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Background: Elevated circulatory phosphate levels are linked to age-related muscle dysfunction, yet the mechanisms remain unclear. This study investigated the hypothesis that inflammation plays a role in connecting elevated phosphate levels to muscular dysfunction in middle-aged and older individuals and explored potential sex-based differences in these associations. Methods: The study, based on the I-Lan Longitudinal Aging Study Cohort, analyzed individuals' serum phosphate and hsCRP levels. Sex-specific analyses explored links between circulatory phosphate, inflammation, and muscle profiles (mass, handgrip strength, and walking speed). The study also examined potential mediation or synergistic effects of inflammation in the circulatory phosphate-muscle relationship. Results: The study included 2006 participants (mean age: 65.5 ± 6.5 years; 49.8 % men). Women exhibited higher circulatory phosphate levels than men. Linear analyses revealed that higher phosphate levels were significantly associated with weaker handgrip strength but not with reduced muscle mass in both men and women. In women, circulatory phosphate was not associated with inflammation (hsCRP levels), while in men, higher phosphate levels were significantly associated with higher hsCRP levels. In men, a synergistic effect was observed, where the combination of high hsCRP and elevated phosphate levels had a more pronounced impact on reducing handgrip strength than either factor alone. Conclusions: This study highlights a sex-specific association of inflammation in the mechanisms of hyperphosphatemia-related muscle weakness. The findings emphasize the importance of managing both hyperphosphatemia and chronic inflammation to mitigate their collective impact on muscle function, particularly in older men. Addressing these factors is crucial for promoting muscle health in later life.

Abstract Background The relationship between inflammation and covert cerebral small vessel disease (SVD) with regards to sex difference has received limited attention in research. We aim to unravel the intricate associations between inflammation and covert SVD, while also scrutinizing potential sex-based differences in these connections. Methods Non-stroke/dementia-free study population was from the I-Lan longitudinal Aging Study. Severity and etiology of SVD were assessed by 3T-MRI in each participant. Systemic and vascular inflammatory-status was determined by the circulatory levels of high-sensitivity C-reactive protein (hsCRP) and homocysteine, respectively. Sex-specific multivariate logistic regression to calculate odds ratios (ORs) and interaction models to scrutinize women-to-men ratios of ORs (RORs) were used to evaluate the potential impact of sex on the associations between inflammatory factors and SVD. Results Overall, 708 participants (62.19 ± 8.51 years; 392 women) were included. Only women had significant associations between homocysteine levels and covert SVD, particularly in arteriosclerosis/lipohyalinosis SVD (ORs[95%CI]: 1.14[1.03–1.27] and 1.15[1.05–1.27] for more severe and arteriosclerosis/lipohyalinosis SVD, respectively). Furthermore, higher circulatory levels of homocysteine were associated with a greater risk of covert SVD in women compared to men, as evidenced by the RORs [95%CI]: 1.14[1.01–1.29] and 1.14[1.02–1.28] for more severe and arteriosclerosis/lipohyalinosis SVD, respectively. No significant associations were found between circulatory hsCRP levels and SVD in either sex. Conclusion Circulatory homocysteine is associated with covert SVD of arteriosclerosis/lipohyalinosis solely in women. The intricacies underlying the sex-specific effects of homocysteine on SVD at the preclinical stage warrant further investigations, potentially leading to personalized/tailored managements. Trial registration Not applicable.

Background: This retrospective study aimed to determine the risk of venous thromboembolism (VTE) in patients with PsA after surgery for lumbar degenerative disease (LDD). Methods: The study data of adults aged ≥20 years admitted to U.S. hospitals with diagnoses of LDD and undergoing spinal decompression or fusion between 2005 and 2018 were extracted from the National Inpatient Sample (NIS) database. Patients were further divided into two groups based on a diagnosis of PsA or not via codes ICD-9: 696.0 and ICD-10: L40.50. Patients with missing information were excluded. Propensity score matching (PSM) was employed to enhance comparability between groups. Logistic regression was used to determine associations between PsA and various outcomes, including complications, unfavorable discharge, and prolonged length of stay (LOS). Results: Data on 471,283 patients with LDD was extracted from the NIS database.from 2005 to 2018. Before propensity score matching, patients with PsA had higher proportions of overall morbidity (8.8 % vs. 6.9 %), VTE (1.4 % vs. 0.7 %), and unfavorable discharge (20.8 % vs. 16.9 %). After matching, patients with PsA still had higher VTE incidence and unfavorable discharge proportions. After adjustments, multivariable regression analysis indicated that patients with PsA had a higher risk of unfavorable discharge (aOR: 1.26, 95 % CI: 1.03–1.55) and VTE (aOR: 1.99, 95 % CI: 1.05–3.75). Conclusions: Among patients undergoing surgery for LDD, pre-existing PsA may be associated with increased risks of unfavorable discharge and VTE occurrence. The findings may benefit preoperative risk stratifications before LDD surgeries.

In this study, we propose a self-aligned stacked Ge nanowire (NW) p-type gate-all-around field-effect transistor (pGAAFET) on Si nFinFET of single gate complementary FET (CFET). The self-aligned stacked Ge NW pGAAFET on Si nFinFET of single gate CFET device is fabricated on a SOI wafer. The CFET device is fully compatible with current Si technology platform using alternating anisotropic and isotropic dry etching process. The Ge NW pGAAFET presents an on-state current (ION) of $166 ~\mu \text{A}/\mu \text{m}$ at ${\mathrm{ V}}_{\mathrm{ D}}\,\,=$ VG-VTH $=\,\,-0.5$ V and shows minimum subthreshold swing (SSmin) of 79, 91 mV/dec, and ION/IOFF of $3.03\times10\,\,^{\mathrm{ 5}}$ , $3.4\times 10^{4}$ at ${\mathrm{ V}}_{\mathrm{ D}}\,\,=\,\,-0.05$ V and −0.5 V, respectively. The Si nFinFET presents an ${\mathrm{ I}}_{\mathrm{ ON}}$ of $60.4 ~\mu \text{A}/\mu \text{m}$ at ${\mathrm{ V}}_{\mathrm{ D}}\,\,=$ VG-VTH = 0.5 V and shows ${\mathrm{ SS}}_{\min }$ of 91, 101 mV/dec, and ION/IOFF of $9.01\times10\,\,^{\mathrm{ 4}}$ , $5.62\times 10^{5}$ at ${\mathrm{ V}}_{\mathrm{ D}}\,\,=$ 0.05 V and 0.5 V, respectively. The proposed CFET can simplify the process and shows promising potential for extending scaling beyond the technology node.

Abstract Background Wound pain after surgery for lumbar spine disease may interfere with patients’ recovery. Acupuncture is commonly used for pain management, but its efficacy for postoperative pain control is unclear. This study aimed to evaluate the effectiveness of acupuncture for adjuvant pain control after surgery for degenerative lumbar spine disease. Methods We retrospectively reviewed the records of consecutive patients who received surgery for degenerative lumbar spine disease at our institution from 2013 to 2014. Surgical procedures included open laminectomy, discectomy, and trans-pedicle screw instrumentation with posterior-lateral fusion. Patients were grouped by pain control methods, including routine analgesia, patient-controlled analgesia (PCA), and acupuncture. The routine analgesia group received oral acetaminophen/non-steroidal anti-inflammatory drugs with meperidine as needed for immediate pain control. The PCA group received a basal dose of morphine and subsequent user-demand doses. The acupuncture group received acupuncture every other day after surgery. Results Ninety-six patients were included, of whom 37 received acupuncture, 27 received PCA, and 32 received routine analgesics for pain control. Visual analog scale (VAS) pain scores in all 3 groups decreased significantly, and to the same degree, from the first postoperative day to the second day. No significant differences were found in VAS scores over the next 6 postoperative days; however, the scores of patients treated with PCA were slightly but still significantly higher (p = 0.026) on postoperative day 4 than scores of patients treated with acupuncture and traditional analgesia, a difference likely due to PCA being discontinued on postoperative day 3. No major complications were noted in the acupuncture group, but 2 patients dropped out because of fear of needle insertion. Conclusions Acupuncture may be as effective as traditional analgesia and PCA for adjuvant pain control after surgery for degenerative lumbar spine disease.

Over the past few decades, recognition of early lung cancers was researched for effective treatments. In early lung cancers, the invasiveness is an important factor for expected survival rates. Hence, how to effectively identify the invasiveness by computed tomography (CT) images became a hot topic in the field of biomedical science. Although a number of previous works were shown to be effective on this topic, there remain some problems unsettled still. First, it needs a large amount of marked data for a better prediction, but the manual cost is high. Second, the accuracy is always limited in imbalance data. To alleviate these problems, in this paper, we propose an effective CT invasiveness recognizer by semi-automated segmentation. In terms of semi-automated segmentation, it is easy for doctors to mark the nodules. Just based on one clicked pixel, a nodule object in a CT image can be marked by fusing two proposed segmentation methods, including thresholding-based morphology and deep learning-based mask region-based convolutional neural network (Mask-RCNN). For thresholding-based morphology, an initial segmentation is derived by adaptive pixel connections. Then, a mathematical morphology is performed to achieve a better segmentation. For deep learning-based mask-RCNN, the anchor is fixed by the clicked pixel to reduce the computational complexity. To incorporate advantages of both, the segmentation is switched between these two sub-methods. After segmenting the nodules, a boosting ensemble classification model with feature selection is executed to identify the invasiveness by equalized down-sampling. The extensive experimental results on a real dataset reveal that the proposed segmentation method performs better than the traditional segmentation ones, which can reach an average dice improvement of 392.3%. Additionally, the proposed ensemble classification model infers better performances than the compared method, which can reach an area under curve (AUC) improvement of 5.3% and a specificity improvement of 14.3%. Moreover, in comparison with the models with imbalance data, the improvements of AUC and specificity can reach 10.4% and 33.3%, respectively.

Abstract Background Cases of acute sphenoid sinusitis complicated by septic cavernous sinus (CS) thrombosis and internal carotid artery (ICA) stenosis are rarely reported. Different causative pathogens have been reported for this condition. We present two extremely rare and special cases with diverse clinical presentations and outcomes. Case 1 involved a female patient with less extensive sinusitis, but critical ICA occlusion. Case 2 involved a male patient with extensive pansinusitis, meningitis, cerebritis, and vasculitis due to fungal infection, but less stenosis of the ICA lumen. Both patients underwent surgical debridement and received broad-spectrum antibiotics. Additional anti-fungal medication was also administered in Case 2. However, outcomes differed considerably between cases. Discussion Case 1 recovered with minimal neurological deficits and had Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores of 5 and 2, respectively; however, the Case 2 had GOS and mRS scores of 3 and 4, respectively. Although rare, septic CS thrombosis with ICA stenosis can lead to unexpected and severe neurological sequelae. Fungal infection can result in catastrophic complications and poorer prognosis. Conclusion In addition to early detection, aggressive surgical debridement and adequate antimicrobial treatment are crucial to satisfactory outcomes in patients with septic CS thrombosis complicated with ICA stenosis.

The supernova remnant (SNR) 30 Dor B is associated with the H ii region ionized by the OB association LH99. The complex interstellar environment has made it difficult to study the physical structure of this SNR. We have used Hubble Space Telescope H α images to identify SNR shocks and deep Chandra X-ray observations to detect faint diffuse emission. We find that 30 Dor B hosts three zones with very different X-ray surface brightnesses and nebular kinematics that are characteristic of SNRs in different interstellar environments and/or evolutionary stages. The ASKAP 888 MHz map of 30 Dor B shows counterparts to all X-ray emission features except the faint halo. The ASKAP 888 and 1420 MHz observations are used to produce a spectral index map, but its interpretation is complicated by the background thermal emission and the pulsar PSR J0537−6910's flat spectral index. The stellar population in the vicinity of 30 Dor B indicates a continuous star formation in the past 8–10 Myr. The observed very massive stars in LH99 cannot be coeval with the progenitor of 30 Dor B’s pulsar. Adopting the pulsar’s spin-down timescale, 5000 yr, as the age of the SNR, the X-ray shell would be expanding at ∼4000 km s ^−1 and the post-shock temperature would be 1–2 orders of magnitude higher than that indicated by the X-ray spectra. Thus, the bright central region of 30 Dor B and the X-ray shell requires two separate SN events, and the faint diffuse X-ray halo perhaps other older SN events.

A midline shift (MLS) is an important clinical indicator for intracranial hemorrhage. In this study, we proposed a robust, fully automatic neural network-based model for the detection of MLS and compared it with MLSs drawn by clinicians; we also evaluated the clinical applications of the fully automatic model. We recruited 300 consecutive non-contrast CT scans consisting of 7269 slices in this study. Six different types of hemorrhage were included. The automatic detection of MLS was based on modified Keypoint R-CNN with keypoint detection followed by training on the ResNet-FPN-50 backbone. The results were further compared with manually drawn outcomes and manually defined keypoint calculations. Clinical parameters, including Glasgow coma scale (GCS), Glasgow outcome scale (GOS), and 30-day mortality, were also analyzed. The mean absolute error for the automatic detection of an MLS was 0.936 mm compared with the ground truth. The interclass correlation was 0.9899 between the automatic method and MLS drawn by different clinicians. There was high sensitivity and specificity in the detection of MLS at 2 mm (91.7%, 80%) and 5 mm (87.5%, 96.7%) and MLSs greater than 10 mm (85.7%, 97.7%). MLS showed a significant association with initial poor GCS and GCS on day 7 and was inversely correlated with poor 30-day GOS (p < 0.001). In conclusion, automatic detection and calculation of MLS can provide an accurate, robust method for MLS measurement that is clinically comparable to the manually drawn method.

Summary Background Oxidative stress process plays a key role in aging and cancer; however, currently, there is paucity of machine-learning model studies investigating the relationship between oxidative stress and prognosis of elderly patients with esophageal squamous cancer (ESCC). Methods This study included elderly patients with ESCC who underwent curative ESCC resection surgery continuously from January 2013 to December 2020 and were stratified into the training and external validation cohorts. Using Cox stepwise regression analysis based on Akaike information criterion, the relationship between oxidative stress biomarkers and prognosis was explored, and a geriatric ESCC-related oxidative stress score (OSS) was constructed. To construct a predictive model for 3-year overall survival (OS), machine-learning strategies including decision tree (DT), random forest (RF), and support vector machine (SVM) were employed. These machine-learning strategies play a key role in data mining and pattern recognition tasks. Each model was tested in the external validation cohort through 1000 resampling iterations. Validation was conducted using receiver operating characteristic area under the curve (AUC) and calibration plots. Results The training cohort and validation cohort consisted of 340 and 145 patients, respectively. In the training cohort, the 3-year OS rate for patients was 59.2%. We constructed the OSS based on systemic oxidative stress biomarkers using the training cohort. The study found that pathological N stage, pathological T stage, tumor histological type, lymphovascular invasion, CEA, OSS, CA 19 − 9, and the amount of bleeding were the most important factors influencing the 3-year OS. These eight important features were included in training the RF, DT, and SVM and trained on the training cohort and validated cohort, respectively. In the training cohort, the RF model demonstrated the highest predictive performance with an AUC of 0.975 (0.962–0.987), while the DT model is 0.784 (0.739–0.830) and the SVM is 0.879 (0.843–0.916). In the external validation cohort, the RF model again exhibited the highest performance with an AUC of 0.791 (0.717–0.864), compared to the DT model with an AUC of 0.717 (0.640–0.794) and 0.779 (0.702–0.856) in SVM. Conclusions The random forest clinical prediction model constructed based on OSS can effectively predict the prognosis of elderly patients with ESCC after curative surgery.

The global dissemination of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) Omicron variants has been characterized by a distinct 9-base pair (bp) deletion within the nucleocapsid (N) gene, a genomic feature absent in previously circulating variants. In response to this unique characteristic, we have developed an innovative amplicon-competition strategy to differentiate Omicron lineages from other SARS-CoV-2 variants using a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay. This novel methodology demonstrates high specificity and sensitivity, effectively detecting viral loads ranging from 1500 to 1.5x106 copies per milliliter in nasopharyngeal swab specimens. The potential applications of this approach extend beyond current needs, providing a robust framework for the genomic characterization of future variants exhibiting unique genetic signatures.

Pulsed-laser deposition was utilized to fabricate Eu-doped ZnO epitaxial films on c-plane sapphire substrates with Eu concentrations ranging from 0.5 to 4.0 at. %. The structural properties were analyzed using x-ray diffraction surface normal radial scans and azimuthal cone scans, which confirmed the epitaxy of the film samples. Reciprocal space mapping was performed on ZnO(101̄1) to visualize the effect of Eu incorporation. X-ray fluorescence mapping confirmed the homogeneous distribution of Zn and Eu, and x-ray absorption near-edge structure spectra directly confirmed the trivalent state of Eu ions. The optical properties were assessed using temperature-dependent photoluminescence (PL). Various defects were identified. With increasing Eu dopant concentration, PL emissions from defects and the Eu 4f-intraband transitions gradually became the predominant features in the PL spectra at low temperatures. Furthermore, PL analysis suggested that Eu ions substituted Zn, occupying sites with lower C3v symmetry due to the distortion caused by Eu incorporation.