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Although the 2021 Western North America (WNA) heat wave was predicted by weather forecast models, questions remain about whether such strong events can be simulated by global climate models (GCMs) at different model resolutions. Here, we analyze sets of GCM simulations including historical and future periods to check for the occurrence of similar events. High- and low-resolution simulations both encounter challenges in reproducing events as extreme as the observed one, particularly under the present climate. Relatively stronger amplitudes are observed during the future periods. Furthermore, high- and low-resolution short initialized GCM simulations are both able to reasonably predict such strong events and their associated high-pressure ridge over the WNA with a 1 week forecast lead time. Moisture sensitivity experiments further indicate a drier atmospheric moisture condition results in substantially higher near-surface temperatures in the simulated heat events.

BACKGROUND AND AIMS: Despite the substantial impact of environmental factors, individuals with a family history of liver cancer have an increased risk for HCC. However, genetic factors have not been studied systematically by genome-wide approaches in large numbers of individuals from European descent populations (EDP). APPROACH AND RESULTS: We conducted a 2-stage genome-wide association study (GWAS) on HCC not affected by HBV infections. A total of 1872 HCC cases and 2907 controls were included in the discovery stage, and 1200 HCC cases and 1832 controls in the validation. We analyzed the discovery and validation samples separately and then conducted a meta-analysis. All analyses were conducted in the presence and absence of HCV. The liability-scale heritability was 24.4% for overall HCC. Five regions with significant ORs (95% CI) were identified for nonviral HCC: 3p22.1, MOBP , rs9842969, (0.51, [0.40-0.65]); 5p15.33, TERT , rs2242652, (0.70, (0.62-0.79]); 19q13.11, TM6SF2 , rs58542926, (1.49, [1.29-1.72]); 19p13.11 MAU2 , rs58489806, (1.53, (1.33-1.75]); and 22q13.31, PNPLA3 , rs738409, (1.66, [1.51-1.83]). One region was identified for HCV-induced HCC: 6p21.31, human leukocyte antigen DQ beta 1, rs9275224, (0.79, [0.74-0.84]). A combination of homozygous variants of PNPLA3 and TERT showing a 6.5-fold higher risk for nonviral-related HCC compared to individuals lacking these genotypes. This observation suggests that gene-gene interactions may identify individuals at elevated risk for developing HCC. CONCLUSIONS: Our GWAS highlights novel genetic susceptibility of nonviral HCC among European descent populations from North America with substantial heritability. Selected genetic influences were observed for HCV-positive HCC. Our findings indicate the importance of genetic susceptibility to HCC development.

Tropical cyclone (TC) projections with atmosphere-only models are associated with uncertainties due to their inability to represent TC-ocean interactions. However, global coupled models, which represent TC-ocean interactions, can produce basin-scale sea surface temperature biases in seasonal to centennial simulations that lead to challenges in representing TC activity. Therefore, focusing on recent individual major hurricane events, we investigated the influence of TC-ocean coupling on the response of TCs to anthropogenic change using atmosphere-only and coupled atmosphere-ocean regional model simulations. Under an extremely warm scenario, coupling does not influence the signs of projected TC rainfall and intensity responses. Coupling, however, does influence the magnitude of projected intensity and especially rainfall. Within a 500 km radius region of the TCs, the projected rainfall increases in coupled simulations are 3–47 % less than in the atmosphere-only simulations, driven by enhanced TC-induced sea surface temperature cooling in the former. However, the influence of coupling on the magnitude of projected rainfall could vary considerably over the regions of highest rainfall generated by TCs.

Neonicotinoid insecticides are among the most used insecticides and their residues are frequently found in surface water due to their persistence and mobility. Neonicotinoid insecticides exhibit toxicity to a wide range of aquatic invertebrates at environmentally relevant levels, and therefore their contamination in surface water is of significant concern. In this study, we investigated the spatiotemporal distribution of six neonicotinoids in a large wetland system, the Prado Wetlands, in Southern California, and further evaluated the wetlands' efficiency at removing these insecticides. Total neonicotinoid concentrations in water ranged from 3.17 to 46.9 ng L-1 at different locations within the wetlands, with imidacloprid and dinotefuran among the most detected. Removal was calculated based on concentrations as well as mass flux. The concentration-based removal values for a shallow pond (vegetation-free), moderately vegetated cells, densely vegetated cells, and the entire wetland train were 16.9%, 34.2%, 90.2%, and 61.3%, respectively. Principal component analysis revealed that pH and temperature were the primary factors affecting neonicotinoids removal. Results from this study demonstrated the ubiquitous presence of neonicotinoids in surface water impacted by urban runoff and wastewater effluent and highlighted the efficiency of wetlands in removing these trace contaminants due to concerted effects of uptake by wetland plants, photolysis, and microbial degradation.

Abstract Background Advanced gastric cancer (GC) exhibits a high recurrence rate and a dismal prognosis. Myocyte enhancer factor 2c (MEF2C) was found to contribute to the development of various types of cancer. Therefore, our aim is to develop a prognostic model that predicts the prognosis of GC patients and initially explore the role of MEF2C in immunotherapy for GC. Methods Transcriptome sequence data of GC was obtained from The Cancer Genome Atlas (TCGA), the Gene Expression Omnibus (GEO) and PRJEB25780 cohort for subsequent immune infiltration analysis, immune microenvironment analysis, consensus clustering analysis and feature selection for definition and classification of gene M and N. Principal component analysis (PCA) modeling was performed based on gene M and N for the calculation of immune checkpoint inhibitor (ICI) Score. Then, a Nomogram was constructed and evaluated for predicting the prognosis of GC patients, based on univariate and multivariate Cox regression. Functional enrichment analysis was performed to initially investigate the potential biological mechanisms. Through Genomics of Drug Sensitivity in Cancer (GDSC) dataset, the estimated IC50 values of several chemotherapeutic drugs were calculated. Tumor-related transcription factors (TFs) were retrieved from the Cistrome Cancer database and utilized our model to screen these TFs, and weighted correlation network analysis (WGCNA) was performed to identify transcription factors strongly associated with immunotherapy in GC. Finally, 10 patients with advanced GC were enrolled from Sun Yat-sen University Cancer Center, including paired tumor tissues, paracancerous tissues and peritoneal metastases, for preparing sequencing library, in order to perform external validation. Results Lower ICI Score was correlated with improved prognosis in both the training and validation cohorts. First, lower mutant-allele tumor heterogeneity (MATH) was associated with lower ICI Score, and those GC patients with lower MATH and lower ICI Score had the best prognosis. Second, regardless of the T or N staging, the low ICI Score group had significantly higher overall survival (OS) compared to the high ICI Score group. For its mechanisms, consistently, for Camptothecin, Doxorubicin, Mitomycin, Docetaxel, Cisplatin, Vinblastine, Sorafenib and Paclitaxel, all of the IC50 values were significantly lower in the low ICI Score group compared to the high ICI Score group. As a result, based on univariate and multivariate Cox regression, ICI Score was considered to be an independent prognostic factor for GC. And our Nomogram showed good agreement between predicted and actual probabilities. Based on CIBERSORT deconvolution analysis, there was difference of immune cell composition found between high and low ICI Score groups, probably affecting the efficacy of immunotherapy. Then, MEF2C, a tumor-related transcription factor, was screened out by WGCNA analysis. Higher MEF2C expression is significantly correlated with a worse OS. Moreover, its higher expression is also negatively correlated with tumor mutation burden (TMB) and microsatellite instability (MSI), but positively correlated with several immunosuppressive molecules, indicating MEF2C may exert its influence on tumor development by upregulating immunosuppressive molecules. Finally, based on transcriptome sequencing data on 10 paired tumor tissues from Sun Yat-sen University Cancer Center, MEF2C expression was significantly lower in paracancerous tissues compared to tumor tissues and peritoneal metastases, and it was also lower in tumor tissues compared to peritoneal metastases, indicating a potential positive association between MEF2C expression and tumor invasiveness. Conclusions Our prognostic model can effectively predict outcomes and facilitate stratification GC patients, offering valuable insights for clinical decision-making. The identified transcription factor MEF2C can serve as a biomarker for assessing the efficacy of immunotherapy for GC.

We presented the development of a consensus guideline for managing juvenile idiopathic arthritis-associated uveitis (JIAU) in Taiwan, considering regional differences in manifestation and epidemiology. The Taiwan Ocular Inflammation Society (TOIS) committee formulated this guideline using a modified Delphi approach with two panel meetings. Recommendations were based on a comprehensive evidence-based literature review and expert clinical experiences, and were graded according to the Oxford Centre for Evidence-Based Medicine's “Levels of Evidence” guideline (March 2009). The TOIS consensus guideline consists of 10 recommendations in four categories: screening and diagnosis, treatment, complications, and monitoring, covering a total of 27 items. These recommendations received over 75% agreement from the panelists. Early diagnosis and a coordinated referral system between ophthalmologists and pediatric rheumatologists are crucial to prevent irreversible visual impairment in children with JIAU. However, achieving a balance between disease activity and medication use remains a key challenge in JIAU management, necessitating further clinical studies.

Despite the emergence of antibiotic resistance genes (ARGs) and antibiotic resistant bacteria (ARBs), how biological inter-trophic interactions, modulated by watershed urbanization, shape the resistome remains unexplored. We collected water samples from the highly urbanized (western: 65 % built land, sewage-affected) and lesser-urbanized (northern: 25 % built land, drinking water source) downstream tributaries of the Jiulong River in southeast China over dry and wet seasons. We utilized metagenomic and amplicon (16S and 18S rDNA) sequencing to investigate the relationships among microeukaryotic algae, consumer protists, bacterial communities, and the resistome. Metagenomic results showed that ARG-MGE-carrying contigs (mobile ARGs), rather than ARG-carrying contigs (non-mobile ARGs), exhibited more pronounced discrepancies between tributaries. A higher total abundance of ARGs and a greater number of co-shared ARGs between pathogen and non-pathogen bacteria were observed in the more urbanized western tributary. Structural equation modeling revealed that consumer protist-bacteria and algae-bacteria cohesions predominantly influenced the resistome in the western and northern tributaries, respectively. Additionally, consumer protists had more significant associations (511 out of 634) with bacteria carrying mobile ARGs in western tributary, while algae had more significant associations (73 out of 105) in northern tributary. These results highlight the distinct inter-trophic driving factors of the resistome modulated by watershed urbanization.

AbstractPurpose To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies.Methods Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established.Results A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS.Conclusion While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.

The original version of this Article contained an error in Fig. 3, in which the uncertainty of the Atlantic Multidecadal Variability index was included as an orange trend line labelled with the letter ‘g’. This index however was found to be not linked to the findings of this study and has been removed. This has been corrected in both the PDF and HTML versions of the Article. The original version of this Article contained an error in the caption of Figure 3, which incorrectly read ‘g Orange: Atlantic Multidecadal Variability index55. Black: total solar irradiance12.’ The correct version replaces this sentence with ‘g Total solar irradiance12.’. This has been corrected in both the PDF and HTML versions of the Article. The original version of this Article contained an error in the Results section, which incorrectly read ‘Fromthe 1400 s C.E. onwards, sea ice extent decreased significantly (Fig. 3b, c) due to an intrusion of warm Atlantic Water into the North Atlantic54, as reflected by a positive phase of the Atlantic Multidecadal Variability (Fig. 3g)55.’ The correct version replaces this sentence with ‘Fromthe 1400 s C.E. onwards, sea ice extent decreased significantly (Fig. 3b, c), possibly related to sea-ice conditions54,55.’. This has been corrected in both the PDF and HTML versions of the Article.

Two new diatom species belonging to the genus Gomphonemopsis are described, Gomphonemopsis nana sp. nov. and Gomphonemopsis gaoi sp. nov. These two species were compared in detail with congeners. Gomphonemopsis nana is distinguished by its high stria density and small size. This species was found so far to be epiphytic only on the eelgrass collected from Qingdao Bay (Yellow Sea). Gomphonemopsis gaoi is characterized by its isopolar valves, simple proximal raphe endings and acutely rounded apices. This taxon was separated from the exoskeleton of marine copepods sampled from the Futian Mangrove Nature Reserve (South China Sea). In addition, two new combinations, Gomphonemopsis oahuensis (Hustedt) Lang Li, Yuhang Li & Changping Chen, comb. nov. and Gomphonemopsis platypus (Østrup) Lang Li, Yuhang Li & Junxiang Lai, comb. nov. are proposed. This study increases the records and knowledge of Gomphonemopsis along the coast of China.

Background: Studies using machine learning to identify the target characteristics and develop predictive models for coronary artery disease severity in patients with premature myocardial infarction (PMI) are limited. Methods: In this observational study, 1111 PMI patients (≤55 years) at Tianjin Chest Hospital from 2017 to 2022 were selected and divided according to their SYNTAX scores into a low-risk group (≤22) and medium–high-risk group (>22). These groups were further randomly assigned to a training or test set in a ratio of 7:3. Lasso–logistic was initially used to screen out target factors. Subsequently, Lasso–logistic, random forest (RF), k-nearest neighbor (KNN), support vector machine (SVM), and eXtreme Gradient Boosting (XGBoost) were used to establish prediction models based on the training set. After comparing prediction performance, the best model was chosen to build a prediction system for coronary artery severity in PMI patients. Results: Glycosylated hemoglobin (HbA1c), angina, apolipoprotein B (ApoB), total bile acid (TBA), B-type natriuretic peptide (BNP), D-dimer, and fibrinogen (Fg) were associated with the severity of lesions. In the test set, the area under the curve (AUC) of Lasso–logistic, RF, KNN, SVM, and XGBoost were 0.792, 0.775, 0.739, 0.656, and 0.800, respectively. XGBoost showed the best prediction performance according to the AUC, accuracy, F1 score, and Brier score. In addition, we used decision curve analysis (DCA) to assess the clinical validity of the XGBoost prediction model. Finally, an online calculator based on the XGBoost was established to measure the severity of coronary artery lesions in PMI patients Conclusions: In summary, we established a novel and convenient prediction system for the severity of lesions in PMI patients. This system can swiftly identify PMI patients who also have severe coronary artery lesions before the coronary intervention, thus offering valuable guidance for clinical decision-making.

Natural environments play a crucial role in transmission of antimicrobial resistance (AMR). Development of methods to manage antibiotic resistance genes (ARGs) in natural environments are usually limited to the laboratory or field scale, partially due to the complex dynamics of transmission between different environmental compartments. Here, we conducted a nine-year longitudinal profiling of ARGs at a watershed scale, and provide evidence that restrictions on livestock farms near water bodies significantly reduced riverine ARG abundance. Substantial reductions were revealed in the relative abundance of genes conferring resistance to aminoglycosides (42%), MLSB (36%), multidrug (55%), tetracyclines (53%), and other gene categories (59%). Additionally, improvements in water quality were observed, with distinct changes in concentrations of dissolved reactive phosphorus, ammonium, nitrite, pH, and dissolved oxygen. Antibiotic residues and other pharmaceuticals and personal care products (PPCPs) maintain at a similarly low level. Microbial source tracking demonstrates a significant decrease in swine fecal indicators, while human fecal pollution remains unchanged. These results suggest that the reduction in ARGs was due to a substantial reduction in input of antibiotic resistant bacteria and genes from animal excreta. Our findings highlight the watershed as a living laboratory for understanding the dynamics of AMR, and for evaluating the efficacy of environmental regulations, with implications for reducing environmental risks associated with AMR on a global scale.

The original version of this Article contained an error in Fig. 3g, inwhich the age on theXaxis for the AtlanticMultidecadal Variability index recordwas incorrect. This has been corrected in both the PDF and HTML versions of the Article.

The Little Ice Age (LIA; ca. 1450-1850 C.E.) is the best documented cold period of the past millennium, characterized by high-frequency volcanism, low solar activity, and high variability of Arctic sea-ice cover. Past studies of LIA Atlantic circulation changes have referenced the North Atlantic Oscillation (NAO), but recent studies have noted that LIA climate patterns appear to possess complexity not captured by an NAO analogue. Here, we present a new precipitation-sensitive stalagmite record from northern Italy that covers the past 800 years. We show that in the early LIA (1470-1610 C.E.), increased atmospheric ridging over northern Europe split the climatological westerlies away from central and northern Europe, possibly caused by concurrent Artic sea-ice reduction. With ongoing ice melting in the northern high latitudes and decreasing solar irradiance in the coming years, the early LIA may potentially serve as an analogue for European hydroclimatic conditions in the coming decades.

Purpose: To investigate the treatment outcome, visual outcome, and adverse effects of five-fraction stereotactic radiosurgery (SRS) to medium- and large-sized uveal melanoma with a non-invasive eye immobilization device. Methods: Medical records of 14 patients with uveal melanoma receiving SRS with a total dose of 50 Gy in five fractions from 2008 to 2017 were retrospectively reviewed. A non-invasive eye fixation device was used to achieve and monitor eye immobilization. Results: Local tumor control rates were 85.7% and 75.0% at 2 and 5 years, respectively. The average tumor diameter decreased significantly from 10.0 ± 3.21 mm to 8.36 ± 3.71 mm (p = 0.038) 15 months after SRS, while the average tumor thickness decreased significantly from 5.45 ± 2.21 mm to 4.34 ± 2.29 (p = 0.036) 21 months after SRS. The 5-year metastasis-free survival was 87.5%. The mean best-corrected visual acuity (BCVA) deteriorated from logMAR 0.296 at baseline to logMAR 1.112 at the last individual follow-up visits (p

Introduction Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs.Methods and analysis A total of 204 participants aged 18–80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively.Ethics and dissemination The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals.Trial registration number The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).