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Chinese classical gardens are a significant cultural heritage in the history of world gardening, with their central architectural principle of "scenes changing as steps move" (步移景异) embodying traditional Chinese aesthetic ideals. This study employed the variation of visual complexity during a tour as a representation of this principle, using Jingxinzhai (静心斋) Garden as a case study. The visual environmental characteristics were quantified using the Fraclab box-counting, Canny edge detection, and DeepLab V3 + model, and the spatial distribution of fractal dimension and visual index of landscape elements were analyzed. Through partial correlation analysis, hierarchical regression analysis, and one-way ANOVA, the relevant factors (BVI, RVI, GVI, WVI) and influencing factors (BVI, RVI, GVI) and the differences among landscape element combinations of visual complexity were identified. Furthermore, the distribution patterns and causes of visual complexity in Chinese classical gardens were then discussed. This study proposes an effective method for quantifying the visual environmental characteristics of Chinese classical gardens and provides an explanation of the concept of "scenes changing as steps move" from the perspective of visual environment. It offers important references for a deeper understanding of Chinese classical garden design and planning. [ABSTRACT FROM AUTHOR]

The global population is ageing, life expectancy is gradually increasing, and employment is extended. We used an integrative literature review to study how using technological tools impacts the quality of working life among older workers.The integrative literature review method following PRISMA guidelines was used. The selection of articles in English was made according to the following inclusion criteria: scientific papers, content relevance, and topicality. The literature search covered the bibliographic-catalogue databases Web of Science, PubMed, and Scopus. After selection, a qualitative content analysis was applied to the data. From the initial twelve articles, we gained insight into how using technological tools impacts the quality of working life among older workers through a substantive analysis of the articles. Two content categories were identified: health of older workers and technostress. Regarding the impact on health, studies have focussed on various health outcomes like sleeping quality, mental health, workability arthritis as a chronic condition, physical and quality of life in older community-dwelling low-income, diet, physical activity, stress and tobacco use, stress, and job quality. Studies regarding technostress that we identified show mixed effects of significant and non-significant effects. Digital technologies can potentially improve the quality of working life among older workers but are currently under-researched. Further research is needed to develop effective interventions and evaluate their impact on the quality of life of older workers. [ABSTRACT FROM AUTHOR]

Raindrop impact causes soil erosion and the transfer of solutes into surface runoff, leading to soil solute loss and water pollution. Accurately modelling this process in complex agricultural environments is challenging. A new prediction model was applied to illustrate mechanisms of soil solute transfer into surface runoff, addressing the underestimation of solute concentration in surface runoff but limited by uncertain model parameters. Two laboratory experiments were conducted, studying solute loss from soil to surface runoff under initially saturated and unsaturated soil conditions. An elasticity sensitivity analysis was used to identify crucial parameters. To improve prediction results, the ensemble Kalman filter (EnKF) method was coupled with the model during the early stage of the simulation, assimilating observed solute concentrations in surface runoff to update model parameters. After the early stage, the model generated predicted solute concentrations in surface runoff without the observed data until the simulation ended. Four model parameters, including incomplete mixing parameters α and γ, soil mixing layer depth hmix,t(t), and moving rate of the soil mixing layer front imix, were updated. The inflation method was used to prevent filter divergence caused by the EnKF. The simulation results showed that the EnKF significantly improved the model's prediction accuracy, even when applied during specific periods throughout the simulation. Updating α, γ, hmix,t(t) and imix resulted in better predictions compared to updating only α, γ and imix. This further demonstrated that the hmix,t(t) must be updated using the EnKF. [ABSTRACT FROM AUTHOR]

Objectives: To establish a breast lesion risk stratification system using ultrasound images to predict breast malignancy and assess Breast Imaging Reporting and Data System (BI-RADS) categories simultaneously. Methods: This multicenter study prospectively collected a dataset of ultrasound images for 5012 patients at thirty-two hospitals from December 2018 to December 2020. A deep learning (DL) model was developed to conduct binary categorization (benign and malignant) and BI-RADS categories (2, 3, 4a, 4b, 4c, and 5) simultaneously. The training set of 4212 patients and the internal test set of 416 patients were from thirty hospitals. The remaining two hospitals with 384 patients were used as an external test set. Three experienced radiologists performed a reader study on 324 patients randomly selected from the test sets. We compared the performance of the DL model with that of three radiologists and the consensus of the three radiologists. Results: In the external test set, the DL model achieved areas under the receiver operating characteristic curve (AUCs) of 0.980 and 0.945 for the binary categorization and six-way categorizations, respectively. In the reader study set, the DL BI-RADS categories achieved a similar AUC (0.901 vs. 0.933, p = 0.0632), sensitivity (90.98% vs. 95.90%, p = 0.1094), and accuracy (83.33% vs. 79.01%, p = 0.0541), but higher specificity (78.71% vs. 68.81%, p = 0.0012) than those of the consensus of the three radiologists. Conclusions: The DL model performed well in distinguishing benign from malignant breast lesions and yielded outcomes similar to experienced radiologists. This indicates the potential applicability of the DL model in clinical diagnosis. Key Points: • The DL model can achieve binary categorization for benign and malignant breast lesions and six-way BI-RADS categorizations for categories 2, 3, 4a, 4b, 4c, and 5, simultaneously. • The DL model showed acceptable agreement with radiologists for the classification of breast lesions. • The DL model performed well in distinguishing benign from malignant breast lesions and had promise in helping reduce unnecessary biopsies of BI-RADS 4a lesions. [ABSTRACT FROM AUTHOR]

Engineering microbes to produce plant-derived natural products provides an alternate solution to obtain bioactive products. Here we report a systematic approach to sequentially identify the rate-limiting steps and improve the biosynthesis of the cannabinoid precursor olivetolic acid (OLA) in Yarrowia lipolytica. We find that Pseudomonas sp LvaE encoding a short-chain acyl-CoA synthetase can efficiently convert hexanoic acid to hexanoyl-CoA. The co-expression of the acetyl-CoA carboxylase, the pyruvate dehydrogenase bypass, the NADPH-generating malic enzyme, as well as the activation of peroxisomal β-oxidation pathway and ATP export pathway are effective strategies to redirect carbon flux toward OLA synthesis. Implementation of these strategies led to an 83-fold increase in OLA titer, reaching 9.18 mg/L of OLA in shake flask culture. This work may serve as a baseline for engineering cannabinoids biosynthesis in oleaginous yeast species. A yeast host Yarrowia lipolytica is genetically engineered to overcome rate-limiting steps and synthesize the cannabinoid precursor olivetolic acid. [ABSTRACT FROM AUTHOR]

Purpose: The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors.Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6 months. Perioperative factors influencing CPTS at 3 months were analyzed through univariate and multivariate methods.A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3 months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24 h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS.This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3 months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS.Methods: The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors.Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6 months. Perioperative factors influencing CPTS at 3 months were analyzed through univariate and multivariate methods.A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3 months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24 h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS.This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3 months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS.Results: The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors.Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6 months. Perioperative factors influencing CPTS at 3 months were analyzed through univariate and multivariate methods.A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3 months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24 h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS.This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3 months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS.Conclusion: The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors.Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6 months. Perioperative factors influencing CPTS at 3 months were analyzed through univariate and multivariate methods.A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3 months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24 h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS.This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3 months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS. [ABSTRACT FROM AUTHOR]

Background: Studies on deep learning (DL)-based models in breast ultrasound (US) remain at the early stage due to a lack of large datasets for training and independent test sets for verification. We aimed to develop a DL model for differentiating benign from malignant breast lesions on US using a large multicenter dataset and explore the model's ability to assist the radiologists. Methods: A total of 14,043 US images from 5012 women were prospectively collected from 32 hospitals. To develop the DL model, the patients from 30 hospitals were randomly divided into a training cohort (n = 4149) and an internal test cohort (n = 466). The remaining 2 hospitals (n = 397) were used as the external test cohorts (ETC). We compared the model with the prospective Breast Imaging Reporting and Data System assessment and five radiologists. We also explored the model's ability to assist the radiologists using two different methods. Results: The model demonstrated excellent diagnostic performance with the ETC, with a high area under the receiver operating characteristic curve (AUC, 0.913), sensitivity (88.84%), specificity (83.77%), and accuracy (86.40%). In the comparison set, the AUC was similar to that of the expert (p = 0.5629) and one experienced radiologist (p = 0.2112) and significantly higher than that of three inexperienced radiologists (p < 0.01). After model assistance, the accuracies and specificities of the radiologists were substantially improved without loss in sensitivities. Conclusions: The DL model yielded satisfactory predictions in distinguishing benign from malignant breast lesions. The model showed the potential value in improving the diagnosis of breast lesions by radiologists. [ABSTRACT FROM AUTHOR]

Background: Internal jugular vein catheterization (IJVC) and subclavian vein catheterization (SCVC) have been the most preferred central venous catheterizations (CVC) clinically. Individual preference and institutional routine dominate the traditional CVC choice; however, it is lack of high-level evidence. We sought to provide better clinical strategy for CVC site choice based on anatomical landmark technique between IJVC and SCVC. Methods: We systematically reviewed eligible studies from PubMed, OVID, Cochrane and ClinicalTrials.Gov till February 2020. The primary outcomes were catheterization time and overall success rate, and the secondary outcomes were the first-attempt success rate and the instant mechanical complications. Ethical problems are not applicable. Results: A total of 3378 patients from 7 studies were included in the analyses. Neither difference was found on the catheterization time (SMD 95% CI: −0.095–0.124, p = 0.792), nor any difference on the overall success rate (RR = 1.017, 95% CI: 0.927–1.117, p = 0.721, I2 = 89.6%) between the 2 procedures. However, subgroup analyses showed overall success rate of IJVC was significantly lower than that of SCVC (RR = 0.906, 95% CI: 0.850–0.965, p = 0.002) in adults. The first-attempt success rate of IJVC group was higher in the adults (RR = 1.472, 95% CI: 1.004–2.156, p = 0.047). No significance was detected in arterial injury (RR = 1.137, 95% CI: 0.541–2.387, p = 0.735) and pneumothorax (RR = 0.600, 95% CI: 0.32–1.126, p = 0.112) between the two procedures. Hematoma was significantly more in IJVC group than that in SCVC group (RR = 2.824, 95% CI: 1.181–6.751, p = 0.02). Conclusions: Compared with IJVC, SCVC shows a higher overall success rate while a lower first-attempt success rate in adults, and has involved with less hematoma. PROSPERO Registration: CRD42020165444. [ABSTRACT FROM AUTHOR]

A primary-side regulation (PSR) constant current (CC) output and constant voltage (CV) output AC–DC converter is proposed and an adaptive high-precision closed-loop constant current control scheme is put forward in this paper. In the CC mode, the converter adopts the closed-loop control strategy to realize that the switching period adaptively converges to twice the demagnetization time, which realizes the CC output. In addition, exactly detecting the demagnetization time is a prerequisite for obtaining a high-precision output current. Therefore, a demagnetization time detection circuit is designed to provide accurate and reliable demagnetization information. The control IC was fabricated with the Nuvoton 0.5um BCD process, and a 5 V/2 A prototype circuit was implemented to verify its performance. Experimental results show that the CC deviation is within ± 1.4%, which is lower than the target value of ± 2.0%. Under different loads and AC inputs, the conversion efficiency in the CC mode varies between 76.3% and 80.7%. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of azilsartan on myocardial remodeling after acute myocardial infarction (AMI). Methods: A total of 200 AMI patients under percutaneous coronary intervention (PCI) were selected from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from Jan 2021 to Dec 2021. The subjects were randomly divided to take either azilsartan or benazepril. Serum C1q tumor necrosis factor-associated protein 1 (CTRP1) levels were detected in all subjects after admission, and the indices of left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were measured by using echocardiography. At the follow-up of 6 months and 1 year after PCI, the differences in CTRP1 and echocardiogram indices between the two groups were compared, and the influencing factors of myocardial remodeling after acute myocardial infarction were analyzed. Results: The levels of LVEDV and CTRP1 in all subjects at 6 months and 1 year after PCI were lower than those before discharge, and the LVEDV in the azilsartan group at 6 months and 1 year after PCI was lower than that in the benazepril group. An improvement in myocardial remodeling was obviously observed within 6 months after PCI, but the effect declined over time. Conclusions: Azilsartan can improve myocardial remodeling after acute myocardial infarction. CTRP1 may become an effective target for the prevention and treatment of myocardial remodeling after acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Purpose: This study compared the clinical effectiveness and wound complications of a three-dimensional model-assisted spatial weaving screw fixation (3D-SWSF) versus open reduction and internal fixation (ORIF) via an L-shaped extensile lateral approach for calcaneal fractures. Methods: This single-centre retrospective cohort study was conducted with two cohort groups in which patients with Sanders II and III calcaneal fractures underwent 3D-SWSF or conventional ORIF. The clinical outcome measures included operation duration, time to operation, wound complications, blood loss volume, hospital stays, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and visual analog scale (VAS) score. The pre-operative, post-operative, and one-year follow-up Gissane's angle (GA), Böhler's angle (BA), height, and width and length of the calcaneal fractures were also compared between the two groups. Results: From Oct 2015 to Oct 2019, 31 patients received 3D-SWSF and 41 received conventional ORIF. A total of 11 (26.8%) patients in ORIF group had wound complications, compared with only two (6.5%) in 3D-SWSF group (p = 0.032). Operative time, blood loss, and hospital stay in 3D-SWSF group were lesser than those in ORIF group. The patients treated with 3D-SWSF had better AOFAS and VAS scores than those treated with ORIF at the last follow-up. The post-operative and one-year follow-up radiographic indexes as well as the GA, BA, length, width, and height of the calcaneal fractures were relatively comparable between the two groups. Conclusion: Our study revealed that 3D-SWSF could effectively decrease the risk of wound complications, shorten operation time, reduce length of hospitalization, and improve post-operative rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To assess the consistency of Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon interpretation between senior and junior sonologists and to investigate its impact on O-RADS classification and diagnostic performance. Methods: We prospectively studied 620 patients with adnexal lesions, all of whom underwent transvaginal or transrectal ultrasound performed by a senior sonologist (R1) who selected the O-RADS lexicon description and O-RADS category for the lesion after the examination. Meanwhile, the junior sonologist (R2) analyzed the images retained by R1 and divided the lesion in the same way. Pathological findings were used as a reference standard. kappa (к) statistics were used to assess the interobserver agreement. Results: Of the 620 adnexal lesions, 532 were benign and 88 were malignant. When using the O-RADS lexicon, R1 and R2 had almost perfect agreement regarding lesion category, external contour of solid lesions, presence of papillary inside cystic lesions, and fluid echogenicity (к: 0.81–1.00). Substantial agreement in solid components, acoustic shadow, vascularity and O-RADS categories (к: 0.61–0.80). Consistency in classifying classic benign lesions in the O-RADS category was only moderate (к = 0.535). No significant difference in diagnostic performance between them using O-RADS (P = 0.1211). Conclusion: There was good agreement between senior and junior sonologists in the interpretation of the O-RADS lexicon and in the classification of O-RADS, except for a moderate agreement in the interpretation and classification of classic benign lesions. Differences in O-RADS category delineation between sonologists had no significant effect on the diagnostic performance of O-RADS. [ABSTRACT FROM AUTHOR]

The combination of Escherichia coli BL21 (DE3) and the pET expression system is used extensively for the expression of various recombinant proteins (RPs). However, RP overexpression often introduces a growth burden for the host, especially in the case of toxic proteins. The key to solving this problem is to reduce the host burden associated with protein overproduction, which is often achieved by regulating the expression or activity of T7 RNAP or growth-decoupled systems. However, these strategies mainly relieve or interrupt the robbing of host resources, and do not eliminate other types of host burdens in the production process. In this study, we constructed a production system based on a dynamic equilibrium to precisely relieve the host burden and increase the RP production. The system is composed of three modules, including the overexpression of basic growth-related genes (rRNA, RNAP core enzyme, sigma factors), prediction and overexpression of key proteins using the enzyme-constrained model ec_iECBD_1354, and dynamic regulation of growth-related and key protein expression intensity based on a burden-driven promoter. Using this system, the production of many high-burden proteins, including autolysis protein and E. coli membrane proteins, was increased to varying degrees. Among them, the cytosine transporter protein (CodB) was most significantly improved, with a 4.02-fold higher production compared to the wild strain. This system can effectively reduce the optimizing costs, and is suitable for developing various types of RP expression hosts rapidly. Key points: • The basic growth-related resources can relieve the host burden from recombinant protein. • The enzyme-constrained model can accurately predict key genes to improve yield. • The expression intensity can be dynamically adjusted with changes in burden. [ABSTRACT FROM AUTHOR]

Background and aims: The "competition-trait similarity" and "competition-trait hierarchy" hypotheses can be used to predict competitive outcomes between terrestrial plant species in response to environmental variation. However, their validity in aquatic plants remains poorly understood, particularly in terms of variation in the water exchange rate (WER). Methods: We compared competitive outcomes and variation in functional traits in two pairs of submerged macrophytes (Vallisneria natans vs. Myriophyllum aquaticum and V. natans vs. Myriophyllum spicatum) at three levels of WER using the replacement series method. Results: We found that the relative competitive ability of V. natans consistently decreased with increasing WER and decreasing the planting proportion of V. natans. Under these conditions, V. natans experienced reduced plant nutrient content and the inhibition of dissolved carbon dioxide absorption, which eventually shifted this species from a stronger to weaker competitor. With increasing WER and decreasing the planting proportion of V. natans, the below-:above-ground biomass ratio and root diameter increased, while the root length and specific root length decreased, for V. natans. In contrast, all of these traits exhibited the opposite patterns for the co-cultured Myriophyllum species. In addition, the branch number per plant mass increased in V. natans but exhibited no change in co-cultured Myriophyllum species under the same conditions. Conclusions: Our results indicate that WER affected the outcome of interspecies competition between submerged macrophyte species. Moreover, the relative competitive ability of each species within a pair was more strongly linked to species competition-trait hierarchy than to competition-trait similarity. [ABSTRACT FROM AUTHOR]