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The influence of pressure and environment on urban polyethylene (PE) gas pipeline makes structural deterioration and leaking to the pipeline and pipeline easy. This paper proposes an analysis method for optimizing Variational Mode Decomposition (VMD) algorithm. Firstly, the optimal bandwidth is obtained by using the adaptive weighted frequency band entropy (AFBE), and the optimal quadratic penalty factor is obtained by curve fitting. Then, the AFBE is used as the fitness function, and the optimal decomposition level is obtained by the optimized beetle whisker search algorithm. Experimental results show that the signal-to-noise ratio (SNR) is improved by 12.74% on average. [ABSTRACT FROM AUTHOR]

Background: This study addresses the scarcity of research on nausea and vomiting in pregnancy (NVP) in China. It aims to explore the current NVP status in the country using validated questionnaires, analyze associated factors, and provide a useful reference for future research. The study also compares results from different assessment tools. Methods: Online questionnaires were utilized to gather data from 535 pregnant women across 24 provinces. Demographic, pregnancy, and NVP-related information were collected. NVP severity was assessed using Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) and the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) scales. Ordinal logistic regression identified factors linked to NVP severity. Differences between PUQE and RINVR assessments were compared. Results: NVP prevalence exceeded 90%, with 96.1% assessed by PUQE and 90.8% by RINVR. Incidence decreased from nausea to retching and vomiting. Severe NVP correlated with reduced gestational weight gain, younger age, fewer gestational weeks, and living in North (all P values < 0.05). There was moderate consistency between PUQE and RINVR assessments. The NVP prevalence assessed by the PUQE is higher than that assessed by the RINVR in the same population. However, the proportion of NVP levels above moderate assessed by RINVR is greater than that assessed by PUQE. Conclusions: NVP is highly prevalent among Chinese pregnant women, with nausea being predominant. RINVR assessments may be better able to identify severe NVP, thereby improving the low treatment rates for severe NVP. [ABSTRACT FROM AUTHOR]

A self-adaptive energy storage coordination control strategy based on virtual synchronous machine technology was studied and designed to address the oscillation problem caused by new energy units. By simulating the characteristics of synchronous generators, the inertia level of the new energy power system was enhanced, and frequency stability optimization was achieved. This strategy is integrated with the frequency response model of the new energy power system to improve the system's frequency regulation capability and achieve more stable and efficient operation. From the results, the damping of the system increased, the oscillation frequency decreased after a duration of about 15 s, and the system stability improved by 76.09%. The proposed strategy based on virtual synchronous generator adaptive energy storage coordination control strategy was improved by 83.25%. In addition, the proposed strategy has improved stability indicators and system completion efficiency by 40.57% and 22.21% respectively, both of which are better than the comparative strategies. As a result, this strategy significantly enhances the frequency regulation capability of the system, which has a positive effect on achieving efficient operation of the new energy power system and maintaining the stability of the power system. [ABSTRACT FROM AUTHOR]

Mountain town ecosystems are fragile and highly susceptible to the impacts of human activities and ecological imbalances. This study aimed to improve the traditional ecological footprint (EF) model by incorporating expanded land functions, localised factors, and temporal continuity. Using Lushan County in Sichuan Province as a case study, we calculated spatial and temporal changes from 2009 to 2022 and evaluated sustainable development through four indicators: ecological pressure, ecological sustainability, ecological occupation, and ecological–economic coordination. The results show that from 2009 to 2022, the per capita ecological carbon footprint in Lushan County decreased by 48%, and the ecological carrying capacity declined by 9%. Despite a more than 73% reduction in the ecological surplus, indicating gradual ecological recovery, Lushan County remains in an ecological deficit state with increasing ecological unsustainability. Only forest land is in an ecological surplus state among the six land use categories, while all other categories are in ecological deficit states. Regarding ecological sustainability assessment, Lushan County's overall land use is in a strong sustainability state, with the sustainable development index gradually improving. However, ecological–economic coordination remains poor, with a high ecological occupation index and significant ecological pressure, indicating an imbalance between economic development and ecosystem protection. For future sustainable development in mountainous areas, Lushan County should focus on reducing the ecological carbon footprint and enhancing the ecological carrying capacity. These research findings provide valuable insights and methodological references for the sustainable development of mountain towns. [ABSTRACT FROM AUTHOR]

The study of Features and Characteristics of Mountainous Rural Settlements (RFCMRS) is a key factor in the development of rural settlements during the urbanization process. Mountainous rural settlements, due to their unique mountainous conditions, climate, living environments, and regional culture, are among the important subjects of research for governments and the academic community worldwide. This paper, utilizing the knowledge mapping software CiteSpace (6.2.R3) for co-citation and collaboration analysis, keyword clustering, keyword time zoning, and keyword emergence, analyzes the research trajectory, key issues, and future trends of RFCMRSs. The study finds that current RFCMRS research can be categorized into the following three key issues: "implications of climate change: risks and adaptive responses", "regional cultural heritage and economic development", and "ecological conservation and fostering harmonious symbiosis". Future research will focus on the following three development trends: "risk response based on climate resilience and ecological protection", "factors of features and characteristics based on regional culture and landscape configurations", and "human settlements based on low-carbon objectives and sustainable development principles". Lastly, the paper proposes the following three future research suggestions: "improving the evaluation system for features and characteristics of mountainous rural settlements", "deepening the study on the evolutionary phenomenon and mechanism for features and characteristics of mountainous rural settlements", and "exploring the design methods for features and characteristics of mountainous rural settlements based on the concept of sustainable development". [ABSTRACT FROM AUTHOR]

Myelolipoma is a kind of benign lipoma containing myeloid cells. It is a rare type of tumor that typically presents as an occasional adrenal tumor, generally manifesting as a nonfunctional adrenal mass. Although it can occur in extra-adrenal tissues, its occurrence in bone tissue is extremely rare. Most cases are discovered accidentally during physical examinations of adults, and there are currently no reports of cases with pathological fractures as the main symptoms. We present a case of a 15-year-old teenager who developed a pathological fracture caused by femoral myelolipoma. The diagnosis of the specific type of bone tumor of the patient was determined through pathology and imaging. To treat the condition, we utilized a technique known as the "soft drill" to fully access the tumor space, remove the bone septum, and scrape away the diseased tissue. The fracture was then stabilized using a hybrid external fixation. After a 2-year follow-up period, there was no recurrence of the bone tumor. This case is the first case of intraosseous myelolipoma that occurred in a minor with the initial symptom of pathological fracture, filling the gap in our existing body of knowledge and providing a reference for the treatment of this type of intraosseous myelolipoma. [ABSTRACT FROM AUTHOR]

Low-fertility rate has been a common problem in many industrialized countries. To reverse the declining trend of new births, Chinese government gradually lifted its restrictions on the number of births per family, allowing for a household to have no more than two children. Little is known about the additional births or population increase contributed by the gradual relaxation of birth restrictions. To fill this gap, this quasi-experimental design study including data from 124 regions used the synthetic control method and controlled interrupted time series analysis to evaluate the differences in birth rates and rates of natural population increase between China and its synthetic control following implementation of the two-child policy from 2011 to 2020. A total of 123 regions were included in the control pool. Data collected during 1990–2010 were used to identify the synthetic China for each study outcome. The mean rate differences of birth rates and rates of natural increase between China and synthetic China after two-child policy implementation were 1.16 per 1000 population and 1.02 per 1000, respectively. These rate differences were distinguished from variation due to chance (one-sided pseudo- P -values: P for birth rates = 0.047, P for rates of natural increase = 0.020). However, there were statistically significant annual reductions in the pre–post trend of birth rates and rates of natural increase compared with those of controls of <0.340 per 1000 population per year [ P  = 0.007, 95% CI = (−0.584, −0.096)] and <0.274 per 1000 per year [ P  = 0.028, 95% CI = (−0.518, −0.031)]. The results suggested that lifting birth restrictions had a short-term effect on the increase in birth rates and rates of natural population increase. However, birth policy with lifting birth restrictions alone may not have sustained impact on population growth in the long run. [ABSTRACT FROM AUTHOR]

The carbon-to-nitrogen (C/N) ratio in the cultivation medium significantly influences the growth rate, vigor of mycelium, yield of fruiting bodies, and their nutritional composition. Recently, agricultural and forestry wastes have been increasingly used in cultivating Flammulina velutipes. However, systematic research on how these materials affect the nutritional and functional properties of the fruiting bodies is lacking. This study investigated the effects of different C/N ratios on F. velutipes cultivation. We evaluated the agronomic traits, nutritional composition, and flavor compounds of the fruiting bodies. Our findings reveal that an optimal C/N ratio of 27:1 in the composted substrates enhances the total yield of fruiting bodies, with 25.1% soybean straw as the primary raw material. This ratio also significantly increases the levels of crude protein, total amino acids, and essential amino acids in the fruiting bodies (p < 0.05). Fruiting bodies from the high-nitrogen (HN) treatment showed the highest content of umami amino acids and equivalent umami concentration value. Additionally, we employed an untargeted liquid chromatography–mass spectrometry (LC-MS)-based metabolomics approach to analyze the metabolite profiles of fruiting bodies cultivated in high-nitrogen (HN), medium-nitrogen (MN), and low-nitrogen (LN) substrates. We found that the carbon–nitrogen ratio can affect the flavor and quality of fruiting bodies by regulating amino acid biosynthesis and metabolism and other related pathways. Our results suggest that a C/N ratio of 27:1 offers numerous benefits for the cultivation of F. velutipes with comprehensive analyses and has promising application prospects. [ABSTRACT FROM AUTHOR]

Ecological networks in mountainous regions are vital for enhancing ecosystem functionality and ensuring regional ecological stability, alleviating the contradiction between land use and ecological development in rapid urbanization. However, the complexity of mountains and the need to establish a connection between ecosystem services and human well-being present significant challenges in constructing ecological networks. This study proposes an idea that identifies and derives an optimal scenario for ecological networks, integrating insights from ecosystem services and network analysis. The aim of the ecological network is to improve and protect the ecosystem's stability while better guiding sustainable development in mountainous regions' urban and rural areas. This study uses qualitative evaluation methods and a graph theory model to obtain the ecological network's sources and links. The results indicate that (1) 58 important ecological source areas were identified, with a total area of 5746 km2, mainly covered by woodland and water bodies. (2) An optimal and feasible scenario comprising 5 horizontal and 14 longitudinal corridors was established. Corridors rely primarily on the river system and mountains. (3) A total of 5 key ecological function areas and some ecological zones in important urban development areas were identified. Control measures for these ecological lands were proposed to enhance the effectiveness of ecosystem service construction. It can be concluded that identifying and deriving an optimal scenario of ecological networks in mountainous regions from the perspectives of ecosystem services and network analysis is feasible. [ABSTRACT FROM AUTHOR]

Background: The importance of the gut microbiota in maintaining bone homeostasis has been increasingly emphasized by recent research. This study aimed to identify whether and how the gut microbiome of postmenopausal women with osteoporosis and osteopenia may differ from that of healthy individuals. Methods: Fecal samples were collected from 27 individuals with osteoporosis (OP), 44 individuals with osteopenia (ON), and 23 normal controls (NC). The composition of the gut microbial community was analyzed by 16S rRNA gene sequencing. Results: No significant difference was found in the microbial composition between the three groups according to alpha and beta diversity. At the phylum level, Proteobacteria and Fusobacteriota were significantly higher and Synergistota was significantly lower in the ON group than in the NC group. At the genus level, Roseburia, Clostridia_UCG.014, Agathobacter, Dialister and Lactobacillus differed between the OP and NC groups as well as between the ON and NC groups (p < 0.05). Linear discriminant effect size (LEfSe) analysis results showed that one phylum community and eighteen genus communities were enriched in the NC, ON and OP groups, respectively. Spearman correlation analysis showed that the abundance of the Dialister genus was positively correlated with BMD and T score at the lumbar spine (p < 0.05). Functional predictions revealed that pathways relevant to amino acid biosynthesis, vitamin biosynthesis, and nucleotide metabolism were enriched in the NC group. On the other hand, pathways relevant to metabolites degradation and carbohydrate metabolism were mainly enriched in the ON and OP groups respectively. Conclusions: Our findings provide new epidemiologic evidence regarding the relationship between the gut microbiota and postmenopausal bone loss, laying a foundation for further exploration of therapeutic targets for the prevention and treatment of postmenopausal osteoporosis (PMO). [ABSTRACT FROM AUTHOR]

Climate change and urbanization intersect with escalating danger. Urban areas significantly contribute to climate change, which, in turn, poses severe threats to urban settings. The frequency and intensity of extreme events, like flooding and heat, are rising, with the need to enhance urban climate resilience (UCR) becoming more immediate. Scholarship tends to underrepresent general climate resilience in favor of specific hazards. This research seeks to contribute to the literature by exploring the case of Shanghai, China, discovering the mechanisms and characteristics of UCR governance, and examining how these outcomes are formed from a comparative gesture. The findings indicate that in Shanghai, 36.8% and 26.8% of climate resilience governance strategies are reflected in regional management and infrastructure construction led by the Water Affairs Bureau and the Meteorological Bureau. Furthermore, 30.6% of the strategies relate to the Water Affairs Bureau, showcasing a robust and integrated flood response. Meanwhile, 15.7% involve the Meteorological Bureau, boosting responses to high temperatures with better monitoring and early warning for increased flexibility and efficiency. Distinct governance processes for floods and extreme heat mirror these hazards' inherent characteristics and societal perceptions. With strong government willingness and support, Shanghai has rapidly enhanced its flood resilience capabilities within a brief timeframe. Conversely, addressing the emerging risk of extreme heat is still in the early stages of evaluation, due to the lack of a clear disaster-bearing system and identified responsible agents. This research suggests that the future of climate resilience governance in Shanghai may emphasize identifying the characteristics of critical climate-related risks, expanding social autonomy through grassroots self-governance, procuring economic backing from the central government, and applying the tool of urban spatial planning. [ABSTRACT FROM AUTHOR]

PSI is a sophisticated photosynthesis protein complex that fuels the light reaction of photosynthesis in algae and vascular plants. While the structure and function of PSI have been studied extensively, the dynamic regulation on PSI oligomerization and high light response is less understood. In this work, we characterized a high light-responsive immunophilin gene FKB20-2 (FK506-binding protein 20-2) required for PSI oligomerization and high light tolerance in Chlamydomonas (Chlamydomonas reinhardtii). Biochemical assays and 77-K fluorescence measurement showed that loss of FKB20-2 led to the reduced accumulation of PSI core subunits and abnormal oligomerization of PSI complexes and, particularly, reduced PSI intermediate complexes in fkb20-2. It is noteworthy that the abnormal PSI oligomerization was observed in fkb20-2 even under dark and dim light growth conditions. Coimmunoprecipitation, MS, and yeast 2-hybrid assay revealed that FKB20-2 directly interacted with the low molecular weight PSI subunit PsaG, which might be involved in the dynamic regulation of PSI-light-harvesting complex I supercomplexes. Moreover, abnormal PSI oligomerization caused accelerated photodamage to PSII in fkb20-2 under high light stress. Together, we demonstrated that immunophilin FKB20-2 affects PSI oligomerization probably by interacting with PsaG and plays pivotal roles during Chlamydomonas tolerance to high light. FKB20-2 interacts with PSI small subunit PsaG in thylakoid lumen, ensuring the accumulation of PSI complexes and influencing the high light tolerance of Chlamydomonas. [ABSTRACT FROM AUTHOR]

The compaction quality is directly related to the deformation and stability of the rockfill dam. Measuring the test pit volume efficiently and accurately is the most critical step during the compaction quality inspection. A new method for calculating the test pit volume based on point cloud data is proposed. An auxiliary device that can change the scanning distance and angle of the handheld 3D laser scanner is developed to collect the initial point cloud. The segmentation method of the initial point cloud data including the test pit and the compaction surface outside the pit is to divide the data into two parts according to the order number of the segmentation point, after slicing and sorting point clouds, which is the key to ensuring the computational precision. The segmentation points are the adjacent two points with the greatest order number difference in these point clouds whose distance from the line connecting the end points of the slicing point clouds is less than dz. The compaction surface point clouds are used to construct a plane by the least-squares algorithm so that the closed three-dimensional model is formed by registering it with the test pit point clouds. After converting the test pit surface to the horizontal plane by the Rodrigues formula, the test pit point clouds are divided into n2 parts with equal projection areas on the horizontal plane, and n2 prisms are constructed using them and their projection areas. The test pit volume is the sum of the intersection space volumes of all prisms and the test pit model, and the intersection space is determined by comparing the Z-values of point clouds. The new method was programmed in MATLAB and applied to the Shuangjiangkou rockfill dam with a height of 315 m. The relative error of volume results between the new method and the old water-filling method is 0.14–2.31%. The cause of the error is analyzed, and it is proved that the results of the new method are closer to the real volume of the test pit in theory. This method reduces the inspection cost but greatly improves the level of precision, efficiency, and intelligence for compaction quality inspection. [ABSTRACT FROM AUTHOR]

China accounted for 45.3% of new cases of primary liver cancer (PLC) worldwide in 2020. While variations in PLC incidence between different regions of China and decreasing incidence in overall China have been reported, incidence patterns have not been thoroughly explored by region. We examined the nearly status and temporal trends of PLC incidence in different geographical regions in China and project future trends. The age‐standardized incidence rate (ASR) was estimated for 1978 to 2012 by different geographical regions and gender in China. Age‐period‐cohort model was adopted to evaluate age and birth cohort effects on the temporal trend of five registries of China (Hong Kong, Shanghai, Jiashan, Harbin and Zhongshan), Bayesian age‐period‐cohort model was adopted to project future trends for 2013 to 2032. PLC incidence in China exhibits marked geographical disparity, with the highest incidence in Southwest China, and gender differences being particularly pronounced in South China. While other registries exhibited decreasing trend, Zhongshan exhibited an increasing trend, with the cohort effect showing a marked upward trend for females born in 1916 to 1949 and males born in 1916 to 1962. During 2013 to 2032, the ASR appears to increase by 86.9% for men and 40.0% for women in Zhongshan, while the remaining registries will decline by around 50%. Since the high incidence of hepatitis B virus infection in early birth cohort, recent rise of nonviral risk factors and the severe aging of the Chinese population, it may be critical to tailor future prevention and control strategies for PLC to the distribution of risk factors in different geographical regions. [ABSTRACT FROM AUTHOR]

SF6/N2 mixture is an alternative gas of SF6, which is already used in electrical equipment. When a malfunction occurs, SF6/N2 will decompose and further react with trace water and oxygen to produce nitrogen-containing gases such as NO, NO2, N2O and NF3. It is necessary to monitor these gases to ensure the safe operation of the equipment. This paper is based on density functional theory (DFT), the nanomaterial Ti3C2T x doped with Au atom was selected as sensing material. The result shows that Au/Ti3C2T x has larger adsorption energy when NO and NO2 adsorbed on the surface, the stable structures were conformed more easily with NO and NO2 compared with N2O and NF3. The density of states analysis and the frontier molecule orbital analysis reveal more change of the system before and after NO and NO2 adsorption, suggesting the material showed good sensitivity performance to NO and NO2. Thus, Au/Ti3C2T x is considered to have the potential for sensing NO and NO2. [ABSTRACT FROM AUTHOR]

Currently, China is using the SF6/N2 gas mixture to gradually replace SF6 in GIS and other equipment. However, gas-insulated equipment will inevitably have local overheating faults. The SF6/N2 gas mixture will decompose to some extent at high temperatures. Impurities such as moisture in the equipment can affect this decomposition process. At present, there are fewer studies on the moisture content of the superheated decomposition of the SF6/N2 gas mixture. Therefore, this paper carries out the SF6/N2 mixed gas superheat decomposition experiment on the constructed superheat decomposition simulation experiment platform. By changing the content of trace water, the influence of trace water on the decomposition of the SF6/N2 mixed gas insulation medium with superheat failure was initially investigated. It is found that trace H2O will promote the generation of SF6 characteristic decomposition products, especially for the generation of SO2F2. The generation of SO2 in the product is the largest, and its generation process needs the full participation of H2O. In addition, the addition of trace water will also improve the yield of nitrogen-containing products NO and NO2, and under the experimental conditions of this paper, by adding the microwater, the yield reaches 100–300 µl/l. The reaction mechanism of H2O decomposition and combining with N atoms to generate NO and NO2 at high temperatures was analyzed in this paper. The thermodynamic properties of the main reaction paths and the equilibrium constants were calculated based on the density functional theory, which provided theoretical references for the further study of the mechanism of SF6/N2 superheated decomposition. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare no conflict of interest.

Although hydrophobic interactions provide the main driving force for initial peptide aggregation, their role in regulating suprastructure handedness of higher-order architectures remains largely unknown. We here interrogate the effects of hydrophobic amino acids on handedness at various assembly stages of peptide amphiphiles. Our studies reveal that relative to aliphatic side chains, aromatic side chains set the twisting directions of single β-strands due to their strong steric repulsion to the backbone, and upon packing into multi-stranded β-sheets, the side-chain aromatic interactions between strands form the aromatic ladders with a directional preference. This ordering not only leads to parallel β-sheet arrangements but also induces the chiral flipping over of single β-strands within a β-sheet. In contrast, the lack of orientational hydrophobic interactions in the assembly of aliphatic peptides implies no chiral inversion upon packing into β-sheets. This study opens an avenue to harness peptide aggregates with targeted handedness via aromatic side-chain interactions., (© 2024. The Author(s).)

Background: Due to the slower dissipation of the osmotic gradient, icodextrin-based solutions, compared to glucose-based solutions, can improve water removal. We investigated scenarios where one icodextrin-based long dwell (Extraneal) replaced two glucose-based exchanges., Methods: The three-pore model with icodextrin hydrolysis was used for numerical simulations of a single exchange to investigate the impact of different peritoneal dialysis schedules on fluid and solute removal in patients with different peritoneal solute transfer rates (PSTRs). We evaluated water removal (ultrafiltration, UF), absorbed mass of glucose (AbsGluc) and carbohydrates (AbsCHO, for glucose and glucose polymers), ultrafiltration efficiency (UFE = UF/AbsCHO) per exchange, and specified dwell time, and removed solute mass for sodium (ReNa), urea (ReU), and creatinine (ReCr) for a single peritoneal exchange with 7.5% icodextrin (Extraneal ® ) and glucose-based solutions (1.36% and 2.27%) and various dwell durations in patients with fast and average PSTRs., Results: Introducing 7.5% icodextrin for the long dwell to replace one of three or four glucose-based exchanges per day leads to increased fluid and solute removal and higher UF efficiency for studied transport groups. Replacing two glucose-based exchanges with one icodextrin exchange provides higher or similar water removal and higher daily sodium removal but slightly lower daily removal of urea and creatinine, irrespective of the transport type present in the case of reference prescription with three and four daily exchanges., Conclusion: One 7.5% icodextrin can replace two glucose solutions. Unlike glucose-based solutions, it resulted only in minor differences between PSTR groups in terms of water and solute removal with UFE remaining stable up to 16 h., Competing Interests: Authors JY and QY were employed by Baxter Healthcare Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Stachowska-Pietka, Waniewski, Olszowska, Garcia-Lopez, Yan, Yao, Wankowicz and Lindholm.)

The long-term incidence trends of 32 cancers in China remained unclear. Cancer statistics for young population were often presented in aggregate, masking important heterogeneity. We aimed to assess the incidence trends of 32 cancers in China from 1983 to 2032, stratified by sex and age groups. Data on cancer incidence from 1983 to 2017 were extracted from Cancer Incidence in Five Continents Volumes VI-XII. The age-period-cohort model was utilized to assess age and birth cohort effects on the temporal trends of 32 cancers in China, while the Bayesian age-period-cohort model was utilized to project future trends from 2018 to 2032. An increase in cohort effects is observed in some cancers such as thyroid and kidney cancers. Eight of the 12 obesity-related cancers may rise in the 0-14 age group, and nine in the 15-39 age group from 2013 to 2032. Liver and stomach cancers show an increasing trend among the younger population, contrasting with the observed declining trend in the middle-aged population. There has been a significant rise in the proportions of cervical cancer among females aged 40-64 (4.3%-19.1%), and prostate cancer among males aged 65+ (1.1%-11.8%) from 1983 to 2032. Cancer spectrum in China is shifting toward that in developed countries. Incidence rates of most cancers across different age groups may increase in recent cohorts. It is essential to insist effective preventive interventions, and promote healthier lifestyles, such as reducing obesity, especially among younger population., (© 2024 UICC.)

Introduction: Research examining the bidirectional relationship between C-reactive protein (CRP) and depressive symptoms, while accounting for cumulative effect of repeated episodes of CRP or depressive symptoms, is currently deficient in non-Western populations., Methods: A nationally representative population-based cohort data from the Chinese Health and Retirement Longitudinal Study (CHARLS) was utilized. In bi-directional analysis, we considered both single determinations and two successive determinations of CRP or depressive symptoms. Multivariate logistic regression assessed the association between elevated CRP levels at baseline or repeated episodes of CRP elevations over two successive determinations and subsequent elevated depressive symptoms, and vice versa., Results: Although single determinations of CRP or depressive symptoms yielded non-significant results in both directions, full multivariate models, adjusting for baseline depressive symptoms, socio-demographic characteristics, health-related behaviors, metabolic measures, and health status, revealed a significantly positive association based on two successive determinations of CRP or depressive symptoms. This significant association was observed between cumulative effects of sustained CRP elevations over two successive determinations (2 vs. 0) and subsequent elevated depressive symptoms (OR=1.58; 95% CI: 1.15 to 2.17) and between cumulative effect of repeated episodes of depression (2 vs. 0) and later elevated CRP (OR=1.26; 95% CI: 1.02 to 1.56). Furthermore, sex-stratified analyses confirmed the robustness of these relationships., Conclusion: There are bidirectional associations between depressive symptoms and CRP, driven by the cumulative effect of repeated episodes of CRP or depressive symptoms among middle-aged and older Chinese adults. These findings hold significant clinical implications, highlighting the potential of both anti-inflammatory and anti-depression approaches., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhao, Jiang, Hu, Zhang, Lin, Yao, Hao and Zhu.)

Rationale: To report a peculiar case of vaginal delivery of a triplet after emergency transvaginal cerclage and to find a way to optimize some extreme situations encountered in clinical practice after evaluating feasibility., Patient Concerns: A 33-year-old gravida 6, para 0050 woman at 21 + 6 weeks of gestation was referred to the obstetric department for opening of the cervical canal. An emergency McDonald cerclage was performed at 22 weeks of gestation after a comprehensive assessment, and the pregnancy ended with vaginal delivery at 24 + 6 weeks of gestation. The postpartum period was normal, and the newborns were discharged to home care after treatment in the neonatal intensive care unit., Interventions: After discussing the risks, the patient requested emergency transvaginal McDonald cerclage at 22 weeks of gestation., Outcomes: Emergency McDonald cerclage was performed at 22 weeks of gestation, and the pregnancy ended with vaginal delivery at 24 + 6/25 weeks of gestation, successfully prolonging gestation by 20/21 days. The postpartum period had no exceptional circumstances, and newborns were discharged to home care after treatment in the neonatal intensive care unit for 104/98/104 days., Lessons: Emergency cerclage seems to be impossible in multiple pregnancies. However, in this case, after a comprehensive assessment, it was feasible to extend the gestational age by emergency cerclage, and prompt and accurate evaluation is important to avoid complications and individualize the following management. In this case, we may find a way to optimize some extreme situations encountered in clinical practice and offer a glimmer of hope for families challenged with multiple pregnancies at risk of preterm delivery. However, more high-quality studies are needed to prove the effectiveness and safety of emergency cerclages in triplets., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: We report a rare case of moyamoya disease caused by an RNF213 mutation, complicated with systemic lupus erythematosus., Case Report: A 32-year-old woman experienced 4 cerebral ischemia stroke events within 6 months. The main symptom was left limb weakness with blurred vision in the right eye. Results of digital subtraction angiography conducted at another hospital were consistent with moyamoya disease. On genetic testing, we found that the patient carried 2 mutations in the moyamoya disease-related gene RNF213 (p.R4810K, p.T1727M). On the basis of the laboratory immunologic indicators, such as positive antibodies and abnormal immunoglobulin levels and imaging examinations, the patient was finally diagnosed as moyamoya disease complicated with systemic lupus erythematosus. She was treated with aspirin, butylphthalide, urinary kallidinogenase, and sodium methylprednisolone., Conclusions: This was a 32-year-old young patient diagnosed with moyamoya disease carrying RNF213 gene mutation and accompanied by lupus with cerebral ischemic event as the first occurrence. The patient's condition was complex; therefore, comprehensive analysis and in-depth consideration were needed to avoid a missed diagnosis and misdiagnosis. When the primary disease cannot be identified, genetic testing can help to clarify the diagnosis of moyamoya disease., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)