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Yi Li,1– 3,&ast; Yixuan Lu,1,2,&ast; Youdan Zhao,1 Zhi Lyu1,2 1Department of Senior Cadres Ward, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China; 2The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China; 3Department of General Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhi Lyu, Department of Senior Cadres Ward, Zhongshan Hospital of Xiamen University, No. 201-209 hubin South Road, Siming District, Xiamen, 361000, People’s Republic of China, Tel +86-13779950606, Email lyuzhi@xmu.edu.cnBackground: Central obesity, as measured by examination instruments, has been shown to be associated with both OSA and short sleep duration. However, objective measurement tools like CT, MRI, and DXA are expensive, cause radiation exposure, and have limited availability, especially in resource-limited settings. Thus, this study aimed to demonstrate the relevance of Body Mass Index (BMI) and Waist-to-Height Ratio (WHtR) as surrogate indicators of visceral obesity in the assessment of OSA and short sleep duration. We also intend to evaluate whether WHtR, in combination with BMI, can be a suitable surrogate marker for visceral adiposity.Methods: We recruited 333 adults with complete polysomnographic (PSG) records retrospectively. Logistic regression helped to assess the association of BMI and WHtR as surrogates for central adiposity with OSA and short sleep duration. Moreover, ROC curve analysis was conducted to evaluate the predictive ability of BMI and WHtR.Results: Following the relevant adjustments, logistic regression analysis results showed that the combination of WHtR and BMI acting as central obesity surrogates was significantly associated with OSA and short sleep duration (p< 0.05). According to univariate regression analysis, sleep latency and wake after sleep onset were independent predictors of the risk of central obesity in patients with short sleep duration and OSA. Additionally, ROC curve analysis demonstrated that the combination of BMI and WHtR provided a better assessment of central adiposity in patients with OSA and short sleep duration, compared to each measure alone.Conclusion: BMI and WHtR are significantly associated with OSA and short sleep duration, and might serve as a potential surrogate marker for central obesity. Sleep latency and wake after sleep onset can independently predict the risk of central obesity in patients with short sleep time and OSA. Thus, larger prospective studies are needed to verify our findings.Keywords: body mass index, central obesity, obstructive sleep apnea, short sleep duration, waist-to-height ratio

Zhengyi Lyu,1,&ast; Qiongying Shen,1,&ast; Shuxin Tian,1,&ast; Liyan Gong,2 Haizhou Lou,3 Guanai Bao,2 Zhuoxuan Wu,3 Chao Lu,2 Weiping Zhang,4 Rui Huang,5 Conghua Ji,6 Siyi Zheng,1 Wei Pan,1 Yinyin Ying,4 Jianwei Jin,4 Yi Liang4 1The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Medical Oncology, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 5Department of Acupuncture and Tuina, Wenzhou Central Hospital, Wenzhou, Zhejiang, People’s Republic of China; 6Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yi Liang, Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, 219 Moganshan Road, Hangzhou City, Zhejiang Province, 310053, People’s Republic of China, Email liangyiwww@126.comBackground: Transcutaneous Electrical Acupoint Stimulation (TEAS) therapy opens up the possibility for individuals with Cancer-induced bone pain (CIBP) to receive a home-based, patient-controlled approach to pain management. The aim of this study is designed to evaluate the efficacy of patient-controlled TEAS (PC-TEAS) for relieving CIBP in patients with non-small cell lung cancer (NSCLC).Methods/Design: This is a study protocol for a prospective, triple-blind, randomized controlled trial. We anticipate enrolling 188 participants with NSCLC bone metastases who are also using potent opioid analgesics from 4 Chinese medical centers. These participants will be randomly assigned in a 1:1 ratio to either the true PC-TEAS or the sham PC-TEAS group. All participants will receive standard adjuvant oncology therapy. The true group will undergo patient-controlled TEAS intervention as needed, while the sham group will follow the same treatment schedule but with non-conductive gel patches. Each treatment course will span 7 days, with a total of 4 courses administered. There will be 4 assessment time points: baseline, the conclusion of weeks 4, 8, and 12. The primary outcome of this investigation is the response rate of the average pain on the Brief Pain Inventory (BPI) scale at week 4 after treatment. Secondary outcomes include pain related indicators, quality of life scale, mood scales, and routine blood counts on the assessment days. Any adverse events will be promptly addressed and reported if they occur. We will manage trial data using the EDC platform, with a data monitoring committee providing regular quality oversight.Discussion: PC-TEAS interventions offer an attempt to achieve home-based acupuncture treatment and the feasibility of achieving triple blinding in acupuncture research. This study is designed to provide more rigorous trial evidence for the adjuvant treatment of cancer-related pain by acupuncture and to explore a safe and effective integrative medicine scheme for CIBP.Trial Registration: ClinicalTrials.gov NCT05730972, registered February 16, 2023.Keywords: bone cancer pain, TEAS, transcutaneous electrical nerve stimulation, patient-controlled analgesia, integrative medicine, home-based treatment

Jiong Zhou,&ast; Yang Yang,&ast; Mengjun Xu, Zhongfa Lyu, Xianjie Wu Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xianjie Wu, Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, People’s Republic of China, Email wuxianjie@zju.edu.cnObjective: To evaluate and explore the efficacy, safety, and pharmacoeconomics of three common strategies for pediatric alopecia areata.Methods: Chinese pediatric alopecia areata patients meeting the criteria were included and divided into three groups based on the received treatments. The efficacy, adverse events and pharmacoeconomics of these treatments were retrospectively analyzed.Results: Twenty-four pediatric AA patients were recruited in this study. 100% (12/12) of patients from the traditional group achieved SALT100. In the tofacitinib group, 40.0% (2/5) of patients achieved SALT50. 20.0% (1/5) of patients achieved SALT75 and 40.0% (2/5) of patients achieved SALT100. In the MN group, 42.86% (3/7) of patients were non-responders. 14.28 (1/7) of patients achieved SALT75 and 42.86% (3/7) of patients achieved SALT100. The adverse effects (AEs) were mild in all three groups, and none of the patients discontinued the treatments due to the AEs. Comparing the other two groups, the MN treatment would be more time-intensive and more expensive.Conclusion: For newly diagnosed or naive pediatric patients, the traditional treatment was the first-line approach. For long-duration, severe and refractory patients, tofacitinib and microneedling can be alternative options.Keywords: pediatric, alopecia areata, tofacitinib, microneedling, efficacy

Mingyu Yang,&ast; Meng Li,&ast; Zhuozhen Lyu, Zhen Yang Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 25000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhen Yang, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, JingWu Road, Jinan, Shandong, 25000, People’s Republic of China, Tel +86 15168867123, Email yangzhen@sdfmu.edu.cnAbstract: Cholangiocarcinoma (CCA), the second most common liver neoplasm, has a poor overall 5-year survival rate of less than 10%. A deeper understanding of the molecular pathogenesis contributing to CCA progression is essential for developing better therapeutic approaches to manage this disease. Ferroptosis, an oxidative iron-dependent form of regulated cell death, has been reported to be involved in tumorigenesis and progression. In particular, ferroptosis and inflammation, which are common issues in cholangiocarcinogenesis and CCA development, might be in concert with disease progression. Notably, the key feature of cancer cells is “iron addiction”, which is crucial for the high metabolic demand in carcinogenesis and cancer progression. Additionally, iron metabolism is of great importance in ferroptosis. Moreover, that cancer cells are vulnerable to ferroptosis might be a possible mechanism of CCA development. Although the underlying mechanism of how ferroptosis is implicated in CCA development requires further investigation, developing a new strategy combined with a pro-ferroptotic treatment would be an exciting CCA treatment approach in the future.Keywords: cholangiocarcinoma, ferroptosis, inflammation, iron metabolism, treatment target

Zhiyong Lyu,1 Jing Li,2 Jinghui Zhen,1 Wei Shi,3 Qingying Meng,1 Wei Zhou,1 Jingyun An,1 Kaihu Yao,3,&ast; Fang Dong1,&ast; 1Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Department of Clinical Laboratory, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 3Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fang Dong; Kaihu Yao, Department of Clinical Laboratory Center, Beijing Children’s Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, People’s Republic of China, Email fangd32@163.com; yaokaihu@bch.com.cnIntroduction: Streptococcus pneumoniae (S. pneumoniae) is a major pathogen causing death in children. Few studies have evaluated the importance of S. pneumoniae in the identified bacteria in clinical work. This retrospective study aimed to reveal the rank of S. pneumoniae in determined bacteria isolated from children in Beijing, China, as well as the antimicrobial resistance of this pathogen.Methods: The number of specimen for bacterial culture and of bacterial species were cumulated and ranked based on the data of the two largest children’s hospitals in Beijing from 2015 to 2021. The temporal change of S. pneumoniae culture, as well as the clinical data of S. pneumoniae isolates were collected and analyzed. The minimum inhibitory concentrations of antimicrobial agents were determined by BD Phoenix 100 automated system or Vitek 2 automated system for antimicrobial susceptibility testing. The breakpoints recommended by CLSI were adopted.Results: During the 7-year study period, a total of 45,631 bacterial isolates were cultured from 462,144 submitted specimens, in which S. pneumoniae was the third frequent agent following S. aureus and H. influenza, and accounting for 8.79% of the isolates (4011/45,631). In the 4011 S. pneumoniae isolates, 2239 and 997 ones were, respectively, isolated from sputum and bronchial lavage fluid. Most of S. pneumoniae strains were identified in winter (34.7%) and spring (26.1%), and were mainly isolated from patients under 5 years old (77.1%). Low susceptible rate (27.6%) of CSF isolates was determined to penicillin according to the parenteral meningitis breakpoints, while high susceptible rate (56.9%) of non-CSF isolates was obtained according to the parenteral non-meningitis breakpoints. The isolates showed low sensitivity to erythromycin and tetracycline (< 5%). All isolates were susceptible to vancomycin and linezolid.Conclusion: The present results demonstrated that S. pneumoniae was one of the most commonly detected bacteria in current pediatric clinical tests, especially in young children under 5 years old, which emphasized the importance of prevention. Penicillin could still be the first empiric choice to treat non-meningitis pneumococcal infections, while erythromycin should not be involved in the treatment.Keywords: Streptococcus pneumoniae, antimicrobial resistance, children, China

Ningcen Li,1,2,&ast; Yi Guo,1,3,4,&ast; Yinan Gong,1– 3 Yue Zhang,1,2 Wen Fan,5 Kaifang Yao,1,2 Zhihan Chen,1,2 Baomin Dou,1,2 Xiaowei Lin,1,3,4 Bo Chen,1– 3 Zelin Chen,1– 3 Zhifang Xu,1– 3 Zhongxi Lyu1– 3 1Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People’s Republic of China; 2School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People’s Republic of China; 3National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People’s Republic of China; 4School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin City, People’s Republic of China; 5Suzuka University of Medical Science, Suzuka City, Japan&ast;These authors contributed equally to this workCorrespondence: Zhifang Xu; Zhongxi LyuSchool of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, No. 10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People’s Republic of ChinaTel/Fax +86 22-5959-6290Email xuzhifangmsn@hotmail.com; 1025117807@qq.comAbstract: Inflammation plays a significant role in the occurrence and development of multiple diseases. This study comprehensively reviews and presents literature from the last five years, showing that acupuncture indeed exerts strong anti-inflammatory effects in multiple biological systems, namely, the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genitourinary systems. It is well known that localized acupuncture-mediated anti-inflammatory effects involve the regulation of multiple populations and functions of immune cells, including macrophages, granulocytes, mast cells, and T cells. In acupuncture stimulation, macrophages transform from the M1 to the M2 phenotype and the negative TLR4 regulator PPARγ is activated to inhibit the intracellular TLR/MyD88 and NOD signaling pathways. The downstream IκBα/NF-κB and P38 MAPK pathways are subsequently inhibited by acupuncture, followed by suppressed production of inflammasome and proinflammatory mediators. Acupuncture also modulates the balance of helper T cell populations. Furthermore, it inhibits oxidative stress by enhancing SOD activity via the Nrf2/HO-1 pathway and eliminates the generation of oxygen free radicals, thereby preventing inflammatory cell infiltration. The anti-inflammatory effects of acupuncture on different biological systems are also specific to individual organ microenvironments. As part of its anti-inflammatory action, acupuncture deforms connective tissue and upregulates the secretion of various molecules in acupoints, further activating the NF-κB, MAPK, and ERK pathways in mast cells, fibroblasts, keratinocytes, and monocytes/macrophages. The somatic afferents present in acupuncture-activated acupoints also convey sensory signals to the spinal cord, brainstem, and hypothalamic neurons. Upon information integration in the brain, acupuncture further stimulates multiple neuro-immune pathways, including the cholinergic anti-inflammatory, vagus-adrenal medulla-dopamine, and sympathetic pathways, as well as the hypothalamus-pituitary-adrenal axis, ultimately acting immune cells via the release of crucial neurotransmitters and hormones. This review provides a scientific and reliable basis and viewpoints for the clinical application of acupuncture in various inflammatory conditions.Keywords: inflammation, acupuncture, immune, vagus, sympathetic nerve

Xiang Li,1 Jinzhu Bai,2 Yi Hong,2 Junwei Zhang,2 Hehu Tang,2 Zhen Lyu,2 Shujia Liu,2 Shizheng Chen,2 Jiesheng Liu2 1Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Department of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center; School of Rehabilitation, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Jinzhu BaiDepartment of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center; School of Rehabilitation, Capital Medical University, No. 10 North Jiaomen Road, Fengtai District, Beijing, 100068, People’s Republic of ChinaEmail baijinzhu@126.comPurpose: To investigate the long-term (> 7 years) clinical outcomes of percutaneous endoscopic lumbar discectomy for lumbar degenerative disease to address postoperative problems including postoperative dysesthesia (POD), residual back pain and segmental instability.Methods: Inclusion and exclusion criteria were established. All patients who met the above criteria were treated by PELD using the transforaminal approach. Limited discectomy was performed to preserve the disc material in the intervertebral space as much as possible. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back pain (VAS-B) and leg pain (VAS-L) and Modified MacNab’s criterion were used for clinical evaluation. Radiographic parameters including height of intervertebral disc and segmental instability were also evaluated.Results: Forty-two patients (24 men and 18 women) who met our inclusion and exclusion criteria were included in our study. The average follow-up period was 95.71± 5.63 months (ranging from 87 to 105 months). There were no neurological complications associated with the operation. POD was found in 14.29% of patients, while only 2 patients (4.76%) complained of mild dysesthesia at final follow-up. Two patients (4.76%) required revision surgery during the follow-up period. The final follow-up ODI, JOA score, VAS-B and VAS-L were significantly better than preoperative values. The average disc-height ratio was 84.52± 5.66% of the preoperative disc height. No instability at the operation level was noted at final follow-up.Conclusion: Our study showed that PELD using the transforaminal approach can provide favorable results after a long-term follow-up period. POD is a common complication at initial prognosis. Limited discectomy can preserve the disc height well and minimize the risk of residual back pain.Keywords: percutaneous endoscopic lumbar discectomy, transforaminal approach, long-term follow-up, back pain

BackgroundAlpha-fetoprotein-producing gastric cancer (AFPGC) represents a particularly aggressive subtype of gastric carcinoma characterized by elevated rates of vascular invasion, lymphatic dissemination, hepatic metastasis, and an unfavorable clinical outcome. Treatment strategies for AFPGC have historically lacked specificity. Herein, a case is presented involving AFPGC in which the patient exhibited a notable response to combined anti-PD-1 antibody immunotherapy and SOX chemotherapy, potentially achieving a cure. This report marks the first application of this regimen in neoadjuvant therapy for AFP gastric cancer, followed by radical resection and postoperative adjuvant therapy.Case summaryA 62-year-old male patient presented with persistent upper abdominal distension and discomfort lasting over 2 months. Initial investigations revealed markedly elevated serum alpha-fetoprotein (AFP) levels, and subsequent pathological examination confirmed the diagnosis of AFPGC via gastroscopy. Due to the patient’s condition, surgical resection was initially deemed unfeasible. Therefore, a chemo-immunotherapy regimen consisting of SOX chemotherapy and the PD-1 inhibitor tislelizumab was administered for 3 cycles. Following this, successful laparoscopic radical gastrectomy was performed. The treatment protocol was continued with an additional 3 cycles postoperatively. At the time of this case report, the patient maintained a good quality of life with no evidence of disease recurrence or adverse events.ConclusionThe present report highlights a case of AFPGC where significant therapeutic success was achieved through a combined regimen of chemotherapy and immunotherapy, both before and after surgery. The use of anti-PD-1 antibody (tislelizumab) in combination with SOX regimen (S-1 and oxaliplatin) demonstrated effective treatment of AFPGC, potentially offering a curative approach. This approach represents a promising targeted therapy option for patients with AFPGC.

BackgroundPrevention and intervention of procrastination in college students are of great practical significance， and studies have illustrated a pairwise correlation among mindfulness， self-control， insecure attachment and procrastination， whereas the mechanism by which insecure attachment leads to procrastination remains unclear， and the related mediation path is quite understudied.ObjectiveTo investigate the effect of insecure attachment on procrastination among college students and the pathway of mindfulness and self-control， so as to inform the design of interventions for procrastination among college students.MethodsRandom and cluster sampling method were utilized to enroll 514 college students from 4 colleges in Guangdong Province From February to April 2023. Subjects were assessed using Irrational Procrastination Scale （IPS）， Adult Attachment Scale （AAS）， Mindful Attention Awareness Scale （MAAS） and Brief Self-Control Scale （BSCS）. Pearson correlation analysis were adopted to identify the correlation among above scales， and the mediation effect was examined via Bootstrap procedure.ResultsAAS score was positively correlated with IPS score （r=0.382， P

ObjectiveIn recent years, there has been a significant increase in the severity of leaf diseases in maize, with a noticeable trend of mixed occurrence. This poses a serious threat to the yield and quality of maize. However, there is a lack of studies that combine the identification of different types of leaf diseases and their severity classification, which cannot meet the needs of disease prevention and control under the mixed occurrence of different diseases and different severities in actual maize fields.MethodsA method was proposed for identifying the types of typical leaf diseases in maize and classifying their severity using hyperspectral technology. Hyperspectral data of three leaf diseases of maize: northern corn leaf blight (NCLB), southern corn leaf blight (SCLB) and southern corn rust (SCR), were obtained through greenhouse pathogen inoculation and natural inoculation. The spectral data were preprocessed by spectral standardization, SG filtering, sensitive band extraction and vegetation index calculation, to explore the spectral characteristics of the three leaf diseases of maize. Then, the inverse frequency weighting method was utilized to balance the number of samples to reduce the overfitting phenomenon caused by sample imbalance. Relief-F and variable selection using random forests (VSURF) method were employed to optimize the sensitive spectral features, including band features and vegetation index features, to construct models for disease type identification based on the full stages of disease development (including all disease severities) and for individual disease severities using several representative machine learning approaches, demonstrating the effectiveness of the research method. Furthermore, the study individual occurrence severity classification models were also constructed for each single maize leaf disease, including the NCLB, SCLB and SCR severity classification models, respectively, aiming to achieve full-process recognition and disease severity classification for different leaf diseases. Overall accuracy (OA) and Macro F1 were used to evaluate the model accuracy in this study.Results and DiscussionThe research results showed significant spectrum changes of three kinds of maize leaf diseases primarily focusing on the visible (550-680 nm), red edge (740-760 nm), near-infrared (760-1 000 nm) and shortwave infrared (1 300-1 800 nm) bands. Disease-specific spectral features, optimized based on disease spectral response rules, effectively identified disease species and classify their severity. Moreover, vegetation index features were more effective in identifying disease-specific information than sensitive band features. This was primarily due to the noise and information redundancy present in the selected hyperspectral sensitive bands, whereas vegetation index could reduce the influence of background and atmospheric noise to a certain extent by integrating relevant spectral signals through band calculation, so as to achieve higher precision in the model. Among several machine learning algorithms, the support vector machine (SVM) method exhibited better robustness than random forest (RF) and decision tree (DT). In the full stage of disease development, the optimal overall accuracy (OA) of the disease classification model constructed by SVM based on vegetation index reached 77.51%, with a Macro F1 of 0.77, representing a 28.75% increase in OA and 0.30 higher of Macro F1 compared to the model based on sensitive bands. Additionally, the accuracy of the disease classification model with a single severity of the disease increased with the severity of the disease. The accuracy of disease classification during the early stage of disease development (OA=70.31%) closely approached that of the full disease development stage (OA=77.51%). Subsequently, in the moderate disease severity stage, the optimal accuracy of disease classification (OA=80.00%) surpassed the optimal accuracy of disease classification in the full disease development stage. Furthermore, the optimal accuracy of disease classification under severe severity reached 95.06%, with a Macro F1 of 0.94. This heightened accuracy during the severity stage can be attributed to significant changes in pigment content, water content and cell structure of the diseased leaves, intensifying the spectral response of each disease and enhancing the differentiation between different diseases. In disease severity classification model, the optimal accuracy of the three models for maize leaf disease severity all exceeded 70%. Among the three kinds of disease severity classification results, the NCLB severity classification model exhibited the best performance. The NCLB severity classification model, utilizing SVM based on the optimal vegetation index features, achieved an OA of 86.25%, with a Macro F1 of 0.85. In comparison, the accuracy of the SCLB severity classification model (OA=70.35%, Macro F1=0.70) and SCR severity classification model (OA=71.39%, Macro F1=0.69) were lower than that of NCLB.ConclusionsThe aforementioned results demonstrate the potential to effectively identify and classify the types and severity of common leaf diseases in maize using hyperspectral data. This lays the groundwork for research and provides a theoretical basis for large-scale crop disease monitoring, contributing to precision prevention and control as well as promoting green agriculture.

Immune checkpoint inhibitors (ICIs) have been approved for the treatment of urothelial carcinoma(UC). However, the use of antibiotics, proton pump inhibitors, corticosteroids, beta-blockers, metformin, and statin concomitant medications in some patients due to complications during the treatment process may affect the clinical efficacy of ICIs through different pathway, making it difficult for patients to derive clinical benefit or making it more likely to develop drug resistance. In this paper, we present a review of the effects of the above concomitant drugs on ICIs in the treatment of patients with advanced UC, with a view to provide reference for the application of individualized treatment strategies of ICIs in patients with advanced UC.

Hydrogen energy storage has many characteristics such as large energy storage capacity, long storage time, clean and pollution-free, and it realizes the interconnection and complementation of multiple energy networks and collaborative optimization. It is expected to become an important supporting technology to promote the development of distributed energy and improve the efficiency of terminal energy utilization. In order to improve the reliability and renewable energy utilization rate of islanded microgrid, the operation characteristics of typical electric, hydrogen and thermal devices are analyzed, and a multi-objective optimization configuration model of the islanded microgrid is proposed. Then, the target problem is solved based on simulated annealing particle swarm optimization (SAPSO) algorithm to obtain technical and economic indicators under different configuration schemes. Finally, based on the annual natural resource and electric heating load characteristic curve of a certain place in the north, the model built on MATLAB can effectively promote that the load loss rate of the proposed multi-energy complementary configuration scheme decreases by 3.18%, and the utilization rate of renewable energy increases by 8.37% compared with the traditional electric energy storage configuration scheme. Thus, the proposed configuration scheme can effectively promote the consumption of renewable energy and ensure the economy and power supply reliability of the independent micro-grid.

[Objective] This paper aims to explore the explosion resistance performance of full-contact metal floating decks under gas explosion loads by employing a combination of experimental and numerical simulation methods. [Methods] In this study, a series of experiments were performed using various types of floating deck specimens in an explosion resistance experimental system designed for floating decks, to investigate the impact of different floating deck materials, connection modes, and thickness of upper and lower panels on their explosion resistance performance. A finite element model was established using the experimental data, and its correctness was subsequently verified by comparing the results obtained from the experiments with those obtained through numerical simulation.Furthermore, this study focused on analyzing the dynamic response process and failure mode of floating decks by studying displacement and stress contours, deformation-velocity curves at the center point over time, and examining the energy absorption ratio data of the honeycomb core. [Results] The study results revealed that the upper panel of the floating decks exhibited a radial stress distribution with a monotonically increasing trend, reaching the maximum value of 98.1 MPa at the edge. In contrast, the lower panel experienced relatively lower stress levels compared to the upper panel, displaying a radial distribution trend characterized by an initial increase, followed by a decrease in the middle, and another increase towards the end. The maximum stress observed on the lower panel was 63.18 MPa at the edge. Additionally, the maximum deformation observed on the floating decks was 48.9 mm for the upper panel and 3.2 mm for the lower panel, respectively. During the process of withstanding the explosion, the middle honeycomb core absorbed 72%— 86% of the impact energy. [Conclusion] The central zone of the upper panel in floating decks is identified as a weak area in the overall structure.To enhance the explosion resistance performance,it is crucial to strengthen the upper panel appropriately.Additionally,under the same specifications and conditions,floating decks filled with honeycomb cores exhibit improved performance in explosion resistance.

The development of nuclear reactor structural materials with excellent comprehensive performance is the basis of nuclear energy development, and it is one of the difficulties that have long restricted the promotion of nuclear energy. Multiprincipal element alloys(MEAs) have been recognized as candidate materials for advanced reactor structural materials due to their good irradiation resistance and mechanical properties, which has expanded a broad space for the design of new radiation-resistant materials. In recent years, the research on the irradiation damage of multiprincipal element alloys has tried to reveal the influence of some factors and characteristics of multiprincipal element alloys on the formation and evolution of defects in the irradiation process. For example, the type, number and concentration of alloying elements, lattice distortion, chemical short range order, etc. Although some existing research results show that the above factors can improve the resistance of multiprincipal element alloys to irradiation damage, under different irradiation conditions, the influence mechanism of the above factors on the formation and evolution of defects in multiprincipal element alloys is quite different, and it is difficult to draw generalization conclusions. Focusing on the four aspects of irradiation swelling, helium bubble formation, irradiation-induced element segregation and phase transition, irradiation hardening of FCC and BCC systems.The research progress of multiprincipal element alloys in irradiation damage in recent years was reviewed, the mechanism of action of multiprincipal element alloys to improve radiation resistance was summarized.And based on this, the future research directions for multiprincipal element alloys used in nuclear power structures were prospected, including tuning short-range order, high-entropy ceramics, additive manufacturing technology, accelerating development of new materials by integrating high-throughput computing with machine learning, etc. Finally, it is pointed out that new radiation-resistance MEAs must be designed based on the actual environment of material service from the perspective of composition design.

The inner wall corrosion of pipelines is concealed and hard to monitor in time. In order to visualize the shape of the internally corroded pipeline, as well as the defect volume and its spatial distribution, a three-dimensional(3D) model reconstruction method based on the ultrasonic phased array technology was proposed for the internally corroded pipeline. A self-built acquisition platform was used to control the one-dimensional linear array probes for the phased array, and the reflected echo signal was used to obtain the space coordinates between the inner and outer diameters of the corroded pipeline. Then, the point cloud data set between the inner and outer diameters was constructed by the interpolation method, and the point cloud data of each fracture zone were obtained by the hierarchical scanning method. Besides,data processing, reverse model reconstruction and forward modeling were performed for the 3D model reconstruction of the collected point cloud data. Finally, the reconstructed 3D model was compared with the point cloud data obtained by the Creaform 3D laser scanner. The results show that it is feasible to obtain the point cloud data using one-dimensional linear array probes based on the ultrasonic phased array technology, and the established 3D model and defects have small errors and high precision, which has important reference value for the safety evaluation of oil and gas pipelines.

In the coastal area of Pujian to Mulantou on Hainan Island, a set of medium to deep metamorphic rocks (Mulantou complex) has been discovered, composed of migmatite, dolomite, shale, and amphibolite, with migmatite being the predominant lithology. This study selected well-developed and typical migmatitic gneisses as the research focus and conducted systematic zircon U-Pb isotope dating and petrological and geochemical studies. The results indicate that the protolith of the Mulantou migmatitic gneisses was intermediate basic volcanic rock formed around 276 Ma. These rocks exhibit geochemical characteristics of island-arc calc-alkaline basalt, suggesting a tectonic setting related to the subduction of the Paleo-Tethys Ocean. Early anatectic metamorphism occurred around 261 Ma, indicating a tectonic environment related to the collision between the South China Block and the Indochina Block. Later metamorphism took place around 248 Ma, signifying a tectonic environment associated with extension following the collision between the South China Block and the Indochina Block. Therefore, the Mulantou migmatitic gneisses preserve a comprehensive record of the tectonic evolution in Hainan Island from the Early Permian to the Early Triassic. They represent the geological consequences of events such as the closure of the Paleo-Tethys Ocean, the collision between the South China Block and the Indochina Block, and the subsequent extension. The discovery of these rocks provides new insights into the eastern extension of the Song Ma suture zone.

Small-cell lung cancer (SCLC) has a poor prognosis and can be diagnosed with systemic metastases. Nevertheless, the molecular mechanisms underlying the development of SCLC are unclear, requiring further investigation. The current research aims to identify relevant biomarkers and available drugs to treat SCLC. The bioinformatics analysis comprised three Gene Expression Omnibus datasets (including GSE2149507, GSE6044, and GSE30219). Using the limma R package, we discovered differentially expressed genes (DEGs) in the current work. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were made by adopting the DAVID website. The DEG protein–protein interaction network was built based on the Search Tool for the Retrieval of Interacting Genes/Proteins website and visualized using the CytoHubba plugin in Cytoscape, aiming to screen the top ten hub genes. Quantitative real-time polymerase chain reaction was adopted for verifying the level of the top ten hub genes. Finally, the potential drugs were screened and identified using the QuartataWeb database. Totally 195 upregulated and 167 downregulated DEGs were determined. The ten hub genes were NCAPG, BUB1B, TOP2A, CCNA2, NUSAP1, UBE2C, AURKB, RRM2, CDK1, and KIF11. Ten FDA-approved drugs were screened. Finally, two genes and related drugs screened could be the prospective drug targets for SCLC treatment.

Zhi-yong Lyu, Jing-hui Zhen, Qing-ying Meng, Wei Zhou, Jing-yun An, Fang Dong Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of ChinaCorrespondence: Fang Dong, Department of Clinical Laboratory Center, Beijing Children’s Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, People’s Republic of China, Email fangd32@163.comPurpose: Bloodstream infections (BSIs) was an essential cause of morbidity and mortality in children. Empiric broad-spectrum treatment of BSIs may be costly and unable to effectively eliminate the correct pathogenic microbes, resulting in downstream antimicrobial resistance. The purpose was to provide evidence for diagnosis and treatment of bloodstream infections in pediatrics, by revealing the pathogen distribution and antibiotic resistance pattern of BSIs.Methods: In this 5-year study, a total of 2544 pathogenic bacteria stains, isolated from 2368 patients with BSI, were retrospectively analyzed, to define the species distribution and the antimicrobial resistance pattern in Beijing.Results: The most frequently isolated pathogenic bacteria were K. pneumoniae (12.1%), S. aureus (11.5%), E. coli (11.2%), and E. faecium (11.2%). Hematological malignancies were the most common disease among patients with underlying conditions. Methicillin resistance was detected in 30.0% of S. aureus and 81.7% of coagulase-negative Staphylococcus (CoNS), respectively. The detection rates of carbapenem-resistant-E. coli (CRECO) and carbapenem-resistant-K. pneumoniae (CRKPN) were 10.8% and 50.8%, respectively. In terms of 122 isolates of S. pneumonia, 5 isolates (4.1%) were penicillin-resistant Streptococcus pneumoniae (PRSP); meanwhile, 50 isolates (41.0%) were penicillin-intermediate Streptococcus pneumoniae (PISP). Among the non-fermentative gram-negative bacilli isolates, 22.8% and 26.9% of the P. aeruginosa, were resistant to imipenem and meropenem. Furthermore, the resistance rates of A. baumannii to imipenem and meropenem both were 54.5%.Conclusion: In the study, we demonstrated the characteristics of bloodstream infections and antimicrobial susceptibility pattern of pediatrics in Beijing. Gram positive bacteria were the main pathogens of BSIs. CoNS strains presented even higher resistance to multiple antibiotics, including methicillin, than S. aureus. K. pneumoniae and E. coli represent the most common isolated gram-negative bacteria and exhibited high resistance to a variety of antimicrobial agents. Therefore, it was of critical importance to implement appropriate antimicrobial medication according to pathogen distribution and drug susceptibility test.Keywords: bloodstream infections, children, etiology, antimicrobial resistance, methicillin-resistant S. aureus, methicillin-resistant coagulase-negative staphylococci, S. pneumoniae, carbapenem-resistant Enterobacter

Aiming at the small imaging, complex background and crowded distribution of remote sensing image targets, a remote sensing image target detection algorithm (HQ-S2ANet) based on perceptual extension and anchor frame optimal matching is proposed by using the rotating target detection method S2ANet as a baseline network. Firstly, a cooperative attention(SEA) module is built to capture the relationship among the feature pixels when extending the model perception area to realize the relationship modeling between the target and the global. Secondly, the feature pyramid (FPN) feature fusion process is improved to form a perceptual extension feature pyramid module (HQFPN), which guarantees the low-level detail position information in the down sampling process when extending the perception area to enhance the model information capturing capability. Finally, a high-quality anchor frame is used to detect the target by using the high quality anchor frame as the baseline network. The high-quality anchor frame matching method (MaxIoUAssigner_HQ) is used to control the anchor frame truth value assignment by using a constant factor to ensure the recall rate while preventing the generation of low-quality anchor frame matching. The experimental results show that, under the DOTA dataset, the average accuracy(mAP) of HQ-S2ANet is improved by 3.1%, the parameters number increased by only 2.61M and the average recall(recall) is improved by 1.6% compared with the S2ANet algorithm, and the present algorithm effectively enhances the detection capability of the remote sensing image target.

A 38-year-old female presented with irregular menstruation and hirsutism that started at age of 16 and diagnosed with polycystic ovary syndrome at age of 29 with elevated testosterone. When treated with ethinestradiol cyproterone tablets, her menstruation returned to normal and androgen levels was not changed. At age of 38 she was referred to the hospital with infertility, a diagnosis of nonclassical 21-hydroxylase deficiency was confirmed using 17-hydroxyprogesterone, dehydroepiandrosterone-sulfate, a cosyntropin-stimulation test and genetic test. This case suggested that nonclassical congenital adrenal hyperplasia should be considered when a patient is presented with oligomenorrhea, hirsutism with hyperandrogenemia and infertility.

Summary: Radiative cooling presents a method for reducing the operational temperature of solar panels without additional energy consumption. However, its applicability to PV modules has been limited by the thermal properties of existing materials. To overcome these challenges, we introduce a V-shaped design that enhances cooling in vertical PV modules by effectively harnessing thermal radiation from both the front and rear sides, resulting in a substantial temperature reduction of 10.6°C under 1 sun illumination in controlled laboratory conditions. Field tests conducted in warm and humid conditions, specifically in Thuwal, Saudi Arabia, demonstrate a remarkable 15% increase in efficiency while maintaining an operating temperature 0.2°C lower than that of conventional horizontal PV modules, corresponding to a significant 16.8% increase in power output. Our innovative V-shaped design offers a promising thermal strategy suitable for diverse climates, contributing to improved performance and reduced module temperatures, thereby supporting the global pursuit of carbon neutrality.

Objective To investigate the effect of concurrent chemoradiotherapy on immune function, inflammatory state, and gut microbiota in patients with pelvic tumor. Methods Peripheral blood and stool samples were collected before and after concurrent chemoradiotherapy from 60 patients with pelvic tumor who were treated in Qingdao Central Hospital from July 2021 to December 2022. Flow cytometry was used to measure the levels of peripheral blood lymphocyte subsets and cytokines, and quantitative real-time PCR was used to measure the number of Fusobacterium nucleatum, Bifidobacterium, Lactobacillus acidophilus, and Streptococcus in stool. Each index was compared in terms of change before and after concurrent chemoradiotherapy, and their correlation with treatment outcome was analyzed. Results After concurrent chemoradiotherapy, the patients with pelvic tumor had significant reductions in the percentages of peripheral blood CD3+CD8+ and CD3-CD19+ cells and the level of interleukin-10 (t=2.571-2.995,P

The authors develop an imaging-based intelligent spectrometer on a plasmonic “rainbow” chip. It can accurately and precisely determine the spectroscopic and polarimetric information of the illumination spectrum using a single image assisted by suitably trained deep learning algorithms.

In order to accurately evaluate the complexity of the mine geological structure, taking Huangling No.1 coal mine as the research object, based on the analysis of the development characteristics and laws of the mine geological structure, 11 evaluation indicators that can reflect and affect the complexity of the mine geological structure are selected. The well field is divided into 185 evaluation units according to the specification of 1 km×1 km, the evaluation index value of each evaluation unit is calculated, and each evaluation index value is divided into 4 categories according to the orderly quality optimal segmentation analysis, corresponding to the geological structure of simple, medium, complex, and extremely complex. The training samples of BP neural network are obtained by using the segment interpolation method. In order to overcome the defects of the simple BP neural network program, which lacks the global optimization of the hidden layer neuron structure, slows the convergence speed and is easy to fall into the local minimum value, this paper tries to use the BP neural network algorithm( IGA-BP) based on the immune genetic algorithm (IGA) for optimization to comprehensively evaluate the complexity of the mine geological structure. With the help of the established training samples, the global optimization of the hidden layer structure of the BP network and the training of the BP neural network were successfully realized. Finally, the trained IGA-BP network was used to comprehensively evaluate the complexity of the geological structure of the unknown evaluation unit, and the complex degree zoning map of mine structure is drawn. The results show that the structurally simple area is located in the north, northeast and south of the study area, the structurally complex area is located in the west of the middle of the study area, and the structurally moderate area is distributed on the north and south sides of the tectonic complex area in the middle of the study area. Compared with the GA-BP and BP neural network methods, the evaluation results based on IGA-BP are more consistent with the actual situation of the mine, and the IGA-BP evaluation method does not need to consider the correlation and weight between the evaluation indicators, which provides a useful tool for mine structure evaluation. A new evaluation method, the evaluation results can guide the reasonable mining deployment of the mine.

A series of three-dimensional porous lead dioxide anode materials were prepared by anodizing method using oxygen bubbles as templates. The effects of additives sodium acetate, cetyltrimethyl ammonium bromide(CTAB), sodium dodecyl benzene sulfonate(SDBS) and polyethylene glycol(PEG) on three-dimensional porous PbO2 anode materials were studied. The morphology and phase composition of the electrode surface were characterized by SEM and XRD. The electrocatalytic activity of the electrode material in Na2SO4 solution was determined by anodic polarization curve(LSV), cyclic voltammetry curve(CV) and AC impedance spectrum(EIS).The results show that after the addition of additives, the directional arrangement on the surface of the plating bath can promote the uniform dispersion of Pb2+, when PbO2 is deposited, the surface is coated, the particle aggregation is reduced, and the coating is flatter and denser; at the same time, due to the adsorption of organic additives, the preferred orientation of grains is changed, but the crystal form is not changed, the prepared electrode materials are still β-PbO2 with complete morphology and three-dimensional porous structure. With the addition of organic additives, the pore density of the electrode material is increased, the specific surface area of the electrode material is promoted, the charge transfer resistance in the electrocatalysis process is reduced, and the electrocatalytic activity of the electrode material is improved. Among all organic additives, the porous PbO2 electrodes added with SDBS has the largest j0 (5.514×10-5 A·cm-2) and the smallest Rct (0.3395 Ω·cm2), showing good electrocatalytic performance. According to the CV data, the qi* of the PbO2 electrode with SDBS is 0.652 C·cm-2, which is 4 times higher than that of the porous PbO2 electrode without additive, The addition of organic additives effectively increases the electrochemically active surface area of the electrode material.