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A new wintertime surface air temperature (SAT) pattern, called the Asia-Kuroshio and Oyashio Extension-North America (AKNA) pattern, is identified over the Pan-North Pacific region (85°E–85°W, 25°–65°N) based on NCEP reanalysis data. The AKNA pattern is likely to influence the climate of the extratropical area of Asia and North America via two SAT dipoles, and has a significant impact on the wintertime extremely cold weather along the eastern coastal regions of East Asia. Simulations using an atmospheric general circulation model indicate that wintertime sea surface temperature anomalies (SSTa) in the Kuroshio and Oyashio Extension (KOE) region can force an equivalent barotropic atmospheric ridge downstream and weaken Siberian high and Alaska atmospheric ridge, resulting in the formation of the AKNA pattern. This circulation pattern tends to intensify the midlatitude (40°–60°N) westerlies over East Asia, which inhibits the southward invasion of the cold air into southern East Asia. Further diagnostic analysis indicates that the KOE SSTa can modulate the variation of storm track and westerlies by affecting baroclinic instability and eddy-mean flow interaction. Moreover, the KOE SSTa can provide a favorable environment for the development of the local atmospheric ascending motion and secondary circulation across the KOE SSTa, thereby affecting variability of the free atmosphere.

OBJECTIVES This paper presents a randomized controlled trial on assimilative integration, which is aimed at integrating elements from other orientations within one approach to enrich its conceptual and practical repertoire. Elements from Emotion-Focused Therapy (EFT) were integrated into a form of cognitive behavior therapy: Psychological Therapy (PT). In one treatment condition, EFT was added to PT (+EFT) with the intent to enhance therapists' working with emotions. In the other condition, concepts and interventions based on the socialpsychological self-regulation approach were added to PT (+SR). Our assumption was that the +EFT would lead to greater and deeper change, particularly in the follow-up assessments. METHOD Patients (n = 104) with anxiety, depression, or adjustment disorders were randomized to the two conditions and treated by 38 therapists who self-selected between the conditions. Primary outcome was symptom severity at 12-month follow-up; secondary outcomes included several measures such as interpersonal problems and quality of life. Variables were assessed at baseline, after 8 and 16 sessions, at posttreatment, and at 6- and 12-month follow-up. RESULTS Contrary to our hypothesis, no significant between-group effects were found. CONCLUSION The findings first suggest the difficulty of topping an already very effective approach to psychotherapy. Alternative interpretations were that the EFT training, while corresponding to regular practice in AI, was not sufficient to make a difference in outcome, or that while profiting from the enhancement of abilities for working with emotions, this was outbalanced by negative effects of difficulties related to the implementation of the new elements.

In recent decades, freak waves, characterized by their unusual high amplitude, sharp crest, and concentrated energy, have attracted researchers’ attention due to their potential threat to marine structures. Green-water loads caused by freak waves can be significant and may lead to local damage to the ship structures. Therefore, this paper focuses on the study of green-water loads and examines the structural responses of ship bow structures under the influence of the green-water loads caused by freak waves. Firstly, a three-dimensional numerical wave tank is established in which the superposition model is used to generate freak waves. Validations on the freak-wave generation, ship motion response and the wave loading are carried out to verify the present solvers. The simulation on the interaction between the freak wave and the ship are conducted to obtain the interaction process and green-water loads. Secondly, a finite element (FEM) model of the ship bow is built, on which the green-water loads are applied to calculate the structural responses. Finally, the displacement and stress of the deck and breakwater structures are analyzed. It is found that green water events caused by freak waves can generate enormous impact forces on the bow deck and breakwater, resulting in severe structural responses and even possible damage to the structures. The local strength of structures under freak waves needs to be considered in practical engineering applications.

The objective was to determine effects of cellulase, xylanase, and commercial fibrolytic enzymes on fermentation quality, aerobic stability, bacterial community, and in vitro degradation of mixed silages. Mixtures of alfalfa, wheat bran, and rice straw (80:15:5 on a fresh matter [FM] basis) were ensiled for 1, 3, 5, 7, 15, 30, and 45 d after treatment with: distilled water (control, C); cellulase (E); xylanase (X); or commercial fibrolytic enzymes (EX), with all enzyme preparations applied at 100U/g FM. The 45-d silages were subjected to an in vitro degradation test. Each of the 3 enzyme-treated groups enriched relative abundance (RA)of Lactobacillus, Weissella, and Stenotrophomonas maltophilia, increased water soluble carbohydrate (WSC) concentrations, and extended aerobic stability over 384 h, but concurrently inhibited growth of undesirable microbes (i.e., Acinetobacter sp, Erwinia sp, Lelliottia amnigena, and Sphingomonas sp), reducing pH and concentrations of ammonia nitrogen (AN), butyric acid (BA) and propionic acid (PA). Compared to C, adding X or EX increased the RA of L. paralimentarius and L. parabrevis, enhanced accumulation of acetic acid (AA) and crude protein (CP), and reduced hemicellulose content. Furthermore, E group silage had the highest abundance of W. cibaria. In addition, EX enriched RA of Bacillus velezensis, reduced AN concentration, increased DM degradability, total VFA production, and gas production during in vitro incubation. In conclusion, addition of X or EX enhanced ensiling by enhancing concentrations of AA; however, EX was the most promising enzyme, based on reducing AN concentration and increasing DM content and DM degradability.

Background. Quinolinic acid phosphoribosyltransferase (QPRT) is a rate-limiting enzyme that encodes the uronic acid pathway, which is involved in cell cycle progression and cancer cell metabolism. Some studies have demonstrated the progrowth effect of QPRT on breast cancer (BRCA) tumour cells, but its mechanism of action requires further exploration. Methods. We investigated the expression of QPRT and the prognosis of patients with different tumours by performing a pan-cancer analysis of QPRT. Prognostic values for overall survival (OS) were determined using uni- and multivariate Cox proportional hazard analyses. The prognostic survival of patients with a different pathological staging of BRCA and with QPRT high and low expression was also analysed. We also explored the relevant pathways by which QPRT affected BRCA tumorigenesis by gene set enrichment analysis (GSEA) and western blotting. The impact of QPRT on the PI3K/Akt pathway was also evaluated. Results. Pan-cancer analysis revealed significant QPRT expression in pan-cancer and correlated with prognosis in most tumour patients. QPRT was also highly expressed in BRCA when patients had poor prognoses, and its expression was associated with different pathological BRCA subtypes. GSEA revealed an association between BRCA progression and the cell cycle and the phosphatidylinositol 3-kinase (PI3K)/Akt signalling pathway, and this association was confirmed by western blotting. Conclusion. QPRT is highly expressed in breast cancer and particularly in HER2 breast cancer. Upregulated QPRT expression is an independent predictor of breast cancer prognosis and promotes breast cancer progression by activating the PI3K/Akt signalling pathway.

Background Alzheimer’s disease (AD) is a major global health crisis in need of more effective therapies. However, difficult choices to optimize value-based care will need to be made. While identifying preferred therapeutic attributes of new AD therapies is necessary, few studies have explored how preferences may vary between the stakeholders. In this study, the trade-offs among key attributes of amyloid plaque-lowering therapies for AD were assessed using a discrete choice experiment (DCE) and compared between caregivers and neurologists. Methods An initial pilot study was conducted to identify the potentially relevant features of a new therapy. The DCE evaluated seven drug attributes: clinical effects in terms of delay in AD progression over the standard of care (SOC), variation in clinical effects, biomarker response (achieving amyloid plaque clearance on PET scan), amyloid-related imaging abnormalities-edema (ARIA-E), duration of therapy, need for treatment titration as well as route, and frequency of drug administration. Respondents were then randomly presented with 12 choice sets of treatment options and asked to select their preferred option in each choice set. Hierarchical Bayesian regression modeling was used to estimate weighted preference attributes, which were presented as mean partial utility scores (pUS), with higher scores suggesting an increased preference. Results Both caregivers (n = 137) and neurologists (n = 161) considered clinical effects (mean pUS = 0.47 and 0.82) and a 5% incremental in ARIA-E (mean pUS = − 0.26 and − 0.52) to be highly impactful determinants of therapeutic choice. In contrast, variation in clinical effects (mean pUS = 0.12 and 0.14) and treatment duration (mean pUS = − 0.02 and − 0.13) were the least important characteristics of any new treatment. Neurologists’ also indicated that subcutaneous drug delivery (mean pUS = 0.42 vs. 0.07) and administration every 4 weeks (mean pUS = 1.0 vs. 0.20) are highly desirable therapeutic features. Respondents were willing to accept up to a 9% increment in ARIA-E for one additional year of delayed progression. Conclusions Caregivers and neurologists considered incremental clinical benefit over SOC and safety to be highly desirable qualities for a new drug that could clear amyloid plaques and delay clinical progression and indicated a willingness to accept incremental ARIA-E to achieve additional clinical benefits.

TCM takes clinical symptoms and signs as the treatment target. Under the guidance of the "overall concept" and "syndrome differentiation and treatment," the patient's condition was analyzed, and the appropriate treatment method was selected. TCM believes that the leading cause of POAG is stagnation of liver qi and retention of water. Therefore, the treatment of dispersing stagnated liver qi for relieving qi stagnation and eliminating water should be adopted.

Change detection of high-resolution remote sensing images is an important task in earth observation and was extensively investigated. Recently, deep learning has shown to be very successful in plenty of remote sensing tasks. The current deep learning-based change detection method is mainly based on conventional long short-term memory (Conv-LSTM), which does not have spatial characteristics. Since change detection is a process with both spatiality and temporality, it is necessary to propose an end-to-end spatiotemporal network. To achieve this, Conv-LSTM, an extension of the Conv-LSTM structure, is introduced. Since it shares similar spatial characteristics with the convolutional layer, L-UNet, which substitutes partial convolution layers of UNet-to-Conv-LSTM and Atrous L-UNet (AL-UNet), which further using Atrous structure to multiscale spatial information is proposed. Experiments on two data sets are conducted and the proposed methods show the advantages both in quantity and quality when compared with some other methods.

The surface waves investigation and monitoring (SWIM) instrument onboard the China-France Oceanography Satellite (CFOSAT) can retrieve directional wave spectra with a wavelength range of 70-500 m. This study aims to validate the partitioned integrated wave parameters (PIWPs) from SWIM, including partitioned significant wave height (PSWH), partitioned peak wave period (PPWP), and partitioned peak wave direction (PPWD), against those from National Data Buoy Center (NDBC) buoys. With quasi-simultaneous spectra from two NDBC buoys 13 km away from each other near Hawaii, the methods of comparing PIWPs from two sets of spectra were discussed first. After cross-assigning partitions according to the spectral distance, it is found that wrong cross-assignments lead to many outliers strongly impacting the estimate of error metrics. Three methods, namely comparing only the best-matched partition, changing the threshold of spectral distance during cross-assignment, and maximum likelihood estimation of root-mean-square error (RMSE) of PIWPs, were used to reduce the impact of potential wrong cross-assignments. Using these methods, the SWIM PIWPs were validated against NDBC buoys. The results show that SWIM performs well at finding the spectral peaks of different partitions with the RMSE of PPWPs and PPWDs of 0.9 s and 20°, respectively, which can be a useful complement for other wave observations. However, the accuracy of PSWH from SWIM is not that good at this stage, probably because the high noise level in the spectra impacts the result of the partitioning algorithm. Further improvement is needed to obtain better PSWH information.

This study dealt with the rotary draw bending method most used for tube bending and investigates how applied bending such as normal bending, using mandrels or pressing with booster have an effect on machining accuracy, focusing on dimensional defects due to springback and flat deformation to the transverse plane. The study used particle swarm optimization (PSO) algorithms to investigate the optimal machining conditions for improving the accuracy of dimension and shape of a bent part. The following findings were obtained: The springback during applied machining using a mandrel, or using a mandrel and booster together, is almost the same as during normal processing; The flattening near the center of the bend in applied processing using a mandrel, or a mandrel and booster together, decreases more than with normal processing at mandrel protrusion L ≥ 4 mm, and the maximum can be suppressed to approximately 0.15%; When the sum of the springback and the flattening is taken as the objective function and the minimum value is obtained, the optimal solution is around L = 7 mm.

Background and purpose: Radiation-induced erectile dysfunction (RiED) is commonly seen in prostate cancer patients. Clinical trials have been developed in multiple institutions to investigate whether dose-sparing to the internal-pudendal-arteries (IPA) will improve retention of sexual potency. The IPA is usually not considered a conventional organ-at-risk (OAR) due to segmentation difficulty. In this work, we propose a deep learning (DL)-based auto-segmentation model for the IPA that utilizes CT and MRI or CT alone as the input image modality to accommodate variation in clinical practice. Materials and methods: 86 patients with CT and MRI images and noisy IPA labels were recruited in this study. We split the data into 42/14/30 for model training, testing, and a clinical observer study, respectively. There were three major innovations in this model: 1) we designed an architecture with squeeze-and-excite blocks and modality attention for effective feature extraction and production of accurate segmentation, 2) a novel loss function was used for training the model effectively with noisy labels, and 3) modality dropout strategy was used for making the model capable of segmentation in the absence of MRI. Results: The DSC, ASD, and HD95 values for the test dataset were 62.2%, 2.54mm, and 7mm, respectively. AI segmented contours were dosimetrically equivalent to the expert physician's contours. The observer study showed that expert physicians' scored AI contours (mean=3.7) higher than inexperienced physicians' contours (mean=3.1). When inexperienced physicians started with AI contours, the score improved to 3.7. Conclusion: The proposed model achieved good quality IPA contours to improve uniformity of segmentation and to facilitate introduction of standardized IPA segmentation into clinical trials and practice.

Ferroptosis-related renal tubular lesions play important roles in diabetic kidney disease (DKD) progression, and these pathophysiological responses are collectively described as diabetic tubulopathy (DT), which lacks an effective treatment. Total flavones from Abelmoschus manihot (TFA), a natural extract that extensively used in patients with chronic kidney disease, has been used for treatment of renal tubular injury in DKD; however, whether TFA alleviates DT and its potential mechanisms remain unclear. Hence, we investigated the effects of TFA, compared to dapagliflozin, in DT management both in vivo and in vitro, using a DKD rat model and the NRK-52 E cells. Following modeling, the DKD rats received TFA, dapagliflozin, or vehicle for 6 weeks. For the in vitro research, the NRK-52 E cells were exposed to advanced glycation end products (AGEs) plus ferrostatin-1 (Fer-1), dapagliflozin, or TFA. Changes in biochemical parameters and renal tubular injury were analyzed in vivo, while changes in ferroptosis of renal tubular cells and the ferroptosis-related proteins expression were analyzed both in vivo and in vitro. We found that TFA and dapagliflozin improved biochemical parameters, renal tubular injury, and ferroptosis in the DKD rats. Moreover, TFA and dapagliflozin inhibited ferroptosis by ameliorating iron deposition, lipid peroxidation capacity, and ferroptosis-related proteins expression in vitro, which was similar to the effects of Fer-1. Collectively, this study demonstrated that TFA treated DT in a manner similar to dapagliflozin by inhibiting ferroptosis of renal tubular cells via improving iron deposition and antioxidant capacity. Our findings provide new pharmacological evidence for TFA application in DT treatment.铁死亡相关的肾小管损伤在糖尿病肾脏疾病(DKD)进展中发挥着重要作用，这些病理生理学的变化被统称为糖尿病肾小管病(DT)，缺乏有效的治疗。黄蜀葵花总黄酮(TFA)作为一个广泛用于慢性肾脏病患者的天然提取物已被应用于DKD肾小管损伤的治疗，但是，TFA是否能减轻DT以及它的潜在机制仍不清楚。因此，在DT的体内外干预性研究中，我们用DKD大鼠模型和NRK-52E细胞观察了TFA的作用，并与达格列净对比。在造模后，DKD大鼠接受了6周的TFA、达格列净或安慰剂的干预。在体外研究中，NRK-52E细胞与晚期糖基化终末产物(AGEs)、ferrostatin-1(Fer-1)、达格列净以及TFA共培养。在体内，生化参数和肾小管细胞损伤的变化得到了分析。在体内外研究中，肾小管细胞铁死亡和铁死亡相关蛋白表达的变化也得到了分析。我们发现，TFA和达格列净改善了DKD大鼠生化参数、肾小管损伤和铁死亡。此外，TFA和达格列净在体外通过改善铁超载、脂质过氧化以及铁死亡相关蛋白表达而抑制了铁死亡，这些作用类似于Fer-1。总之，本研究阐明，TFA与达格列净类似，通过抑制铁死亡和改善铁超载、脂质过氧化而干预了DT。我们的发现为TFA在DT治疗上的应用提供了新的药理学依据。.

Lifeboat is one of the most important life-saving equipment for escaping at sea when a ship is abandoned in an extreme emergency. An accurate drift model can help rescuers find the drift position of lifeboat in the shortest time, thus improving the efficiency of marine search and rescue (SAR) at sea and ensuring the safety of wrecked people. The purpose of this paper is to investigate the drift characteristics and to develop an accurate drift prediction model for the open lifeboat. First, large-scale drift experiments were conducted to analyze the drift characteristics with three 6.5-meter-long real-size open lifeboats in the South China Sea. Next, three drift prediction models of the lifeboats were developed using the least squares method based on the drift experimental data. Finally, the drift prediction models of the lifeboats were compared and evaluated using the Lagrangian method and Monte Carlo technique, respectively. Results indicate that the probability of positive crosswind leeway (CWL) of the open lifeboat is 47.5%. The jibing frequency is 6% per hour, and the maximum leeway divergence angle is 45°. These drift characteristics are very important for the prediction of the open lifeboat drift trajectory. The comparison results of three drift models show that the improved drift model is more accurate than the other two drift models for predicting drift trajectories of the open lifeboat, which can be directly applied to maritime search and rescue operations in the South China Sea.

Detecting the evolutionary stages of social media events such as Twitter and Sina Weibo is beneficial for enterprises and governments to take necessary actions before emergent phenomena become uncontrollable. Prior work on event extraction from microblogs mostly focused on extracting event summary. However, the evolutionary stages of an event can provide more details about the evolution of the event, which are more critical to predict the future trend of the event. On the other hand, many events have a lifecycle-like evolutionary property, i.e., beginning, developing, climax, descending, and disappearing. Such a feature is helpful to detect the evolutionary stages of events. Thus, we propose a graph-based approach to represent and extract the evolutionary stages of events from microblogs based on this consideration. The contributions of this study are threefold. First, differing from existing methods that use a keyword set or a microblog set to represent an event, we propose a Keyword Popularity Information Graph (KPIG) to represent the keywords and the statistical information of events using a graph. With this mechanism, we can capture both the textual information and the statistical information of an event. Second, based on the KPIG graph, we present a graph-kernel-based approach to measure the similarity among events. Third, we conduct extensive experiments on a real dataset and compare our proposal with several competitor algorithms. The results show that our approach outperforms other competitors in terms of various metrics.

Purpose To explore the clinical significance of plasma pyruvate kinase M2 (PKM2) in assessing the incidence and prognosis of acute leukemia. Methods Plasma samples from 56 acute myeloid leukemia (AML) patients, 40 acute lymphoblastic leukemia (ALL) patients, and 66 plasma samples from healthy individuals were collected. The level of plasma PKM2 was detected by enzyme-linked immunosorbent assay. The clinical significance of PKM2 in acute leukemia was assessed by analyzing receiver operating characteristic and survival curves. Results The plasma levels of PKM2 in AML or ALL patients were significantly higher than those in healthy individuals, respectively. PKM2 can be used as a potential diagnostic index with the AUC of 0.827 for AML and 0.837 for ALL. The level of plasma PKM2 in ALL patients with a BCR/ABL-positive genotype was significantly higher than that in patients with a BCR/ABL-negative genotype (p

Cancer is one of the leading causes of death in the world. It is very important to find drugs with high efficiency, low toxicity, and low side effects for the treatment of cancer. Flavonoids and their derivatives with broad biological functions have been recognized as anti-tumor chemicals. 8-Formylophiopogonanone B (8-FOB), a naturally existed homoisoflavonoids with rarely known biological functions, needs pharmacological evaluation. In order to explore the possible anti-tumor action of 8-FOB, we used six types of tumor cells to evaluate in vitro effects of this agent on cell viability and tested the effects on clone formation ability, scratching wound-healing, and apoptosis. In an attempt to elucidate the mechanism of pharmacological action, we examined 8-FOB-induced intracellular oxidative stress and -disrupted mitochondrial function. Results suggested that 8-FOB could suppress tumor cell viability, inhibit cell migration and invasion, induce apoptosis, and elicit intracellular ROS production. Among these six types of tumor cells, the nasopharyngeal carcinoma CNE-1 cells were the most sensitive cancer cells to 8-FOB treatment. Intracellular ROS production played a pivotal role in the anti-tumor action of 8-FOB. Our present study is the first to document that 8-FOB has anti-tumor activity in vitro and increases intracellular ROS production, which might be responsible for its anti-tumor action. The anti-tumor pharmacological effect of 8-FOB is worthy of further investigation.

Diabetic kidney disease (DKD) is the most-common cause of chronic renal failure and end-stage renal disease (ERSD) in diabetes mellitus (DM) patients. Renal inflammation and glomerular or interstitial fibrosis are mainly associated with the progression of DKD. Carbohydrate response element binding protein (ChREBP) is activated and transcribed in a glucose dependent manner. This study is aimed at exploring the role and underlying mechanisms of ChREBP in DKD.ChREBP knockout mice, obtained by CRISPR Cas9 gene editing technology, were used to study the effects of ChREBP on inflammation and fibrosis in diabetic kidney of mice. Human renal tubular epithelial (HK-2) cells were cultured in a medium containing normal or high glucose levels. Additionally, the role of ChREBP in high glucose (HG)-induced NLRP3 inflammasome activation was assessed.We identified that renal inflammation, renal extracellular matrix deposition, and renal fibrosis were restored by ChREBP deficiency in diabetic mouse kidney. Consequently, ChREBP deficiency decreased the activation of nucleotide leukin-rich polypeptide 3 (NLRP3) inflammasome, which later restrained hyperglycemia-induced renal fibrosis. Importantly, NLRP3 inflammasome aggravated the above-mentioned renal fibrosis via TGF-β1 expression and the signaling pathways of Smad2/3 and the p38 MAPK. Additionally, ChREBP deficiency inhibited NLRP3 inflammasome activation both in HG-induced HK-2 cells and diabetic mouse kidney.Our findings establish a critical role of ChREBP in engaging inflammation and renal fibrosis by regulating NLRP3 inflammasome activation in DKD.

Background and aimsMethamphetamine (MA) is a psychostimulant associated with a high relapse rate among patients with MA use disorder (MUD). Long-term use of MA is associated with mental disorders, executive dysfunction, aggressive behaviors, and impulsivity among patients with MUD. However, identifying which factors may be more closely associated with relapse has not been investigated. Thus, we aimed to investigate the psychological factors and the history of MA use that may influence MA relapse.MethodsThis cross-sectional study included 168 male MUD patients (MUD group) and 65 healthy male residents (control group). Each patient was evaluated with self-report measures of executive dysfunction, psychopathological symptoms, impulsiveness, aggressiveness, and history of MA use. Data were analyzed with t-tests, analyses of variance, and correlation and regression analyses.ResultsThe MUD group reported greater executive dysfunction, psychopathological symptoms, impulsivity, and aggression than the control group. Lower age of first MA use was associated both with having relapsed one or more times and with having relapsed two or more times; greater executive dysfunction was associated only with having relapsed two or more times.ConclusionPatients with MUD reported worse executive function and mental health. Current results also suggest that lower age of first MA use may influence relapse rate in general, while executive dysfunction may influence repeated relapse in particular. The present results add to the literature concerning factors that may increase the risk of relapse in individuals with MUD.

Quantitative analyses of storm surge risk, which are mostly focused on physical vulnerability, have been widely used to help coastal communities mitigate impacts and damage. Such assessments, however, overlook the social aspect of vulnerability in storm surge risk. By considering both the community’s social vulnerability and buildings’ physical vulnerability, this study proposed a methodology that incorporates social vulnerability into the framework for making quantitative risk assessments of storm surge using a coupled hydrodynamic and wave model, Geographical Information System (GIS) techniques, and the Principal Component Analysis (PCA) method. The coastal area of Huizhou was chosen as the case study due to its high concentration of oil and gas infrastructure in China’s southern Guangdong Province. By combining hazard, exposure, physical vulnerability, and social vulnerability, it was possible to explore the effect of social vulnerability on the physical vulnerability-based risk assessment of storm surge and determine the overall risk level. First, the Gumbel distribution was utilized to establish five representative and plausible hypothetical typhoon events with different return periods (10, 20, 50, 100, and 1000 years) for the study area. Then, using the well-validated fully-coupled model, the Simulating Waves Nearshore (SWAN) model and the ADvanced CIRCulation (ADCIRC) model, storm surge simulations for defined return periods were run, and the geographical distribution of the maximum surge elevations displayed on a GIS platform was used to assess hazard levels. In terms of the physical aspect, the depth-damage functions for buildings were established to estimate direct economic losses and assign risk levels accordingly. For the social vulnerability of a community, a composite score was computed using the PCA method by combining and aggregating indicators representing various characteristics of the social group. The results show that the overall risk level, taking into account both social vulnerability and physical vulnerability, has decreased on average. It suggests that social vulnerability-based risk assessment may account for a significant portion of the overall risk assessment, which is frequently overlooked in traditional storm surge risk assessment. Additionally, the comprehensive and precise risk maps can assist local policymakers in identifying areas at different risk levels and developing evacuation plans, thereby minimizing potential losses, especially in high-risk areas.

To explore the effect and mechanism of Dahuang Zhechong Pills(DHZCP), a classical prescription, in improving testicular aging(TA) in vivo, the authors randomly divided 24 male rats into four groups: the normal, model, DHZCP and vitamin E(VE) groups. The TA rat model was established by continuous gavage of D-galactose(D-gal). During the experiment, the rats in the DHZCP and VE groups were given DHZCP suspension and VE suspension, respectively by gavage, while those in the normal and model groups were gavaged saline separately every day. After the co-administration of D-gal and various drugs for 60 days, all rats were sacrificed, and their blood and testis were collected. Further, various indexes related to TA and necroptosis of testicular cells in the model rats were examined and investigated, which included the aging phenotype, total testicular weight, testicular index, histopathological features of testis, number of spermatogenic cells, sex hormone level, expression characteristics of reactive oxygen species(ROS) in testis, expression levels and characteristics of cyclins in testis, and protein expression levels of the key molecules in receptor-interacting serine/threonine-protein kinase 1(RIPK1)/receptor-interacting serine/threonine-protein kinase 3(RIPK3)/mixed lineage kinase domain like pseudokinase(MLKL) signaling pathway in each group. The results showed that, for the TA model rats, both DHZCP and VE improved their aging phenotype, total testicular weight, testicular index, pathological features of testis, number of spermatogenic cells, serum testosterone and follicle stimulating hormone levels, expression characteristics of ROS and protein expression levels and characteristics of P21 and P53 in testis. In addition, DHZCP and VE improved the protein expression levels of the key molecules in RIPK1/RIPK3/MLKL signaling pathway in testis of the model rats. Specifically, DHZCP was better than VE in the improvement of RIPK3. In conclusion, in this study, the authors found that DHZCP, similar to VE, ameliorated D-gal-induced TA in model rats in vivo, and its mechanism was related to reducing necroptosis of testicular cells by inhibiting the activation of RIPK1/RIPK3/MLKL signaling pathway. This study provided preliminary pharmacological evidence for the development and application of classical prescriptions in the field of men's health.

Alzheimer's disease (AD) is a chronic neurodegenerative disorder associated with a high burden of illness. New therapies under development include agents that target amyloid-beta (Aβ), a key component in AD pathogenesis. Understanding the decision-making process for new AD drugs would help determine if such therapies should be adopted by society. Multicriteria decision analysis (MCDA) was applied to three key stakeholder groups to assess treatment alternatives for AD based on a multitude of decision trade-offs covering main components of care.AD caregivers (n = 117), neurologists (n = 90), and payors (n = 90) from the USA received an online survey. The decision problem was broken down into four decision criterion and 12 subcriteria for two treatment scenarios: an Aβ-targeted therapy vs. the standard of care (SOC). Respondents were asked to indicate how much they preferred one option over another on a scale from 1 (equal preference) to 9 (high preference) based on each criterion and subcriterion. The decision criteria and subcriteria were weighted and presented as partial utility scores (pUS), with higher scores suggesting an increased preference for that decision-making component.Caregivers and payors applied the highest value to need for intervention (mean pUS = 0.303 and 0.259) and clinical outcomes (mean pUS = 0.286 and 0.377). In contrast, neurologists placed the highest value on clinical outcomes and types of benefits (mean pUS = 0.436 and 0.248). When decision subcriteria were examined, efficacy (mean pUS = 0.115, 0.219, and 0.166) and the type of patient benefits (mean pUS = 0.135, 0.178, and 0.126) were among the most valued by caregivers, neurologists, and payors.All groups placed the highest value on drug efficacy and types of benefit derived by patients. In contrast, cost implications were among the least important aspects in their decision-making.

BACKGROUND The brain is the most complex organ in the human body. Treatment for a glioma always involves a multi-disciplinary team. Nursing care in fast-track surgery or enhanced recovery after surgery is such kind of work implemented by an interdisciplinary team to provide services to patients to improve their outcomes. AIM To explore the effects of nursing care in fast-track surgery on postoperative pain, psychological state, and patient satisfaction with nursing for glioma. METHODS From June 2018 to June 2020, 138 patients who underwent operation for glioma at Cancer Hospital Affiliated to Chongqing University were selected. They were categorized into groups according to different nursing care that they received. Of them, 69 patients receiving nursing care in fast-track surgery were included in an experimental group, and 69 patients receiving conventional postoperative nursing were included in a control group. Visual analogue scale was used to evaluate postoperative pain in the two groups immediately after the operation and at 3 d after the operation. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the psychological status of patients immediately after operation and on the 3rd postoperative day. A self-made satisfaction scale for patient satisfaction with nursing was used to evaluate and compare patient satisfaction with nursing between the two groups. RESULTS Time to excretion, time to out-of-bed activities, and length of hospital stay were significantly shorter in the observation group than in the control group (P < 0.05). There was no significant difference in duration of operative time or intraoperative bleeding between the two groups (P > 0.05). There was no significant difference in postoperative pain score between the two groups (P > 0.05). The pain score was significantly lower in the observation group than in the control group at 3 d after the operation (P < 0.05). There was no significant difference in postoperative SAS or SDS score between the two groups (P > 0.05). SAS and SDS scores were significantly lower in the observation group than in the control group at 3 d after operation (P < 0.05). The rate of patient satisfaction with nursing was 94.2% in the observation group, which was significantly higher than that (81.2%) of the control group (P < 0.05). CONCLUSION Nursing care in fast-track surgery can relieve postoperative pain, anxiety, and depression, and improve patient satisfaction with nursing in patients with glioma, which is worthy of clinical application.