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In the post-industrial period, traditional Chinese enterprises are facing the awkward situation of being 'big but not strong', with their core technologies being controlled by others. The digital transformation of enterprises has not only reshaped business models and industrial boundaries, but also boosted the high-quality development of China's economy. This paper reviews the existing literature and discovers that digital technology promotes enterprise production efficiency through cost reduction, efficiency improvement, and innovation. Based on the data of listed manufacturing companies in the Shanghai and Shenzhen stock exchanges from 2009 to 2017, this paper constructs a differences in differences (DID) model to empirically study the relationship between digital transformation and production efficiency. The results revealed that the implementation of digital transformation plays a significant role in promoting economic benefits and the results of the lag regression method are still robust. Based on this, combined with the actual situation of Chinese enterprises, this paper proposes countermeasures and suggestions to promote the development of enterprise digital transformation. The conclusion is of great significance for Chinese enterprises to occupy a dominant position in the new wave of global industrial revolution.

Although the gut microbiota has been reported to influence osteoporosis risk, the individual species involved, and underlying mechanisms, remain largely unknown. We performed integrative analyses in a Chinese cohort of peri-/post-menopausal women with metagenomics/targeted metabolomics/whole-genome sequencing to identify novel microbiome-related biomarkers for bone health. Bacteroides vulgatus was found to be negatively associated with bone mineral density (BMD), which was validated in US white people. Serum valeric acid (VA), a microbiota derived metabolite, was positively associated with BMD and causally downregulated by B. vulgatus . Ovariectomized mice fed B. vulgatus demonstrated increased bone resorption and poorer bone micro-structure, while those fed VA demonstrated reduced bone resorption and better bone micro-structure. VA suppressed RELA protein production (pro-inflammatory), and enhanced IL10 mRNA expression (anti-inflammatory), leading to suppressed maturation of osteoclast-like cells and enhanced maturation of osteoblasts in vitro. The findings suggest that B. vulgatus and VA may represent promising targets for osteoporosis prevention/treatment. Gut microbiota has been reported to influence osteoporosis risk, but the individual species, and underlying mechanisms, remain largely unknown. Here, the authors identify Bacteroides vulgatus and serum valeric acid as potential targets for osteoporosis prevention/treatment.

•Body size and renal status affect plasma exposure after topical sternal vancomycin.•Minimal systemic exposure, even with small body size or impaired renal function.•For hemodialysis patients, accumulation of plasma vancomycin is worth cautioning. Intraoperative topical vancomycin has been widely used in several surgical fields to prevent wound infection. However, there have been limited studies on the systemic exposure of topical vancomycin. The aim of this study was to investigate systemic exposure after topical vancomycin over the sternal edge in cardiac surgical patients. The impact of impaired renal function and body size on the exposure was also examined. Topical vancomycin (2.5 g) was applied to the sternal edge in 129 adult cardiac surgical patients. Plasma concentrations were measured on postoperative days 0 through 7 and analyzed using linear mixed-effects models. Sixty (46.5%) patients were in chronic kidney disease stages 3 to 5, including 20 patients in end-stage renal disease (ERSD) status with regular hemodialysis preoperatively. A total of 377 plasma vancomycin levels were modeled. It was reported that there was a 7.7% increase in vancomycin level per postoperative day for patients with ESRD in contrast to a decrease of 6.1% each day for patients without ESRD. Every increase of 1 mL/min/1.73 m2 in the estimated glomerular filtration rate is associated with a 0.9% decline in vancomycin concentration. Increasing body surface area (BSA) by 0.1 m2 reduces the vancomycin level by 6.3%. Model simulations using 10,000 replicates reported that the probability of vancomycin level >10 mg/L declines to near 0 within 1 week after surgery in patients without ESRD, even in subjects with low estimated glomerular filtration rate and BSA. For the ESRD group with a BSA <2 m2, the chance of vancomycin >10 mg/L is up to 20% to 30%. Plasma exposure after topical vancomycin for the sternal edge is influenced by renal function and body size. The low probability of significant plasma vancomycin levels supports the typical fixed-dose strategy. For patients with ESRD receiving hemodialysis, accumulation of plasma vancomycin is worth cautioning. [Display omitted]

Background In patients with stable coronary artery disease (CAD), treatment options include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). The decision between PCI and CABG depends on disease severity and revascularization risk. Guidelines promote a heart team approach (HTA) with shared decision‐making, yet PCI remains prevalent. Methods and Results We conducted a retrospective analysis of 753 patients with complex CAD (left main or multivessel disease and SYNTAX score ≥ 33) between January 2019 and April 2022. We evaluated a quality improvement program featuring a clinical decision flow map, a support system for risk score calculations, and a standard operating procedure for HTA. We compared HTA activation, revascularization strategy choices, and long‐term cardiovascular outcomes (composite endpoint: death, myocardial infarction, or unplanned revascularization) between patients treated with HTA (HTA group, n = 448) and without HTA (non‐HTA group, n = 304). The program significantly increased HTA activation (from 26.4% to 61.7%) and CABG selection (from 11.1% to 20.4%). The HTA group had better CABG recommendations and choices (75.5% vs. 37.2%, and 26.8% vs. 7.2%, respectively), with a lower incidence of the primary composite endpoint (18.1% vs. 42.4%). Conclusion A quality improvement program enhances HTA activation and revascularization strategies, leading to improved cardiovascular outcomes in complex CAD patients. Implementation of the quality improvement program significantly enhanced HTA activation, led to a significant increase in the selection of CABG as a treatment option. In addition, HTA activation reduced primary composite endpoint after adjustment for confounders.

To evaluate the secular trend in incidence of and mortality from Type 1 diabetes mellitus (T1DM) in Taiwan, 1999-2010. All 7,225 incident cases of T1DM were retrospectively retrieved from Taiwan's National Health Insurance Research Database from 1999 to 2010. Trend of bi-annual age- and sex-specific incidence rates of T1DM was calculated and tested with Poisson regression model. Standardized mortality ratios (SMRs) were calculated, using age-, sex-, and calendar years-specific mortality rates of the general population as the reference, to estimate the relative mortality risk of T1DM. The number of male and female T1DM was 3,471 (48%) and 3,754 (52%), respectively. The annual number of incident T1DM increased from 543 in 1999 to 737 in 2010. The overall bi-annual incidence rate rose from 1999-00 to 2003-04 and mildly declined thereafter rose to 2009-10, with an insignificant trend (P = 0.489) over the study period. Regardless of gender, the higher age-specific incidence rate was noted in the younger groups (<30 years) and highest at <15 years. The incidence rates in younger groups were constantly higher in female population than in male one. The SMR from all causes was significantly increased at 3.00 (95% Confidence Interval (CI) 2.83-3.16) in patients with T1DM. The sex-specific SMR was 2.66 (95% CI 2.46-2.85) and 3.58 (95% CI 3.28-3.87) for male and female patients, respectively. For both sexes, the age-specific SMR peaked at 15-29 years. Among T1DM patients in Taiwan, there were significant increasing trends in males and female aged <15 years. We also noted a significantly increased overall and sex-specific SMR from all causes in patients with TIDM which suggests a need for improvements in treatment and care of patients with T1DM.

Aims The Registry to Evaluate Early and Long‐Term PAH Disease Management (REVEAL) risk scores differentiate survivals in patients with pulmonary arterial hypertension (PAH). However, measurements of N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) in the peripheral blood may not adequately reflect early‐stage decompensated heart failure (HF). Given that right heart catheterization (RHC) can facilitate measurements of intracardiac NT‐proBNP, in this study our aim was to evaluate the predictive role of right ventricular (RV) NT‐proBNP measurements in patients with PAH. Methods and results We prospectively collected intracardiac blood samples for NT‐proBNP measurements from patients diagnosed with World Health Organization Group I PAH during RHC. Clinical information including the aetiology of PAH (idiopathic, connective tissue disease, or congenital heart disease) and REVEAL scores were recorded. The primary endpoint was hospitalization for decompensated HF; median duration of follow‐up was 28 months. Among the 62 patients evaluated, 12 reached the designated endpoint. REVEAL risk scores were higher among patients hospitalized for HF. We detected no significant differences in plasma NT‐proBNP levels in peripheral circulation, in the right atrium, or in pulmonary arterial blood; however, significantly higher levels of NT‐proBNP were detected in the RV in patients diagnosed with PAH. RV NT‐proBNP was a sensitive predictor (cut‐off value 1500 pg/mL) of subsequent hospitalization for HF. Our findings indicate that RV NT‐proBNP levels add predictive value to REVEAL scores with respect to future hospitalization due to HF. Conclusions Right ventricular NT‐proBNP levels combined with REVEAL 2.0 could predict the development of subsequent HF in patients with PAH and may be a potential biomarker.

Introduction This study characterized the population pharmacokinetics (PK) of vancomycin in patients treated with and without continuous renal replacement therapy (CRRT) or temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation or extracorporeal ventricular assist device. Methods Critically ill adults with and without tMCS or CRRT prescribed vancomycin were enrolled for population PK modeling. Monte Carlo simulation provided dosing recommendations based on the probability of target attainment (PTA), achieving a 24-h area under curve (AUC24h) of 400–600 mg*h/L. Results Twenty-five patients with 184 plasma samples were analyzed. The median age was 61.0 years. The final model was a two-compartment PK model. CRRT, serum creatinine, and body weight were significant predictors of clearance. CRRT was a covariate on the central volume of distribution. tMCS significantly decreased the intercompartmental clearance. The simulated mean trough levels at the 48th hour were lower in the tMCS group (13.4 versus 14.2 mg/dL in non-tMCS, p  < 0.001) in a 70-kg subject with a creatinine of 1 mg/dL and a daily dose of 20 mg/kg, but the PTA was similar (61.8% versus 62.2%). A reduction of maintenance dose from 30 to 10 mg/kg/day with loading dose from 25 to 15 mg/kg is recommended while serum creatinine progresses from 0.5 to 4.0 mg/dL. For CRRT, the optimal regimen consists of 20–25 mg/kg loading and maintenance of 15 mg/kg/day. Conclusions The dosing strategy of vancomycin can be based on body weight or renal function, regardless of tMCS. Intercompartmental clearance decreases under tMCS, which can mislead a dosing adjustment based on trough level.

The present study aimed to evaluate the incidence and risk factors of severe low anterior resection syndrome (LARS) in patients with rectal cancer undergoing sphincter-preserving resection, and to provide the clinical basis and reference for the treatment of rectal cancer and the prevention of LARS. Studies on the incidence and risk factors for severe LARS in patients with rectal cancer undergoing sphincter-preserving resection were searched using PubMed, Embase, Cochrane Library, Scopus and Web of Science, according to the inclusion and exclusion criteria. After evaluating the study quality and extracting relevant data, RevMan 5.2 and STATA software were used to conduct a meta-analysis. A total of 12 articles were considered eligible for the present meta-analysis. Within these articles, there were 3,877 cases of sphincter-preserving resection for rectal cancer and 1,589 cases of severe LARS; the incidence of severe LARS was 40.99%. The results of the meta-analysis revealed that sex [female; odds ratio (OR), 6.54; 95% CI, 3.63-11.76; Z, 6.27; P<0.00001], radiotherapy and chemotherapy (OR, 3.45; 95% CI, 2.29-5.21; Z, 5.91; P<0.00001), total mesorectal excision (TME; OR, 4.39; 95% CI, 3.32-5.79; Z, 10.41; P<0.00001), and distance between tumor and anal margin (OR, 2.74; 95% CI, 0.86-8.72; Z, 1.70; P<0.00001) may be the risk factors for severe LARS.

Abstract Objectives This study aimed to investigate the prevalence and characteristics of Aspergillus lentulus clinical and environmental isolates in Taiwan. Methods Aspergillus isolates obtained from patients at three hospitals and from 530 soil samples across Taiwan were screened. A. lentulus, confirmed by calmodulin sequencing, was subjected to antifungal susceptibility testing and cyp51A analyses. Soil samples yielding A. lentulus were analysed for residues of 25 azole fungicides. Results Nine A. lentulus isolates were identified, which included seven (1.2%, 7/601) isolates from three antifungal-naïve patients out of 601 Aspergillus section Fumigati clinical isolates and two (0.3%, 2/659) isolates out of 659 Aspergillus soil isolates. All isolates developed white colonies and failed to grow at 48°C. They were susceptible to anidulafungin but showed reduced susceptibility to amphotericin B (AmB), voriconazole and azole fungicides. One heart transplant recipient with proven invasive pulmonary aspergillosis (IPA) initially showed suboptimal response to voriconazole monotherapy but was cured with a combination of voriconazole–caspofungin, liposomal AmB (LAmB)–caspofungin, along with surgery, followed by voriconazole maintenance therapy. Among two critically ill patients with probable IPA, one survived with micafungin, while the other died of aspergillosis despite sequential isavuconazole and LAmB monotherapy. Clinical and environmental isolates sharing identical Cyp51A sequence are identified, matching the Cyp51A sequence of A. lentulus NIID0096. Flusilazole (0.0009 mg/kg) was detected in one soil sample. Conclusions This study raises concerns about health threat posed by human pathogenic A. lentulus originating from natural environments and underscores the need for increased clinical and laboratory vigilance regarding A. lentulus infections.

Background Previous studies have assessed note quality and the use of electronic medical record (EMR) as a part of medical training. However, a generalized and user-friendly note quality assessment tool is required for quick clinical assessment. We held a medical record writing competition and developed a checklist for assessing the note quality of participants’ medical records. Using the checklist, this study aims to explore note quality between residents of different specialties and offer pedagogical implications. Methods The authors created an inpatient checklist that examined fundamental EMR requirements through six note types and twenty items. A total of 149 records created by residents from 32 departments/stations were randomly selected. Seven senior physicians rated the EMRs using a checklist. Medical records were grouped as general medicine, surgery, paediatric, obstetrics and gynaecology, and other departments. The overall and group performances were analysed using analysis of variance (ANOVA). Results Overall performance was rated as fair to good. Regarding the six note types, discharge notes (0.81) gained the highest scores, followed by admission notes (0.79), problem list (0.73), overall performance (0.73), progress notes (0.71), and weekly summaries (0.66). Among the five groups, other departments (80.20) had the highest total score, followed by obstetrics and gynaecology (78.02), paediatrics (77.47), general medicine (75.58), and surgery (73.92). Conclusions This study suggested that duplication in medical notes and the documentation abilities of residents affect the quality of medical records in different departments. Further research is required to apply the insights obtained in this study to improve the quality of notes and, thereby, the effectiveness of resident training.