Shanghai International Medical Center

High-definition transcranial alternating current stimulation (HD-tACS) is an emerging neuromodulatory intervention for major depressive disorder (MDD). Here, we evaluate the efficacy and safety of a portable, low-intensity (1.6 mA), 10 Hz HD-tACS protocol targeting the bilateral dorsolateral prefrontal cortex (DLPFC) in adults with MDD. This randomized clinical trial was conducted including 120 adult MDD participants. Participants underwent 20 sessions (5 sessions/week for 4 weeks) of either active 10 Hz HD-tACS (1.6 mA) or sham stimulation a ratio of 1:1 and were followed for an additional 4 weeks. The primary outcome was the percentage reduction in 17-item Hamilton Depression Rating Scale scores at week 4. The active group showed significantly greater improvement in depression than the sham group (48% ± 14% vs 24% ± 13%, p < 0.001), sustained through the 4-week follow-up period. Additionally, significant improvements in the active group were also found in anxiety, sleep efficiency, quality of life components of physical, vitality, social functioning, and mental health. Adverse events including two cases of new-onset hypomania occurred, but no serious adverse events were observed. Thus, this trial supported the efficacy and good tolerability of 10 Hz HD-tACS for patients with MDD. Further research requires more focus on the underlying neural mechanisms and the optimized stimulation protocols. Trial Registration: China Clinical Trial Registry Identifier: ChiCTR2500103570. ClinicalTrials.gov Identifier: NCT06891326.

ABSTRACT Endoscopic sphincterotomy (EST) remains essential for managing biliary obstruction but lacks tools that both restore tissue integrity and continuously monitor sphincter mechanics post‐procedure. This work introduces a catheter‐deployable, magnetically guided Janus hydrogel actuator patch that couples precise biliary sealing with real‐time mechano‐sensing. The bilayer design integrates a hydrophobic PDMS/Fe 3 O 4 top layer for magnetic steering and anti‐adhesion with a hydrophilic PNIPAM bottom layer that swells to conform and adhere to mucosa, enabling secure deployment and anti‐reflux sealing. Mechanical deformations are transduced into resistance changes with fast electrical response (≈79 ms) and recovery (≈85 ms), supporting continuous readout of contraction, dilation and subtle vibrations. In benchtop ducts and ex vivo intestinal models, the patch exhibits directed motion under uniform fields, stable adhesion under sustained flushing and agitation, and repeatable thermo‐/swelling‐driven actuation. Waveform features of relative resistance enable machine‐learning classifiers to discriminate multiple deformation states with high accuracy, providing objective indicators of healing progression. This soft, steerable hydrogel platform addresses an unmet need in post‐EST care by unifying minimally invasive deployment, robust sealing and quantitative biomechanical monitoring, and it offers a generalizable route to personalized management of biliary and other soft‐tissue repairs.

Acute kidney injury (AKI) resulting from ureteral stones in the emergency department is typically accompanied with anxiety and sleep issues in patients, which can have adverse effects on their mental health and quality of life. Cognitive behavioural therapy (CBT) is helpful in improving mental health and sleep. This work aims to analyse the effects of CBT on mental health and sleep of AKI patients caused by ureteral calculi in the emergency department. The clinical data of patients with AKI caused by ureteral calculi in the emergency department of our hospital from February 2021 to February 2023 were retrospectively analyzed. The patients were divided into the control group (routine nursing) and observation group (cognitive behavioural nursing) according to the different nursing methods of data recording. Propensity Score Matching (PSM) was used to balance the confounding factors of the two groups. After matching, the State Trait Anxiety Inventory (STAI), Insomnia Severity Index (ISI), Mishel Uncertainty in Illness Scale-Adult (MUIS) and 36-Item Short-Form Health Survey (SF-36) were compared between the two groups. After matching at a ratio of 1:1, 130 patients were included in the observation group and the control group, with 65 cases in each group. No significant difference was observed in STAI, ISI, MUIS and SF-36 scores between the two groups before nursing (p > 0.05). After nursing, the STAI, ISI and MUIS scores of the observation group were lower than those of the control group (p < 0.05). Furthermore, the SF-36 score of the observation group was higher than that of the control group (p < 0.05). Cognitive behavioural nursing for patients with AKI caused by ureteral calculi in the emergency department may help in retrieving patients' anxiety, reducing the severity of disease uncertainty and insomnia, improving the quality of life of patients and providing theoretical reference for clinical practice.

We present a new technique that allows an intraocular lens to be explanted through the small incisions used in modern cataract surgery. The intraocular lens optic is cut into three connected pieces at the 1-mm-wide end with scissors. Then, with the stabilizing counterforce provided by a pair of vitreoretinal forceps through a paracentesis, the middle piece is removed first, followed by the two side pieces connected with haptics flipped over at the connected part. These two parts overlap each other when passing through the incision, eventually resulting in the explantation of the intraocular lens, as an intact piece. We believe this method provides a simple and effective way to remove intraocular lens through very small incisions, which could also reduce complications and hasten patient's recovery.

Unicompartmental knee arthroplasty (UKA) is the preferred treatment for anterior medial knee osteoarthritis (OA) owing to the rapid postoperative recovery. However, the risk factors for UKA failure remain controversial. The clinical data of Oxford mobile-bearing UKAs performed between 2011 and 2017 with a minimum follow-up of five years were retrospectively analyzed. Demographic, surgical, and follow-up data were collected. The Cox proportional hazards model was used to identify the risk factors that contribute to UKA failure. Kaplan-Meier survival was used to compare the effect of the prosthesis position on UKA survival. A total of 407 patients who underwent UKA were included in the study. The mean age of patients was 61.8 years, and the mean follow-up period of the patients was 91.7 months. The mean Knee Society Score (KSS) preoperatively and at the last follow-up were 64.2 and 89.7, respectively (p = 0.001). Overall, 28 patients (6.9%) with UKA underwent revision due to prosthesis loosening (16 patients), dislocation (eight patients), and persistent pain (four patients). Cox proportional hazards model analysis identified malposition of the prostheses as a high-risk factor for UKA failure (p = 0.007). Kaplan-Meier analysis revealed that the five-year survival rate of the group with malposition was 85.1%, which was significantly lower than that of the group with normal position (96.2%; p < 0.001). UKA constitutes an effective method for treating anteromedial knee OA, with an excellent five-year survival rate. Aseptic loosening caused by prosthesis malposition was identified as the main cause of UKA failure. Surgeons should pay close attention to prevent the potential occurrence of this problem.

In this study, a surface-enhanced Raman spectroscopy (SERS) magnetic sensor is established based on SERS principle and magnetic separation technology, and a highly sensitive, simple and fast method for quantitative detection of neutralizing antibodies (nABs) and specific IgG of SARS-CoV-2 in plasma is established combined with immunoassay. Two kinds of Raman nanospheres (RNPs) with different characteristic Raman shifts are used as signal sources and coupled to ACE2 and anti-IgG (FC) antibodies respectively, and magnetic beads are coupled to RBD. The competitive relationship between ACE2 and nABs, the binding relationship between specific IgG and anti-IgG (FC) antibodies are determined. The results show that the concentrations of nABs and specific IgG in the range of 10–2000 ng ml−1 are well correlated with SERS response intensity, and the recoveries are both between 90%–110%, with good precision. Bilirubin and common anticoagulants have no interference on the detection results. This method is accurate, reliable, sensitive and does not require complex pre-treatment, and is expected to be used for simultaneous detection of nABs and specific IgG in plasma of SARS-CoV-2. It has guiding significance for the development and evaluation of vaccines and the formulation of individualized vaccination schedule.

Abstract In the context of intensified climate change and resource scarcity, the impact of water risk on corporate sustainable operation is increasingly prominent; firms must not only be aware of corporate water risks but also take actions in its comprehensive management. For the purpose of integrating literature on corporate water risk and to find research deficiencies and point out future research directions, based on the definition of corporate water risk proposed by the Carbon Disclosure Project, bibliometrics was performed to study the research focus, research hotspots, and research trends in this field by using CITESPACE software. Results showed: (1) researches mainly focus on corporate adaptation under climate change, and corporate environmental management and social responsibility; (2) research hotspots include corporate performance under climate change, supply chain sustainability under water scarcity, environmental regulation and firm performance, environmental strategy and stakeholder management, and so forth; (3) research focuses have gradually changed from the study of corporate behavior under regulatory policies to the physical risk management under climate change, until the comprehensive corporate water risk management. Based on the relationships between water and firms, this paper discussed sources, impact and theories of corporate water risk, and further proposed a new research perspective of value chain. This work not only helps researches understand corporate water risk and further study on it, but also helps enterprises be aware of corporate water risk so as to take actions to deal with it and achieve corporate sustainable development.

To establish a deep learning (DL) model for predicting tumor grades and expression of pathologic markers of meningioma. A total of 1192 meningioma patients from two centers who underwent surgical resection between September 2018 and December 2021 were retrospectively included. The pathological data and post-contrast T1-weight images for each patient were collected. The patients from institute I were subdivided into training, validation, and testing sets, while the patients from institute II served as the external testing cohort. The fine-tuned ResNet50 model based on transfer learning was adopted to classify WHO grade in the whole cohort and predict Ki-67 index, H3K27me3, and progesterone receptor (PR) status of grade 1 meningiomas. The predictive performance was evaluated by the accuracy and loss curve, confusion matrix, receiver operating characteristic curve (ROC), and area under curve (AUC). The DL prediction model for each label achieved high predictive performance in two cohorts. For WHO grade prediction, the area under the curve (AUC) was 0.966 (95%CI 0.957-0.975) in the internal testing set and 0.669 (95%CI 0.643-0.695) in the external validation cohort. The AUC in predicting Ki-67 index, H3K27me3, and PR status were 0.905 (95%CI 0.895-0.915), 0.773 (95%CI 0.760-0.786), and 0.771 (95%CI 0.750-0.792) in the internal testing set and 0.591 (95%CI 0.562-0.620), 0.658 (95%CI 0.648-0.668), and 0.703 (95%CI 0.674-0.732) in the external validation cohort, respectively. DL models can preoperatively predict meningioma grades and pathologic marker expression with favorable predictive performance. Our DL model could predict meningioma grades and expression of pathologic markers and identify high-risk patients with WHO grade 1 meningioma, which would suggest a more aggressive operative intervention preoperatively and a more frequent follow-up schedule postoperatively. WHO grades and some pathologic markers of meningioma were associated with therapeutic strategies and clinical outcomes. A deep learning-based approach was employed to develop a model for predicting meningioma grades and the expression of pathologic markers. Preoperative prediction of meningioma grades and the expression of pathologic markers was beneficial for clinical decision-making.

BACKGROUNDIn a previous study, autologous bone marrow infusion (ABMI) was performed in patients with decompensated liver cirrhosis (DLC) and acquired immunodeficiency syndrome and achieved good results, but whether splenectomy affected outcome was unclear.AIMTo investigate the efficacy of ABMI combined with splenectomy for treatment of DLC.METHODSEighty-three patients with DLC were divided into an intervention group (43 cases) and control group (40 cases) according to whether splenectomy was performed. The control group was treated with ABMI through the right omental vein, and the intervention group was additionally treated with splenectomy.RESULTSAfter ABMI, the prothrombin time, serum total bilirubin levels, ascites volume and model for end-stage liver disease score in both groups were significantly lower, while the albumin levels were significantly higher than before ABMI (P < 0.01), but there were no significant differences between the groups (P > 0.05). After ABMI, the white blood cell and platelets counts in both groups were significantly higher than before ABMI (P < 0.01), and the counts in the intervention group were significantly higher than in the control group (P < 0.01). After ABMI the CD4+ and CD8+ T cell counts in both groups were significantly higher than before ABMI (P < 0.01). The CD8+ T cell counts in the intervention group increased continuously and the increase had a shorter duration compared with control group.CONCLUSIONABMI through the portal vein in patients with DLC can significantly improve liver synthetic and secretory functions, and splenectomy promotes improvement of bone marrow hematopoietic and cellular immune functions.