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ObjectiveTo evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of 1–2 cm lower pole renal calculi (LPC) in obese patients.Patients and methodsThis prospective, randomized study included 149 obese patients with 1–2 cm LPC. Patients were allocated into two groups: 76 patients underwent RIRS with FV-UAS, and 73 patients received ESWL. The parameters assessed included stone-free rate (SFR), retreatment rate, complications, operative time, and pain intensity measured by the visual analog scale (VAS). Stone-free status was defined as the absence of stones on computed tomography or residual fragments smaller than 4 mm at 4 weeks post-procedure.ResultsThe baseline characteristics of the two groups were comparable. The SFR was significantly higher in the RIRS group, reaching 86.8%, compared to 63.0% in the ESWL group (p = 0.034). Furthermore, the retreatment rate was significantly lower in the RIRS group, at 5.2%, versus 24.7% in the ESWL group (p

Nowadays, problems such as greenhouse effect and air pollution become increasingly prominent. The power generation process should pay attention to the fuel cost and reduce the pollution to the environment. In this paper, an arithmetic optimization algorithm (AOA) based on Cauchy mutation trigonometric function search is proposed to solve the combined economic emission dispatch (CEED) problem. The price penalty factor is used to convert multiple objective functions of CEED problem into one objective. The math optimization probability (MOP) parameter is used to control the position update of the AOA. MOP is replaced by the oscillation coefficient and Cauchy mutation, which can not only guarantee the local search accuracy but also enhance the global search capability. 6 kinds of trigonometric function search operators, sine function, hyperbolic sine, inverse hyperbolic sine, hyperbolic tangent, inverse hyperbolic tangent, are used to replace the fixed value control parameters in AOA algorithm. The algorithm still has a certain ability to jump out of the local optimal in the late running. The 23 test functions are used to verify the effect of the improved AOA method. The AOA is compared with 6 kinds of improved AOA, and the improvement method with the best effect is selected, and then compared with other intelligent optimization algorithms to verify the effectiveness of the improved strategy. In addition to improving the algorithm, the constraint of CEED problem is also treated. Five kinds of random disturbance penalty functions are proposed, which are cosine function, hyperbolic sine function, tangent function, hyperbolic tangent function and V-type function. The CEED problem of 6 units was selected for simulation experiment under 4 different load demands. The experimental data show that the arithmetic optimization algorithm based on Cauchy mutation trigonometric function search has a good effect on solving CEED problems, and the random disturbance penalty strategy is more effective in solving quality.

The merger of a neutron star (NS)–NS binary can form different productions of compact remnants, among which a supramassive NS (SMNS) can create an internal plateau, and the following steep decay marks the collapse of the SMNS. The proportion of the SMNS and the corresponding collapse time are often used to constrain the NS equation of state (EOS). This paper revisits this topic by considering the effect of an accretion disk on a compact remnant, which is not considered in previous works. Compared with previous works, the collapse-time distribution (peaks ∼100 s) of SMNSs formed from an NS–NS merger is almost unaffected by the initial surface magnetic field ( B _s, _i ) of the NS, but the total energy output of the magnetic dipole radiation from the SMNSs depends on B _s, _i significantly. Coupling the constraints from the SMNS fraction, we exclude some EOSs and obtain three candidate EOSs, i.e., DD2, ENG, and MPA1. By comparing the distributions of the collapse time and the luminosity of the internal plateau (in the short gamma-ray bursts) for observations obtained based on the three candidate EOSs, it is shown that only the EOS of ENG is favored. Our sample, based on the ENG EOS and a mass distribution motivated by Galactic systems, suggests that approximately 99% of NS–NS mergers collapse to form a black hole (BH) within 10 ^7 s. This includes scenarios promptly forming a BH (36.5%), an SMNS (60.7%), or a stable NS that transitions into a BH or an SMNS following accretion (2.1%). It also indicates that the remnants for GW170817 and GW190425, and the second object of GW190814, are more likely to be BHs.

Abstract The development of acute respiratory distress syndrome (ARDS) in sepsis is associated with substantial morbidity and mortality. However, the molecular pathogenesis underlying sepsis‐induced ARDS remains elusive. Neutrophil heterogeneity and dysfunction contribute to uncontrolled inflammation in patients with ARDS. A specific subset of neutrophils undergoing reverse transendothelial migration (rTEM), which is characterized by an activated phenotype, is implicated in the systemic dissemination of inflammation. Using single‐cell RNA sequencing (scRNA‐seq), it identified functionally activated neutrophils exhibiting the rTEM phenotype in the lung of a sepsis mouse model using cecal ligation and puncture. The prevalence of neutrophils with the rTEM phenotype is elevated in the blood of patients with sepsis‐associated ARDS and is positively correlated with disease severity. Mechanically, scRNA‐seq and proteomic analys revealed that inflamed endothelial cell (EC) released extracellular vesicles (EVs) enriched in karyopherin subunit beta‐1 (KPNB1), promoting abluminal‐to‐luminal neutrophil rTEM. Additionally, EC‐derived EVs are elevated and positively correlated with the proportion of rTEM neutrophils in clinical sepsis. Collectively, EC‐derived EV is identified as a critical regulator of neutrophil rTEM, providing insights into the contribution of rTEM neutrophils to sepsis‐associated lung injury.

Abstract Background Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) with large vessel occlusion. Hypertension and increased blood pressure variability within the first 24 h after successful reperfusion are related to a higher risk of symptomatic intracerebral hemorrhage and higher mortality. AIS patients might suffer from ischemia-reperfusion injury following reperfusion, especially within 24 h. Dexmedetomidine (DEX), a sedative commonly used in EVT, can stabilize hemodynamics by inhibiting the sympathetic nervous system and alleviate ischemia-reperfusion injury through anti-inflammatory and antioxidative properties. Postoperative prolonged sedation for 24 h with DEX might be a potential pharmacological approach to improve long-term prognosis after EVT. Methods This single-center, open-label, prospective, randomized controlled trial will include 368 patients. The ethics committee has approved the protocol. After successful reperfusion (modified thrombolysis in cerebral infarction scores 2b–3, indicating reperfusion of at least 50% of the affected vascular territory), participants are randomly assigned to the intervention or control group. In the intervention group, participants will receive 0.1~1.0 μg/kg/h DEX for 24 h. In the control group, participants will receive an equal dose of saline for 24 h. The primary outcome is the functional outcome at 90 days, measured with the categorical scale of the modified Rankin Scale, ranging from 0 (no symptoms) to 6 (death). The secondary outcome includes (1) the changes in stroke severity between admission and 24 h and 7 days after EVT, measured by the National Institute of Health Stroke Scale (ranging from 0 to 42, with higher scores indicating greater severity); (2) the changes in ischemic penumbra volume/infarct volume between admission and 7 days after EVT, measured by neuroimaging scan; (3) the length of ICU/hospital stay; and (4) adverse events and the all-cause mortality rate at 90 days. Discussion This randomized clinical trial is expected to verify the hypothesis that postoperative prolonged sedation with DEX after successful reperfusion may promote the long-term prognosis of patients with AIS and may reduce the related socio-economic burden. Trial registration ClinicalTrials.gov NCT04916197. Prospectively registered on 7 June 2021.

Abstract The importance of uncommon/rare oncogenic drivers in non‐small cell lung cancer (NSCLC) was underscored during the 20th China Lung Cancer Summit. These drivers, while present in a significant proportion of NSCLC patients, remain a challenge for diagnosis and therapeutic targeting. In the never‐smokers/low smokers category with mutations such as EGFR and HER2, the efficacy of immune checkpoint inhibitors (ICIs) remains suboptimal, attributed to lower PD‐L1 expression and tumor mutation burden (TMB). However, heavy smokers, often with mutations like KRAS, may derive benefits from ICIs, as supported by trials like CheckMate‐057. With the complex landscape of these drivers and their clinical implications, the summit culminated in six pivotal consensus points, aiming to guide future research and clinical decisions. Despite the advancements, the detection, interpretation, and therapeutic strategies involving these drivers necessitate further exploration and standardization.

The economic load dispatch (ELD) in the power system is to reasonably allocate the output power of each generating unit under the premise of satisfying the operation constraints and the balance of supply and demand, so as to optimize the total cost of power generation as the objective function. Taking the system power balance and the upper limits and lower limits of generator output as constraints in the ELD problem, its mathematical model was established. A differential evolution (DE) algorithm based on different strategies is proposed to solve the ELD problem. Aiming at three ELD examples, the most suitable differential evolution strategy for the ELD problems was found through the results of simulation experiments. Under the same starting conditions, DE algorithm, particle swarm optimization (PSO) algorithm, genetic algorithm (GA) and simulated annealing (SA) algorithm were used to conduct simulation experiments to verify the superiority of DE algorithm. Experimental results show that the proposed DE algorithm has the best performance in solving ELD problems. [ABSTRACT FROM AUTHOR]

BackgroundThe tertiary lymphatic structure (TLS) is an important component of the tumor immune microenvironment and has important significance in patient prognosis and response to immune therapy. However, the underlying mechanism of TLS in soft tissue sarcoma remains unclear.MethodsA total of 256 RNAseq and 7 single-cell sequencing samples were collected from TCGA-SARC and GSE212527 cohorts. Based on published TLS-related gene sets, four TLS scores were established by GSVA algorithm. The immune cell infiltration was calculated via TIMER2.0 and “MCPcounter” algorithms. In addition, the univariate, LASSO, and multivariate-Cox analyses were used to select TLS-related and prognosis-significant hub genes. Single-cell sequencing dataset, clinical immunohistochemical, and cell experiments were utilized to validate the hub genes.ResultsIn this study, four TLS-related scores were identified, and the total-gene TLS score more accurately reflected the infiltration level of TLS in STS. We further established two hub genes (DUSP9 and TNFSF14) prognosis markers and risk scores associated with soft tissue sarcoma prognosis and immune therapy response. Flow cytometry analysis showed that the amount of CD3, CD8, CD19, and CD11c positive immune cell infiltration in the tumor tissue dedifferentiated liposarcoma patients was significantly higher than that of liposarcoma patients. Cytological experiments showed that soft tissue sarcoma cell lines overexpressing TNFSF14 could inhibit the proliferation and migration of sarcoma cells.ConclusionThis study systematically explored the TLS and related genes from the perspectives of bioinformatics, clinical features and cytology experiments. The total-gene TLS score, risk score and TNFSF14 hub gene may be useful biomarkers for predicting the prognosis and immunotherapy efficacy of soft tissue sarcoma.

Inflammation and dyslipidemia are critical inducing factors of atherosclerosis. Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors and control the expression of multiple genes that are involved in lipid metabolism and inflammatory responses. However, synthesized PPAR agonists exhibit contrary therapeutic effects and various side effects in atherosclerosis therapy. Natural products are structural diversity and have a good safety. Recent studies find that natural herbs and compounds exhibit attractive therapeutic effects on atherosclerosis by alleviating hyperlipidemia and inflammation through modulation of PPARs. Importantly, the preparation of natural products generally causes significantly lower environmental pollution compared to that of synthesized chemical compounds. Therefore, it is interesting to discover novel PPAR modulator and develop alternative strategies for atherosclerosis therapy based on natural herbs and compounds. This article reviews recent findings, mainly from the year of 2020 to present, about the roles of natural herbs and compounds in regulation of PPARs and their therapeutic effects on atherosclerosis. This article provides alternative strategies and theoretical basis for atherosclerosis therapy using natural herbs and compounds by targeting PPARs, and offers valuable information for researchers that are interested in developing novel PPAR modulators.

With the vigorous development of material synthesis, mechanical manufacturing, and computer technology, as well as the in-depth study of control theory and bionics, robotics has undergone tremendous changes in recent decades. From rigid robots to discrete redundancy robots, from continuum robots to soft robots, the application of robots has long been beyond traditional industrial fields such as assembly, welding, and painting. It has expanded to medicine, education, agriculture, the military, etc., covering almost every aspect of people's lives. Soft manipulators have broad application prospects in medicine, aerospace engineering, and other fields due to their excellent environmental adaptability and safe human–machine interaction. However, soft robots comprise flexible materials and often have no internal support structure, so their ends have a very limited carrying capacity. To compensate for this inadequacy, soft robots usually use the bending of the entire body to grasp objects or operate underwater to partially counteract gravity. In addition, the deformation state of a soft robot is difficult to estimate when it is affected by external force or in contact with the environment, which also causes many difficulties in the modeling and control of soft robots. In the case of inaccurate modeling and poor controllability, the accessibility and accuracy of its end are bound to be greatly compromised. For a class of line-driven soft manipulators, a modeling method based on strain parameterization is proposed that can describe the motion of soft manipulators in three-dimensional space under different wiring methods. First, the entire soft manipulator is treated as a Cosserat beam and modeled by the mature Cosserat beam theory, wherein the strain field of the soft manipulator is discretized using the Ritz method to obtain a set of ordinary differential equations, and then a back propagation (BP) neural network is used to complete the drive force conversion between the shape and driver spaces. A radial basis function (RBF) neural network is used to approximate and compensate for the unknown dynamics present in the soft manipulator model. The stability of the closed-loop system after introducing the adaptive neural network controller is then demonstrated on the basis of Lyapunov's stability theory. Finally, a series of simulation experiments are performed for the model and the adaptive neural network controller to verify the effectiveness of the model and the control algorithm. Therefore, the modeling control of a type of soft manipulator is realized.