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Climate change is a global concern driven by greenhouse gas emissions. Bangladesh, being densely populated and a significant carbon emitter, must urgently reduce its “carbon-dioxide emissions”. The primary objectives of this research are to meticulously examine the impact of green growth, non-renewable energy, renewable energy, and technological innovations on carbon dioxide emissions in Bangladesh from 1990 to 2020, with the goal of informing policies for effective and sustainable climate change mitigation in Bangladesh. The analysis using advanced econometric methods, including autoregressive distributed lag, fully modified ordinary least squares, and canonical cointegration regression, reveals that green growth and technological innovations have adverse long-term but positive short-term effects on carbon emissions in Bangladesh. Additionally, it is noteworthy that both non-renewable and renewable energy sources significantly contribute to long-term and short-term carbon emissions. The study confirms the Environmental Kuznets Curve, showing a “∩” shaped relationship between green development and carbon emissions. Policymakers should prioritize green growth, incentivize technological innovation, promote sustainable economic practices, and implement comprehensive energy transition strategies. The insights from this study inform policy formulation to address the complex relationships between green growth, energy sources, and carbon-dioxide emissions for sustainable climate change mitigation in Bangladesh. Bangladesh’s efforts contribute to global emission reduction and foster a resilient future.

Aging brings about physiological dysfunction, disease, and eventual mortality. An increasing number of studies indicate that aging can easily lead to dysbiosis of the gut microbiota, which can further affect digestion, nerves, cognition, emotions, and more. Therefore, gut bacteria play an important role in regulating the physical functions of aging populations. While saponins, the primary components of American ginseng, are frequently utilized for treating common ailments in the elderly due to their potent antioxidant properties, there is a scarcity of comprehensive studies on aging organisms. This study focused on 18 month old aging mice and investigated the effects of single intervention and combined intervention of Rb1 and Re, the main components of Panax quinquefolium saponins, on the gut microbiota of aging mice. High throughput 16s RNA gene sequencing analysis was performed on the gut contents of the tested mice, and the results showed that Rb1 and Re had a significant impact on the gut microbiota. Rb1, Re, and Rb1 + Re can effectively enhance the diversity of gut microbiota, especially in the combined Rb1 + Re group, which can recover to the level of young mice. Re can promote the abundance of probiotics such as Lactobacillus, Lactobacillaceae, and Lactobacillus, and inhibit the abundance of harmful bacteria such as Enterobacteriaceae. This indicates that the intervention of Rb1, Re, and Rb1 + Re can maintain the homeostasis of gut microbiota, and the combined application of Rb1 + Re has a better effect. The relationship between aging, brain gut axis, and gut microbiota is very close. Saponins can improve the gut microbiota of aging individuals by maintaining the balance of gut microbiota and the normal function of the brain gut axis, enabling the body to achieve a gut microbiota homeostasis closer to that of young healthy mice.

ObjectiveTo analyze the risk factors of lower extremity deep venous thrombosis (DVT) detachment in orthopedic patients, and to establish a risk nomogram prediction model.MethodsThe clinical data of 334 patients with orthopedic DVT admitted to the Third Hospital of Hebei Medical University from January 2020 to July 2021 were retrospectively analyzed. General statistics included gender, age, BMI, thrombus detachment, inferior vena cava filter window type, filter implantation time, medical history, trauma history, operation, use of tourniquet, thrombectomy, anesthesia mode, anesthesia grade, operative position, blood loss during operation, blood transfusion, immobilization, use of anticoagulants, thrombus side, thrombus range, D-dimer content before filter implantation and during removal of inferior vena cava filter. Logistic regression was used to perform univariate and multivariate analysis on the possible factors of thrombosis detachment, screen out independent risk factors, establish a risk nomogram prediction model by variables, and internally verify the predictability and accuracy of the model.ResultsBinary logistic regression analysis showed that Short time window filter (OR = 5.401, 95% CI = 2.338–12.478), lower extremity operation (OR = 3.565, 95% CI = 1.553–8.184), use of tourniquet (OR = 3.871, 95% CI = 1.733–8.651), non-strict immobilization (OR = 3.207, 95% CI = 1.387–7.413), non-standardized anticoagulation (OR = 4.406, 95% CI = 1.868–10.390), distal deep vein thrombosis (OR = 2.212, 95% CI = 1.047–4.671) were independent risk factors for lower extremity DVT detachment in orthopedic patients (P

BackgroundThe Metabolic score of insulin resistance (METS-IR) has recently been accepted as a reliable alternative to insulin resistance (IR), which was demonstrated to be consistent with the hyperinsulinemic-euglycemic clamp. Few pieces of research have focused on the relationship between METS-IR and diabetes in Chinese. The purpose of this research was to explore the effect of METS-IR on new-onset diabetes in a large multicenter Chinese study.MethodsAt the baseline of this retrospective longitudinal research, 116855 participators were included in the Chinese cohort study administered from 2010 to 2016. The subjects were stratified by quartiles of METS-IR. To assess the effect of METS-IR on incident diabetes, the Cox regression model was constructed in this study. Stratification analysis and interaction tests were applied to detect the potential effect of METS-IR and incident diabetes among multiple subgroups. To verify whether there was a dose-response relationship between METS-IR and diabetes, a smooth curve fitting was performed. In addition, to further determine the performance of METS -IR in predicting incident diabetes, the receiver operating characteristic curve (ROC) was conducted.ResultsThe average age of the research participators was 44.08 ± 12.93 years, and 62868 (53.8%) were men. METS-IR were significant relationship with new-onset diabetes after adjusting for possible variables (Hazard ratio [HR]: 1.077; 95% confidence interval [CI]: 1.073-1.082, P < 0.0001), the onset risk for diabetes in Quartile 4 group was 6.261-fold higher than those in Quartile 1 group. Moreover, stratified analyses and interaction tests showed that interaction was detected in the subgroup of age, body mass index, systolic blood pressure, diastolic blood pressure, and fasting plasma glucose, there was no significant interaction between males and females. Furthermore, a dose-response correlation was detected between METS-IR and incident diabetes, the nonlinear relationship was revealed and the inflection point of METS-IR was calculated to be 44.43. When METS-IR≥44.43, compared with METS-IR < 44.43, the trend was gradually saturated, with log-likelihood ratio test P < 0.001. Additionally, the area under receiver operating characteristic of the METS-IR in predicting incident diabetes was 0.729, 0.718, and 0.720 at 3, 4, and 5 years, respectively.ConclusionsMETS-IR was correlated with incident diabetes significantly, and showed a nonlinear relationship. This study also found that METS-IR had good discrimination of diabetes.

Stropharia rugosoannulata is a widely grown edible mushroom with a high nutritional value. S. rugosoannulata polysaccharides is one of the most important bioactive components of S. rugosoannulata and has a wide range of activities. A S. rugosoannulata polysaccharides, named SRF-3, was derived from the S. rugosoannulata extraction by freeze-thaw combine with hot water extraction method, then prepareed with DEAE-cellulose column and Sephacryl S-200 HR gel column, and its hypolipidemic activity was determined. The structural characteristics of SRF-3 were analyzed by infrared spectral scanning (FT-IR), ultra-high performance liquid chromatography (UHPLC), acid hydrolysis, methylation analysis, nuclear magnetic resonance (NMR), and Gas Chromatography-Mass Spectrometer (GC-MS). SRF-3 is composed of mannose, galactose, methyl galactose and fructose with ratios of 16, 12, 58 and 12, respectively. In addition, the average relative molecular mass of SRF-3 is approximately 24 kDa. The main chain of SRF-3 is mainly composed of repeating α-D-1,6-Galp and α-D-1,6-Me-Galp units, with branches in the O-2 position of Gal. The structure is presumed to be a mannogalactan, with a small amount of t-β-D-Manp present as a side chain. Hypolipidemic activity assay showed that SRF-3 had good antioxidant and hypolipidemic effects in vitro, suggesting that SRF-3 have potential application in reducing liver fat accumulation.

PurposeThe purpose of this study was to realize automatic segmentation of lung parenchyma based on random walk algorithm to ensure the accuracy of lung parenchyma segmentation. The explicable features of pulmonary nodules were added into VGG16 neural network to improve the classification accuracy of pulmonary nodules.Materials and MethodsLIDC-IDRI, a public dataset containing lung Computed Tomography images/pulmonary nodules, was used as experimental data. In lung parenchyma segmentation, the maximum Between-Class Variance method (OTSU), corrosion and expansion methods were used to automatically obtain the foreground and background seed points of random walk algorithm in lung parenchyma region. The shortest distance between point sets was added as one of the criteria of prospect probability in the calculation of random walk weight function to achieve accurate segmentation of pulmonary parenchyma. According to the location of the nodules marked by the doctor, the nodules were extracted. The texture features and grayscale features were extracted by Volume Local Direction Ternary Pattern (VLDTP) method and gray histogram. The explicable features were input into VGG16 network in series mode and fused with depth features to achieve accurate classification of nodules. Intersection of Union (IOU) and false positive rate (FPR) were used to measure the segmentation results. Accuracy, Sensitivity, Specificity, Accuracy and F1 score were used to evaluate the results of nodule classification.ResultsThe automatic random walk algorithm is effective in lung parenchyma segmentation, and its segmentation efficiency is improved obviously. In VGG16 network, the accuracy of nodular classification is 0.045 higher than that of single depth feature classification.ConclusionThe method proposed in this paper can effectively and accurately achieve automatic segmentation of lung parenchyma. In addition, the fusion of multi-feature VGG16 network is effective in the classification of pulmonary nodules, which can improve the accuracy of nodular classification.

Background: There may be a delay in or a poor outcome of endovascular treatment (EVT) among acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours.Methods: We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes.Results: Among 1,788 patients, 1,079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than during on-hours (165 vs. 125 min, P = 0.002 and 410 vs. 392 min, P = 0.027). The rates of successful reperfusion and symptomatic intracranial hemorrhage were similar in both groups. The adjusted odds ratio (OR) for the 90-day modified Rankin Scale score was 0.892 [95% confidence interval (CI), 0.748–1.064]. The adjusted OR for the occurrence of functional independence was 0.892 (95% CI, 0.724–1.098), and the adjusted OR for mortality was 1.214 (95% CI, 0.919–1.603).Conclusions: Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay was not associated with worse functional outcomes or higher mortality rates.Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.

ObjectivesFor colorectal cancer patients, traditional biomarker deficient mismatch repair/microsatellite instability (dMMR/MSI) is an accurate predictor of immune checkpoint inhibitors (ICIs). Recent years, researchers considered tumor mutation burden (TMB) as another predictive biomarker which means the number of nonsynonymous mutations in cancer cells. Several studies have proven that TMB can evaluate the efficacy of ICI therapy in diverse types of cancer, especially in non-small cell lung cancer and melanoma. However, studies on the association between TMB and the response to ICI therapy in colorectal cancer alone are still lacking. In this study, we aim to verify the effect of TMB as a biomarker in predicting the efficacy of ICIs in colorectal cancer.MethodsWe searched the PubMed and Ovid MEDLINE databases up to May 1, 2021 and screened studies for eligibility. Thirteen studies published from 2015 to 2021 with 5062 patients were included finally. We extracted and calculated hazard ratios (HRs) and odds ratios (ORs) of overall survival (OS) and objective response rates (ORRs) and their 95% confidence intervals (95% CIs). Pooled HR and OR were evaluated to compare OS and ORR between TMB-high and TMB-low groups in colorectal cancer patients. Meanwhile, we assessed heterogeneity with the I2 statistic and p-values and performed publication bias assessments, sensitivity analyses, and subgroup analyses to search the cause of heterogeneity.ResultsThe TMB-high patient group had a longer OS than the TMB-low patient group (HR = 0.68, 95% CI: 0.51, 0.92, p = 0.013) among colorectal cancer patients receiving ICIs. In addition, the TMB-high patient group was superior in terms of ORR (OR = 19.25, 95% CI: 10.06, 36.82, p < 0.001) compared to the TMB-low patient group.ConclusionsIn conclusion, this meta-analysis revealed that TMB can be used as a potential predictive biomarker of colorectal cancer patients receiving ICI therapy. Nevertheless, this finding is not stable enough. Therefore, many more randomized controlled trials are needed to prove that TMB is reliable enough to be used clinically to predict the efficacy of immunotherapy in colorectal cancer. And the most relevant biomarker remains to be determined when TMB high overlaps with other biomarkers like MSI and TILs.

ObjectiveImmediate early response 5 (IER5) plays a core role in cell cycle and response to irradiation. However, its role in glioma remains unclear. We aimed to evaluate its prognostic significance in glioma based on The Cancer Genome Atlas data resource.MethodsThe Kruskal–Wallis test, Wilcoxon signed-rank test, and logistic regression were employed to explore the relationship between IER5 expression and clinicopathological features. Kaplan–Meier and Cox regression analyses were implemented to investigate the relationship of IER5 with prognosis. A nomogram to estimate the impact of IER5 on prognosis was created based on the Cox multivariate data. We performed gene set enrichment analysis (GSEA) to determine the key signaling cascades associated with IER5. Immunohistochemistry was performed to examine IER5 expression in a tissue microarray (TMA) of glioma samples.ResultsImmediate early response 5 gene expression was elevated in glioma patients. The level of IER5 was significantly correlated with WHO grade [OR = 6.71 (4.34–10.68) for G4 vs. G2 and G3], IDH (isocitrate dehydrogenase enzyme) status [OR = 13.35 (8.92–20.46) for wild-type (WT) vs. mutated (Mut)], epidermal growth factor receptor status [OR = 8.42 (4.32–18.43) for Mut vs. WT], age [OR = 0.27 (0.18–0.41) for ≤ 60 years vs. >60 years], and histological type [OR = 7.13 (4.63–11.31] for glioblastoma vs. astrocytoma, oligoastrocytoma, and oligodendroglioma). Univariate analyses revealed that high IER5 expression was linked to short overall survival (OS) [hazard ratio (HR): 3.747; 95% confidence interval (CI): 2.847–4.933; and P < 0.001]. High IER5 expression was linked to poor OS in multivariate analyses (HR: 2.474; 95% CI: 1.552–3.943; and P < 0.001). TMA results showed that high IER5 protein levels were related to short OS (HR: 1.84; 95% CI: 1.10–3.07; and P = 0.021) and poor disease-specific survival (HR: 1.82; 95% CI: 1.09–3.04; and P = 0.023). GSEA showed that many tumor related pathways were enriched differentially in the IER5-high expression group. The C-index and calibration plots of the nomogram showed an effective estimation performance in glioma patients.ConclusionHerein, we established that IER5 plays a critical role in glioma progression and prognosis, which might be an important biomarker for the prognosis of glioma patients.

Background: The mechanism underlying delirium, a common acute fluctuating mental state, may be related to the activation of a neuroinflammatory response. In this study, we attempted to investigate whether plasma inflammatory response markers, vascular and cerebrovascular injury-related markers, and neurodegeneration-associated markers were associated with emergence delirium (ED).Methods: Patients aged 50 years or above who underwent elective laparoscopic surgery under general anesthesia were included in this study. Delirium was assessed postoperatively with the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Plasma samples were collected from ED patients and non-ED patients to test concentrations of inflammation markers, including interleukin 6 (IL-6), chitinase 3-like 1 (CHI3L1), S100 calcium-binding protein B (S100B), lipoprotein-associated phospholipase-A2 (Lp-PLA2), and macrophage migration inhibitory factor (MIF); vascular and cerebrovascular injury-related markers, including intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1); and neurodegeneration-associated markers, including alpha-synuclein (α-Syn) and β-secretase 1 (BACE1). Binary logistic regression analysis was performed to analyze the relationship between biomarkers and ED, and receiver operating characteristic (ROC) curves were used to analyze the diagnostic value of biomarkers.Results: A total of 104 patients were included in this study, with an average age of 63.69 ± 7.21. IL-6 (OR = 2.73, 95% CI: 1.66–6.44, P = 0.022), S100B (OR = 4.74, 95% CI: 1.88–11.95, P = 0.001), and BACE1 (OR = 6.54, 95% CI: 2.57–16.65, P < 0.000) were independent biological indicators for the occurrence of ED.CHI3L1, Lp-PLA2, MIF, ICAM-1, VCAM-1, and α-Syn were unrelated to ED. Plasma BACE1 level had a possible diagnostic value for ED [area under curve (AUC) = 0.75, 95% CI: 0.66–0.85], whereas plasma IL-6 (AUC = 0.62, 95% CI: 0.51–0.73) and S100B (AUC = 0.65, 95% CI: 0.54–0.76) levels had little diagnostic value for distinguishing ED vs. non-ED.Conclusion: Higher levels of systemic inflammation marker IL-6, cerebral inflammation marker S100B, and neurodegeneration-associated marker BACE1 are related to ED. Plasma BACE1 may be a potential diagnostic biomarker for ED.