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This study investigates the effect of programming courses on the computational thinking (CT) skills of elementary school students and the learning effectiveness of students from different backgrounds who are studying programming. We designed a OwlSpace programming course into an elementary school curriculum. Students in fourth and fifth grades were taught the fundamentals of programming. We measured and analyzed the effectiveness of their CT skills and self-efficacy in CT. The researchers analyzed the changes in the CT of different gender, different grade, and different past experience students in programming courses and then made specific recommendations for information technology teachers and related units. The results demonstrate that students learned and improved their CT skills by taking OwlSpace programming course. Additionally, gender, grade, and past experience are found to have no impact on the students' learning that means the course can improve students ability without limited any characteristics.

While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

Abstract Objective Pulmonary infection is one of the leading causes of death in patients with ANCA-associated vasculitis (AAV). It is sometimes difficult to differentiate pulmonary infection from pulmonary involvement of vasculitis in AAV patients. Fiberoptic bronchoscopy and bronchoalveolar lavage fluid (BALF) assays are useful diagnostic methods. In addition to conventional microbiological tests (CMTs), metagenomic next-generation sequencing (mNGS) facilitates rapid and sensitive detection of various pathogens. The current study aimed to evaluate the advantages of additional BALF mNGS in the management of pulmonary infection in AAV patients. Methods 27 patients with active AAV and suspected pulmonary infection whose BALF samples were tested by mNGS and CMTs and 17 active AAV patients whose BALF were tested by CMTs alone were retrospectively recruited. The results of microbiological tests, and adjustments of treatment following BALF mNGS, were described. The durations of antimicrobial treatment and in-hospital mortality in patients were compared. Results Among the 27 patients whose BALF samples were tested by mNGS, 25.9% of patients did not have evidence of pathogenic microorganism in their BALF samples, 55.6% had polymicrobial infections, including bacteria, fungi and viruses. Of these 27 patients, 40.7% did not have evidence of pathogenic microorganism in their BALF or serum samples according to CMTs. Patients in the BALF mNGS/CMT group received a significantly shorter duration of antibacterial and total antimicrobial treatment than patients in the CMT alone group (17.3 ± 14.7 vs. 27.9 ± 19.0 days, P = 0.044; 18.9 ± 15.0 vs. 29.5 ± 17.7 days, P = 0.040, respectively). Fewer patients in the BALF mNGS/CMT group died than in the CMT alone group (4/27 vs. 7/17, P = 0.049). Conclusion Compared with CMT alone, additional mNGS tests may shorten the duration of antimicrobial treatment and possibly decrease death from severe infection by providing precise and quick diagnosis of infection.

Abstract Background Healthy dietary patterns have been negatively associated with methylation-based measures of biological age, yet previous investigations have been unable to establish the relationship between them and biological aging assessed through blood chemistry-based clinical biomarkers. We sought to assess the associations of 4 dietary metrics with 4 measures of biological age. Methods Among 16,666 participants in NHANES 1999–2018, 4 dietary metrics [Dietary inflammatory index (DII), Dietary approaches to stop hypertension index (DASH), Alternate mediterranean diet score (aMED), and Healthy eating index-2015 (HEI-2015)] were calculated through the ‘dietaryindex’ R package. Twelve blood chemistry parameters were utilized to compute 4 indicators of biological age [homeostatic dysregulation (HD), allostatic load (AL), Klemera–Doubal method (KDM), and phenotypic age (PA)]. Binomial logistic regression models and restricted cubic spline (RCS) regression were employed to evaluate the associations. Results All 4 dietary metrics were significantly associated with biological age acceleration or deceleration. In comparison to the lowest DII, the odds ratios (ORs) for accelerated HD, AL, KDM, and PA were 1.25 (1.08,1.45), 1.29 (1.11,1.50), 1.34 (1.08,1.65), and 1.61 (1.39,1.87) for the highest. The multivariable-adjusted ORs of the highest quartile of DASH, aMED, and HEI-2015 were 0.85 (0.73,0.97), 0.88 (0.74,1.04), and 0.84 (0.74,0.96) for HD, 0.64 (0.54,0.75), 0.61 (0.52,0.72), and 0.70 (0.59,0.82) for AL, 0.68 (0.54,0.85), 0.62 (0.50,0.76), and 0.71 (0.58,0.87) for KDM, and 0.50 (0.42,0.59), 0.64 (0.54,0.76), and 0.51 (0.44,0.58) for PA when compared with the lowest level. The findings were validated by the best-fitting dose-response curves for the associations. Among participants consuming dietary supplements (P interaction < 0.05), the positive effects of a healthy dietary pattern on biological aging were more pronounced. Systemic immune inflammation index (SII) and atherogenic index of plasma (AIP) were identified as being involved in and mediating the associations. Conclusions Biological aging assessed through blood chemistry-based clinical biomarkers is negatively associated with diet quality. The anti-aging benefits of improving the diet may be due to its ability to reduce inflammation and lower blood lipids.

Abstract Promoting teachers’ long-term professional growth is a critical problem in teacher education. Professional learning communities have a long-term, positive impact on teacher development, while teacher resilience gives drive for long-term improvement. However, little research indicates how professional groups indirectly affect teacher resilience through their identity, which has consequences for long-term teacher development. After adjusting for demographic characteristics, a recent survey of 2815 primary and secondary school teachers in East China discovered that professional learning communities strongly predict the formation of teacher resilience. This study explores the relationship between professional learning community and teacher resilience by establishing a multi-mediating model, and confirms the mediating role of each dimension of teacher identity. Based on these results, facilitating sustainable professional development requires constructing strong professional learning communities, nurturing teacher identity, and enhancing positive emotions and resilience. Further research should explore how specific activities within communities and forms of teacher support develop resilience over time while accounting for contextual factors. Investigating mechanisms underlying the relationships between communities, identity, emotions, and sustained growth can inform policies and programs aiming to promote long-lasting teacher development.

Abstract The reverse water gas shift reaction can be considered as a promising route to mitigate global warming by converting CO2 into syngas in a large scale, while it is still challenging for non-Cu-based catalysts to break the trade-off between activity and selectivity. Here, the relatively high loading of Ni species is highly dispersed on hydroxylated TiO2 through the strong Ni and −OH interactions, thereby inducing the formation of rich and stable Ni clusters (~1 nm) on anatase TiO2 during the reverse water gas shift reaction. This Ni cluster/TiO2 catalyst shows a simultaneous high CO2 conversion and high CO selectivity. Comprehensive characterizations and theoretical calculations demonstrate Ni cluster/TiO2 interfacial sites with strong CO2 activation capacity and weak CO adsorption are responsible for its unique catalytic performances. This work disentangles the activity-selectivity trade-off of the reverse water gas shift reaction, and emphasizes the importance of metal−OH interactions on surface.

Abstract Background There is currently a lack of comprehensive evidence regarding the correlation between Alternate Mediterranean Diet (AMED) and the survival of patients with ovarian cancer (OC). This prospective cohort study first assessed the association of AMED, not only pre-diagnosis and post-diagnosis but also the change from pre-diagnosis to post-diagnosis with OC survival. Methods A total of 560 OC patients were included in the study, and their dietary intake was assessed using a reliable 111-item food frequency questionnaire. The overall survival (OS) of the patients was monitored through active follow-up and review of medical records until February 16th, 2023. Cox proportional hazard regression models were utilized to compute the hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). Results Out of the total 560 patients with OC, 211 (37.68%) succumbed during a median follow-up period of 44.40 months (interquartile range: 26.97–61.37). Comparative analysis indicated a significant association between the highest tertiles of pre-diagnosis (HR = 0.59; 95% CI 0.38–0.90; P trend

Abstract Purpose The duration of response to treatment is a significant prognostic indicator, with early recurrence (ER) often predicting poorer survival outcomes in nasopharyngeal carcinoma (NPC) survivors. This study seeks to elucidate the factors contributing to the onset of ER following radiotherapy in NPC survivors. Methods This investigation encompassed 2,789 newly diagnosed NPC patients who underwent radical intensity-modulated radiotherapy. Ordinal logistic regression analysis was employed to evaluate the independent predictors of earlier recurrence. A machine learning-based prediction model of NPC recurrence patterns was developed. Tumorous RNA-sequencing (in-house cohort: N = 192) and biological tipping point analysis were utilized to infer potential molecular mechanisms associated with ER. Results Our results demonstrated that ER within 24 months post-initial treatment was the optimal time frame for identifying early malignant progression in NPC survivors. The ER cohort (150 of 2,789, 5.38%) exhibited a notably short median overall survival of 48.6 months. Multivariate analyses revealed that male gender, T4 stage, local or regional residual disease, detectable pre- and post-radiotherapy EBV DNA, and the absence of induction chemotherapy were significant predictors of earlier recurrence. The machine learning-based predictive model further underscored the importance of tumor-related factors in NPC recurrence. Moreover, ER emerged as a pivotal stage in NPC progression, with 15 critical transition signals identified potentially associated with the negative modulation of the immune response. Conclusions Our comprehensive analysis of NPC recurrence patterns has unveiled insights into the key factors driving ER and provided novel insights into potential early warning biomarkers and the mechanisms underlying NPC progression.

为了快速、准确检测市售橄榄油中非法添加的脂溶性色素，建立了一种测定橄榄油中铜-焦脱镁素a的高效液相色谱串联质谱法（HPLC-MS/MS）。使用SPE柱对样品进行净化前处理，随后通过HPLC-MS/MS进行定性和定量检测，色谱分析采用C8色谱柱，以甲醇-1 mol/L乙酸铵水溶液（体积比8∶ 2）和甲醇-丙酮(体积比6∶ 4)作为流动相，进行梯度洗脱；质谱分析采用大气压化学电离，负离子扫描模式，多重反应监测模式，电子倍增电压600 V，碎裂电压260 V，用外标法进行定量。经过方法学验证，该方法的检出限和定量限分别为12 μg/kg和64 μg/kg，回收率为910%~106.0%，相对标准偏差为3.9%~5.7%。该方法具有较高的灵敏度和精密度，能够准确、快速地检测市售橄榄油中的铜-焦脱镁素a。An analytical method for determining copper pyropheophytin-a in olive oil utilizing high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) was established to accurately and quickly detect illegally added liposoluble pigments in commercial olive oil. Purification of the sample was performed using a SPE column for pre-treatment, followed by qualitative and quantitative detection using HPLC-MS/MS. The Chromatographic analysis was carried out on C8 column, with methanol-1 mol/L aqueous solution of ammonium acetate (volume ratio 8∶ 2) and methanol-acetone (volume ratio 6∶ 4) as mobile phases for gradient elution. Atmospheric pressure chemical ionization at negative ion mode and multi reaction monitoring scanning were used for mass spectrometry analysis under the conditions of electronic multiplication voltage 600 V and fragmentation voltage 260 V, and the analyte was quantified by external standard method. The results of the methodological validation showed that this method exhibited a limit of detection of 12 μg/kg and a limit of quantification of 64 μg/kg, with spiked recovery rates ranging from 91.0% to 106.0%, with relative standard deviations varying from 3.9% to 5.7%. This method had advantages of high sensitivity and precision, and can detect of copper pyropheophytin-a in olive oil rapidly.

Abstract Background We aimed to evaluate microaneurysms (MAs) after treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy to understand causes of chronic edema and anti-VEGF resistance. Methods Patients with non-proliferative diabetic retinopathy, with or without macular edema were recruited. Optical coherence tomography angiography (OCTA) MAs-related parameters were observed, including the maximum diameter of overall dimensions, material presence, and flow signal within the lumen. OCTA parameters also included central macular thickness (CMT), foveal avascular zone, superficial and deep capillary plexuses, and non-flow area measurements on the superficial retinal slab. Results Overall, 48 eyes from 43 patients were evaluated. CMT differed significantly between the diabetic macular edema (DME ) and non-DME (NDME) groups at 1st, 2nd, 3rd, and 6th months of follow-up (P

To improve the hydration and functional properties of dietary fiber from burdock root by ultrasonic treatment combined with hydrogen peroxide modification. The dietary fiber from burdock root was modified by ultrasonic, alkaline hydrogen peroxide, ultrasound-alkaline hydrogen peroxide and alkaline hydrogen peroxide-ultrasonic methods, which was aim to explore the effects of different methods of modification on the structure and functional properties. The results showed that the expansibility and water-holding capacity of dietary fiber from burdock root were significantly (P

Abstract Thyroid cancer is the most frequently observed endocrine-related malignancy among which anaplastic thyroid cancer (ATC) is the most fatal subtype. The synthesis of protein is active to satisfy the rapid growth of ATC tumor, but the mechanisms regulating protein synthesis are still unknown. Our research revealed that kinetochore protein NUF2 played an essential role in protein synthesis and drove the progression of ATC. The prognosis of patients with thyroid carcinoma was positively correlated with high NUF2 expression. Depletion of NUF2 in ATC cells notably inhibited the proliferation and induced apoptosis, while overexpression of NUF2 facilitated ATC cell viability and colony formation. Deletion of NUF2 significantly suppressed the growth and metastasis of ATC in vivo. Notably, knockdown of NUF2 epigenetically inhibited the expression of magnesium transporters through reducing the abundance of H3K4me3 at promoters, thereby reduced intracellular Mg2+ concentration. Furthermore, we found the deletion of NUF2 or magnesium transporters significantly inhibited the protein synthesis mediated by the PI3K/Akt/mTOR pathway. In conclusion, NUF2 functions as an emerging regulator for protein synthesis by maintaining the homeostasis of intracellular Mg2+, which finally drives ATC progression.

We investigated a fatal case of primary amoebic meningoencephalitis from an indoor surfing center in Taiwan. The case was detected through encephalitis syndromic surveillance. Of 56 environmental specimens, 1 was positive for Naegleria fowleri ameba. This report emphasizes the risk for N. fowleri infection from inadequately disinfected recreational waters, even indoors.

Objective: Monitoring the disease status of Epstein–Barr virus (EBV)–related hemophagocytic lymphohistiocytosis (HLH) patients is crucial. This study aimed to investigate the different strategies and outcomes of patients with EBV-HLH and re-elevated EBV-DNA. Method: A retrospective analysis was conducted on 20 patients diagnosed with EBV-HLH. Clinical features, laboratory tests, treatments, plasma EBV-DNA levels, and outcomes were assessed. Three cases were highlighted for detailed analysis. Results: Nine of the 20 patients had a re-elevation of EBV-DNA during treatment, and 55.5 % (5/9) experienced relapses. Patients with persistently positive plasma EBV-DNA (n = 4) and those with re-elevated EBV-DNA after conversion (n = 9) showed a significantly higher relapse rate compared to those with persistently negative EBV-HLH (n = 7) (p < 0.05). Among the highlighted cases, Case 1 exhibited plasma EBV-DNA re-elevation after four weeks of treatment without relapse, maintaining stability with the original treatment regimen, and eventually, his plasma EBV-DNA turned negative. In Case 2, plasma EBV-DNA was elevated again with a recurrence of HLH after L-DEP. Consequently, she underwent allogeneic hematopoietic stem cell transplantation and eventually achieved complete remission (CR) with negative plasma EBV-DNA. Case 3 experienced plasma EBV-DNA re-elevation after L-DEP but remained in CR, discontinuing chemotherapy without relapse. Conclusion: The re-elevation of plasma EBV-DNA during EBV-HLH treatment poses challenges in determining disease status and treatment strategies. Optimal management decisions require a combination of the level of elevated EBV-DNA, the intensity of hyperinflammation, and the patient's immune function.

Oral ulcers can be managed using a variety of biomaterials that deliver drugs or cytokines. However, many patients experience minimal benefits from certain medical treatments because of poor compliance, short retention times in the oral cavity, and inadequate drug efficacy. Herein, we present a novel hydrogel patch (SCE2) composed of a biopolymer matrix (featuring ultraviolet-triggered adhesion properties) loaded with cuttlefish ink nanoparticles (possessing pro-healing functions). Applying a straightforward local method initiates the formation of a hydrogel barrier that adheres to mucosal injuries under the influence of ultraviolet light. SCE2 then demonstrates exceptional capabilities for near-infrared photothermal sterilization and neutralization of reactive oxygen species. These properties contribute to the elimination of bacteria and the management of the oxidation process, thus accelerating the healing phase's progression from inflammation to proliferation. In studies involving diabetic rats with oral ulcers, the SCE2 adhesive patch significantly quickens recovery by altering the inflamed state of the injured area, facilitating rapid re-epithelialization, and fostering angiogenesis. In conclusion, this light-sensitive hydrogel patch offers a promising path to expedited wound healing, potentially transforming treatment strategies for clinical oral ulcers.

Cerebral venous sinus thrombosis (CVST) and hyperlipidemia are severe complications of L-Asparaginase (L-Asp) during the treatment of B-cell acute lymphoblastic leukemia (B-ALL). Herein, we reported a 9-year-old B-ALL boy who underwent abnormal hypertriglyceridemia and CVST presenting as seizures and disturbance of consciousness twice during the induction therapy. Fortunately, he survived treatment with anticoagulant and lipid-lowering therapy. No thrombophilia-related gene mutation was detected, but a heterozygous mutation in lipoprotein lipase (LPL) gene was identified. His neurological symptoms were managed with short-term anticoagulant therapy and long-term lipid-lowering therapy. This case illustrated the manifestation and potential pathogenesis of CVST and highlighted the essentiality of screening baseline lipid profile and dyslipidemia- and thrombophilia-related gene mutation.

Abstract Threaded fasteners are one of the most commonly used connection methods for mechanical structures. Its primary function is to generate appropriate clamping forces and fasten the connected parts. An inappropriate preload can cause loosening, fatigue fracture, and other problems. This will affect the safety and reliability of mechanical equipment. The precise control of the preload has become a critical issue in mechanical assembly processes. Over the past few decades, various tightening measures and methods have been proposed to address this issue. However, many problems continue to exist with practical applications that have not been reviewed comprehensively and systematically. First, various control methods were summarized systematically, and their advantages and disadvantages in engineering applications were analyzed. Torque control is the most widely used tightening method owing to its simple operation and low cost. Therefore, the research on the torque control method was summarized systematically from three aspects: the torque–preload correlation formula, effective friction radius, and friction characteristics during tightening. In addition, the special circumstances that may increase preload uncertainty were discussed. Finally, based on a summary of the current research status, the prospects for future research were discussed. This study would aid researchers in extensively understanding the problems in preload control.

Abstract Background China has made remarkable achievements in tuberculosis (TB) prevention and control, but it still takes long way to achieve the End TB goal especially in underdeveloped Southwest China. TB healthcare workers (HCWs) are core forces in TB prevention and control but often face job burnout. This study aimed to explore the burden and associated factors of job burnout among TB HCWs in Southwest China. Methods This cross-sectional study used both survey questionnaires and semi-structured interviews, to assess job burnout among TB HCWs based on Malasch Model and explore the associated factors based on Herzberg’s two-factor theory (different hygiene and motivation factors). Quantitative data analysis adopts multiple linear regression to in SPSS 22.0, and qualitative data were analyzed through a framework approach. Results A total of 1140 TB HCWs were included in questionnaire surveys. The overall job burnout rates of TB HCWs in Centers for Disease Control and Prevention (CDC), designated hospitals and Primary Health Care (PHC) sectors were 55%, 70.1% and 67.5%, respectively. TB HCWs in CDC who scored lower in interpersonal factors had a higher risk of depersonalization (DP) [B(95%CI): -0.89 (-1.71 to -0.80)]. TB HCWs in designated hospitals who scored lower in doctor-patient relationship factors [B (95%CI): 6.63 (-12.06 to -1.20)] were more likely to have emotional exhaustion (EE). TB HCWs who were less satisfied with training, supervision and assessment in PHC sectors [B(95%CI): 0.65 (0.03 to 1.26)] had less personal accomplishment (PA). Interviews with nine TB HCWs showed that poor environment could lead to high infection and heavy workload could lead to work pressure among TB HCWs in Chongqing. It is also found that performance assessment and management of TB HCWs, communication and cooperation and so on are related to job burnout. Conclusions TB HCWs had different levels of job burnout in CDC, designated hospitals, and PHC sectors of Chongqing, which were affected by different hygiene and motivation factors. Governments, organizations and individuals should take cooperative measures such as strengthening communication to deal with job burnout among TB HCWs.

Abstract Photo-thermal-coupling ammonia decomposition presents a promising strategy for utilizing the full-spectrum to address the H2 storage and transportation issues. Herein, we exhibit a photo-thermal-catalytic architecture by assembling gallium nitride nanowires-supported ruthenium nanoparticles on a silicon for extracting hydrogen from ammonia aqueous solution in a batch reactor with only sunlight input. The photoexcited charge carriers make a predomination contribution on H2 activity with the assistance of the photothermal effect. Upon concentrated light illumination, the architecture significantly reduces the activation energy barrier from 1.08 to 0.22 eV. As a result, a high turnover number of 3,400,750 is reported during 400 h of continuous light illumination, and the H2 activity per hour is nearly 1000 times higher than that under the pure thermo-catalytic conditions. The reaction mechanism is extensively studied by coordinating experiments, spectroscopic characterizations, and density functional theory calculation. Outdoor tests validate the viability of such a multifunctional architecture for ammonia decomposition toward H2 under natural sunlight.

Abstract OSCA/TMEM63 channels, which have transporter-like architectures, are bona fide mechanosensitive (MS) ion channels that sense high-threshold mechanical forces in eukaryotic cells. The activation mechanism of these transporter-like channels is not fully understood. Here we report cryo-EM structures of a dimeric OSCA/TMEM63 pore mutant OSCA1.1-F516A with a sequentially extracellular dilated pore in a detergent environment. These structures suggest that the extracellular pore sequential dilation resembles a flower blooming and couples to a sequential contraction of each monomer subunit towards the dimer interface and subsequent extrusion of the dimer interface lipids. Interestingly, while OSCA1.1-F516A remains non-conducting in the native lipid environment, it can be directly activated by lyso-phosphatidylcholine (Lyso-PC) with reduced single-channel conductance. Structural analysis of OSCA1.1-F516A in lyso-PC-free and lyso-PC-containing lipid nanodiscs indicates that lyso-PC induces intracellular pore dilation by attracting the M6b to upward movement away from the intracellular side thus extending the intracellular pore. Further functional studies indicate that full activation of MS OSCA/TMEM63 dimeric channels by high-threshold mechanical force also involves the opening of both intercellular and extracellular pores. Our results provide the fundamental activation paradigm of the unique transporter-like MS OSCA/TMEM63 channels, which is likely applicable to functional branches of the TMEM63/TMEM16/TMC superfamilies.

Abstract The concept of Yin-Yang, originating in ancient Chinese philosophy, symbolizes two opposing but complementary forces or principles found in all aspects of life. This concept can be quite fitting in the context of extracellular vehicles (EVs) and inflammatory diseases. Over the past decades, numerous studies have revealed that EVs can exhibit dual sides, acting as both pro- and anti-inflammatory agents, akin to the concept of Yin-Yang theory (i.e., two sides of a coin). This has enabled EVs to serve as potential indicators of pathogenesis or be manipulated for therapeutic purposes by influencing immune and inflammatory pathways. This review delves into the recent advances in understanding the Yin-Yang sides of EVs and their regulation in specific inflammatory diseases. We shed light on the current prospects of engineering EVs for treating inflammatory conditions. The Yin-Yang principle of EVs bestows upon them great potential as, therapeutic, and preventive agents for inflammatory diseases. Graphical Abstract

Abstract Background The aim of this study was to describe our preliminary experience in the procedure of laparoscopic radical resection of hilar cholangiocarcinoma and to evaluate its feasibility, safety, and clinical efficacy. Methods A retrospective analysis was conducted on 44 patients with hilar cholangiocarcinoma who underwent laparoscopic surgery at our hospital from August 2019 to September 2023. Clinical data were collected from these patients, including 13 cases of Bismuth type I, 17 cases of Bismuth type II, 5 cases of Bismuth type IIIa, and 9 cases of Bismuth type IIIb. Results Laparoscopic radical resection of hilar cholangiocarcinoma was successfully performed in 38 patients (86.3%). Among the remaining patients, 3 required vascular reconstruction to complete radical surgery and were converted to laparotomies, while 3 others underwent T-tube drainage only due to unresectable metastases. The median operation time was 285 min (range, 190–450), and the median estimated blood loss was 360 mL (range, 260–1200). The postoperative hospital stay duration was 14.3 ± 3.6 days. No perioperative mortality was observed. Postoperative pathological examination revealed negative microscopic margins (R0) in 39 cases and positive microscopic margins (R1) in 2 cases. Postoperative complications occurred in 8 patients (18.1%), with 4 cases (9.0%) of Grade I, 3 cases (6.8%) of Grade II, 1 case (2.2%) of Grade IIIa, and no Grade IIIb or IV complications. The median overall survival for patients who underwent radical R0 resection was 30.4 months (range, 5.3–43.6). The Disease-free survival rates were 73.6% at 1 year, 61.2% at 2 years, and 40.1% at 3 years. Conclusion Total laparoscopic radical resection of hilar cholangiocarcinoma can be performed safely, feasibly, and effectively by experienced surgeons after an accurate preoperative evaluation.

Abstract Rapid urbanization and industrialization with their negative repercussions draw attention to the need for urban sustainability. This research built on the urban systems understanding linked with resource utilization, environmental effects, people-environment interactions, and adaptive management by integrating quantitative modelling of urban metabolism with a qualitative investigation into human responses. A hybrid methodology was applied in a typical industrial city of Jinchang, China, which exemplified a model of how complex urban dynamics link to and inform sustainability transitions. The study found that Jinchang City had taken on an unsustainable trajectory underpinned by continuous growth of material consumption, whereas a potential for sustainability transitions was also observed in decoupled negative material outputs, improved material efficiency, and environment regeneration collectively. The challenges in industrial cities have been framed in terms of development model lock-in, conceptual and institutional constraints, innovation and human capital deficiencies, and governance failure. The research proposed a government-led transformation system that integrates multi-level and multi-perspective transformations and management employing discipline insights to facilitate urban sustainability transitions. This involves governance, economic and technological innovations, social transformations, and implementations, in which urban governance and public engagement are essential elements for adapting to undesirable difficulties and exploring locally appropriate strategies. This research provided a theoretical and empirical basis along with scientific and policy implications, which contributed to the developing interdisciplinary knowledge on the understanding of complex urban systems and provided insights into real-world sustainability solutions.

Abstract Green manufacturing has become a necessary way to promote new industrialization and realize the high-quality development of China’s manufacturing industry. Based on the panel data of 30 provinces in China from 2012 to 2022, this paper constructs a comprehensive evaluation index system for the green manufacturing development level and introduces the TOPSIS- Gray correlation method to comprehensively measure the green manufacturing development level of China as a whole and the four major regions in the eastern, central, western, and northeastern parts of the country. The regional differences, distribution dynamics and evolutionary trends of China's green manufacturing development level are also explored with the help of the Gini coefficient, kernel density estimation and Markov chain methods. Research Findings: (1) The green manufacturing development level in China is on an upward trend, with an overall spatial distribution pattern of “East is superior and West is inferior”. (2) There are regional differences in the green manufacturing development level in China, and the differences are widening, with interregional differences being the main reason for this overall difference. (3) The country as a whole, the central region and the western region are polarized to varying degrees, with the rest of the country showing an improvement in polarization. (4) Without considering spatial factors, the development of green manufacturing in each province experiences “club convergence” in the short term, and it is difficult to realize rapid development. Considering spatial factors, China's green manufacturing development level is generally characterized by “elevated in proximity to high levels and suppressed in proximity to low levels”, and in the long run, it shows a distribution trend toward the concentration of high values. The findings of this study can provide new ideas for promoting synergistic efficient development of green manufacturing in China.

Abstract Background A combination of prone positioning (PP) and venovenous extracorporeal membrane oxygenation (VV-ECMO) is safe, feasible, and associated with potentially improved survival for severe acute respiratory distress syndrome (ARDS). However, whether ARDS patients, especially non-COVID-19 patients, placed in PP before VV-ECMO should continue PP after a VV-ECMO connection is unknown. This study aimed to test the hypothesis that early use of PP during VV-ECMO could increase the proportion of patients successfully weaned from ECMO support in severe ARDS patients who received PP before ECMO. Methods In this prospective observational study, patients with severe ARDS who were treated with VV-ECMO were divided into two groups: the prone group and the supine group, based on whether early PP was combined with VV-ECMO. The proportion of patients successfully weaned from VV-ECMO and 60-day mortality were analyzed before and after propensity score matching. Results A total of 165 patients were enrolled, 50 in the prone and 115 in the supine group. Thirty-two (64%) and 61 (53%) patients were successfully weaned from ECMO in the prone and the supine groups, respectively. The proportion of patients successfully weaned from VV-ECMO in the prone group tended to be higher, albeit not statistically significant. During PP, there was a significant increase in partial pressure of arterial oxygen (PaO2) without a change in ventilator or ECMO settings. Tidal impedance shifted significantly to the dorsal region, and lung ultrasound scores significantly decreased in the anterior and posterior regions. Forty-five propensity score-matched patients were included in each group. In this matched sample, the prone group had a higher proportion of patients successfully weaned from VV-ECMO (64.4% vs. 42.2%; P = 0.035) and lower 60-day mortality (37.8% vs. 60.0%; P = 0.035). Conclusions Patients with severe ARDS placed in PP before VV-ECMO should continue PP after VV-ECMO support. This approach could increase the probability of successful weaning from VV-ECMO. Trial Registration ClinicalTrials.Gov: NCT04139733. Registered 23 October 2019.

In order to study the size effect law of carbon fiber reinforced polymer (CFRP) constrained coal cylinders, a numerical model of coal circular confined by carbon fiber reinforced polymer (CFRP) sheet is established by a three-dimensional PFC-FLAC coupling method. The validity of the model was verified with experimental data. On this basis, the study of the size effect of 0, 1, 2 and 3 layers of CFRP sheet on different sizes (50 mm, 100 mm, 150 mm) of coal cylinders were studied; the functional relationship of the evolution law of compressive strength under different layer number (L) is obtained; the functional relationship of elastic modulus evolution under different number of layers is obtained; a modified Richart strength analysis model of coal cylinder confined by CFRP sheet is established. The results show that when the number of CFRP sheets is constant, the compressive strength of coal cylinders is constrained by different sizes of CFRP sheets, and the size effect is obvious; the relative peak strength enhancement ratio of coal cylinder constrained by CFRP sheet increases with the increase of the size. The elastic modulus of a coal cylinder with a diameter of 50 mm increases with the number of CFRP layers. The elastic modulus of a coal cylinder with a diameter of 100 mm and 150 mm increases first and then decreases at 0≤L≤3 layers, showing an obvious layer effect law. The accumulation of cracks increases with the increase of the number of CFRP layers.

Abstract Red swamp crayfish, Procambarus clarkii, is the most cultured freshwater crayfish species. It attracts significant research attention due to its considerable economic importance. However, the limited availability of genome information has impeded further genetic studies and breeding programs. By utilizing Illumina, PacBio, and Hi-C sequencing technologies, we present a more comprehensive and continuous chromosome-level assembly for P. clarkii than the published one. The final genome size is 4.03 Gb, consisting of 2,358 scaffolds with a N50 of 42.87 Mb. Notably, 3.68 Gb, corresponding to 91.42% of the genome, was anchored to 94 chromosomes. The assembly comprises 70.64% repetitive sequences, including 5.21% tandem repeats and 65.40% transposable elements. Additionally, a total of 4,456 non-coding RNAs and 28,852 protein-coding genes were predicted in the P. clarkii genome, with 96.26% of the genes were annotated. This high-quality genome assembly not only represents a significant improvement for the genome of P. clarkii and provides insights into the unique genome evolution, but also offers valuable information for developing freshwater aquaculture and accelerating genetic breeding.

Abstract Enterovirus 71 (EV-71) has strong neurotropism, and it is the main pathogen causing severe hand, foot, and mouth disease (HFMD). In clinical observations, significant differences were observed in the severity and prognosis of HFMD among children who were also infected with EV-71. Genetic differences among individuals could be one of the important causes of differences in susceptibility to EV-71–induced HFMD. As P-selectin glycoprotein ligand-1 (PSGL-1) is an important receptor of EV-71, the correlation between single-nucleotide polymorphisms (SNPs) in PSGL-1 and the susceptibility to severe HFMD following EV-71 infection is worth studying. Given the role of PSGL-1 in immunity, the correlations between PSGL-1 SNPs and the immune status after EV-71 infection are also worth studying. Meanwhile, PSGL-1 variable number of tandem repeats (VNTR) represents a research hotspot in cardiovascular and cerebrovascular diseases, but PSGL-1 VNTR polymorphism has not been investigated in HFMD caused by EV-71 infection. In this study, specific gene fragments were amplified by polymerase chain reaction, and PSGL-1 VNTR sequences were genotyped using an automatic nucleic acid analyzer. The correlations of PSGL-1 VNTR polymorphism with the susceptibility to EV-71–associated severe HFMD and the post-infection immune status were analyzed. The PSGL-1 VNTR A allele was identified as a susceptible SNP for severe HFMD. The risk of severe HFMD was higher for AA + AB genotype carriers than for BB genotype carriers. The counts of peripheral blood lymphocyte subsets were lower in AA + AB genotype carries than in BB genotype carries. In conclusion, PSGL-1 VNTR polymorphism is associated with the susceptibility to EV-71–induced severe HFMD and the immune status after infection. PSGL-1 VNTR might play a certain role in the pathogenesis of severe cases.

Abstract The Indonesian seas, with their complex passages and vigorous mixing, constitute the only route and are critical in regulating Pacific–Indian Ocean interchange, air–sea interaction, and global climate events. Previous research employing remote sensing and numerical simulations strongly suggested that this mixing is tidally driven and localized in narrow channels and straits, with only a few direct observations to validate it. The current study offers the first comprehensive temporal microstructure observations in the south of Lombok Strait with a radius of 0.05° and centered on 115.54oE and 9.02oS. Fifteen days of tidal mixing observations measured potential temperature and density, salinity, and turbulent energy dissipation rate. The results revealed significant mixing and verified the remotely sensed technique. The south Lombok temporal and depth averaged of the turbulent kinetic energy dissipation rate, and the diapycnal diffusivity from 20 to 250 m are $$\varepsilon$$ ε = 4.15 ± 15.9) × 10–6 W kg–1 and $$K\rho$$ K ρ = (1.44 ± 10.7) × 10–2 m2s–1, respectively. This $$K\rho$$ K ρ is up to 104 times larger than the Banda Sea [ $$K\rho$$ K ρ = (9.2 ± 0.55) × 10–6 m2s–1] (Alford et al. Geophys Res Lett 26:2741–2744, 1999) or the “open ocean” $$K\rho$$ K ρ = 0.03 × 10–4 m2s−1 within 2° of the equator to (0.4–0.5) × 10–4 m2s−1 at 50°–70° (Kunze et al. J Phys Oceanogr 36:1553–1576, 2006). Therefore, nonlinear interactions between internal tides, tidally induced mixing, and ITF plays a critical role regulating water mass transformation and have strong implications to longer-term variations and change of Pacific–Indian Ocean water circulation and climate.

Abstract Background Post-stroke depression (PSD) is closely associated with poor stroke prognosis. However, there are some challenges in identifying and assessing PSD. This study aimed to identify scales for PSD diagnosis, assessment, and follow-up that are straightforward, accurate, efficient, and reproducible. Methods A systematic literature search was conducted in 7 electronic databases from January 1985 to December 2023. Results Thirty-two studies were included, the Patient Health Questionnaire-9 (PHQ-9) and Hamilton Depression Scale (HDRS) had higher diagnostic accuracy for PSD. The sensitivity, specificity, and diagnostic odds ratio of PHQ-9 or diagnosing any depression were 0.82, 0.87, and 29 respectively. And for HDRS, used for diagnosing major depression, the scores were 0.92, 0.89, and 94. Furthermore, these two scales also had higher diagnostic accuracy in assessing depressive symptoms during both the acute and chronic phases of stroke. In patients with post-stroke aphasia and cognitive impairment, highly diagnostic scales have not been identified for assessing depressive symptoms yet. Conclusions The PHQ-9 and HDRS scales are recommended to assess PSD. HDRS, which demonstrates high diagnostic performance, can replace structured interviews based on diagnostic criteria.

Abstract Objective Pregnancy care can improve maternal pregnancy outcomes. Cluster nursing, an evidence-based, patient-centered model, enhances pregnancy care, can provide patients with high-quality nursing services, has been widely used in clinical practice in recent years. However, most previous studies evaluated cluster nursing program only for a single clinical scenario. In this study, we developed and implemented a antenatal cluster care program for various prenatal issues faced by puerpera to analyze its application effect. Methods This is a historical before and after control study. 89 expectant mothers who had their prenatal information files registered in the outpatient department of a grade III, level A hospital from June 2020 to September 2021 were finally enrolled in observation group, and received prenatal cluster management. Another set of 89 expectant mothers from January 2019 to December 2019 were included in the control group and received traditional routine prenatal management. The effect of cluster nursing management on maternal delivery and postpartum rehabilitation was evaluated and compared between the two groups. Results Compared with the control group, the observation group had a significantly higher natural delivery rate, better neonatal prognosis, higher rates of exclusive breastfeeding, lower incidence of postpartum complications, shorter postpartum hospital stay, better postpartum health status, and higher satisfaction with nursing services. Compared with before intervention, the SAS and SDS scores of the observation group showed significant improvement after intervention. Conclusion Antenatal cluster care is beneficial to improve maternal and neonatal outcomes, and can have positive effects on natural pregnancy and breastfeeding, while improving the multimedia health education ability of medical care and emphasizing the importance of social support.

Abstract Background Radiotherapy can modulate systemic antitumor immunity, while immune status in the tumor microenvironment also influences the efficacy of radiotherapy, but relevant molecular mechanisms are poorly understood in lung adenocarcinoma (LUAD). Methods In this study, we innovatively proposed a radiotherapy response classification for LUAD, and discovered ESYT3 served as a tumor suppressor and radioimmune response sensitizer. ESYT3 expression was measured both in radioresistant and radiosensitive LUAD tissues and cells. The influence of ESYT3 on radiotherapy sensitivity and resistance was then investigated. Interaction between ESYT3 and STING was evaluated through multiple immunofluorescent staining and coimmunoprecipitation, and downstream molecules were further analyzed. In vivo models were constructed to assess the combination treatment efficacy of ESYT3 overexpression with radiotherapy. Results We found that radioresistant subtype presented immunosuppressive state and activation of DNA damage repair pathways than radiosensitive subtype. ESYT3 expression was remarkably attenuated both in radioresistant LUAD tissues and cells. Clinically, low ESYT3 expression was linked with radioresistance. Overexpression of ESYT3 enabled to alleviate radioresistance, and sensitize LUAD cells to DNA damage induced by irradiation. Mechanically, ESYT3 directly interacted with STING, and activated cGAS-STING signaling, subsequently increasing the generation of type I IFNs as well as downstream chemokines CCL5 and CXCL10, thus improving radioimmune responses. The combination treatment of ESYT3 overexpression with radiotherapy had a synergistic anticancer effect in vitro and in vivo. Conclusions In summary, low ESYT3 expression confers resistance to radiotherapy in LUAD, and its overexpression can improve radioimmune responses through activating cGAS-STING-dependent pathway, thus providing an alternative combination therapeutic strategy for LUAD patients.

Abstract Background In the realm of swine production, optimizing body composition and reducing excessive fat accumulation is critical for enhancing both economic efficiency and meat quality. Despite the acknowledged impact of dietary calcium (Ca) and phosphorus (P) on lipid metabolism, the precise mechanisms behind their synergistic effects on fat metabolism remain elusive. Results Research observations have shown a decreasing trend in the percentage of crude fat in carcasses with increased calcium and phosphorus content in feed. Concurrently, serum glucose concentrations significantly decreased, though differences in other lipid metabolism-related indicators were not significant across groups. Under conditions of low calcium and phosphorus, there is a significant suppression in the expression of FABPs, CD36 and PPARγ in the jejunum and ileum, leading to inhibited intestinal lipid absorption. Concurrently, this results in a marked increase in lipid accumulation in the liver. Conversely, higher levels of dietary calcium and phosphorus promoted intestinal lipid absorption and reduced liver lipid accumulation, with these changes being facilitated through the activation of the CAMKK2/AMPK signaling pathway by high-calcium-phosphorus diets. Additionally, the levels of calcium and phosphorus in the diet significantly altered the composition of liver lipids and the gut microbiota, increasing α-diversity and affecting the abundance of specific bacterial families related to lipid metabolism. Conclusion The evidence we provide indicates that the levels of calcium and phosphorus in the diet alter body fat content and lipid metabolism by modulating the response of the gut-liver axis to lipids. These effects are closely associated with the activation of the CAMKK2/AMPK signaling pathway.

Abstract Previous studies in small samples have identified inconsistent cortical abnormalities in major depressive disorder (MDD). Despite genetic influences on MDD and the brain, it is unclear how genetic risk for MDD is translated into spatially patterned cortical vulnerability. Here, we initially examined voxel-wise differences in cortical function and structure using the largest multi-modal MRI data from 1660 MDD patients and 1341 controls. Combined with the Allen Human Brain Atlas, we then adopted transcription-neuroimaging spatial correlation and the newly developed ensemble-based gene category enrichment analysis to identify gene categories with expression related to cortical changes in MDD. Results showed that patients had relatively circumscribed impairments in local functional properties and broadly distributed disruptions in global functional connectivity, consistently characterized by hyper-function in associative areas and hypo-function in primary regions. Moreover, the local functional alterations were correlated with genes enriched for biological functions related to MDD in general (e.g., endoplasmic reticulum stress, mitogen-activated protein kinase, histone acetylation, and DNA methylation); and the global functional connectivity changes were associated with not only MDD-general, but also brain-relevant genes (e.g., neuron, synapse, axon, glial cell, and neurotransmitters). Our findings may provide important insights into the transcriptomic signatures of regional cortical vulnerability to MDD.

To investigate the protective effect of selenated Acanthopanax polysaccharide (Se-ASPS) against D-galactose-induced (D-gal) oxidative damage in mice. The oxidative damage model of mice was established by intrabitoneal injection of D-gal. The mice in the high, medium and low dose groups were supplemented with 200, 100 and 50 mg/kg·bw of selenated Acanthopanax polysaccharide, respectively. The mice were gavaged continuous intragastric administration for 28 days. Changes in body weight and feed intake and organ indices of mice in each group were compared, and HE staining was used to observe liver lesions in mice. Serum, heart, liver, spleen and kidney tissues were analyzed for SOD, CAT, GSH-Px, MDA, AST, ALT using the kit. Compared with the D-gal model group, both selenated Acanthopanax polysaccharide groups significantly increased the body weights of mice (P

Abstract Objective Subcortical nuclei such as the thalamus and striatum have been shown to be related to seizure modulation and termination, especially in drug‐resistant epilepsy. Enhance diffusion‐weighted imaging (eDWI) technique and tri‐component model have been used in previous studies to calculate apparent diffusion coefficient from ultra high b‐values (ADCuh). This study aimed to explore the alterations of ADCuh in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy. Methods Twenty‐nine patients with MRI‐negative drug‐resistant epilepsy and 18 healthy controls underwent eDWI scan with 15 b‐values (0–5000 s/mm2). The eDWI parameters including standard ADC (ADCst), pure water diffusion (D), and ADCuh were calculated from the 15 b‐values. Regions‐of‐interest (ROIs) analyses were conducted in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus. ADCst, D, and ADCuh values were compared between the MRI‐negative drug‐resistant epilepsy patients and controls using multivariate generalized linear models. Inter‐rater reliability was assessed using the intra‐class correlation coefficient (ICC) and Bland–Altman (BA) analysis. False discovery rate (FDR) method was applied for multiple comparisons correction. Results ADCuh values in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus in MRI‐negative drug‐resistant epilepsy were significantly higher than those in the healthy control subjects (all p

Abstract Background The SET domain group (SDG) genes encode histone lysine methyltransferases, which regulate gene transcription by altering chromatin structure and play pivotal roles in plant flowering determination. However, few studies have investigated their role in the regulation of flowering in upland cotton. Results A total of 86 SDG genes were identified through genome-wide analysis in upland cotton (Gossypium hirsutum). These genes were unevenly distributed across 25 chromosomes. Cluster analysis revealed that the 86 GhSDGs were divided into seven main branches. RNA-seq data and qRT‒PCR analysis revealed that lysine methyltransferase 3 (KMT3) genes were expressed at high levels in stamens, pistils and other floral organs. Using virus-induced gene silencing (VIGS), functional characterization of GhKMT3;1a and GhKMT3;2a revealed that, compared with those of the controls, the GhKMT3;1a- and GhKMT3;2a-silenced plants exhibited later budding and flowering and lower plant heightwere shorter. In addition, the expression of flowering-related genes (GhAP1, GhSOC1 and GhFT) significantly decreased and the expression level of GhSVP significantly increased in the GhKMT3;1a- and GhKMT3;2a-silenced plants compared with the control plants. Conclusion A total of 86 SDG genes were identified in upland cotton, among which GhKMT3;1a and GhKMT3;2a might regulate flowering by affecting the expression of GhAP1, GhSOC1, GhFT and GhSVP. These findings will provide genetic resources for advanced molecular breeding in the future.

Abstract Purpose To develop and validate a nomogram based on 3D-PDU parameters and clinical characteristics to predict LNM and LVSI in early-stage cervical cancer preoperatively. Materials and methods A total of first diagnosis 138 patients with cervical cancer who had undergone 3D-PDU examination before radical hysterectomy plus lymph dissection between 2014 and 2019 were enrolled for this study. Multivariate logistic regression analyses were performed to analyze the 3D-PDU parameters and selected clinicopathologic features and develop a nomogram to predict the probability of LNM and LVSI in the early stage. ROC curve was used to evaluate model differentiation, calibration curve and Hosmer-Lemeshow test were used to evaluate calibration, and DCA was used to evaluate clinical practicability. Results Menopause status, FIGO stage and VI were independent predictors of LNM. BMI and maximum tumor diameter were independent predictors of LVSI. The predicted AUC of the LNM and LSVI models were 0.845 (95%CI,0.765–0.926) and 0.714 (95%CI,0.615–0.813). Calibration curve and H-L test (LNM groups P = 0.478; LVSI P = 0.783) all showed that the predicted value of the model had a good fit with the actual observed value, and DCA indicated that the model had a good clinical net benefit. Conclusion The proposed nomogram based on 3D-PDU parameters and clinical characteristics has been proposed to predict LNM and LVSI with high accuracy, demonstrating for the first time the potential of non-invasive prediction. The probability derived from this nomogram may have the potential to provide valuable guidance for physicians to develop clinical individualized treatment plans of FIGO patients with early cervical cancer.

Teachers' conceptions of assessment are a significant indicator of teacher assessment literacy. This study contextualized pre-service teachers' conceptions of assessment in Chinese second language education. An exploratory factor analysis generated eight first-order factors and the following confirmatory factor analysis found a hierarchical model, reflecting a noticeable influence of prior learning experiences and official assessment regimes on conceptions. A follow-up latent profile analysis showed three profiles. Improvement-oriented was the most prevalent profile, but more than 40% of the participants were categorized as negative. The study substantiated the need to develop an integrative and balanced understanding of assessment in teacher education to prepare pre-service teachers for teaching in international contexts.

While phonetic training in laboratory settings has been shown to be helpful for second language (L2) sounds learning in prior studies , it is still open to debate whether a perception- or a production-based approach can better help adults learn L2 sounds in classroom settings. This study aimed to fill this knowledge gap. The participants were three groups of adult Chinese college students who had difficulties in perceiving and producing English/?/-/s/and/ð/-/z/. Group 1 and Group 2 were exposed to a perception-based and a production-based training approach respectively. Group 3 was the control group (no training). The training materials were "minimal pairs" embedding the target contrasts in various phonetic environments. Each session included explicit articulatory instructions and perception- or production-based practice activities. Individual participants' perception and production of the target contrasts were tested before (pretest), after (posttest), and one month after the training programme (delayed posttest). According to the results, (1) in comparison with the pretest, both the perception- and production-based groups showed significant perception and production improvement in the posttest, which remained in the delayed posttest; the control group had no significant perception or production changes across the three tests; (2) the production-based group had significantly better perception and production performance than the perception-based group both in the posttest and the delayed posttest. The overall results suggest that a production-based approach may be optimal for L2 sounds learning.