratio of 7∶3, and those without POCD (1 189 cases) were also randomly divided into A2 group and B2 group at a same ratio. The patients from A1 and A2 groups were combined together as training set, and those out of B1 and B2 groups as test set. Thirty-six indexes related to perioperative anesthesia decision, disease outcome and length of stay in TKR were selected as nodes, and the probability distribution model diagram of each node was established by using BN algorithm to predict the probability of risk for POCD, so as to minimize the length of stay and promote the maximum recovery of patients. Results The prediction model of risk for POCD after TKR was established based on BN algorithm. The area value under receiver operating characteristic curve (ROC-AUC) of the training set was 0.966 1 (95% CI: 0.954 1~0.978 4), and the ROC-AUC value of the test set was 0.897 4 (95% CI: 0.867 2~0.928 5), with an accuracy of 96.43% (95%CI: 0.951 1~0.976 4) and 93.44% (95% CI: 0.909 2~0.959 6), respectively. Conclusion Our risk prediction model for POCD after TKR based on BN algorithm has good performance and high accurac

Distribution network cluster division strategy for active power flow optimization problem

Cluster division can effectively solve the problem of massive data analysis and a large number of equipment regulation caused by large-scale access of new energy to the distribution network. However, existing research on cluster partitioning algorithms exhibits low accuracy and may yield unreasonable outcomes. In order to solve the above problems, factors that should be considered in the cluster division strategy of distribution network are described when a large number of distributed power sources are connected, and the scale limit index is designed accordingly. By studying the process of genetic algorithm, the reason why genetic algorithm shows poor global optimization ability is found out, and then the algorithm is enhanced. Simulation results demonstrate that the proposed scale limit index successfully avoids unreasonable partitioning outcomes. The proposed improved genetic algorithm greatly improves the accuracy of the algorithm. Because the genetic algorithm has no convergence criterion, the reduction of the number of iterations can not directly reduce the experiment time. In summary, the research effectively improve the accuracy of genetic algorithm and enhance the efficiency of cluster division in distributed network