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The use of Electronic Health Records (EHR) in pregnancy care and obstetrics-gynecology (OB/GYN) research has increased in recent years. In pregnancy, timing is important because clinical characteristics, risks, and patient management are different in each stage of pregnancy. However, the difficulty of accurately differentiating pregnancy episodes and temporal information of clinical events presents unique challenges for EHR phenotyping. In this work, we introduced the concept of time relativity and proposed a comprehensive framework of computational phenotyping for prenatal and postpartum episodes based on the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). We implemented it on the All of Us national EHR database and identified 6,280 pregnancies with accurate start and end dates among 5,399 female patients. With the ability to identify different episodes in pregnancy care, this framework provides new opportunities for phenotyping complex clinical events and gestational morbidities for pregnant women, thus improving maternal and infant health., (©2023 AMIA - All rights reserved.)

The increasing global demand for skin disease diagnostics emphasizes the urgent need for advancements in AI-assisted diagnostic technologies for dermatoscopic images. In current practical medical systems, the primary challenge is balancing lightweight models with accurate image analysis to address constraints like limited storage and computational costs. While knowledge distillation methods hold immense potential in healthcare applications, related research on multi-class skin disease tasks is scarce. To bridge this gap, our study introduces an enhanced multi-source knowledge fusion distillation framework, termed DSP-KD, which improves knowledge transfer in a dual-stage progressive distillation approach to maximize mutual information between teacher and student representations. The experimental results highlight the superior performance of our distilled ShuffleNetV2 on both the ISIC2019 dataset and our private skin disorders dataset. Compared to other state-of-the-art distillation methods using diverse knowledge sources, the DSP-KD demonstrates remarkable effectiveness with a smaller computational burden.

Nitrate contamination in aquatic systems is a widespread problem across the world. The isotopic composition (δ 15 N, δ 18 O) of nitrate and their isotope effect ( 15 ε, 18 ε) can facilitate the identification of the source and transformation of nitrate. Although previous researches claimed the isotope fractionations may change the original δ 15 N/δ 18 O values and further bias identification of nitrate sources, isotope effect was often ignored due to its complexity. To fill the gap between the understanding and application, it is crucial to develop a deep understanding of isotopic fractionation based on available evidence. In this regard, this study summarized the available methods to determine isotope effects, thereby systematically comparing the magnitude of isotope effects ( 15 ε and 18 ε) in nitrification, denitrification and anammox. We found that the enzymatic reaction plays the key role in isotope fractionations, which is significantly affected by the difference in the affinity, substrate channel properties and redox potential of active site. Due to the overlapping of microbial processes and accumulation of uncertainties, the significant isotope effects at small scales inevitably decrease in large-scale ecosystems. However, the proportionality of N and O isotope fractionation (δ 18 O/δ 15 N; 18 ε/ 15 ε) associated with nitrate reduction generally follows enzyme-specific proportionalities (i.e., Nar, 0.95; Nap, 0.57; eukNR, 0.98) in aquatic ecosystems, providing enzyme-specific constant factors for the identification of nitrate transformation. With these results, this study finally discussed feasible source portioning methods when considering the isotope effect and aimed to improve the accuracy in nitrate source identification., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Advanced oxidation processes (AOPs) are increasingly applied in water and wastewater treatment, but their energy consumption and chemical use may hinder their further implementation in a changing world. This study investigated the feasibility and mechanisms involved in a chemical-free nanobubble-based AOP for treating organic micropollutants in both synthetic and real water matrices. The removal efficiency of the model micropollutant Rhodamine B (RhB) by oxygen nanobubble AOP (98%) was significantly higher than for air (73%) and nitrogen nanobubbles (69%). The treatment performance was not significantly affected by pH (3-10) and the presence of ions (Ca 2+ , Mg 2+ , HCO 3 - , and Cl - ). Although a higher initial concentration of RhB (10 mg/L) led to a slower treatment process when compared to lower initial concentrations (0.1 and 1 mg/L), the final removal performance reached a similar level (∼98%) between 100 and 500 min. The coexistence of organic matter (humic acid, HA) resulted in a much lower reduction (70%) in the RhB removal rate. Both qualitative and quantitative analysis of reactive oxygen species (ROSs) using fluorescent probe, electron spin resonance, and quenching experiments demonstrated that the contributions of ROSs in RhB degradation followed the order: hydroxyl radical (•OH) > superoxide radical (•O 2 - ) > singlet oxygen ( 1 O 2 ). The cascade degradation reactions for RhB were identified which involve N-de-ethylation, hydroxylation, chromophore cleavage, opening-ring and final mineralisation processes. Moreover, the treatment of real water samples spiked with RhB, including natural lake water and secondary effluent from a sewage works, still showed considerable removals of the dye (75.3%-90.8%), supporting its practical feasibility. Overall, the results benefit future research and application of chemical free nanobubble-based AOP for water and wastewater treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Having sufficient population coverage from the electronic health records (EHRs)-connected health system is essential for building a comprehensive EHR-based diabetes surveillance system. This study aimed to establish an EHR-based type 1 diabetes (T1D) surveillance system for children and adolescents across racial and ethnic groups by identifying the minimum population coverage from EHR-connected health systems to accurately estimate T1D prevalence., Materials and Methods: We conducted a retrospective, cross-sectional analysis involving children and adolescents <20 years old identified from the OneFlorida+ Clinical Research Network (2018-2020). T1D cases were identified using a previously validated computable phenotyping algorithm. The T1D prevalence for each ZIP Code Tabulation Area (ZCTA, 5 digits), defined as the number of T1D cases divided by the total number of residents in the corresponding ZCTA, was calculated. Population coverage for each ZCTA was measured using observed health system penetration rates (HSPR), which was calculated as the ratio of residents in the corresponding ZTCA and captured by OneFlorida+ to the overall population in the same ZCTA reported by the Census. We used a recursive partitioning algorithm to identify the minimum required observed HSPR to estimate T1D prevalence and compare our estimate with the reported T1D prevalence from the SEARCH study., Results: Observed HSPRs of 55%, 55%, and 60% were identified as the minimum thresholds for the non-Hispanic White, non-Hispanic Black, and Hispanic populations. The estimated T1D prevalence for non-Hispanic White and non-Hispanic Black were 2.87 and 2.29 per 1000 youth, which are comparable to the reference study's estimation. The estimated prevalence of T1D for Hispanics (2.76 per 1000 youth) was higher than the reference study's estimation (1.48-1.64 per 1000 youth). The standardized T1D prevalence in the overall Florida population was 2.81 per 1000 youth in 2019., Conclusion: Our study provides a method to estimate T1D prevalence in children and adolescents using EHRs and reports the estimated HSPRs and prevalence of T1D for different race and ethnicity groups to facilitate EHR-based diabetes surveillance., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Using statistical methods to analyze and summarize the research data of the inclusion criteria, to provide a quantitative average effect size to interpret the influence of mindfulness yoga exercise on patients with different depressive symptoms, explain the therapeutic effect of mindfulness yoga therapy on depression and its possible mechanism of action, and provide new ideas for the clinical treatment of patients with depression., Method: Review Manage 5.4 software was used to comprehensively evaluate the effect of yoga exercise on depression interventions to provide a reference for improving mental health. CNKI, PubMed, Web of science, EBSCO were searched for all case-control research articles on yoga for depression from 2000 to 2022. After screening, data extraction and quality evaluation of randomized controlled trials (RCTs) by inclusion and exclusion criteria, a total of 22 studies with 2,216 patients were included, including 1,101 in the yoga intervention group and 1,115 in the control group., Results: The results showed a large heterogeneity in the literature on the effect of yoga exercise on depression, with a combined total effect size [ SMD  = -1.53, 95% CI (-1.96, -1.10), p  < 0.00001]., Conclusion: Mindfulness yoga exercise is effective in preventing and treating depression and improving mental health, and may be considered as a non-medical, low-cost intervention as an adjunct to pharmacological treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yang, Cao, Lyu and Gao.)

The perennial woody plant Hydrangea arborescens 'Annabelle' is of great research value due to its unique mechanism of flower development that occurs in the current year, resulting in decorative flowers that can be enjoyed for a relatively long period of time. However, the mechanisms underlying the regulation of current-year flower development in H. arborescens 'Annabelle' are still not fully understood. In this study, we conducted an associated analysis to explore the core regulating network in H . arborescens 'Annabelle' by combining phenological observations, physiological assays, and transcriptome comparisons across seven flower developmental stages. Through this analysis, we constructed a gene co-expression network (GCN) based on the highest reciprocal rank (HRR), using 509 differentially expressed genes (DEGs) identified from seven flowering-related pathways, as well as the biosynthesis of eight flowering-related phytohormones and signal transduction in the transcriptomic analysis. According to the analysis of the GCN, we identified 14 key genes with the highest functional connectivity that played critical roles in specific development stages. We confirmed that 135 transcription factors (AP2/ERF, bHLH, CO-like, GRAS, MIKC, SBP, WRKY) were highly co-expressed with the 14 key genes, indicating their close associations with the development of current-year flowers. We further proposed a hypothetical model of a gene regulatory network for the development of the whole flower. This model suggested that the photoperiod, aging, and gibberellin pathways, along with the phytohormones abscisic acid (ABA), gibberellin (GA), brassinosteroid (BR), and jasmonic acid (JA), work synergistically to promote the floral transition. Additionally, auxin, GA, JA, ABA, and salicylic acid (SA) regulated the blooming process by involving the circadian clock. Cytokinin (CTK), ethylene (ETH), and SA were key regulators that affected flower senescence. Additionally, several floral integrators ( HaLFY , HaSOC1-2 , HaAP1 , HaFULL , HaAGL24 , HaFLC , etc.) were dominant contributors to the development of H . arborescens flowers. Overall, this research provides a comprehensive understanding of the dynamic mechanism underlying the entire process of current-year flower development, thereby offering valuable insights for further studies on the flower development of H. arborescens 'Annabelle'.

The growing concerns surrounding water pollution and the degradation of ecosystems worldwide have led to an increased use of nature-based solutions (NbSs). This study assessed the feasibility of using floating treatment wetlands (FTWs) as an NbS to treat propylene glycol-contaminated water and quantitatively investigated different removal pathways. With an environmentally relevant concentration of propylene glycol (1,250 mg/L), FTWs containing Acorus calamus and mixed species demonstrated the highest average glycol mass removal efficacy (99%), followed by Carex acutiformis (98%), Juncus effusus (93%), and the control group without plants (10%) after 1 week. Additional mesocosm-scale experiments with varying FTW configurations, including surface coverage to reduce evaporation and photodegradation processes, and the addition of antibiotics to inhibit microbial activity, were conducted to quantify glycol removal pathways. Mass balance analysis results revealed that microbial biodegradation (33.3-39.7%) and plant uptake (37.9-45.2%) were the primary pathways for glycol removal. Only 15.5-19.5% of the glycol removal via evaporation and photodegradation was accounted in this study, which may be attributed to the mesocosm experimental setup (static water and no wind). Aligned with the broader discussion regarding biodiversity improvements and carbon storage capacity, this study demonstrated that FTWs are an environmentally friendly and effective NbS for addressing glycol-contaminated water.

Recurrent events are often important endpoints in randomized clinical trials. For example, the number of recurrent disease-related hospitalizations may be considered as a clinically meaningful endpoint in cardiovascular studies. In some settings, the recurrent event process may be terminated by an event such as death, which makes it more challenging to define and estimate a causal treatment effect on recurrent event endpoints. In this paper, we focus on the principal stratum estimand, where the treatment effect of interest on recurrent events is defined among subjects who would be alive regardless of the assigned treatment. For the estimation of the principal stratum effect in randomized clinical trials, we propose a Bayesian approach based on a joint model of the recurrent event and death processes with a frailty term accounting for within-subject correlation. We also present Bayesian posterior predictive check procedures for assessing the model fit. The proposed approaches are demonstrated in the randomized Phase III chronic heart failure trial PARAGON-HF (NCT01920711)., (© 2023 The International Biometric Society.)

With the development of microfluidic technology, tumor-on-chip models have gradually become a new tool for the study of breast cancer because they can simulate more key factors of the tumor microenvironment compared with traditional models in vitro . Here, we review up-to-date advancements in breast tumor-on-chip models. We summarize and analyze the breast tumor microenvironment (TME), preclinical breast cancer models for TME simulation, fabrication methods of tumor-on-chip models, tumor-on-chip models for TME reconstruction, and applications of breast tumor-on-chip models and provide a perspective on breast tumor-on-chip models. This review will contribute to the construction and design of microenvironments for breast tumor-on-chip models, even the development of the pharmaceutical field, personalized/precision therapy, and clinical medicine.

PM 2.5 is the main component of haze, and PM 2.5 -bound heavy metals (PBHMs) can induce various toxic effects via inhalation. However, comprehensive macroanalyses on large scales are still lacking. In this study, we compiled a substantial dataset consisting of the concentrations of eight PBHMs, including As, Cd, Cr, Cu, Mn, Ni, Pb and Zn, across different cities in China. To improve prediction accuracy, we enhanced the traditional land-use regression (LUR) model by incorporating emission source-related variables and employing the best-fitted machine-learning algorithm, which was applied to predict PBHM concentrations, analyze geographical patterns and assess the health risks associated with metals under different PM 2.5 control targets. Our model exhibited excellent performance in predicting the concentrations of PBHMs, with predicted values closely matching measured values. Noncarcinogenic risks exist in 99.4% of the estimated regions, and the carcinogenic risks in all studied regions of the country are within an acceptable range (1 × 10 -5 -1 × 10 -6 ). In densely populated areas such as Henan, Shandong, and Sichuan, it is imperative to control the concentration of PBHMs to reduce the number of patients with cancer. Controlling PM 2.5 effectively decreases both carcinogenic and noncarcinogenic health risks associated with PBHMs, but still exceed acceptable risk level, suggesting that other important emission sources should be given attention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The efficacy of the BNT162b2 vaccine in pediatrics was assessed by randomized trials before the Omicron variant's emergence. The long-term durability of vaccine protection in this population during the Omicron period remains limited., Objective: To assess the effectiveness of BNT162b2 in preventing infection and severe diseases with various strains of the SARS-CoV-2 virus in previously uninfected children and adolescents., Design: Comparative effectiveness research accounting for underreported vaccination in three study cohorts: adolescents (12 to 20 years) during the Delta phase, children (5 to 11 years) and adolescents (12 to 20 years) during the Omicron phase., Setting: A national collaboration of pediatric health systems (PEDSnet)., Participants: 77,392 adolescents (45,007 vaccinated) in the Delta phase, 111,539 children (50,398 vaccinated) and 56,080 adolescents (21,180 vaccinated) in the Omicron period., Exposures: First dose of the BNT162b2 vaccine vs. no receipt of COVID-19 vaccine., Measurements: Outcomes of interest include documented infection, COVID-19 illness severity, admission to an intensive care unit (ICU), and cardiac complications. The effectiveness was reported as (1-relative risk)*100% with confounders balanced via propensity score stratification., Results: During the Delta period, the estimated effectiveness of BNT162b2 vaccine was 98.4% (95% CI, 98.1 to 98.7) against documented infection among adolescents, with no significant waning after receipt of the first dose. An analysis of cardiac complications did not find an increased risk after vaccination. During the Omicron period, the effectiveness against documented infection among children was estimated to be 74.3% (95% CI, 72.2 to 76.2). Higher levels of effectiveness were observed against moderate or severe COVID-19 (75.5%, 95% CI, 69.0 to 81.0) and ICU admission with COVID-19 (84.9%, 95% CI, 64.8 to 93.5). Among adolescents, the effectiveness against documented Omicron infection was 85.5% (95% CI, 83.8 to 87.1), with 84.8% (95% CI, 77.3 to 89.9) against moderate or severe COVID-19, and 91.5% (95% CI, 69.5 to 97.6)) against ICU admission with COVID-19. The effectiveness of the BNT162b2 vaccine against the Omicron variant declined after 4 months following the first dose and then stabilized. The analysis revealed a lower risk of cardiac complications in the vaccinated group during the Omicron variant period., Limitations: Observational study design and potentially undocumented infection., Conclusions: Our study suggests that BNT162b2 was effective for various COVID-19-related outcomes in children and adolescents during the Delta and Omicron periods, and there is some evidence of waning effectiveness over time., Primary Funding Source: National Institutes of Health.

Purpose: There is a particular anisometropia occurring in one eye with myopia, while the other eye has very low myopia, emmetropia, or very low hyperopia. It is unclear how the binocular axial length changes when these children wear unilateral OK lenses only in the more myopic eyes. This study investigates the changes in the axial elongation of both eyes., Methods: This is a 1-year retrospective study. In total, 148 children with myopic anisometropia were included. The more myopic eyes were wearing orthokeratology lenses (treated eyes), whereas the contralateral eyes were not indicated for visual correction (untreated eyes). The untreated eyes were classified into three subgroups based on the spherical equivalent refraction (SER): low myopia (≤ -0.50 D, n = 37), emmetropia (+0.49 to -0.49 D, n = 76), and low hyperopia (≥0.50 D, n = 35). Changes in the axial length (AL) were compared between the untreated and treated eyes and among the three subgroups., Results: The axial elongation was 0.14 ± 0.18 mm and 0.39 ± 0.27 mm in all treated and untreated eyes, respectively ( p < 0.001). The interocular AL difference decreased significantly from 1.09 ± 0.45 mm at the baseline to 0.84 ± 0.52 mm at 1 year ( p < 0.001). The baseline median (Q1, Q3) SER of the untreated eyes were -0.75 D (-0.56, -0.88 D), 0.00 D (0.00, -0.25 D), and +0.75 D (+1.00, +0.62 D) in low myopia, emmetropia, and low hyperopia subgroups, respectively. The axial elongation was 0.14 ± 0.18 mm, 0.15 ± 0.17 mm, and 0.13 ± 0.21 mm ( p = 0.92) in the treated eyes and 0.44 ± 0.25 mm, 0.35 ± 0.24 mm, and 0.41 ± 0.33 mm in the untreated eyes ( p = 0.11) after 1 year. Multivariate linear regression analyses only showed significant differences in axial elongation between the emmetropia and low myopia subgroups of untreated eyes ( p = 0.04; p > 0.05 between other subgroups)., Conclusion: Unilateral orthokeratology lenses effectively reduced axial elongation in the more myopic eyes and reduced interocular AL differences in children with myopic anisometropia. The refractive state of the untreated eyes did not affect the axial elongation of the more myopic eye wearing the orthokeratology lens. In the untreated eyes, AL increased faster in the low myopia subgroup than in the emmetropia subgroup., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Qin, Qing, Ji, Lyu, Ma, Shi, Yu, Ma and Fu.)

Particles larger than 10 nm from engine exhaust are gaining global concerns. In light of this, to investigate how EGR affects gasoline vehicle SPN10 (solid particles larger than 10 nm) emissions, seven gasoline vehicles (hybrid or conventional) were studied experimentally. The results revealed that EGR vehicles risk failing the current limit (6 * 10 11 #/km) more than those without EGR if the cut-off size was tightened from 23 nm to 10 nm. More specifically, during the WLTC test, EGR increased the SPN10 emission factors by 2 ∼ 3 times depending on vehicle powertrains (conventional or hybrid). Notably, SPN10 emissions increased significantly when EGR was actively engaged but showed a decrease when the EGR rate remained constant. EGR and the enriched fuel-air mixture are the critical reasons for the increased SPN10., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pyrolysis of biomass feedstocks can produce valuable biofuel, however, the final products may present excessive corrosion and poor stability due to the lack of hydrogen content. Co-pyrolysis with hydrogen-rich substances such as waste plastics may compensate for these shortcomings. In this study, the co-pyrolysis of a common biomass, i.e. distiller's grains (DG), and waste polypropylene plastic (PP) were investigated towards increasing the quantity and quality of the production of biofuel. Results from the thermogravimetric analyses showed that the reaction interval of individual pyrolysis of DG and PP was 124-471 °C and 260-461 °C, respectively. Conversely, an interaction effect between DG and PP was observed during co-pyrolysis, resulting in a slower rate of weight loss, a longer temperature range for the pyrolysis reaction, and an increase in the temperature difference between the evolution of products. Likewise, the Coats-Redfern model showed that the activation energies of DG, PP and an equal mixture of both were 42.90, 130.27 and 47.74 kJ mol -1 , respectively. It thus follows that co-pyrolysis of DG and PP can effectively reduce the activation energy of the reaction system and promote the degree of pyrolysis. Synergistic effects essentially promoted the free radical reaction of the PP during co-pyrolysis, thereby reducing the activation energy of the process. Moreover, due to this synergistic effect in the co-pyrolysis of DG and PP, the ratio of elements was effectively optimized, especially the content of oxygen-containing species was reduced, and the hydrocarbon content of products was increased. These results will not only advance our understanding of the characteristics of co-pyrolysis of DG and PP, but will also support further research toward improving an efficient co-pyrolysis reactor system and the pyrolysis process itself., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

It is significant to comprehend the relationship between metabolic pathway and molecular pathway for synthesizing new molecules, for instance optimizing drug metabolization. In bioinformatics fields, multi-label prediction of metabolic pathways is a typical manner to understand this relationship. Graph neural networks (GNNs) have become an effective method to extract molecular structure's features for multi-label prediction of metabolic pathways. Though GNNs can effectively capture structural features from molecular structure graphs, building a well-performed GNN model for a given molecular structure data set requires the manual design of the GNN architecture and fine-tuning of the hyperparameters, which are time-consuming and rely on expert experience. To address the above challenge, we design an end-to-end automatic molecular structure representation learning framework named AutoMSR that can design the optimal GNN model based on a given molecular structure data set without manual intervention. We propose a multi-seed age evolution (MSAE) search algorithm to identify the optimal GNN architecture from the GNN architecture subspace. For a given molecular structure data set, AutoMSR first uses MSAE to search the GNN architecture, and then it adopts a tree-structured parzen estimator to obtain the best hyperparameters in the hyperparameters subspace. Finally, AutoMSR automatically constructs the optimal GNN model based on the best GNN architecture and hyperparameters to extract the molecular structure features for multi-label metabolic pathway prediction. We test the performance of AutoMSR on the real data set KEGG. The experiment results show that AutoMSR outperforms baseline methods on different multi-label classification evaluation metrics.

Floral symmetry plays an important role in plant-pollinator interactions and may have remarkable impacts on angiosperm diversification. However, spatiotemporal patterns in floral symmetry and drivers of these patterns remain unknown. Here, using newly compiled floral symmetry (actinomorphy versus zygomorphy) data of 279,877 angiosperm species and their distributions and phylogenies, we estimated global geographic patterns and macroevolutionary dynamics of floral symmetry. We found that frequency of actinomorphic species increased with latitude, while that of zygomorphic species decreased. Solar radiation, present-day temperature, and Quaternary temperature change correlated with geographic variation in floral symmetry frequency. Evolutionary transitions from actinomorphy to zygomorphy dominated floral symmetry evolution, although the transition rate decreased with decreasing paleotemperature throughout the Cenozoic. Notably, we found that zygomorphy may not favor diversification of angiosperms as previously observed in some clades. Our study demonstrates the influence of (paleo)climate on spatiotemporal patterns in floral symmetry and challenges previous views about role of flower symmetry in angiosperm diversification.

Objective. Since the invention of modern Computed Tomography (CT) systems, metal artifacts have been a persistent problem. Due to increased scattering, amplified noise, and limited-angle projection data collection, it is more difficult to suppress metal artifacts in cone-beam CT, limiting its use in human- and robot-assisted spine surgeries where metallic guidewires and screws are commonly used. Approach. To solve this problem, we present a fine-grained projection-domain segmentation-based metal artifact reduction (MAR) method termed PDS-MAR, in which metal traces are augmented and segmented in the projection domain before being inpainted using triangular interpolation. In addition, a metal reconstruction phase is proposed to restore metal areas in the image domain. Main results. The proposed method is tested on both digital phantom data and real scanned cone-beam computed tomography (CBCT) data. It achieves much-improved quantitative results in both metal segmentation and artifact reduction in our phantom study. The results on real scanned data also show the superiority of this method. Significance. The concept of projection-domain metal segmentation would advance MAR techniques in CBCT and has the potential to push forward the use of intraoperative CBCT in human-handed and robotic-assisted minimal invasive spine surgeries., (© 2023 Institute of Physics and Engineering in Medicine.)

Artificial aeration is a widely used approach in wastewater treatment to enhance the removal of pollutants, however, traditional aeration techniques have been challenging due to the low oxygen transfer rate (OTR). Nanobubble aeration has emerged as a promising technology that utilise nano-scale bubbles to achieve higher OTRs owing to their large surface area and unique properties such as longevity and reactive oxygen species generation. This study, for the first time, investigated the feasibility of coupling nanobubble technology with constructed wetlands (CWs) for treating livestock wastewater. The results demonstrated that nanobubble-aerated CWs achieved significantly higher removal efficiencies of total organic carbon (TOC) and ammonia (NH 4 + -N), at 49 % and 65 %, respectively, compared to traditional aeration treatment (36 % and 48 %) and the control group (27 % and 22 %). The enhanced performance of the nanobubble-aerated CWs can be attributed to the nearly three times higher amount of nanobubbles (Ø < 1 μm) generated from the nanobubble pump (3.68 × 10 8 particles/mL) compared to the normal aeration pump. Moreover, the microbial fuel cells (MFCs) embedded in the nanobubble-aerated CWs harvested 5.5 times higher electricity energy (29 mW/m 2 ) compared to the other groups. The results suggested that nanobubble technology has the potential to trigger the innovation of CWs by enhancing their capacity for water treatment and energy recovery. Further research needs are proposed to optimise the generation of nanobubbles, allowing them to be effectively coupled with different technologies for engineering implementation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

In thermoelectrics, phase engineering serves a crucial function in determining the power factor by affecting the band degeneracy. However, for low-symmetry compounds, the mainstream one-step phase manipulation strategy, depending solely on the valley or orbital degeneracy, is inadequate to attain a high density-of-states effective mass and exceptional zT . Here, we employ a distinctive two-step phase manipulation strategy through stepwise tailoring chemical bonds in GeSe. Initially, we amplify the valley degeneracy via CdTe alloying, which elevates the crystal symmetry from a covalently bonded orthorhombic to a metavalently bonded rhombohedral phase by significantly suppressing the Peierls distortion. Subsequently, we incorporate Pb to trigger the convergence of multivalence bands and further enhance the density-of-states effective mass by moderately restraining the Peierls distortion. Additionally, the atypical metavalent bonding in rhombohedral GeSe enables a high Ge vacancy concentration and a small band effective mass, leading to increased carrier concentration and mobility. This weak chemical bond along with strong lattice anharmonicity also reduces lattice thermal conductivity. Consequently, this unique property ensemble contributes to an outstanding zT of 0.9 at 773 K for Ge 0.80 Pb 0.20 Se(CdTe) 0.25 . This work underscores the pivotal role of the two-step phase manipulation by stepwise tailoring of chemical bonds in improving the thermoelectric performance of p -bonded chalcogenides., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

Opinion Statement: Pyroptosis is a kind of programmed cell death dependent on the caspase pathway that is different from apoptosis and necrosis. Recent studies have shown that pyroptosis can be involved in the pathological processes of many diseases, such as cancers, atherosclerosis, diabetic nephropathy, and blood diseases. However, the specific mechanisms by which pyroptosis participates in the occurrence and development of hematological malignant tumors still need further exploration. This article reviews the characteristics of pyroptosis and the regulatory mechanisms promoting or inhibiting pyroptosis and discusses the role of pyroptosis in hematological malignant tumors, which could provide ideas for the clinical treatment of such tumors in the future., (© 2023. The Author(s).)

Objective To analyze clinical characteristics of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) and to explore the risk factors affecting the occurrence of NPSLE. Methods A total of 63 NPSLE patients and 61 non-NPSLE patients were enrolled. The clinical manifestations and laboratory examination data of the two groups were collected, and the disease characteristics of NPSLE were summarized to analyze the risk factors affecting the occurrence of NPSLE by multivariate Logistic regression. Results The most common clinical manifestations of NPSLE patients were headache (39.7%), affective disorder (33.3%) and cognitive impairment (30.2%), with cranial magnetic resonance abnormalities (63.5%) and a high cerebrospinal fluid protein positive rate (52.4%). Compared with non-NPSLE patients, there were significantly increased levels of Raynaud's phenomenon, renal involvement, anti-RNP antibody, anti-ribosomal P protein, hypocomplementemia, lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in NPSLE patients. Multivariate Logistic regression analysis showed that renal involvement, Raynaud's phenomenon, positive anti-ribosomal P protein antibody, and elevated LMR and NLR were independent risk factors for NPSLE. Conclusion Headache is the most common symptom in patients with NPSLE, and abnormal cranial MRI and cerebrospinal fluid examination are more common. SLE patients who present with renal involvement, Raynaud's phenomenon, positive anti-ribosomal P protein antibodies, and elevated levels of LMR and NLR are more susceptible to developing NPSLE.

Background: Despite previous research findings on higher risks of stillbirth among pregnant individuals with SARS-CoV-2 infection, it is unclear whether the gestational timing of viral infection modulates this risk., Objective: This study aimed to examine the association between timing of SARS-CoV-2 infection during pregnancy and risk of stillbirth., Study Design: This retrospective cohort study used multilevel logistic regression analyses of nationwide electronic health records in the United States. Data were from 75 healthcare systems and institutes across 50 states. A total of 191,403 pregnancies of 190,738 individuals of reproductive age (15-49 years) who had childbirth between March 1, 2020 and May 31, 2021 were identified and included. The main outcome was stillbirth at ≥20 weeks of gestation. Exposures were the timing of SARS-CoV-2 infection: early pregnancy (<20 weeks), midpregnancy (21-27 weeks), the third trimester (28-43 weeks), any time before delivery, and never infected (reference)., Results: We identified 2342 (1.3%) pregnancies with COVID-19 in early pregnancy, 2075 (1.2%) in midpregnancy, and 12,697 (6.9%) in the third trimester. After adjusting for maternal and clinical characteristics, increased odds of stillbirth were observed among pregnant individuals with SARS-CoV-2 infection only in early pregnancy (odds ratio, 1.75, 95% confidence interval, 1.25-2.46) and midpregnancy (odds ratio, 2.09; 95% confidence interval, 1.49-2.93), as opposed to pregnant individuals who were never infected. Older age, Black race, hypertension, acute respiratory distress syndrome or acute respiratory failure, and placental abruption were found to be consistently associated with stillbirth across different trimesters., Conclusion: Increased risk of stillbirth was associated with COVID-19 only when pregnant individuals were infected during early and midpregnancy, and not at any time before the delivery or during the third trimester, suggesting the potential vulnerability of the fetus to SARS-CoV-2 infection in early pregnancy. Our findings underscore the importance of proactive COVID-19 prevention and timely medical intervention for individuals infected with SARS-CoV-2 during early and midpregnancy., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The Mongolian gazelle (Procapra gutturosa) population has shown a considerable range of contractions and local extinctions over the last century, owing to habitat fragmentation and poaching. A thorough understanding of the genetic diversity and structure of Mongolian gazelle populations in fragmented habitats is critical for planning effective conservation strategies., Result: In this study, we used eight microsatellite loci and mitochondrial cytochrome b (Cytb) to compare the levels of genetic diversity and genetic structure of Mongolian gazelle populations in the Hulun Lake National Nature Reserve (HLH) with those in the China-Mongolia border area (BJ). The results showed that the nucleotide diversity and observed heterozygosity of the HLH population were lower than those of the BJ population. Moreover, the HLH and BJ populations showed genetic differentiation. We concluded that the HLH population had lower genetic diversity and a distinct genetic structure compared with the BJ population., Conclusion: The genetic diversity of fragmented Mongolian gazelle populations, can be improved by protecting these populations while reinforcing their gene exchange with other populations. For example, attempts can be made to introduce new individuals with higher genetic diversity from other populations to reduce inbreeding., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Iguratimod (IGU) reduces hypergammaglobulinemia and disease activity in pSS (primary Sjögren's syndrome) patients. However, the therapeutical mechanism of IGU for pSS remains largely unknown. This study aimed to investigate the regulation of Tfh cell differentiation by IGU in pSS patients., Methods: We prospectively enrolled 13 pSS patients treated with IGU for 3 months and examined circulating T cell and B cell subsets by flow cytometry. We measured Tfh cell differentiation treated by IGU in pSS patients and healthy controls. Transcriptome analysis combined with molecular docking were employed to identify potential therapeutical targets of IGU, which were verified by Western blot and Tfh cell differentiation., Results: Tfh, plasmablast, and plasma cells were suppressed by IGU treatment at 1 and 3 months. Tfh cell differentiation and function were significant inhibited by IGU in pSS patients and healthy controls in vitro. Pyruvate dehydrogenase kinase 1 (PDK1) was identified as a target of IGU during Tfh cell differentiation, and the downstream Akt phosphorylation was attenuated by IGU. Moreover, the activity of mTORC1 and phosphorylation of STAT3 were suppressed by IGU, with downregulation of BCL6 and upregulation of PRDM1. Finally, Akt activator restored IGU-suppressed Tfh cell differentiation., Conclusions: IGU suppresses Tfh cell differentiation in pSS patients through interacting with PDK1 and suppressing Akt-mTOR-STAT3 signaling., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: To develop and validate machine learning models for predicting COVID-19 related hospitalization as early as CDC contact tracing using integrated CDC contact tracing and South Carolina medical claims data., Methods: Using the dataset (n=82,073, 1/1/2018 - 3/1/2020), we identified 3,305 patients with COVID-19 and were captured by contact tracing. We developed and validated machine learning models (i.e., support vector machine, random forest, XGboost), followed by multi-level validations and pilot statewide implementation., Results: Using 10-cross validation, random forest outperformed other models (F1=0.872 for general hospitalization and 0.763 for COVID-19 related hospitalization), followed by XGBoost (F1=0.845 and 0.682) and support vector machine (F1=0.845 and 0.644). We identified new self-reported symptoms from contact tracing (e.g., fatigue, congestion, headache, loss of taste) that are highly predictive of hospitalization., Conclusions: Our study demonstrated the feasibility of identifying individuals at risk of hospitalization at the time of contact tracing for early intervention and prevention., Policy Implications: Our findings demonstrate existing promise for leveraging CDC contact tracing for establishing a cost-effective statewide surveillance and generalizability for nationwide adoption for enhancing pandemic preparedness in the US., Competing Interests: Competing Interests: Authors disclose no competing interest. Authors disclose no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Background: Detection of mutations in one or a couple of genes may not provide enough data or cover all the genomic DNA variance related to antibiotic resistance of Helicobacter pylori to clarithromycin (CLA) and levofloxacin (LVX). We aimed to perform whole genome sequencing to explore novel antibiotic resistance-related genes to increase predictive accuracy for future targeted sequencing tests., Methods: Gastric mucosal biopsies were taken during upper endoscopy in 27 H. pylori-infected patients. According to culture-based antibacterial susceptibility test, H. pylori strains were divided into three groups, with nine strains in each group: CLA single-drug resistance (group C), LVX single-drug resistance (group L), and strains sensitive to all antibacterial drugs (group S). Based on whole genome sequencing with group S being the control, group C and group L group-specific single nucleotide variants and amino acid mutations were screened, and potential candidate genes related to CLA and LVX resistance were identified., Results: The median age of study subjects was 35 years (IQR: 31-40), and 17 (63.0%) were male. All nine CLA-resistant strains had A2143G mutations in 23S rRNA, while none of nine sensitive strains had the mutation. Six of nine strains in group L and six of nine strains in group S had 87th or 91st mutation in gyrA. After comparing sequencing data of strains among the three groups, we identified five mutated positions belonging to four genes related to CLA resistance, and 31 mutated positions belonging to 20 genes related to LVX resistance. Novel genetic mutations were detected for CLA resistance (including fliJ and clpX) and LVX resistance (including fliJ, cheA, hemE, Val360Ile, and HP0568). Missense mutations in fliJ and cheA gene were mainly involved in chemotaxis and flagellar motility to facilitate bacterial escape of antibiotics, while the functions of other novel gene mutations underpinning antibiotic resistance remain to be investigated., Conclusion: Whole genome sequencing detected potential novel genetic mutations conferring resistance of H. pylori to CLA and LVX including fliJ and cheA. Further studies to correlate these findings with treatment outcome should be performed., (© 2023 The Authors. Helicobacter published by John Wiley & Sons Ltd.)

Introduction: This study aims to explore machine learning (ML) methods for early prediction of Alzheimer's disease (AD) and related dementias (ADRD) using the real-world electronic health records (EHRs)., Methods: A total of 23,835 ADRD and 1,038,643 control patients were identified from the OneFlorida+ Research Consortium. Two ML methods were used to develop the prediction models. Both knowledge-driven and data-driven approaches were explored. Four computable phenotyping algorithms were tested., Results: The gradient boosting tree (GBT) models trained with the data-driven approach achieved the best area under the curve (AUC) scores of 0.939, 0.906, 0.884, and 0.854 for early prediction of ADRD 0, 1, 3, or 5 years before diagnosis, respectively. A number of important clinical and sociodemographic factors were identified., Discussion: We tested various settings and showed the predictive ability of using ML approaches for early prediction of ADRD with EHRs. The models can help identify high-risk individuals for early informed preventive or prognostic clinical decisions., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Literature suggests that federal funding allocation for HIV-related research in the US may not align with HIV disease burden but is influenced by structural disparities. This study sought to examine how federal funding allocation is associated with HIV disease burden and research capacity of states by applying Big Data integration, text mining, and statistics. Using text mining, we identified 20,678 HIV-related federal projects from 2008 to 2018 in NIH ExPORTER, which were then integrated with data from AtlasPlus and US Census Bureau. We developed Gini coefficients to assess the inequality of funding and the Generalized Estimating Equations model to examine the associations between funding allocation and (1) state HIV disease burden, (2) state research capacity, and (3) geographic regions, respectively. The Gini coefficients (0.60 to 0.80) suggest a highly skewed funding distribution. Funding allocation was not associated with state HIV disease burden ( p  = 0.269) but HIV research capacity ( p  = 0.000). The South (with the heaviest HIV disease burden) did not receive significantly more federal funding. Our findings for the first time identified disparities of federal funding allocation, suggesting that federal agencies favor states of high research capacity over heavy disease burden, which may reinforce the HIV-related health disparities.

Objective: Transcatheter-arterial chemoembolization (TACE) is a well-established interventional technique for various tumor treatments, whereas its application in renal angiomyolipoma (RAML) is seldom reported. Conventional TACE (cTACE) with bleomycin-lipiodol emulsion is effective and tolerable for RAML treatment. In this study, we aimed to further explore the efficacy and safety between bleomycin-loaded CalliSpheres ® microsphere TACE (CSM-TACE) and cTACE in treating RAML patients., Methods: We retrospectively analyzed the data of 54 RAML patients treated by CSM-TACE (n = 17) or cTACE (n = 37). Data on tumor size, tumor volume reduction ratio, patient percentage with tumor size reduction, white blood cells (WBCs), creatinine (Cre) after treatment, complications, and adverse events were retrieved., Results: Tumor size (88.66 vs. 81.19 cm 3 , P = 0.970), patient percentage with tumor size reduction (12 [70.59%] vs. 30 [81.08%], P = 0.486) after treatment, WBCs (P = 0.114), Cre (P = 0.659), and change in Cre after treatment (P = 0.947) were not significantly different between groups, whereas tumor volume reduction ratio was slightly lower in the CSM-TACE group than in the cTACE group (12 ± 34% vs. 32 ± 31%, P = 0.047). The most common postoperative complication was a post-embolization syndrome, including fever, nausea, and abdominal pain, which occurred in 9 (52.94%) and 14 (37.84%) patients from the CSM-TACE and cTACE groups, respectively (P = 0.347)., Conclusion: CSM-TACE is effective in and well tolerated by RAML patients, implying its potential as an alternative therapy., Competing Interests: None

Controlling diamond structures with nanometer precision is fundamentally challenging owing to their extreme and far-from-equilibrium synthetic conditions. State-of-the-art techniques, including detonation, chemical vapor deposition, mechanical grinding, and high-pressure-high-temperature synthesis, yield nanodiamond particles with a broad distribution of sizes. Despite many efforts, the direct synthesis of nanodiamonds with precisely controlled diameters remains elusive. Here the geochemistry-inspired synthesis of sub-5 nm nanodiamonds with sub-nanometer size deviation is described. High-pressure-high-temperature treatment of uniform iron carbide nanoparticles embedded in iron oxide matrices yields nanodiamonds with tunable diameters down to 2.13 and 0.22 nm standard deviation. A self-limiting, redox-driven, and diffusion-controlled solid-state reaction mechanism is proposed and supported by in situ X-ray diffraction, ex situ characterizations, and computational modeling. This work provides a unique mechanism for the precise control of nanostructured diamonds under extreme conditions and paves the road for the full realization of their potential in emerging technologies., (© 2023 Wiley-VCH GmbH.)

Wearing a mask greatly reduced the possibility of infection during the COVID-19 pandemic. However, major inconveniences occur regarding patients with upper limb amputations, as they cannot independently wear masks. As a result, bacterial contamination is caused by medical staff touching the quilt when helping. Furthermore, this effect can occur with ordinary people due to accidental touch. This research aims to design an automatic and portable face shield assistive device based on surface electromyography (sEMG) signals. A concise face shield-wearing mechanism was built through 3D printing. A novel decision-making control method regarding a feature extraction model of 16 signal features and a Softmax classification neural network model were developed and tested on an STM32 microcontroller unit (MCU). The optimized electrode was fabricated using a carbon nanotube (CNT)/polydimethylsiloxane (PDMS). The design was further integrated and tested, showing a promising future for further implementation., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Tian Lyu et al.)

Background: Helicobacter pylori infection and associated diseases are a growing global public health issue. H. pylori infection is the major cause of gastric cancer, over 90% of duodenal ulcers, and over 70% of gastric ulcers. The infection rate of H. pylori is approximately 50%, and approximately 50% of new cases of gastric cancer worldwide occur in China. Bismuth (BI)-based quadruple therapy is recommended as the first-line treatment for H. pylori in China. Vonoprazan (VPZ), a new potassium-competitive acid blocker that can inhibit gastric acid secretion more effectively than proton pump inhibitors (PPIs), has been combined with antibiotics to effectively eradicate H. pylori. In this study, we compared the efficacy and safety of two VPZ-based therapies with that of BI-based therapy for H. pylori treatment., Methods: A three-armed randomised controlled trial (RCT) is being conducted in Shenzhen, with 327 participants recruited from the Gastroenterology Clinic of the University of Hong Kong-Shenzhen Hospital. Patients were diagnosed with H. pylori infection based on a positive 13 C-urea breath test (UBT). Patients are kept naïve to their treatment and are randomly assigned in a 1:1:1 ratio to either VPZ-based triple, VPZ-based dual, or BI-based quadruple therapy for 14 days. All groups are subjected to follow-up evaluations of safety, adverse drug reactions, and clinical variables in the first, second, and fourth weeks after treatment. Successful eradication is confirmed by a negative 13 C-UBT six weeks after treatment. If initial treatment fails, (1) those patients are turned to another regimen, or (2) a drug resistance test is conducted, after which an individualised treatment regimen shall be prescribed according to antimicrobial susceptibility testing. The resulting data will be evaluated using intention-treat and a per-protocol analysis., Discussion: This study is the a RCT aims to evaluate the efficacy and safety of 14-day VPZ-based triple and dual therapies in comparison with BI-based quadruple therapy. The outcomes of this study may allow treatment recommendations and update drug instructions in China., Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR2200056375). Registered on February 4, 2022, https://www.chictr.org.cn/showproj.aspx?proj=141314., (© 2023. The Author(s).)

Immunotherapy has offered new opportunities to treat head and neck squamous cell carcinoma (HNSCC); however, its clinical applications are hindered by modest therapeutic outcomes and the "always-on" pharmacological activity of immunomodulatory agents. Strategies for precise spatiotemporal activation of antitumor immunity can tackle these issues but remain challenging. Herein, a semiconducting polymeric nanoagonist (SPNM) with in situ sono-activatable immunotherapeutic effects for precision sono-immunotherapy of HNSCC is reported. SPNM is self-assembled from a sonodynamic semiconducting polymer core conjugated with a stimulator of interferon genes (STING) agonist (MSA-2) via a singlet oxygen cleavable linker. Under sono-irradiation, SPNM produces singlet oxygen not only to eradicate tumor cells to trigger immunogenic cell death but also to unleash caged STING agonists via the cleavage of diphenoxyethene bonds for in situ activation of the STING pathway in the tumor region. Such sono-driven STING activation mediated by SPNM promotes effector T cell infiltration and potentiates systemic antitumor immunity, eventually leading to tumor growth inhibition and long-term immunological memory. This study thus presents a promising strategy for the precise spatiotemporal activation of cancer immunotherapy., (© 2023 Wiley-VCH GmbH.)

Metal implants are one of the culprits for image quality degradation in CT imaging, introducing so-called metal artifacts. With the help of the virtual-monochromatic imaging technique, dual-energy CT has been proven to be effective in metal artifact reduction. However, the virtual monochromatic images with suppressed metal artifacts show reduced CNR compared to polychromatic images. To remove metal artifacts on polychromatic images, we propose a dual-energy NMAR (deNMAR) algorithm in this paper that adds material decomposition to the widely used NMAR framework. The dual energy sinograms are first decomposed into water and bone sinograms, and metal regions are replaced with water on the reconstructed material maps. Prior sinograms are constructed by polyenergetically forward projecting the material maps with corresponding spectra, and they are used to guide metal trace interpolation in the same way as in the NMAR algorithm. We performed experiments on authentic human body phantoms, and the results show that the proposed deNMAR algorithm achieves better performance in tissue restoration compared to other compelling methods. Tissue boundaries become clear around metal implants, and CNR rises to 2.58 from ~1.70 on 80 kV images compared to other dual-energy-based algorithms.

Background: Bicuspid aortic valve (BAV) is the most prevalent congenital valvular heart defect, and around 50% of severe isolated calcific aortic valve disease (CAVD) cases are associated with BAV. Although previous studies have demonstrated the cellular heterogeneity of aortic valves, the cellular composition of specific BAV at the single-cell level remains unclear., Methods: Four BAV specimens from aortic valve stenosis patients were collected to conduct single-cell RNA sequencing (scRNA-seq). In vitro experiments were performed to further validate some phenotypes., Results: The heterogeneity of stromal cells and immune cells were revealed based on comprehensive analysis. We identified twelve subclusters of VICs, four subclusters of ECs, six subclusters of lymphocytes, six subclusters of monocytic cells and one cluster of mast cells. Based on the detailed cell atlas, we constructed a cellular interaction network. Several novel cell types were identified, and we provided evidence for established mechanisms on valvular calcification. Furthermore, when exploring the monocytic lineage, a special population, macrophage derived stromal cells (MDSC), was revealed to be originated from MRC1 + (CD206) macrophages (Macrophage-to-Mesenchymal transition, MMT). FOXC1 and PI3K-AKT pathway were identified as potential regulators of MMT through scRNA analysis and in vitro experiments., Conclusions: With an unbiased scRNA-seq approach, we identified a full spectrum of cell populations and a cellular interaction network in stenotic BAVs, which may provide insights for further research on CAVD. Notably, the exploration on mechanism of MMT might provide potential therapeutic targets for bicuspid CAVD., (© 2023. The Author(s).)

Objective: The aim of this study was to evaluate the efficacy and safety of the Chinese herbal formula San-Huang Gu-Ben Zhi-Ke (SHGBZK) as a treatment for patients with stable chronic obstructive pulmonary disease (COPD) diagnosed with lung-spleen Qi deficiency. Method: A randomized, double-blind, placebo-controlled trial was designed. 98 adults aged between 40 and 80 years with stable COPD diagnosed with lung-spleen Qi deficiency were included. All participants received basic treatment for COPD. Patients in the experimental group took SHGBZK, while the control group took placebo. The primary outcome was the frequency of acute exacerbation. The secondary outcomes were lung function, symptom score, exercise capacity and quality of life. Results: Of 98 patients who underwent randomization, 50 patients in the SHGBZK group and 48 in the placebo group were included in the full analysis set. After 24-week therapy and 28-week follow-up, patients in treatment group had significant improvements in symptom, exercise capacity and quality of life. After Subgroup analysis, the frequency of acute exacerbation in patients with a COPD Assessment Test (CAT) score of at least 10 or a modified Medical Research Council (mMRC) score of at least 2 was significantly lower in the SHGBZK group than in the placebo group. Lung function in patients with frequent exacerbation was significantly higher in the SHGBZK group than in the placebo group. The incidence of adverse events was generally similar in the two groups. Conclusion: SHGBZK had beneficial effects on symptom, exercise capacity and quality of life in stable COPD patients. SHGBZK also had the potential to reduce the frequency of exacerbation and improve lung function in specific groups of COPD patients. Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=26933, identifier ChiCTR1800016349., Competing Interests: Author XL was employed by Beijing Qi-Huang Technology Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lyu, Li, Lei, Zhang, Cheng, Shu and Zhang.)

Concussions are a common traumatic brain injury in soccer games but are often ignored by coaches and athletes. The purpose of our study is to assess the concussion knowledge and attitudes among amateur adolescent soccer athletes in China. Data was collected from questionnaire surveying (Rosenbaum Concussion Knowledge and Attitudes Survey (Student Version)) and semi-structured interviews completed by 69 amateur adolescent soccer athletes who participated in the U17 and U15 male groups of the 2022 China Youth Soccer League. The study followed a mixed methodology cross sectional study design. The concussion knowledge index (0-25) and concussion attitude index (15-75) scores were derived from the questionnaire and descriptive statistics were used for data analysis. The mean score of concussion knowledge is 16.8 ± 2.4 (range 10-22), and the mean score of concussion attitude is 61.3 ± 8.8 (range 45-77). Thematic analysis was used to categorize the participant's responses of the semi-structured interview and the results were compared with their survey answers of questionnaire. Interestingly, the interviews revealed the inconsistencies between the questionnaire responses and intended behaviors, and multiple factors (injury severity, the importance of the game and substitution rules) influencing concussion-reporting behaviors were identified. In addition, athletes hope to acquire concussion knowledge through formal education. Our study lay the foundation for educational interventions to potentially improve concussion-reporting behaviors among amateur adolescent soccer athletes., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

The Corsac fox ( Vulpes corsac ) is a species of fox distributed in the arid prairie regions of Central and Northern Asia, with distinct adaptations to dry environments. Here, we applied Oxford-Nanopore sequencing and a chromosome structure capture technique to assemble the first Corsac fox genome, which was then assembled into chromosome fragments. The genome assembly has a total length of 2.2 Gb with a contig N50 of 41.62 Mb and a scaffold N50 of 132.2 Mb over 18 pseudo-chromosomal scaffolds. The genome contained approximately 32.67% of repeat sequences. A total of 20,511 protein-coding genes were predicted, of which 88.9% were functionally annotated. Phylogenetic analyses indicated a close relation to the Red fox ( Vulpes vulpes ) with an estimated divergence time of ~3.7 million years ago (MYA). We performed separate enrichment analyses of species-unique genes, the expanded and contracted gene families, and positively selected genes. The results suggest an enrichment of pathways related to protein synthesis and response and an evolutionary mechanism by which cells respond to protein denaturation in response to heat stress. The enrichment of pathways related to lipid and glucose metabolism, potentially preventing stress from dehydration, and positive selection of genes related to vision, as well as stress responses in harsh environments, may reveal adaptive evolutionary mechanisms in the Corsac fox under harsh drought conditions. Additional detection of positive selection for genes associated with gustatory receptors may reveal a unique desert diet strategy for the species. This high-quality genome provides a valuable resource for studying mammalian drought adaptation and evolution in the genus Vulpes .

To improve their interfacial properties, 3D orthogonal woven fabrics with basalt filament yarns were modified with functionalized carboxylated carbon nanotubes (KH570-MWCNTs) and polydopamine (PDA). Fourier infrared spectroscopy (FT-IR) analysis and scanning electron microscopy (SEM) testing were used. It was demonstrated that both methods could successfully modify basalt fiber (BF) 3D woven fabrics. The 3D orthogonal woven composites (3DOWC) were produced with epoxy resin and 3D orthogonal woven fabrics as raw material by the VARTM molding process. The bending properties of the 3DOWC were tested and analyzed by experimental and finite element analysis methods. The results showed that the bending properties of the 3DOWC modified by KH570-MWCNTs and PDA were significantly improved, and the maximum bending loads were increased by 31.5% and 31.0%. The findings of the finite element simulation and the experiment results were in good agreement, and the simulation error value was 3.37%. The correctness of the finite element simulation results and the model's validity further reveal the material's damage situation and damage mechanism in the bending process.

Aythya marila is one of the few species of Anatidae, and the only Aythya to live in the circumpolar. However, there is a relative lack of research on genetics of this species. In this study, we reported and assembled the first high-quality chromosome-level genome assembly of A. marila. This genome was assembled using Nanopore long reads, and errors corrected using Illumina short reads, with a final genome size of 1.14 Gb, scaffold N50 of 85.44 Mb, and contig N50 of 32.46 Mb. 106 contigs were clustered and ordered onto 35 chromosomes based on Hi-C data, covering approximately 98.28% of the genome. BUSCO assessment showed that 97.0% of the highly conserved genes in aves&#95;odb10 were present intact in the genome assembly. In addition, a total of 154.94 Mb of repetitive sequences were identified. 15,953 protein-coding genes were predicted in the genome, and 98.96% of genes were functionally annotated. This genome will be a valuable resource for future genetic diversity and genomics studies of A. marila., (© 2023. The Author(s).)

Background: In most areas of China, mothers typically do not participate in early care of preterm infants in NICU. This study aims to examine the early experience of mothers of preterm infants participating in skin-to-skin contact combined with non-nutritive comfort sucking in China., Methods: This qualitative research study used one-on-one, face-to-face, semi-structured in-depth interviews. Eighteen mothers who participated in early skin-to-skin contact combined with non-nutritive comfort sucking were interviewed in the NICU of a tertiary children's hospital in Shanghai between July and December 2020. Their experiences were analyzed using the inductive topic analysis method., Results: Five themes about skin-to-skin contact combined with non-nutritive comfort sucking were identified, including alleviation of maternal anxiety and fear during mother infant separation, reshaping the maternal role, promotion of active breast pumping, enhances the mother's willingness to actively breast feed and building the maternal confidence in baby care., Conclusion: Skin-to-skin contact combined with non-nutritive comfort sucking in the NICU can not only enhance the identity and responsibility of the mother's role, but also provide non-nutritive sucking experience for promoting the establishment of oral feeding in preterm infants., (© 2023. The Author(s).)

The flower induction of Hydrangea macrophylla "Endless Summer" is regulated by a complex gene network that involves multiple signaling pathways to ensure continuous flowering throughout the growing season, but the molecular determinants of flower induction are not yet clear. In this study, genes potentially involved in signaling pathway mediating the regulatory mechanism of flower induction were identified through the transcriptomic profiles, and a hypothetical model for this regulatory mechanism was obtained by an analysis of the available transcriptomic data, suggesting that sugar-, hormone-, and flowering-related genes participated in the flower induction process of H. macrophylla "Endless Summer". The expression profiles of the genes involved in the biosynthesis and metabolism of sugar showed that the beta-amylase gene BAM1 displayed a high expression level at the BS2 stage and implied the hydrolysis of starch. It may be a signaling molecule that promotes the transition from vegetative growth to reproductive growth in H. macrophylla "Endless Summer". Complex hormone regulatory networks involved in abscisic acid (ABA), auxin (IAA), zeatin nucleoside (ZR), and gibberellin (GA) also induced flower formation in H. macrophylla . ABA participated in flower induction by regulating flowering genes. The high content of IAA and the high expression level of the auxin influx carrier gene LAX5 at the BS2 stage suggested that the flow of auxin between sources and sinks in H. macrophylla is involved in the regulation of floral induction as a signal. In addition, flowering-related genes were mainly involved in the photoperiodic pathway, the aging pathway, and the gibberellin pathway. As a result, multiple pathways, including the photoperiodic pathway, the aging pathway, and the gibberellin pathway, which were mainly mediated by crosstalk between sugar and hormone signals, regulated the molecular network involved in flower induction in H. macrophylla "Endless Summer".

Abstract: Ferroptosis is an iron-dependent cell death pathway that is different from apoptosis, pyroptosis, and necrosis. The main characteristics of ferroptosis are the Fenton reaction mediated by intracellular free divalent iron ions, lipid peroxidation of cell membrane lipids, and inhibition of the anti-lipid peroxidation activity of intracellular glutathione peroxidase 4 (GPX4). Recent studies have shown that ferroptosis can be involved in the pathological processes of many disorders, such as ischemia-reperfusion injury, nervous system diseases, and blood diseases. However, the specific mechanisms by which ferroptosis participates in the occurrence and development of acute leukemia still need to be more fully and deeply studied. This article reviews the characteristics of ferroptosis and the regulatory mechanisms promoting or inhibiting ferroptosis. More importantly, it further discusses the role of ferroptosis in acute leukemia and predicts a change in treatment strategy brought about by increased knowledge of the role of ferroptosis in acute leukemia., (Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Manipulating and integrating the microstructures at different scales is crucial to tune the electrical and thermal properties of a given compound. High-pressure sintering can modify the multiscale microstructures and thus empower the cutting-edge thermoelectric performance. In this work, the high-pressure sintering technique followed by annealing is adopted to prepare Gd-doped p -type (Bi 0.2 Sb 0.8 ) 2 (Te 0.97 Se 0.03 ) 3 alloys. First, the high energy of high-pressure sintering promotes the reduction of grain size, thus increasing the content of 2D grain boundaries. Next, high-pressure sintering induces strong interior strain, where 1D dense dislocations are generated near the strain field. More interestingly, the rare-earth element Gd with a high melting temperature is dissolved into the matrix via high-pressure sintering, thus promoting the formation of 0D extrinsic point defects. This concurrently improves the carrier concentration and density-of-state effective mass, resulting in an enhanced power factor. In addition, the integrated 0D point defects, 1D dislocations, and 2D grain boundaries by high-pressure sintering strengthen phonon scattering, thereby achieving a low lattice thermal conductivity of 0.5 Wm -1 K -1 at 348 K. Consequently, a maximum zT value of ∼1.1 at 348 K is achieved in the 0.4 at % Gd-doped (Bi 0.2 Sb 0.8 ) 2 (Te 0.97 Se 0.03 ) 3 sample. This work demonstrates that high-pressure sintering enables microstructure modification to enhance the thermoelectric performance of Bi 2 Te 3 -based and other bulk materials.

Background: Growing evidence suggests that gait training can improve stroke patients' balance outcomes. However, it remains unclear which type of gait training is more effective in improving certain types of balance outcomes in patients with stroke. Thus, this network meta-analysis (NMA) included six types of gait training (treadmill, body-weight-supported treadmill, virtual reality gait training, robotic-assisted gait training, overground walking training, and conventional gait training) and four types of balance outcomes (static steady-state balance, dynamic steady-state balance, proactive balance, and balance test batteries), aiming to compare the efficacy of different gait training on specific types of balance outcomes in stroke patients and determine the most effective gait training., Method: We searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases from inception until 25 April 2022. Randomized controlled trials (RCTs) of gait training for the treatment of balance outcomes after stroke were included. RoB2 was used to assess the risk of bias in the included studies. Frequentist random-effects network meta-analysis (NMA) was used to evaluate the effect of gait training on four categories of balance outcomes., Result: A total of 61 RCTs from 2,551 citations, encompassing 2,328 stroke patients, were included in this study. Pooled results showed that body-weight-support treadmill (SMD = 0.30, 95% CI [0.01, 0.58]) and treadmill (SMD = 0.25, 95% CI [0.00, 0.49]) could improve the dynamic steady-state balance. Virtual reality gait training (SMD = 0.41, 95% CI [0.10, 0.71]) and body-weight-supported treadmill (SMD = 0.41, 95% CI [0.02, 0.80]) demonstrated better effects in improving balance test batteries. However, none of included gait training showed a significant effect on static steady-state balance and proactive balance., Conclusion: Gait training is an effective treatment for improving stroke patients' dynamic steady-state balance and balance test batteries. However, gait training had no significant effect on static steady-state balance and proactive balance. To achieve maximum efficacy, clinicians should consider this evidence when recommending rehabilitation training to stroke patients. Considering body-weight-supported treadmill is not common for chronic stroke patients in clinical practice, the treadmill is recommended for those who want to improve dynamic steady-state balance, and virtual reality gait training is recommended for those who want to improve balance test batteries., Limitation: Missing evidence in relation to some types of gait training is supposed to be taken into consideration. Moreover, we fail to assess reactive balance in this NMA since few included trials reported this outcome., Systematic Review Registration: PROSPERO, identifier CRD42022349965., Competing Interests: CX is employed by SUSE Software (Beijing) Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lyu, Yan, Lyu, Zhao, Wang, Zhang, Liu, Xiong, Liu and Wei.)

Recently, graph neural architecture search (GNAS) frameworks have been successfully used to automatically design the optimal neural architectures for many problems such as node classification and graph classification. In the existing GNAS frameworks, the designed graph neural network (GNN) architectures learn the representation of homogenous graphs with one type of relationship connecting two nodes. However, multi-view graphs, where each view represents a type of relationship among nodes, are ubiquitous in the real world. The traditional GNAS frameworks learn the graph representation without considering the interactions between nodes and multiple relationships, so they fail to solve multi-view graph-based problems, such as multi-view graphs modelling the biomedical entity and relation extraction tasks. In this paper, we propose MVGNAS, a multi-view graph neural network automatic modelling framework for biomedical entity and relation extraction, to resolve this challenge. In MVGNAS, we propose an automatic multi-view representation learning to learn low-dimensional representations of nodes that capture multiple relationships in a multi-view graph, representing the first research work in literature to solve the problem of multi-view graph representation learning architecture search for biomedical entity and relation extraction tasks. The experimental results demonstrate that MVGNAS can achieve the best performance in biomedical entity and relation extraction tasks against the state-of-the-art baseline methods.

Objectives: Whether naive CD4+ T cells are dysregulated and associated with the overactivation of CD4+ T cells in primary SS (pSS) remains unclear. We aimed to explore the role and underlying mechanism of naive CD4+ T cells in pSS., Methods: We examined the activation, proliferation and differentiation of naive CD4+ T cells from pSS patients and healthy controls. Differentially expressed genes were identified using RNA sequencing, and were overexpressed or silenced to determine the gene regulating follicular helper T (Tfh) cells. Assay for transposase-accessible chromatin with high-throughput sequencing (ATAC-seq) with chromatin immunoprecipitation with high-throughput sequencing (ChIP-seq) was performed to explore the epigenetic mechanism. Naive CD4+ T cells were treated with pSS-related cytokines to explore the upstream signalling pathway., Results: pSS naive CD4+ T cells had higher potentials of activation, proliferation and differentiation towards Tfh cells. Thymocyte selection-associated high mobility group box protein (TOX) was upregulated in pSS naive CD4+ T cells and promoted T cell activation and Tfh cell polarization. TOX silencing in pSS naive CD4+ T cells downregulated B cell lymphoma 6 (BCL6) expression and altered levels of multiple Tfh-associated genes. ChIP-seq analysis implied that TOX bound to the BCL6 locus, where there were accessible regions found by ATAC-seq. IFN-α induced TOX overexpression, which was attenuated by Janus kinase (JAK) and signal transducer and activator of transcription 1 (STAT1) inhibitors., Conclusion: Our data suggest that TOX in pSS naive CD4+ T cells is upregulated, which facilitates Tfh cell differentiation. Mechanistically, IFN-α induces TOX overexpression in naive CD4+ T cells through JAK-STAT1 signalling and TOX regulates BCL6 expression. Therefore, IFN-α-JAK-STAT1 signalling and TOX might be potential therapeutic targets in pSS., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

A new facultatively cavernicolous planthopper species Borysthenes hainanensis sp. n., from Hainan Island, China, is described and illustrated. Specimens collected from lava tubes and above ground were found to be the same species but males of the former have smaller eyes. Distribution maps of the new and other species are given together with a checklist to all Borysthenes species and a key to Chinese ones. Type images of most Borysthenes species are also provided including Borysthenes dilectus (Walker), comb. n.