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A novel strategy involving warm rolling and tempering-annealing was introduced to optimize the strength-ductility balance of Fe-10.2Mn-2.2Al-0.41C-0.6 V (wt. %) steel. The V- and κ-carbide particles produced during the tempering are critical for tailoring the austenite characteristics during the subsequent annealing. Austenite that nucleates on Mn-rich κ-carbides inherit their high Mn content and fine grain size. Quantitative calculations suggest that the pinning effect exerted by the V-carbide particles strongly resists grain boundary motion and recrystallization grain growth, further refining the final microstructure. Moreover, the dual nano-sized particles induce abnormal variations in the grain size and fraction of austenite, influencing the deformation mechanisms. In the absence of deformation twins, the fresh martensite develops into “separating walls” to refine the microstructure and further enhances the work hardening in addition to the complex dislocation mobile. Finally, the tempered-annealed sample demonstrated a simultaneous increase in the yield and tensile strengths from 1166 to 1452 MPa and 1507–1727 MPa, but a slight decrease in the total elongation from 18.6% to 16.8% compared to annealed sample, achieving a good strength-ductility balance.

Purpose – This paper aims to design an active shock absorber scheme for use in conjunction with a passive shock absorber to suppress the horizontal vibration of elevator cars in a smaller range and shorter time. The developed active shock absorber will also improve the safety and comfort of passengers driving in ultra-high-speed elevators. Design/methodology/approach – A six-degree of freedom dynamic model is established according to the position and condition of the car. Then the active shock absorber and disturbance compensation-based adaptive control scheme are designed and simulated in MATLAB/Simulink. The results are analysed and compared with the traditional shock absorber. Findings – The results show that, compared with traditional spring-based passive damping systems, the designed active shock absorber can reduce vibration displacement by 60%, peak acceleration by 50% and oscillation time by 2/3 and is more robust to different spring stiffness, damping coefficient and load. Originality/value – The developed active shock absorber and its control algorithm can significantly reduce vibration amplitude and converged time. It can also adjust the damping strength according to the actual load of the elevator car, which is more suitable for high-speed elevators.

Abstract This study addresses the challenge of accurately diagnosing sepsis subtypes in elderly patients, particularly distinguishing between Escherichia coli (E. coli) and non-E. coli infections. Utilizing machine learning, we conducted a retrospective analysis of 119 elderly sepsis patients, employing a random forest model to evaluate clinical biomarkers and infection sites. The model demonstrated high diagnostic accuracy, with an overall accuracy of 87.5%, and impressive precision and recall rates of 93.3% and 87.5%, respectively. It identified infection sites, platelet distribution width, reduced platelet count, and procalcitonin levels as key predictors. The model achieved an F1 Score of 90.3% and an area under the receiver operating characteristic curve of 88.0%, effectively differentiating between sepsis subtypes. Similarly, logistic regression and least absolute shrinkage and selection operator analysis underscored the significance of infectious sites. This methodology shows promise for enhancing elderly sepsis diagnosis and contributing to the advancement of precision medicine in the field of infectious diseases.

Abstract In this work, we present fabricated magnetic tunnel junctions (MTJs) that can serve as magnetic memories (MMs) or vortex spin-torque nano-oscillators (STNOs) depending on the device geometry. We explore the heating effect on the devices to study how the performance of a neuromorphic computing system (NCS) consisting of MMs and STNOs can be enhanced by temperature. We further applied a neural network for waveform classification applications. The resistance of MMs represents the synaptic weights of the NCS, while temperature acts as an extra degree of freedom in changing the weights and TMR, as their anti-parallel resistance is temperature sensitive, and parallel resistance is temperature independent. Given the advantage of using heat for such a network, we envision using a vertical-cavity surface-emitting laser (VCSEL) to selectively heat MMs and/or STNO when needed. We found that when heating MMs only, STNO only, or both MMs and STNO, from 25 to 75 °C, the output power of the STNO increases by 24.7%, 72%, and 92.3%, respectively. Our study shows that temperature can be used to improve the output power of neural networks, and we intend to pave the way for future implementation of a low-area and high-speed VCSEL-assisted spintronic NCS.

Abstract Electrocatalytic water splitting is a promising route for sustainable hydrogen production. However, the high overpotential of the anodic oxygen evolution reaction poses significant challenge. SrIrO3-based perovskite-type catalysts have shown great potential for acidic oxygen evolution reaction, but the origins of their high activity are still unclear. Herein, we develop a Co-doped SrIrO3 system to enhance oxygen evolution reaction activity and elucidate the origin of catalytic activity. In situ experiments reveal Co activates surface lattice oxygen, rapidly exposing IrOx active sites, while bulk Co doping optimizes the adsorbate binding energy of IrOx. The Co-doped SrIrO3 demonstrates high oxygen evolution reaction electrocatalytic activity, markedly surpassing the commercial IrO2 catalysts in both conventional electrolyzer and proton exchange membrane water electrolyzer.

Objective To establish a health promotion team consisting of nurses, and to carry out health promotion programs to improve the health care knowledge of patients in the outpatient clinic. Methods Health promotion programs including health education lectures, nursing health counseling, handbook of health-related knowledge and self-made videos were carried out, and the quality of the activities was continuously improved according to the evaluation outcomes. Results Participants’ awareness of disease prevention and control had been enhanced after implementation of health promotion programs(P＜0. 05). Conclusion By taking advantage of workplace competence of nurses, nursing health promotion programs are effective to improve the disease prevention and control knowledge and self-protection ability of the population who had visited the outpatient clinic. (目的 通过组建护理健康科普队伍, 传播护理科学健康知识, 提高就诊患者的健康保健知识水平。方法 利用早、午间候诊时间段开展护理健康科普讲座、护理健康咨询、传递健康知识手册及自媒体视频等方式进行健康科普工作, 根据评价结果不断改进活动质量。结果 干预后, 参加护理健康科普讲座的受众者对相应讲座的健康知识掌握度优于干预前, 差异有统计学意义(P＜0. 05)。结论 通过开展护理健康科普, 发挥护士在健康科普工作中的专业优势, 有助于提高受众者的疾病防治知识水平和自我防护能力。)

Abstract Understanding how plants alter their development and architecture in response to ambient temperature is crucial for breeding resilient crops. Here, we identify the quantitative trait locus qMULTIPLE INFLORESCENCE BRANCH 2 (qMIB2), which modulates inflorescence branching in response to high ambient temperature in tomato (Solanum lycopersicum). The non-functional mib2 allele may have been selected in large-fruited varieties to ensure larger and more uniform fruits under varying temperatures. MIB2 gene encodes a homolog of the Arabidopsis thaliana transcription factor SPATULA; its expression is induced in meristems at high temperature. MIB2 directly binds to the promoter of its downstream gene CONSTANS-Like1 (SlCOL1) by recognizing the conserved G-box motif to activate SlCOL1 expression in reproductive meristems. Overexpressing SlCOL1 rescue the reduced inflorescence branching of mib2, suggesting how the MIB2–SlCOL1 module helps tomato inflorescences adapt to high temperature. Our findings reveal the molecular mechanism underlying inflorescence thermomorphogenesis and provide a target for breeding climate-resilient crops.

Abstract Introduction Ischemia‐reperfusion (I/R) injury, resulting from blood flow interruption and its subsequent restoration, is a prevalent complication in liver surgery. The liver, as a crucial organ for carbohydrate and lipid metabolism, exhibits decreased tolerance to hepatic I/R in patients with diabetes mellitus (DM), resulting in a significant increase in hepatic dysfunction following surgery. This may be attributed to elevated oxidative stress and inflammation. Our prior research established sinomenine's (SIN) protective role against hepatic I/R injury. Nevertheless, the impact of SIN on hepatic I/R injury in DM rats remains unexplored. Objective and Methods This study aimed to investigate the therapeutic potential of SIN in hepatic I/R injury in DM rats and elucidate its mechanism. Diabetic and hepatic I/R injury models were established in rats through high‐fat/sugar diet, streptozotocin injection, and hepatic blood flow occlusion. Liver function, oxidative stress, inflammatory reaction, histopathology, and Nrf‐2/HO‐1 signaling pathway were evaluated by using UV spectrophotometry, biochemical assays, enzyme‐linked immunosorbent assay, hematoxylin‐eosin staining, and Western blot analysis. Results High‐dose SIN (300 mg/kg) significantly attenuated hepatic I/R injury in DM rats, reducing serum activities of ALT and AST, decreasing the AST/ALT ratio, enhancing tissue contents of SOD and GSH‐Px, suppressing the levels of TNF‐α and IL‐6, improving the liver histopathology, and activating Nrf‐2/HO‐1 signaling by promoting Nrf‐2 trans‐location from cytoplasm to nucleus. Low‐dose SIN (100 mg/kg) was ineffective. Conclusions This study demonstrates that high‐dose sinomenine's mitigates hepatic I/R‐induced inflammation and oxidative stress in diabetes mellitus (DM) rats via Nrf‐2/HO‐1 activation, suggesting its potential as a preventive strategy for hepatic I/R injury in DM patients.

This study aimed to elucidate the impact of ultrasound-assisted cellulase (UC) pretreatment on nutrients, phytic acid, and the bioavailability of phenolics during brown rice sprouting. It sought to unveil the underlying mechanisms by quantifying the activity of key enzymes implicated in these processes. The sprouted brown rice (SBR) surface structure was harmed by the UC pretreatment, which also increased the amount of γ-oryzanol and antioxidant activity in the SBR. Concurrently, the UC pretreatment boosted the activity of phytase, glutamate decarboxylase, succinate semialdehyde dehydrogenase, Gamma-aminobutyric acid (GABA) transaminase, chalcone isomerase, and phenylalanine ammonia lyase, thereby decreasing the phytic acid content and increasing the GABA, flavonoid, and phenolic content in SBR. In addition, UC-pretreated SBR showed increased phenolic release and bioaccessibility during in vitro digestion when compared to the treated group. These findings might offer theoretical direction for using SBR to maximize value.

BackgroundIt remains unclear whether intensification of the chemotherapy backbone in tandem with an anti-EGFR can confer superior clinical outcomes in a cohort of RAS/BRAF wild-type colorectal cancer (CRC) patients with initially unresectable colorectal liver metastases (CRLM). To that end, we sought to comparatively evaluate the efficacy and safety of cetuximab plus FOLFOXIRI (triplet arm) versus cetuximab plus FOLFOX (doublet arm) as a conversion regimen (i.e., unresectable to resectable) in CRC patients with unresectable CRLM.Methods and findingsThis open-label, randomized clinical trial was conducted from April 2018 to December 2022 in 7 medical centers across China, enrolling 146 RAS/BRAF wild-type CRC patients with initially unresectable CRLM. A stratified blocked randomization method was utilized to assign patients (1:1) to either the cetuximab plus FOLFOXIRI (n = 72) or cetuximab plus FOLFOX (n = 74) treatment arms. Stratification factors were tumor location (left versus right) and resectability (technically unresectable versus ≥5 metastases). The primary outcome was the objective response rate (ORR). Secondary outcomes included the median depth of tumor response (DpR), early tumor shrinkage (ETS), R0 resection rate, progression-free survival (PFS), overall survival (not mature at the time of analysis), and safety profile. Radiological tumor evaluations were conducted by radiologists blinded to the group allocation. Primary efficacy analyses were conducted based on the intention-to-treat population, while safety analyses were performed on patients who received at least 1 line of chemotherapy. A total of 14 patients (9.6%) were lost to follow-up (9 in the doublet arm and 5 in the triplet arm). The ORR was comparable following adjustment for stratification factors, with 84.7% versus 79.7% in the triplet and doublet arms, respectively (odds ratio [OR] 0.70; 95% confidence intervals [CI] [0.30, 1.67], Chi-square p = 0.42). Moreover, the ETS rate showed no significant difference between the triplet and doublet arms (80.6% (58/72) versus 77.0% (57/74), OR 0.82, 95% CI [0.37, 1.83], Chi-square p = 0.63). Although median DpR was higher in the triplet therapy group (59.6%, interquartile range [IQR], [50.0, 69.7] versus 55.0%, IQR [42.8, 63.8], Mann-Whitney p = 0.039), the R0/R1 resection rate with or without radiofrequency ablation/stereotactic body radiation therapy was comparable with 54.2% (39/72) of patients in the triplet arm versus 52.7% (39/74) in the doublet arm. At a median follow-up of 26.2 months (IQR [12.8, 40.5]), the median PFS was 11.8 months in the triplet arm versus 13.4 months in the doublet arm (hazard ratio [HR] 0.74, 95% CI [0.50, 1.11], Log-rank p = 0.14). Grade ≥ 3 events were reported in 47.2% (35/74) of patients in the doublet arm and 55.9% (38/68) of patients in the triplet arm. The triplet arm was associated with a higher incidence of grade ≥ 3 neutropenia (44.1% versus 27.0%, p = 0.03) and diarrhea (5.9% versus 0%, p = 0.03). The primary limitations of the study encompass the inherent bias in subjective surgical decisions regarding resection feasibility, as well as the lack of a centralized assessment for ORR and resection.ConclusionsThe combination of cetuximab with FOLFOXIRI did not significantly improve ORR compared to cetuximab plus FOLFOX. Despite achieving an enhanced DpR, this improvement did not translate into improved R0 resection rates or PFS. Moreover, the triplet arm was associated with an increase in treatment-related toxicity.Trial registrationClinicalTrials.gov Identifier: NCT03493048.

BackgroundAirway allergic disease (AAD) is a class of autoimmune diseases with predominantly Th2-type inflammation, mainly including allergic rhinitis (AR), allergic asthma (AS), and chronic sinusitis (CRS). There are very complex regulatory mechanisms between immune cells and AAD; however, previous reports found that the functions of the same immune cells in AAD are not identical.ObjectiveThe aim of this study was to explore the causal relationship between different phenotypic immune cells and their association with AAD.MethodUtilizing the publicly available Genome-Wide Association Studies (GWAS) database, this study conducted a bidirectional Mendelian randomization (MR) to assess the causal relationship between immune cells of 731 different immunophenotypes and AAD. The primary assessment methods included inverse variance weighting, weighted median, and MR Egger. Additionally, sensitivity analyses such as MR-PRESSO, leave-one-out, and scatter plots were employed to eliminate the interference of heterogeneity and pleiotropy, ensuring the stability of the causal inference.ResultA total of 38 immune cells with different immunophenotypes were found to be positively and causally associated with AR, of which 26 were protective factors and 12 were risk factors. Positive associations were found between 33 immune cells and AS, of which 14 were protective factors and 19 were risk factors, as well as between 39 immune cells and CRS, of which 22 were protective factors and 17 were risk factors. Finally, the results of all relevant immune cells for the three diseases were taken and intersected, and it was found that CD3 on CD39+-activated Treg (IVWAR = 0.001, IVWCRS = 0.043, IVWAS = 0.027) may be the key immune cell that inhibits the development of AAD (ORAR = 0.940, ORAS = 0.967, ORCRS = 0.976).ConclusionThis study reveals that different immune phenotypes of immune cells are closely related to AAD at the genetic level, which provides a theoretical basis for future clinical studies.

Objective To investigate the effect of palliative care in pain management of terminally ill patients. Methods A total of 50 terminally ill patients with pain were divided into the control group and observation group according to the admission sequence, with 25 cases in each group. Patients in the control group received routine nursing and pain management, and those in the observation group were given palliative care interventions in addition. The degree of pain was evaluated using a Visual Analogue Scale(VAS). Results The VAS score was decreased in both two groups after intervention, and VAS score in the observation group was lower than that in the control group (P＜0. 01). Conclusion Palliative care is effective to reduce the pain of terminally ill patients, and it helps to improve the quality of life in terminal stage. (目的 探讨安宁疗护在临终患者疼痛管理中的应用。方法 选取医院老年科2021年1月—2022年12月收治的50例临终患者为研究对象, 均伴有不同程度的疼痛。根据入院时间将患者分为观察组和对照组, 各25例。对照组采用常规护理和疼痛管理, 观察组在对照组基础上增加安宁疗护, 对比两组患者疼痛视觉模拟量表(VAS)评分。结果 干预后两组VAS量表评分降低, 且观察组VAS量表评分低于对照组, 差异有统计学意义(P＜0. 01)。结论 安宁疗护能有效缓解临终患者疼痛, 有助于改善生存质量。)