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Roll-bonded steel–aluminum composite plates exhibit poor plasticity due to work hardening induced by severe plastic deformation. In this study, the mechanisms for improving the plasticity of steel–aluminum composite plates were investigated through liquid-nitrogen quenching from both material science and mechanical perspectives. From a materials science perspective, rapid cryogenic quenching forms numerous dislocation walls and cells within the Al matrix. These dislocation configurations effectively limit dislocation movement during tensile deformation. Additionally, the difference in thermal expansion properties between the steel and aluminum matrices generate significant microstrain near the interface, enhancing the back stress-induced strengthening effect. From a mechanical perspective, rapid cryogenic quenching increases the hardness and tensile strength of the aluminum matrix. A stronger aluminum matrix restricts the deformation of the steel matrix during tensile loading, delaying the onset of necking in the steel matrix. Additionally, the significant hardening of the aluminum matrix can cause the tensile specimen to bend, creating two potential necking points that divide the tensile strain, thereby significantly increasing the pre-necking deformation of the composite plate. Compared with untreated specimens, the tensile elongation and tensile strength of the specimens treated with rapid cryogenic quenching increased by 49.1% and 10.8%, respectively. This study provides a novel approach to simultaneously enhance the strength and plasticity of composite plates.

Although microsurgical vasoepididymostomy (MVE) is an effective treatment for epididymal obstructive azoospermia, some patients may experience delayed patency or suboptimal semen parameters after patency. However, research into patency time, semen quality postpatency, and associated influencing factors remains limited. This study aimed to address these issues by evaluating 181 patients who underwent at least one-sided MVE employing asingle-armed longitudinal intussusception vasoepididymostomy technique, with a follow-up period of over 12 months for 150 patients. The overall patency rate was 75.3%, with 86.0% of patients achieving patency within 6 months following MVE. Unexpectedly, factors such as age, history of epididymitis, duration of surgery, side of anastomosis, sperm motility in epididymal fluid, and the site of anastomosis showed no correlation with patency time. Nonetheless, our univariate and multivariate linear regression analysis indicated that only the site of anastomosis was positively correlated with and could independently predict postoperative total motile sperm count. Therefore, the site of anastomosis might serve as a predictor for optimal postoperative semen quality following the MVE procedure.

Abstract Background Transmembrane 9 superfamily member 1 (TM9SF1) is involved in inflammation. Since both inflammatory and autoimmune diseases are linked to immune cells regulation, this study investigated the association between TM9SF1 expression and autoimmune disease activity. As B cell differentiation and autoantibody production exacerbate autoimmune disease, the signaling pathways involved in these processes were explored. Methods Tm9sf1 −/− mouse rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) models were used to verify the relationship between gene expression and disease severity. Peripheral blood mononuclear cells (PBMCs) from 156 RA and 145 SLE patients were used to explore the relationship between TM9SF1 expression and disease activity. The effectiveness of TM9SF1 as a predictor of disease activity was assessed using multiple logistic regression and receiver operating characteristic (ROC) curves. The signaling pathways regulated by TM9SF1 in B cell maturation and antibody production were conducted by plasma cell induction experiment in vitro. Results The Tm9sf1 −/− RA and SLE model mice produced fewer autoantibodies and showed reduced disease severity relative to wild-type (WT) mice. TM9SF1 levels in PBMCs of patients were higher than those in healthy controls, and were reduced in patients with low disease activity relative to those with active RA and SLE. Furthermore, TM9SF1 levels were positively linked with autoantibody titers and pro-inflammatory cytokine levels in both diseases. ROC analyses indicated TM9SF1 outperformed several important clinical indicators in predicting disease activity (area under the curve (AUC) were 0.858 and 0.876 for RA and SLE, respectively). In vitro experiments demonstrated that Tm9sf1 knockout blocked differentiation of B cells into antibody-producing plasma cells by activating mTOR and inhibiting autophagy, and mTOR inhibitors such as rapamycin could reverse this effect. Conclusions The primary finding was the identification of the molecular mechanism underlying autophagy regulation in B cells, in which Tm9sf1 knockout was found to modulate mTOR-dependent autophagy to block B cell differentiation into antibody-secreting plasma cells. It was also found that TM9SF1 expression level in PBMCs was an accurate indicator of disease activity in patients with RA and SLE, suggesting its clinical potential for monitoring disease activity in these patients.

We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia (iNOA). We studied 193 patients with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction. The Chi-square test and Mann–Whitney U tests for clinical parameters and seminiferous tubule distribution were used for between-group comparisons. A logistic regression analysis was conducted to identify predictors of retrieval failure. Area under the receiver operating characteristic curve for each variable was evaluated, and the net clinical benefit was calculated using a clinical decision curve. Patients with iNOA had a lower sperm retrieval rate than those with known causes. Moreover, testicular volume was an independent factor affecting sperm extraction outcomes (odds ratio = 0.79, P < 0.05). The testicular volume cut-off value was 6.5 ml (area under the curve: 0.694). The patients with iNOA were categorized into two groups on the basis of the distribution of seminiferous tubules observed. The sperm retrieval rate and testicular volume were significantly different between the groups with a uniform or heterogeneous tubule distribution. There was also a significant association between a uniform tubule distribution and testicular volume. In conclusion, a testicular volume of more than 6.5 ml effectively predicts microsurgical testicular sperm extraction failure due to a uniform tubule distribution in patients with iNOA.

The cause of asthenozoospermia (AZS) is not well understood because of its complexity and heterogeneity. Although some gene mutations have been identified as contributing factors, they are only responsible for a small number of cases. Radial spokes (RSs) are critical for adenosine triphosphate-driven flagellar beating and axoneme stability, which is essential for flagellum motility. In this study, we found novel compound heterozygous mutations in leucine-rich repeat-containing protein 23 (LRRC23; c.1018C>T: p.Q340X and c.881_897 Del: p.R295Gfs*32) in a proband from a nonconsanguineous family with AZS and male infertility. Diff-Quik staining and scanning electron microscopy revealed no abnormal sperm morphology. Western blotting and immunofluorescence staining showed that these mutations suppressed LRRC23 expression in sperm flagella. Additionally, transmission electron microscopy showed the absence of RS3 in sperm flagella, which disrupts stability of the radial spoke complex and impairs motility. Following in vitro fertilization and embryo transfer, the proband’s spouse achieved successful pregnancy and delivered a healthy baby. In conclusion, our study indicates that two novel mutations in LRRC23 are associated with AZS, but successful fertility outcomes can be achieved by in vitro fertilization-embryo transfer techniques.

Microdissection testicular sperm extraction (mTESE) is commonly performed to retrieve sperm in the testes for assisted reproductive techniques in patients with idiopathic nonobstructive azoospermia (iNOA). However, the success rate of sperm retrieval varies among individuals. We aim to investigate the association between clinical parameters and sperm retrieval outcomes in patients with iNOA. We searched PubMed, EMBASE, and Web of Science from database inception to August 2, 2023. The main measure was whether sperm retrieval was successful in patients with iNOA who underwent mTESE. Pooled estimates of the sperm retrieval rate and weighted mean differences were calculated using random-effects models. The overall sperm retrieval rate was 36.8% (95% confidence interval [CI]: 27.5%–46.0%, I2 = 95.0%) in nine studies comprising 1892 patients with iNOA. No significant differences were found in age, testicular volume, serum total testosterone concentrations, or inhibin B concentrations between positive and negative sperm retrieval outcomes. Lower anti-Müllerian hormone concentrations in patients with iNOA were associated with a positive outcome of mTESE (weighted mean differences: −2.70; 95% CI: −3.94–−1.46, I2 = 79.0%). In conclusion, this study shows a significant relationship between anti-Müllerian hormone and sperm retrieval outcomes in patients with iNOA, while age, testicular volume, total testosterone, and inhibin B show no significant association. These findings have important implications for assessing the potential success of sperm retrieval and selecting appropriate treatment strategies in patients with iNOA.

Objective: To evaluate the equity of medical resources in radiotherapy and diagnosis in Shanghai, China, based on population, geography, and economic factors. Methods: Data on medical resources including institutions, equipment, and staff in radiotherapy/diagnosis were collected from all 16 districts of Shanghai, China in 2022. Separate data were collected for institutions and devices in CT. The Gini coefficient (G) and Lorenz curves were used to assess fairness based on population and geography, while the Theil index (T) was employed to evaluate health equity based on economic factors. Health resource agglomeration degree (HRAD) and population agglomeration degree (PAD) were utilized to analyze the equity and accessibility of medical resources considering both population and geography. Results: In 2022, Shanghai had a total of 992 institutions, 4,925 devices, and 10,282 personnel in radiotherapy and diagnosis. Additionally, there were 381 institutions conducting CT examinations and 776 CT machines in Shanghai. The Gini coefficients for institutions, devices, and personnel in radiotherapy and diagnosis based on population ranged from 0.2 to 0.4, while for CT, the Gini coefficients for institutions and devices ranged from 0.2 to 0.4. When considering geography, all Gini coefficients were greater than 0.5. The results of the Theil index indicated that inequities in distribution may be influenced by economic factors. The HRAD and PAD revealed disparities in the accessibility of institutions, devices, and personnel in radiotherapy/diagnosis and CT in Shanghai. Conclusions: Inequities in the distribution of institutions, equipment, and personnel for radiotherapy/diagnosis and CT were observed in Shanghai in 2022, both geographically and economically. There is a critical need to enhance the allocation of resources for radiological equipment and personnel and to establish a scientifically robust urban resource planning framework.

Abstract Due to the multiple influences of unique physicochemical properties of helium, petrographic characteristics and temperature and pressure conditions, little is known about the helium adsorption behaviors in minerals and rocks at geological conditions. Based on the grand canonical Monte Carlo simulations, this study revealed the adsorption characteristics of pure helium and the competitive adsorption of binary mixtures with different proportions of methane and helium under geological temperature and pressure conditions in quartz slit model. Molecular simulation of pure helium shows that physical adsorption of helium exists in mineral surfaces, which indicates a preservation mechanism of helium in helium source rocks. Binary mixtures simulations indicate that the adsorption capacity of methane in quartz is stronger than that of helium, and the competitive adsorption of methane increases with decreasing burial depth. This means that during the upwards migration processes of natural gas, the adsorbed helium that distributed in the migration pathway will be gradually displaced by methane, then concentrate in the hydrocarbon gases and subsequently accumulate together in favorable traps to form helium-rich natural gas reservoirs. Our results provide a molecular-scale insight into the preservation and accumulation of helium in helium source rocks and are significant for assessing the helium resource potential.

Abstract During the operation of sandy railways, the challenge posed by wind-blown sand is a persistent issue. An in-depth study on the influence of wind-blown sand content on the macroscopic and microscopic mechanical properties of the ballast bed is of great significance for understanding the potential problems of sandy railways and proposing reasonable and adequate maintenance and repair strategies. Building upon existing research, this study proposes a new assessment indicator for sand content. Utilizing the discrete element method (DEM) and fully considering the complex interactions between ballast and sand particles, three-dimensional (3D) multi-scale analysis models of sandy ballast beds with different wind-blown sand contents are established and validated through field experiments. The effects of varying wind-blown sand content on the microscopic contact distribution and macroscopic mechanical behavior (such as resistance and support stiffness) of ballast beds are carefully analyzed. The results show that with the increase in sand content, the average contact force and coordination number between ballast particles gradually decrease, and the disparity in contact forces between different layers of the ballast bed diminishes. The longitudinal and lateral resistance of the ballast bed initially decreases and then increases, with a critical point at 10% sand content. At 15% sand content, the lateral resistance is mainly shared by the ballast shoulder. The longitudinal resistance sharing ratio is always the largest on the sleeper side, followed by that at the sleeper bottom, and the smallest on the ballast shoulder. When the sand content exceeds 10%, the contribution of sand particles to stiffness significantly increases, leading to an accelerated growth rate of the overall support stiffness of the ballast bed, which is highly detrimental to the long-term service performance of the ballast bed. In conclusion, it is recommended that maintenance and repair operations should be promptly conducted when the sand content of the ballast bed reaches or exceeds 10%.

The film theory is widely accepted as a bonding mechanism of metallic laminate composites (MLCs). It states that the fresh metal contact after the rupture of the surface film is an important condition for the bonding of MLCs. However, the bonding performance and mechanisms at the interfaces containing surface films have not been sufficiently investigated. In this study, steel–aluminium composite plates were used to study the bonding state, elemental diffusion behaviour, and mechanical properties of the bonding interface between the steel-side work-hardened surface layer (WHSL) and the aluminium matrix. The results indicate that the Al and Mg atoms inside the Al matrix can diffuse to about 100–150 nm into the WHSL (Fe3O4) and undergo selective oxidation, thus generating Fe0.1MgAl2O4 particles during annealing. However, the Fe atoms in the WHSL cannot diffuse into the aluminium matrix, thereby preventing the WHSL–Al interface from generating intermetallic compounds and maintaining beneficial bonding properties after long-term annealing. Additionally, compared to the steel–aluminium composite plate without a WHSL, the steel–aluminium composite plate with a WHSL exhibited a superior bonding performance. It also demonstrated an elongation increase of 28.67%, the mechanism of this increased elongation was also studied. Under the same degree of bending, the composite plates with WHSL maintained a stable bonding state and formed a unique interface deformation mode around the WHSL–Al interface after bending, which are highly desirable bending properties.

Abstract Background Although sorafenib has been consistently used as a first-line treatment for advanced hepatocellular carcinoma (HCC), most patients will develop resistance, and the mechanism of resistance to sorafenib needs further study. Methods Using KAS-seq technology, we obtained the ssDNA profiles within the whole genome range of SMMC-7721 cells treated with sorafenib for differential analysis. We then intersected the differential genes obtained from the analysis of hepatocellular carcinoma patients in GSE109211 who were ineffective and effective with sorafenib treatment, constructed a PPI network, and obtained hub genes. We then analyzed the relationship between the expression of these genes and the prognosis of hepatocellular carcinoma patients. Results In this study, we identified 7 hub ERGs (ACTB, CFL1, ACTG1, ACTN1, WDR1, TAGLN2, HSPA8) related to drug resistance, and these genes are associated with the cytoskeleton. Conclusions The cytoskeleton is associated with sorafenib resistance in hepatocellular carcinoma. Using KAS-seq to analyze the early changes in tumor cells treated with drugs is feasible for studying the drug resistance of tumors, which provides reference significance for future research.

Abstract Treatment of highly aggressive triple‐negative breast cancer (TNBC) in the clinic is challenging. Here, a liposome nanodrug (LP@PFH@HMME) integrating imaging agents and therapeutic agents for bimodal imaging‐guided sonodynamic therapy (SDT) is developed, which boosted immunogenicity to enable potent immunotherapy via immune checkpoint blockade (ICB) in TNBC. In the acidic tumor microenvironment (TME), LP@PFH@HMME undergoes “nano‐to‐micro” transformation due to a pH‐responsive lipid fusion, which makes droplets much more sensitive to ultrasound (US) in contrast‐enhanced ultrasound (CEUS) and SDT studies. The nanodrug demonstrates robust bimodal imaging ability through fluorine‐19 magnetic resonance imaging (19F MRI) and CEUS bimodal imaging, and it exhibits excellent solubility in aqueous solution with relatively high 19F content and desirable long transverse relaxation time (T2 = 1.072 s), making it suitable for high‐performance 19F MRI, in addition to effective accumulation of nanodrugs after tail vein injection. Thus, 19F MRI/CEUS dual imaging is achievable to show adequate time points for US irradiation of tumor sites to induce highly effective SDT, which produces abundant reactive oxygen species (ROS) triggering immunogenic cell death (ICD) to assist ICB‐based immunotherapy. The combination treatment design of sonodynamic therapy with immunotherapy effectively inhibited TNBC growth and recurrence, highlighting the promise of multifunctional nanodrugs in treating TNBC.

Abstract Laying the under-sleeper pad (USP) is one of the effective measures commonly used to delay ballast degradation and reduce maintenance workload. To explore the impact of application of the USP on the dynamic and static mechanical behavior of the ballast track in the heavy-haul railway system, numerical simulation models of the ballast bed with USP and without USP are presented in this paper by using the discrete element method (DEM)—multi-flexible body dynamic (MFBD) coupling analysis method. The ballast bed support stiffness test and dynamic displacement tests were carried out on the actual operation of a heavy-haul railway line to verify the validity of the models. The results show that using the USP results in a 43.01% reduction in the ballast bed support stiffness and achieves a more uniform distribution of track loads on the sleepers. It effectively reduces the load borne by the sleeper directly under the wheel load, with a 7.89% reduction in the pressure on the sleeper. Furthermore, the laying of the USP changes the lateral resistance sharing ratio of the ballast bed, significantly reducing the stress level of the ballast bed under train loads, with an average stress reduction of 42.19 kPa. It also reduces the plastic displacement of ballast particles and lowers the peak value of rotational angular velocity by about 50% to 70%, which is conducive to slowing down ballast bed settlement deformation and reducing maintenance costs. In summary, laying the USP has a potential value in enhancing the stability and extending the lifespan of the ballast bed in heavy-haul railway systems.

Abstract Background Autoimmune uveitis is an inflammatory disease triggered by an aberrant immune response. Mesenchymal stem cell-derived small extracellular vesicles (MSC-sEVs) are emerging as potential therapeutic agents for this condition. CD73, an ectoenzyme present on MSC-sEVs, is involved in mitigating inflammation by converting extracellular adenosine monophosphate into adenosine. We hypothesize that the inhibitory effect of MSC-sEVs on experimental autoimmune uveitis (EAU) could be partially attributed to the surface expression of CD73. Methods To investigate novel therapeutic approaches for autoimmune uveitis, we performed lentiviral transduction to overexpress CD73 on the surface of MSC-sEVs, yielding CD73-enriched MSC-sEVs (sEVs-CD73). Mice with interphotoreceptor retinoid-binding protein (IRBP)-induced EAU were grouped randomly and treated with 50 µg MSC-sEVs, vector infected MSC-sEVs, sEVs-CD73 or PBS via single tail vein injection. We evaluated the clinical and histological features of the induced mice and analyzed the proportion and functional capabilities of T helper cells. Furthermore, T-cells were co-cultured with various MSC-sEVs in vitro, and we quantified the resulting inflammatory response to assess the potential therapeutic benefits of sEVs-CD73. Results Compared to MSC-sEVs, sEVs-CD73 significantly alleviates EAU, leading to reduced inflammation and diminished tissue damage. Treatment with sEVs-CD73 results in a decreased proportion of Th1 cells in the spleen, draining lymph nodes, and eyes, accompanied by an increased proportion of regulatory T-cells (Treg cells). In vitro assays further reveal that sEVs-CD73 inhibits T-cell proliferation, suppresses Th1 cells differentiation, and enhances Treg cells proportion. Conclusion Over-expression of CD73 on MSC-sEVs enhances their immunosuppressive effects in EAU, indicating that sEVs-CD73 has the potential as an efficient immunotherapeutic agent for autoimmune uveitis.

Abstract Wearing face masks is the best way to stop the spread of respiratory infections. However, if masks are not sterilized, changing them too frequently can actually increase the risk of cross‐contamination. Herein, the construction of an antipathogen photocatalytic mask with carbon vacancy‐modified carbon nitride nanosheets (g‐C3N4‐VC Ns) coated on the non‐woven fabrics of the out layer of the mask, offering effective and long‐term protection against damaging pathogens when exposed to light is reported. The introduced carbon vacancies are found capable of creating energy‐disordered sites and inducing energetic electric force to overcome the Coulomb interactions between electron‐hole pairs, thus promoting the electron‐hole separation to achieve a high generation of reactive oxygen species (ROS). Thanks to its high activity in generating ROS upon exposure to light, the as‐prepared photocatalytic mask shows high pathogen sterilization performance. This, in turn, prolongs the mask's protective lifetime, decreases the need for regular replacement, and decreases medical waste production. The work demonstrated here opens new viewpoints in designing pathogens biocidal protective devices for health protection, offering significant promise in specific environment self‐protection.

Plasma fluctuations, the uncertainty of laser ablation, and bremsstrahlung limit the identification of online element analysis during laser processing and cause difficulty in achieving concentration results with sufficient accuracy and repeatability. A laser‐induced breakdown spectroscopy (LIBS) online monitoring system with plasma spatial filtering and spectral screening is proposed to solve this problem. In this system, the high‐frequency ablation noise component of the plasma is eliminated using a specially designed optical Fourier filtering structure, and a spectral screening system based on plasma time waveform monitoring is used to suppress the influence of plasma fluctuations. Without noise filters or algorithm optimizations and based only on the basic internal standard method, the calibration curves of all nine elements in the alloy sample exhibits a Pearson's R2 value ranged from 0.91 to 0.99, with a mean of 0.94. The relative standard deviations are all in the range of 3.5%–8.4% with a mean of 5.4%. The accuracy and repeatability are comparable to those of typical LIBS systems.

Background:. We aimed to track the global trend of cosmetic treatment outcomes for facial rejuvenation and the differences in modalities used in East Asian and Western populations. Methods:. Articles reporting on facial rejuvenation procedures (invasive/noninvasive) were identified in PubMed from 2013 to March 2023 and bibliometrically analyzed for type of published document, citation frequency, authors with most articles, author’s affiliation, and frequency distribution of keywords. Results:. From 553 articles, most were published in 2021 (n = 86, 15.6%). Western countries (n = 323, 58.4%) contributed more than East Asian (n = 230, 41.6%), with more invasive interventions (n = 355, 64.2%) than noninvasive techniques (n = 198, 35.8%). Numbers of invasive techniques in West versus East Asian countries were 225 (40.7%) versus 135 (24.4%). Main indications were the reduction of facial wrinkles and antiageing treatments. Hyaluronic acid, fillers, and botulinum toxin were the main hotspots for invasive treatments, whereas laser, platelet-rich plasma, and radiofrequency were for noninvasive treatments. Nasolabial folds (13.4%) and glabellar lines (12.4%) were the top research hotspots in the East Asian and Western regions. Common adverse events were pain, erythema, swelling, and bruising. Approximately, 89.3% of publications were from single countries, whereas 10.7% of publications were from international collaborations. Most articles (n = 387; 69.95%) presented their findings using level II evidence. Dermatological surgery (IF = 2.914) had the greatest number of publications (n = 109; 19.71%). Conclusions:. The main hotspots were antiaging and youthfulness. This study provides a trend and a new perspective on the future research directions in the field of facial rejuvenation.

IntroductionAcute respiratory distress syndrome (ARDS) is a major cause of death among critically ill patients in intensive care settings, underscoring the need to identify biomarkers capable of predicting ARDS patient clinical status and prognosis at an early time point. This study specifically sought to explore the utility and clinical relevance of TM9SF1 as a biomarker for the early prediction of disease severity and prognostic outcomes in patients with ARDS.MethodsThis study enrolled 123 patients with severe ARDS and 116 patients with non-severe ARDS for whom follow-up information was available. The mRNA levels of TM9SF1 and cytokines in peripheral blood mononuclear cells from these patients were evaluated by qPCR. The predictive performance of TM9SF1 and other clinical indicators was evaluated using received operating characteristic (ROC) curves. A predictive nomogram was developed based on TM9SF1 expression and evaluated for its ability in the early prediction of severe disease and mortality in patients with ARDS.ResultsTM9SF1 mRNA expression was found to be significantly increased in patients with severe ARDS relative to those with non-severe disease or healthy controls. ARDS severity increased in correspondence with the level of TM9SF1 expression (odds ratio [OR] = 2.43, 95% confidence interval [CI] = 2.15–3.72, P = 0.005), and high TM9SF1 levels were associated with a greater risk of mortality (hazard ratio [HR] = 2.27, 95% CI = 2.20–4.39, P = 0.001). ROC curves demonstrated that relative to other clinical indicators, TM9SF1 offered superior performance in the prediction of ARDS severity and mortality. A novel nomogram incorporating TM9SF1 expression together with age, D-dimer levels, and C-reactive protein (CRP) levels was developed and was used to predict ARDS severity (AUC = 0.887, 95% CI = 0.715–0.943). A separate model incorporating TM9SF1 expression, age, neutrophil-lymphocyte ratio (NLR), and D-dimer levels (C-index = 0.890, 95% CI = 0.627–0.957) was also developed for predicting mortality.ConclusionIncreases in ARDS severity and patient mortality were observed with rising levels of TM9SF1 expression. TM9SF1 may thus offer utility as a novel biomarker for the early prediction of ARDS patient disease status and clinical outcomes.

Abstract Background In public health emergencies, nurses are vulnerable to adverse reactions, especially job burnout. It is critical to identify nurses at risk of burnout early and implement interventions as early as possible. Methods A cross-sectional survey of the hospitals in Xiangyang City was conducted in January, 2023 using stratified cluster sampling. Anonymized data were collected from 1584 working nurses. The Impact of Events Scale-Revised (IES-R) and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) were used to evaluate the post-traumatic stress disorder (PTSD) and burnout of nurses in public health emergencies. Logistic regression analysis was established to screen for risk factors of burnout, and a nomogram was developed to predict the risk of burnout. A calibration curve and the area under the receiver operating characteristic (ROC) curve were used to validate the nomogram internally. Results This study showed that only 3.7% of nurses were completely free of PTSD during a public health emergency. We found that PTSD varied by age, marital status, procreation status, length of service, employee status, and whether working in the ICU. The nurses aged 30 ~ 40 years old, single, married without children, non-regular employees, worked for less than three years or worked in the ICU had higher levels of PTSD. Regarding the prevalence of burnout, 27.4%, 48.5%, and 18.6% of nurses had a high level of emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA), respectively. There, 31.1% of nurses had more than two types of job burnout. The number of night shifts, the type of hospital, marital status, and the severity of PTSD were all associated with higher rates of exhaustion among nurses. As a graphical representation of the model, a nomogram was created and demonstrated excellent calibration and discrimination in both sets (AUC = 0.787). Conclusions This study confirmed the PTSD and burnout are common problems for in-service nurses during public health emergencies and screened out the high-risk groups of job burnout. It is necessary to pay more attention nurses who are single and working in general hospitals with many night shifts, especially nurses with severe PTSD. Hospitals can set up nurses’ personal health records to give timely warnings to nurses with health problems, and carry out support interventions to relieve occupational stress.

Abstract Purpose To explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome. Materials and Methods A retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy. Results The total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010). Conclusions The Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.

Background: and purpose: Radiotherapy (RT) is an effective treatment for most malignant chest tumors. However, radiation-induced myocardial fibrosis (RIMF) is a serious side effect of RT. Currently, due to the mechanism of RIMF has not been fully elucidated, there is a lack of effective therapeutic approach. In this study, we aimed to investigate the role and possible mechanisms of bone marrow mesenchymal stem cells (BMSCs) in the therapy of RIMF. Materials and methods: Twenty-four New Zealand white rabbits were allotted into four groups (n = 6). Rabbits in the Control group received neither irradiation nor treatment. A single dose of 20 Gy heart X-irradiation was applied to the RT group, RT + PBS group and RT + BMSCs group. Rabbits in the RT + PBS group and RT + BMSCs group were injected with 200 μL PBS or 2 × 106 cells via pericardium puncture 24 h following irradiation, respectively. Echocardiography was used to test the cardiac function; Then the heart samples were collected, and processed for histopathological, Western blot and immunohistochemistry investigations. Results: It was observed that BMSCs have therapeutic effect on RIMF. Compared with the Control group, inflammatory mediators, oxidative stress and apoptosis were significantly increased, meanwhile, cardiac function was remarkably decreased in the RT group and RT + PBS group. However, in the BMSCs group, BMSCs significantly improved cardiac function, decreased inflammatory mediators, oxidative stress and apoptosis. Furthermore, BMSCs remarkably reduced the expression level of TGF-β1 and the phosphorylated-Smad2/3. Conclusions: In conclusion, our research indicates BMSCs have the potential to alleviate RIMF through TGF-β1/Smad2/3 and would be a new therapeutic approach for patients with myocardial fibrosis.

In recent years, with the rapid advancement of automotive lightweight technology, the mechanical clinching process between aluminum alloy and ultra-high-strength steel sheets has received extensive attention. However, the low ductility of ultra-high-strength steel sheets often results in conventional mechanical clinching processes producing joints that either fail to establish effective interlocks or cause the steel sheets to fracture. To address this issue, a novel mechanical clinching process is presented, called center-punching mechanical clinching (CPMC). This innovative process employs a method of punching, flanging, and bulging gradation to achieve the mechanical clinching of aluminum alloy and ultra-high-strength steel sheets in a single step. In order to determine the effects of different parameters on the quality and strength of the joint, an experimental study was carried out for various die depths and diameters based on the condition of constant punch size. Based on tensile and shear tests, the static strength and failure modes of CPMC joints were analyzed. The results indicated that the CPMC process significantly enhances the connectivity of joints for AA5052 aluminum alloy and DP980 ultra-high-strength steel. Optimal tensile and shear strengths of 1264 and 2249 N, respectively, were achieved at a die depth of 2.2 mm and a diameter of 10.4 mm. The CPMC process provides new ideas for the mechanical clinching of aluminum alloy and ultra-high-strength steels.

Abstract Background Cancer threat is relevant to age, and the threat of a foreshortened life coupled with a lengthy treatment process negatively affects middle‐aged and older adults. Understanding the coping throughout the cancer experience in middle‐aged and older cancer survivors will help develop supportive care to promote their physiological and psychological coping effects. Objectives To explore the cancer coping experiences of middle‐aged adults aged 40–59 and older adults over 60. Design A descriptive phenomenological study was employed. Methods Face‐to‐face, in‐depth, semistructured interviews were conducted with 22 oncology patients in a tertiary university hospital aged 40 or above from August to October 2023. The interview data were analyzed using thematic analysis procedures. Results Five themes and 13 subthemes were formed through analysis: acceptance of cancer (considering cancer as chronic, believing in fate and attributing cancer to karma); having different information needs (desired to be truthfully informed, information‐seeking behaviour, information avoidance behaviour); getting families involved (developing dependent behaviours, feeling emotional support, family members suffering worse); striving to maintain positive psychological state (positive thinking, seeking peer support) and negative experience (undesirable, low self‐esteem). Conclusion Our study reveals that cancer survivors' attitudes towards having cancer have changed from a death sentence to a more positive perception of a chronic disease. Supportive programmes for developing coping strategies should consider the cultural traditions and religious beliefs, different information needs, involvement of family and promoting a positive psychological state while avoiding negative factors. Patient or Public Contribution Participants with experience of coping with cancer were involved in the semistructured interview.

BackgroundThe Ministry of Health in Côte d'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President’s Emergency Plan for AIDS Relief, have been collaborating to develop and implement the Open-Source Enterprise-Level Laboratory Information System (OpenELIS). The system is designed to improve HIV-related laboratory data management and strengthen quality management and capacity at clinical laboratories across the nation. ObjectiveThis evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to HIV care and treatment. MethodsThis evaluation used a quasi-experimental design to perform an interrupted time-series analysis to estimate the changes in the level and slope of 3 data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. We collected paper and electronic records on clusters of differentiation 4 (CD4) testing for 48 weeks before OpenELIS adoption until 72 weeks after. Data collection took place at 21 laboratories in 13 health regions that started using OpenELIS between 2014 and 2020. We analyzed the data at the laboratory level. We estimated odds ratios (ORs) by comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS. ResultsThere was an immediate 5-fold increase in timeliness (OR 5.27, 95% CI 4.33-6.41; P

Laminated metal composites (LMCs) of titanium and aluminum (Ti/Al), combining the high strength and thermal stability of titanium with the low density and corrosion resistance of aluminum, hold substantial promise for industrial applications. Utilizing diffusion bonding under optimal processing conditions—specifically a bonding temperature of 550 °C and a holding time of 120 min—an average interfacial shear strength of 68.7 MPa was achieved. Transmission electron microscopy (TEM) revealed a metallurgically bonded interface facilitated by the mutual atomic diffusion of titanium and aluminum; this diffusion layer predominantly comprises the TiAl3 phase. Detailed insights into the microstructural evolution at the interface, including dislocation configurations, were also obtained in this study. The Burgers vectors of these dislocations were determined using the two-beam electron diffraction contrast imaging method. Based on these results, it can be elucidated that the deformation mechanism of Ti layer was dominated by the dislocation slip (mainly prismatic and the basal slip), while the coordinated deformation of TiAl3/Al interface benefitted by the dislocations gliding across the interface.

Objectives: A noticeable increase in HIV-positive cases among women, particularly those of middle and old age, has been observed worldwide. This study aimed to describe women’s perceived HIV risk, HIV/Acquired Immunodeficiency Syndrome (AIDS) knowledge, attitude, and sexual behaviors to determine factors associated with condom use among these women in Hunan, China. Methods: A cross-sectional study was conducted from July 2019 to August 2020 among 958 women aged 40 and older in four regions of Hunan, China. We collected data on sociodemographic characteristics, perceived HIV risk, HIV/AIDS knowledge and attitude, condom use, and sexual behaviors. Univariate and multivariate logistic regression were performed to identify factors related to condom use. Results: Out of 958 participants, 60.6% perceived no risk of HIV infection, and 46.8% reported they had never used a condom during their past sexual life. Those who were older, had lower monthly household income for family, had not received HIV education in the past year, were unwilling to use condoms, could not determine condom use during sexual activity, and had more negative attitudes towards HIV/AIDS and HIV-positive people were less likely to use condoms in their past sexual behaviors. Conclusions: In Hunan Province, most women aged 40 and older perceived themselves as having a low or no risk of HIV infection; their rate of condom use was low, and six factors were associated with condom use. It is imperative to strengthen HIV prevention and control programs among women aged 40 and above, particularly focusing on those who may use condoms infrequently or not at all.

Abstract Background In April 2022, an outbreak of the SARS-CoV-2 virus Omicron variant in Shanghai precipitated an extensive lockdown. We assessed changes in healthcare utilization during this outbreak and investigated the relationship between the stringency of mitigation strategies and disruptions in healthcare utilization. Methods Using provincial-level data from routine health information systems covering all hospitals across Mainland China, we conducted an interrupted time series analysis to examine changes in healthcare utilization during the Shanghai outbreak. Linear regression was used to evaluate the direction and magnitude of the association between the relative changes in the move-out movement index, a proxy for the stringency in population-level mitigation strategies, and the estimated relative changes in healthcare utilization. Results Overall, there were 22.9 billion outpatient visits and 1.2 billion discharged inpatients during the study period from January 2016 to May 2022, including 9.1 billion (39.7%) and 0.46 billion (38.2%) in the post-COVID-19 period (January 2020–May 2022), respectively. From March through May 2022, the outbreak resulted in an accumulative loss of 23.5 million (47%) outpatient visits and 0.6 million (55%) discharged inpatients in Shanghai, and a loss of 150.3 million (14%) outpatient visits and 3.6 million (7%) discharged inpatients in other regions. We find that for every 10-percentage point reduction in the relative change of move-out index, a 2.7 (95% CI: 2.0–3.4) percentage point decline in the relative change of outpatient visits, and a 4.3 (95% CI: 3.5–5.2) percentage points decline in the relative change of inpatient discharges. Conclusions The Shanghai COVID-19 Omicron outbreak associates with a substantial reduction in outpatient visits and inpatient discharges within Shanghai and other regions in China. The stringency of the COVID-19 lockdown policies associates with more profound reductions in healthcare utilization.

Roll bonding is ideal for preparing metallic composite laminates (MCLs). When MCLs are prepared by roll bonding, a work-hardened surface layer (WHSL) is typically prepared on the plate surface to promote bonding. However, differences in the mechanical properties of the WHSL and substrate lead to the WHSL separated from steel substrate during roll bonding, resulting in low bonding strengths of the roll-bonded laminates. This study focused on steel–Al laminates to successfully heal the cracks between the WHSL and the steel substrates via heat treatment. The crack-healing mechanism, element diffusion behavior, bonding property, and fracture morphology of the laminates were investigated. The results show that after roll bonding, the WHSL of the steel surface was separated from the steel substrate, and the steel–Al laminates exhibited a lower bonding strength. After annealing the laminates with cracks between WHSL and steel substrate at 450 °C for 60 min, a 426.8 nm Fe2O3 layer was generated between the WHSL and the steel substrate, healing the cracks. Additionally, good connectivity was observed between the WHSL and steel substrate. The shear strength of the steel–Al laminates increased by 1.7 times after the formation of the Fe2O3 layer. Analysis of the fracture morphology showed that shear fracture primarily occurs at the interface between the WHSL and steel substrate before the formation of the Fe2O3 layer; after the Fe2O3 layer is formed, shear fracture primarily occurs in the aluminum substrate. This study provides a new strategy for improving the bonding strength of roll-bonded steel–Al laminates.

Aluminum thermal welding joints are widely used in the maintenance welding of heavy-haul railways due to their easy handling and high efficiency. However, due to their inherent welding characteristics, welding results in certain differences in the material’s physical properties at the welding zone compared to adjacent base materials, leading to the occurrence of short-wave irregularity under long-term wheel–rail interactive forces. In order to explore the evolution characteristics of weld irregularity, dynamic characteristics, and plastic deformation under long-term wheel–rail impact, a detailed tracking test was conducted on a normal aluminum weld, and the process from being put on the track to being damaged and replaced was evaluated. At the same time, a rigid–flexible coupling model was established for subsequent analysis, and plastic damage was analyzed using the finite element model. The results show that the service life of the weld can be divided into three different stages: the initial stage, the intermediate stage, and the damage stage. In the damage stage, a temporary separation occurred between the wheel and rail, leading to a sudden change in the wheel–rail interaction. The weight of 250 MT at the weld reached the repairment control limit. The concentration effect of equivalent plastic deformation was most serious at 2~5 mm below the rail head.

Light oil, a high-quality energy resource abundant in deep basins, is prevalent in the northern zone of the Dongying Depression. To elucidate the formation mechanism of light oil reservoirs, this study investigates the molecular and stable isotope composition, biomarkers, light hydrocarbons, and diamondoid compositions of petroleum. The results reveal that the gas primarily consists of oil-cracking gas from a late filling event, mixed with oil-associated gas generated during the source rock’s “oil window” maturity phase. Methane exhibits enriched light carbon isotopes, indicating noticeable migration fractionation effects. The crude oil in the same deep strata exhibits high maturity, originating from both terrestrial and aquatic organic matter in the source materials. Molar proportions of n-alkanes and light hydrocarbon indices (Tol/nC7, nC7/MCH) indicate significant evaporative fractionation in the petroleum reservoirs. This fractionation process modified early-formed oil reservoirs due to the late filling of highly mature gas reservoirs. The evaporative fractionation at different stages has varying effects on the diamondoid ratio (1- + 2-MA)/(3- + 4-MD). It is considered a pivotal mechanism in the formation of deep condensate reservoirs and volatile oil reservoirs.

With the rapid development of lightweight automobiles, the clinching joint technology of ultra-high-strength steel with aluminum alloy sheets have been paid more and more attention. However, due to significant differences in plastic deformation capabilities between the two metals, particularly the difficulty of steel sheet deformation, conventional clinching processes often result in insufficient joint interlocking or fracture issues. Although the preliminary use of clinching processes with preforming methods has shown some effectiveness in connecting two types of sheets, the bond strength is not high. This study employs finite element simulation and orthogonal optimization methods to investigate the impact of relevant process parameters on joint morphology in clinching processes with preforming. Under the condition of optimizing process parameters, a clinching punch with an added pressure-step structure was proposed to compact the joint and further enhance joint quality. Experimental verification demonstrates the feasibility of the improved clinching processes with preforming for bonding ultra-high-strength steel and aluminum alloy sheets.

In order to optimize the application effect of induction heating (IH) tundishes, a four-channel IH tundish is taken as the research object. Based on numerical simulation methods, the influence of different relative placement angles of induction heaters and channels on the electromagnetic field, flow field and temperature field of the tundish is investigated. We focus on comparing the magnetic flux density (B) and electromagnetic force (EMF) distribution of the channel. The results show that regardless of the relative placement angle between the heater and the channel, the distribution of B in the central circular cross-section of the channel is eccentric. When the heater rotates around channel 1 towards the bottom of the tundish, the distribution of B in the central circular cross-section of the channel changes from a horizontal eccentricity to a vertical one. Through the analysis of the B contour in the longitudinal section of the channel, the difference in effective magnetic flux density area (ΔAB) between the upper and lower parts of the channel can be obtained, thereby quantitatively analyzing the distribution of B in this section. The distribution pattern of ΔAB is consistent with the distribution pattern of the electromagnetic force in the vertical direction (FZ) of the channel centerline. The ΔAB and FZ of channel 1 gradually increase as the heater rotates downwards, while those of channel 2 reach their maximum value at a rotation angle of 60°. Compared to the conventional placement, when the heater rotation angle is 60°, the outlet flow velocities at channel 1 and channel 2 decrease by 15% and 12%, respectively. However, the outlet temperature at channel 2 increases by 1.96 K, and the molten steel flow at the outlet of channel 1 and channel 2 no longer exhibits significant downward flow. This shows that when the heater rotation angle is 60°, it has a dual advantage. On the one hand, it is helpful to reduce the erosion of the molten steel on the channel and the bottom of the discharging chamber, and on the other hand, it can more effectively exert the heating effect of the induction heater on the molten steel in the channel. This presents a new approach to enhance the application effectiveness of IH tundish.

Addressing the issue of low bonding strength in Ti/Mg laminated composites due to interfacial oxidation, this study employs a differential temperature rolling method using longitudinal induction heating to fabricate Ti/Mg composite plates. The entire process is conducted under an argon gas protective atmosphere, which prevents interfacial oxidation while achieving uniform deformation. The effects of reduction on the mechanical properties and microstructure of the composite plates are thoroughly investigated. Results indicate that as the reduction increases, the bonding strength gradually increases, mainly attributed to the increased mechanical interlocking area and a broader element diffusion layer. This corresponds to a transition from a brittle to a ductile fracture at the microscopic tensile–shear fracture surface. When the reduction reaches 47.5%, the Ti/Mg interfacial strength reaches 63 MPa, which is approximately a 20% improvement compared to the bonded strength with previous oxidation at the interface. Notably, at a low reduction of 17.5%, the bonding strength is significantly enhanced by about one time. Additionally, it was found that a strong bonded interface at a high reduction is beneficial in hindering the propagation of interfacial cracks during tensile testing, enhancing the ability of the Ti/Mg composite plates to resist interfacial delamination.

Abstract Introduction Rheumatoid arthritis (RA) often involves an altered T-cell subpopulation, higher levels of inflammatory cytokines, and auto-antibodies. This study investigated whether PDCD5 could be a biomarker to predict the incidence and remission of RA so as to guide the therapeutic management of clinical RA. Methods One hundred fifty-two patients (41 being in both active status and stable remission status) who were newly diagnosed with RA and 38 healthy controls were enrolled. Basic clinical data were collected before using blood samples remaining in the clinic after routine complete blood count. The ability of PDCD5 and important indicators to predict the remission of RA was estimated based on receiver operating characteristic curve (ROC) analysis. Results PDCD5 expression was found to be significantly increased in RA patients in active status in comparison with healthy controls or those in stable remission status. Compared with anti-CCP, ESR and DAS28 score, PDCD5 was of better predictive value with an AUC of 0.846 (95% CI 0.780–0.912) for RA remission. The incidence risk of RA increased with higher levels of PDCD5 (OR = 1.73, 95% CI = 1.45–1.98, P = 0.005) in multiple logistic regression analysis, with the risk increasing by 2.94-times for high-risk group in comparison with low-risk group (OR = 2.94, 95% CI = 2.35–4.62, P

In this study, the effect of the degree of hard-phase fracture on the mechanical properties of accumulative-roll-bonded metal composite plates using experimental tests and finite element simulations. Ti–Al plates with two compositions, i.e., those with fractured and continuous intermediate Ti layers, were used as base materials and subjected to accumulative roll bonding five times. The results showed that the fracture of the intermediate Ti layer significantly degraded the mechanical properties. However, the more the Ti layer was broken down and distributed within the composite plate during accumulative roll bonding, the better were the mechanical properties. Tensile fracture of the composite plate only occurred in the Al phase, with the crack path deflected around the Ti phase. The more compact the Ti distribution, the more severe the tearing and delamination of the Al phase. Through finite element simulations, it was concluded that the shorter the distance between the Ti fragments along the loading direction, the higher the stress and the strain rate, which resulted in premature fracture and degradation of the mechanical properties.

Cryptorchidism is a common cause of male infertility, often necessitating microdissection testicular sperm extraction (m-TESE) for sperm retrieval post-surgery. However, uncertainties persist regarding m-TESE outcomes and influencing factors following cryptorchidism surgery. A systematic review and meta-analysis were conducted to evaluate sperm retrieval rates (SRR) among patients undergoing m-TESE after cryptorchidism surgery. Factors including age at orchidopexy, age at m-TESE, type of cryptorchidism, serum hormone levels, testicular volume, and interval from surgery to m-TESE were analyzed for their impact on SRR.Nine studies encompassing 935 patients were included. The overall SRR was 57% (95% confidence interval [CI] 51% to 63%). Compared to patients with negative sperm retrieval (SR-), patients with positive sperm retrieval (SR+) underwent m-TESE at an older age (1.81 years; 95% CI 1.17 to 2.45) and orchidopexy at a younger age (-3.35 years; 95% CI -6.34 to -0.36). Different types of cryptorchidism (including high scrotal, inguinal canal, intra-abdominal) significantly influenced SRR (P0.05). Furthermore, SR- patients typically experienced shorter intervals from orchidopexy to m-TESE compared to SR+ patients (34.09 months; 95% CI 0.40 to 67.77). Earlier orchidopexy and much later m-TESE procedures, as well as undescended testis closer to the scrotum, increase the likelihood of successful sperm retrieval. Orchidopexy for cryptorchidism should be done as early as possible, whether it is performed before 18 months of age or detected at a much older age. In patients with undetected cryptorchidism and azoospermia after puberty, m-TESE should not be performed immediately after orchidopexy, the optimal interval from orchidopexy to m-TESE still requires further study.

BackgroundThis study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates.MethodsData from patients with EOA who underwent two-suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random-effects model, and weighted mean differences were reported.ResultsA total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63-72%), with a patency time of approximately 4.63 months (95% CI: 4.15-5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31-46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double-armed and single-armed LIVE techniques.ConclusionThe single-armed LIVE is a potential alternative surgical option when high quality double-needle sutures are not easily accessible.

AbstractObjective maintenance of an appropriate mean arterial pressure (MAP) is important for critically ill patients. However, the association between MAP and prognosis in acute kidney injury (AKI) patients receiving continuous renal replacement therapy (CRRT) is thus far unclear.Materials and methods a total of 1,144 AKI patients who had received CRRT between January 2009 and September 2016 were enrolled and their MAP was measured at CRRT initiation. Patients were categorized into four groups (Quartile 1: MAP < 67.3 mmHg; Quartile 2: 67.3 ≤ MAP < 76.7 mmHg; Quartile 3: 76.7 ≤ MAP < 86.3 mmHg; Quartile 4: MAP ≥ 86.3 mmHg), and 28- and 90-day mortality rates were compared.Results our results demonstrate that 204 (72.1%), 187 (63.4%), 174 (62.6%), and 145 (50.3%) deaths occurred in quartiles 1, 2, 3, and 4 within 28 days, respectively (p

Abstract Solar arrays are the primary energy source for spacecraft. Although traditional rigid solar arrays improve power supply, the quality increases proportionally. Hence, it is difficult to satisfy the requirements of high-power and low-cost space applications. In this study, a shape-memory polymer composite (SMPC) boom was designed, fabricated, and characterized for flexible reel-type solar arrays. The SMPC boom was fabricated from a smart material, a shape-memory polymer composite, whose mechanical properties were tested. Additionally, a mathematical model of the bending stiffness of the SMPC boom was developed, and the bending and buckling behaviors of the boom were further analyzed using the ABAQUS software. An SMPC boom was fabricated to demonstrate its shape memory characteristics, and the driving force of the booms with varying geometric parameters was investigated. We also designed and manufactured a reel-type solar array based on an SMPC boom and verified its self-deployment capability. The results indicated that the SMPC boom can be used as a deployable unit to roll out flexible solar arrays.

BackgroundIndividual monitoring of occupational external exposure is an essential part of the occupational health management of radiation workers, and is an important basis for the evaluation of individual absorbed dose and the diagnosis of occupational radiation diseases. Continuous participation of monitoring service providers in intercomparison is a fundamental quality assurance for routine monitoring, which can identify problems and improve them in time.ObjectiveTaking the Laboratory of Radiation Protection in Shanghai Institute of Preventive Medicine as an example, to evaluate the performance of an individual occupational external dose monitoring system in the laboratory, identify influencing factors of the monitoring results, and provide a basis for improving the quality of daily monitoring by analyzing the process and results of a national intercomparison of individual dose monitoring.Methods According to the Testing criteria of personnel dosimetry performance for external exposure (GBZ 207-2016), and the relevant requirements of Class II (photon) inspection, a total of 20 groups of blind sample dosimeters were measured for four consecutive years from 2018 to 2021. The radiation energy source of each group was identified, and related personal dose equivalent Hp(10), the uncertainty of measurement results, and the deviation between the reported value and the reference value were calculated. The national intercomparison process and results of individual dose monitoring were also analyzed.ResultsThe energy sources of the blind samples in the tested laboratory for four years were N100 or Cs-137. The reported dose values of the blind samples were 0.57-4.61 mSv, the combined uncertainties were 0.043-0.365 mSv, the expanded uncertainties (k=2) were 0.09-0.73 mSv, and the relative expanded uncertainties (k=2) were 13.8%-16.4%. The single-group performance ∣Pi∣ of 20 sets of blind samples in the four years was ≤0.10, the yearly comprehensive performance of 5 sets of blind samples was ≤0.10, and the yearly Q score of the test report was >15 points. The laboratory achieved excellent results in the national intercomparison of individual dose monitoring in four consecutive years, except the Q value not reaching full score.ConclusionThe laboratory exhibits standardized data processing of individual dose monitoring, generates accurate and reliable results, and meets the requirements of relevant national standards; but it should continue to participate in the national intercomparison of individual dose monitoring, strengthen the angular response research of energy identified dosimeter, improve the monitoring ability of low-dose X-rays, analyze the key points of reducing the uncertainty of measurement results, and continuously improve the monitoring ability.

Based on the application of electromagnetism and hydrodynamics in metallurgy, the selection of the number of inductors as well as the direction of inductor current access is investigated for channel-type induction heating (IH) tundish with dual-channel (D-Ch), three-channel (T-Ch) and four-channel (F-Ch) tundish designs. The results show that when a single inductor is used, the Joule heat power (JHP) and electromagnetic force (EMF) are essentially the same within the two channels of the D-Ch tundish, but in the T-Ch tundish and the F-Ch tundish, the JHP and EMF of channel No.1 (Ch1) is much larger than other channels, which is extremely asymmetric. This will further be reflected in the influence on the flow and temperature consistency of the molten steel in the tundish. When a single inductor is used in the T-Ch or F-Ch tundish, the molten steel flow velocity in Ch1 is 4.2 and 7.4 times higher than that in the symmetric channel, respectively, and the temperature difference at the symmetric strand can be as high as 11 K or more. However, the maximum flow velocity of the molten steel in Ch1 and channel No.2 (Ch2) of the D-Ch tundish is 0.21 and 0.19 m⋅s−1, respectively, and the maximum temperature difference at the symmetrical strand is only 2.3 K. For the tundish with double inductors, the influence of the direction of the access current of the inductors should be taken into account. The inductors of a D-Ch tundish can effectively heat the molten steel only by accessing the same direction current. The physical fields in the intermediate and side channels are significantly different when the same or opposite current is accessed to the dual inductors of T-Ch tundish. The temperature rise rate of the molten steel is 36% higher when the dual inductors of the F-Ch tundish are accessed to the opposite current than when they are accessed to the same current. Therefore, a D-Ch design should be used for the channel-type tundish with a single inductor. And for the channel-type tundish with dual inductors, the same direction current should be accessed under the D-Ch design, and the opposite current should be accessed under the F-Ch design.

ABSTRACT: Objectives: To assess the virological outcomes, prevalence of HIV drug resistance mutation (DRM), and correlates in Butuo County. Methods: We conducted a cross-sectional study. Virological failure (VF) was defined as HIV-1 RNA ≥1000 copies/mL and on antiretroviral therapy (ART) for ≥6 months. Genotypic drug resistance was performed among VF cases. Correlates of DRM were identified using multivariate logistic regression. Results: The overall virological suppression rate was 85.3%; DRM was detected in 42.6% (517/1215) VF cases and 6.2% of the sample patients. A total of 90.9% of patients were infected with HIV-1 CRF07_BC subtype. The prevalence of DRM to nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) were 46.0% and 96.9%, respectively. The most prevalent mutation for NRTI was M184V (84.5%). Lamivudine (3TC), emtricitabine (FTC), and abacavir (ABC) had the highest resistance rates. For NNRTI, K103N (60.7%), nevirapine (NVP), and efavirenz (EFV) had the highest resistance rates and cross resistance to rilpivirine (RPV), doravirine (DOR), and etravirine (ETR). Ritonavir boosted lopinavir (LPV/r) resistance rate was extremely low. The occurrence of DRM was associated with age at ART ≤18 years, baseline CD4 count ≤200 cells/mL, NVP-based regimen, and ART duration >3 years. Conclusion: A relatively high proportion of VF and broad DRM for NRTI and NNRTI were observed, causing high-level resistance to first-line NRTI, NNRTI, and next generation NNRTI. Our findings necessitate the implementation of scaling up virological monitoring, adherence support, and timely switching to an LPV/r-containing regimen when patients with VF to reduce the occurrence of DRM.

The hydrocarbon phase state of deep to ultra-deep reservoirs in the Tarim and Sichuan basins has been of great interest in oil and gas exploration. Based on a combination of molecular dynamics simulation, gold-tube pyrolysis experiments, and geological-geochemical theory, this study discusses the mechanisms governing the stability of oils in deep reservoirs from the perspectives of their reservoir accumulation histories and chemical reactions. Generally, the reason for the existence of liquid oil in the Tarim Basin is widely considered to be only controlled by external geological conditions, mainly including low geothermal gradient, absence of thermal events, low maximum reservoir temperatures, and late hydrocarbon generation process. However, this study firstly proposed that the chemical composition of oil is an internal factor for its thermal stability. The simulation results reveal that the polycondensation reactions of asphaltene will release hydrogen atoms, which can provide a necessary hydrogen source for cracking of liquid chain hydrocarbons. It means that the presence of asphaltene components can promote the cracking of chain hydrocarbons and generate methane. The normal mature oil in the Sichuan Basin generally has higher contents of asphaltenes than that of the high-mature light oil of the Tarim Basin, so more hydrogen has historically been available for the cracking of oil to gas. By looking at the accumulation histories and chemical compositions of the crude oils, this study first explains the stable long-term storage of liquid hydrocarbons in the Tarim Basin, providing important guidance for future deep to ultra-deep oil and gas exploration.

Collaboration among industry, universities, and research is crucial for building an innovative nation. Although industry-university-research collaborative innovation (IURCI) and time-space convergence can drive innovation, increase productivity, and spur economic development, their effects on the regional economy have not been thoroughly examined in existing literature. Therefore, this study investigates the impact of industry-university-research collaborative innovation (IURCI) and time-space convergence on economic development in China. Specifically, we focus on local-level cities in the Chengdu-Chongqing Economic Circle (CCEC) and construct an evaluation index system and time-space convergence model to measure the effects of IURCI and time-space convergence on economic development from 2007 to 2021. Our findings indicate that the efficacy of IURCI on economic development in China follows an inverted U-shaped curve, meaning that the marginal impact of IURC may decrease as more creative funds are deployed. Furthermore, the positive marginal effect of inventive talent input may decrease when it surpasses a certain value in an open innovation environment. The spatiotemporal convergence of collaborative innovation and development levels of IURCI in the CCEC shows significant differences. Regionally, the development level of IURCI in different regions exhibits significant differences in state and speed of convergence. In the southern Sichuan urban agglomeration, the collaborative innovation level of industry, education, and research follows an evolutionary process from convergence to divergence and then to convergence. Policymakers should pay close attention to the spatial effect of high-level development of regional IURCI and promote regions with higher development to drive regions with relatively weak development levels.

The practical applications of lithium metal batteries are limited by uncontrolled dendrite growth during cycling. Herein, we propose a simple and scalable approach to stabilize lithium metal anodes using laser scribing technology to integratively design and construct a laser-induced graphene (LIG) with lithiophilic metal oxide nanoparticles. The porous LIG and lithiophilic MnOx nanoparticles effectively reduce the nucleation overpotential of Li and regulate uniform Li plating, while the array structure offers continuous and ultra-fast ion/electron transport channels, accelerating Li+ transport kinetics at high rate and high capacity. Consequently, the Li@MnOx@LIG-a anode exhibits superior rate capability of up to 40 ​mA ​cm−2 with low nucleation overpotential. It also can withstand ultra-high Li capacity to 20 mAh cm−2 without dendrite growth and stably cycle for 3000 ​h with 100% depth of discharge at 40 ​mA ​cm−2. More importantly, this technology can be expanded to other metal oxides for various metal batteries.

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

A novel three-layer integrated structure was designed to meet the thermal-insulation and load-bearing requirements of high-speed telescopic wing aircraft. The structure consists of heat shield layer, load-bearing skeleton, and pyramid lattice structure filled with aerogel to achieve the insulation function. Sensitivity analysis of the design parameters and optimal design of the integrated structure was carried out, and the structure was optimized by using response surface method. Compared to the initial structure, the optimized structure has an equivalent thermal conductivity of 0.0276, reduced by 40%, and a relative density of 685 . 5 kg / m 3 , reduced by 3.7%. And it has a thermal conductivity that is over 20% lower than that of ceramic insulating tiles. Then, the integrated structure was regarded as a homogeneous plate, and the equivalent mechanical and thermal parameters were determined and verified by simulation and experimental results. The equivalence error was controlled within 10%. Finally, a simulation model of the telescopic wing was established. The result shows that the maximum deformation under 20 kPa surface pressure is 3.96 mm. The temperature resistance of the structure surface is up to 1500°C, and the wing internal temperature is controlled within 200°C after 1200 s of thermal loading. The results verified that the integrated structure meets the requirement of a high-speed telescopic wing.

ObjectiveThis study explored the impact of different doeses of doxorubicin in CT-guided transvertebral foraminal injections for postherpetic neuralgia (PHN) treatment and the impact of 0.5% doxorubicin treatment on patients with different disease courses and lesion locations.MethodsThis retrospective study included 291 patients with PHN who received CT-guided doxorubicin injection at West China Hospital between April 2014 and February 2020.ResultsA total of 228 patients received 0.5% doxorubicin treatment and 63 received 0.33% doxorubicin. Both groups showed significantly improvement in visual analogue scale (VAS) and Brief Pain Inventory (BPI) scores. The 0.5% doxorubicin group demonstrated significant lower VAS scores at 6 and 12 months after surgery (all p