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Background: Postoperative delirium (POD) is an acute postoperative syndrome of the central nervous system that seriously affects the prognosis of patients. Many vital advances have been made in the study of the management of POD. We conducted a bibliometric analysis of research on the prevention and treatment of POD over the past 20 years to consolidate current research focal points and emerging trends in this domain. Methods: We searched the Web of Science Core Collection database for literature published between 2004 and 2023. VOSviewer, CiteSpace, Microsoft Excel, Scimago Graphica, and the R tool “bibliometrix” were used to analyze and visualize annual publications, countries, organizations, journals, authors, keywords, and references. Results: A total of 1848 eligible publications were identified, with a general uptrend observed in both annual publications and citations. The USA was the most profitable country, ranking first in total publications. The most active institution was Harvard Medical School. Inouye, Sharon K was the most prolific scholar due to her numerous publications and citations. According to the co-occurrence network, the strongest citation bursts and co-cited references analysis fresh hot topics included “dexmedetomidine,” “neuroinflammation,” “haloperidol prophylaxis,” and “guideline.” Conclusions: Research on prevention and treatment of POD is gaining significant momentum worldwide. Current hot spots include early perioperative prevention strategies and integrated multi-method treatments. Effective drugs for it is one of the directions in the future. The management of pediatric patients with POD has caused concern in recent years. This bibliometric analysis is poised to guide future research trajectories in this field.

Tumor relapse and metastasis are the major causes of mortality associated with urothelial cancer. In the tumor microenvironment, negative regulatory molecules and various immune cell subtypes suppress antitumor immunity. The inflammatory microenvironment, associated with neutrophils and neutrophil extracellular traps (NETs), promotes tumor metastasis. However, no drugs are currently available to specifically inhibit neutrophils and NETs. In this study, we first demonstrated that icaritin (ICT), a Chinese herbal remedy that is a first-line treatment for advanced and incurable hepatocellular carcinoma, reduces NETs caused by suicidal NETosis and prevents neutrophil infiltration in the tumor microenvironment. Mechanistically, ICT binds to and inhibits the expression of PADI2 in neutrophils, thereby suppressing PADI2-mediated histone citrullination. Moreover, ICT inhibits ROS generation, suppresses the MAPK signaling pathway, and inhibits NET-induced tumor metastasis. Simultaneously, ICT inhibits tumoral PADI2-mediated histone citrullination, which consequently suppresses the transcription of neutrophil-recruiting genes such as GM-CSF and IL-6. The downregulation of IL-6 expression, in turn, forms a regulatory feedback loop through the JAK2/STAT3/IL-6 axis. Through a retrospective study of clinical samples, we found a correlation between neutrophils, NETs, UCa prognosis, and immune evasion. Combining ICT with immune checkpoint inhibitors may have synergistic effects. In summary, our study demonstrated that ICT could be a novel inhibitor of NETs and a novel UCa treatment.

Abstract Preterm delivery (PTD) is associated with severe adverse maternal and neonatal outcomes and higher medical costs. Therefore, PTD warrants more attention. However, predicting PTD remains a challenge for researchers. This study aimed to investigate potential prenatal predictors of PTD. We retrospectively recruited pregnant women who experienced either PTD or term delivery (TD) and underwent laboratory examinations at 32 weeks of gestation. We compared the test results between the two groups and performed logistic regression analysis and receiver operating characteristic (ROC) curve analysis to identify risk factors and predictive factors for PTD. Our investigation revealed that the PTD cohort exhibited statistically significant elevations in lymphocyte count, mean corpuscular hemoglobin concentration, calcium, uric acid, alkaline phosphatase, triglycerides, and total bile acids. Conversely, the PTD group demonstrated statistically significant reductions in mean corpuscular volume, homocysteine, neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), neutrophils to (white blood cells–neutrophils) ratio (dNLR), and (neutrophils × monocytes) to lymphocyte ratio (SIRI). The ROC curve analysis revealed that calcium had an area under the curve (AUC) of 0.705, with a cut-off value of 2.215. Logistic regression analysis showed that premature rupture of membranes was an independent risk factor for PTD. Our study demonstrated that serum calcium levels, NLR, dNLR, and other laboratory tests conducted at 32 weeks of gestation can serve as predictors for PTD. Furthermore, we identified premature rupture of membranes as a risk factor for PTD.

Abstract Background External cephalic version (ECV) is a medical procedure in which an extracorporeal manipulation is performed to render the breech presentation (BP) fetus in the cephalic position. The use of anesthesia to facilitate repositioning has been evaluated in various randomized clinical trials (RCTs), but its potential effectiveness remains controversial. Methods A systematic literature search was carried out in 8 electronic databases. In the meta-analysis, a random effects model was used to calculate the pooled relative risk (RR) and its 95% confidence interval (CI), and the pooled standardized mean difference (SMD) and its 95% CI, in order to systematically assess the effect of anesthesia on the success rates of ECV, vaginal delivery, cesarean delivery as well as other outcomes. Relevant subgroup analyses, publication bias test and sensitivity analyses were also conducted. Results This review included 17 RCTs. Women who received anesthesia had a significantly higher incidence of successful ECV (RR: 1.37, 95% CIs: 1.19-1.58) and vaginal delivery (RR: 1.23, 95% CIs: 1.03-1.47), and a significantly lower incidence of cesarean delivery (RR: 0.69, 95% CIs: 0.53-0.91), compared with those who did not. Conclusion The administration of anesthesia not only significantly reduces maternal pain but also significantly increases the success rate of ECV in women with malpresentation at term, leading to a significant rise in the incidence of vaginal delivery. However, it may increase the incidence of maternal hypotension. Systematic review registration The protocol was prospectively registered with PROSPERO, registration CRD42022381552.

Abstract Ultra‐thin 2D materials have great potential as electrodes for micro‐supercapacitors (MSCs) because of their facile ion transport channels. Here, a high‐precision controllable photonic‐synthesis strategy that provided 1 inch wafer‐scale ultra‐thin film arrays of alloyed WxMo2xSy with sulfur vacancies and expanded interlayer (13.2 Å, twice of 2H MoS2) is reported. This strategy regulates the nucleation and growth of transition metal dichalcogenides (TMDs) on the picosecond or even femtosecond scale, which induces Mo–W alloying, interlayer expansion, and sulfur loss. Therefore, the diffusion barrier of WxMo2xSy is reduced, with charge transfer and ion diffusion enhancing. The as‐prepared symmetric MSCs with the size of 100 × 100 µm2 achieve ultrahigh specific capacitance (242.57 mF cm−2 and 242567.83 F cm−3), and energy density (21.56 Wh cm−3 with power density of 485.13 W cm3). The established synthesis strategy fits numerous materials, which provides a universal method for the flexible synthesis of electrodes in microenergy devices.

Background Neoadjuvant chemoimmunotherapy has a promising effect on locally advanced esophageal squamous cell carcinoma (ESCC). However, reliable biomarkers robustly predicting therapeutic response are still lacking.Methods Formalin-fixed and paraffin-embedded pre-neoadjuvant chemoimmunotherapy biopsy samples from locally advanced ESCC patients were collected. Cohort 1 composed of 66 locally advanced ESCC patients from a prospective clinical trial (NCT04506138) received two cycles of camrelizumab in combination with nab-paclitaxel and carboplatin every 3 weeks. Cohort 2 included 48 patients receiving various types of immune checkpoint inhibitors with (nab-)paclitaxel and platinum-based chemotherapy as neoadjuvant therapy. Cohort 3 consisted of 27 ESCC patients receiving neoadjuvant treatment of toripalimab with chemotherapy and was used as the external validation dataset. Targeted RNA sequencing, immunohistochemistry for programmed death ligand 1 (PD-L1), and multiplex immunofluorescence (mIF) imaging were performed.Results Integration of targeted RNA sequencing, PD-L1 immunohistochemistry, and mIF revealed a significant immune-suppressive microenvironment with higher neutrophil infiltration, enriched TGF-β, and cell cycle pathways in non-pathological complete response (non-pCR) patients. NK, activated CD4+ T cell infiltration, interferon-gamma, antigen processing and presentation, and other immune response signatures were significantly associated with pCR. Based on discovered tumor microenvironmental characteristics and their closely related genes were screened. Consequently, a seven-gene neoadjuvant chemoimmunotherapy risk prediction signature (NCIRPs) model, was constructed. In addition to cohort 1, this model alone or with PD-L1-combined positive score (CPS) demonstrated a higher prediction accuracy of pathological response than PD-L1 CPS or other routinely used immune signatures, such as IFN-γ, in cohorts 2 and 3. Neither prognostic association nor correlation with response to chemoradiotherapy was observed in The Cancer Genome Atlas Program ESCC dataset or in ESCC patients in the neoadjuvant chemoradiotherapy cohort (cohort 4).Conclusion The NCIRPs model that was developed and validated using treatment-naïve endoscopic samples from the largest ESCC neoadjuvant chemoimmunotherapy dataset represents a robust and clinically meaningful approach to select a putative responder for neoadjuvant chemoimmunotherapy in locally advanced ESCC patients.

Abstract The transpedicular procedure has been widely used in spinal surgery. The determination of the best entry point is the key to perform a successful transpedicular procedure. Various techniques have been used to determine this point, but the results are variable. This study was carried out to determine the posterior endpoint of the lumbar pedicle central axis on the standard anterior–posterior (AP) fluoroscopic images. Computer-aided design technology was used to determine the pedicle central axis and the posterior endpoint of the pedicle central axis on the posterior aspect of the vertebra. The standard AP fluoroscopic image of the lumbar vertebral models by three-dimensional printing was achieved. The endpoint projection on the AP fluoroscopic image was determined in reference to the pedicle cortex projection by the measurements of the angle and distance on the established X–Y coordinate system of the radiologic image. The projection of posterior endpoint of the lumbar pedicle central axis were found to be superior to the X-axis of the established X–Y coordinate system and was located on the pedicle cortex projection on the standard AP fluoroscopic image of the vertebra. The projection point was distributed in different sectors in the coordinate system. It was located superior to the X-axis by 18° to 26° at L1, while they were located superior to the X-axis by 12° to 14° at L2 to L5. The projections of posterior endpoints of the lumbar pedicle central axis were located in different positions on the standard AP fluoroscopic image of the vertebra. The determination method of the projection point was helpful for selecting an entry point for a transpedicular procedure with a fluoroscopic technique.

Nowadays, the risk of pesticides to the environment and human health arises with its increasing applications. Bioconcentration Factor (BCF) is utilized to evaluate the potential plant contamination by pesticides from the soil. Large-scale BCF mapping is significant to urban planning, yet it remains challenging. To address this issue, this study integrates the plant uptake model with remote sensing techniques to map BCF considering various land surface properties. Two simplified approaches were developed: the first involves relative humidity and air temperature (RA-model), while the second uses plant transpiration (PT-model). To evaluate these models, BCF mappings generated by each approach were compared and found to be consistent in space and time, with R2 at 0.68 over the continental U.S. Both approaches showed that the eastern part of the U.S. had higher BCF values than the west throughout the year, with an annual cycle of BCF where the highest values occurred in summer and the lowest in winter. To further analyze the impact of BCF on human health, spatial heterogeneity detection was used to examine seven diseases at the county scale. The results suggest that BCF may explain the incidence of spatial heterogeneity of most diseases, specifically high blood pressure (q-value >0.3). Overall, this study demonstrates the potential of integrating plant uptake modeling with remote sensing to map BCF and provides insight into the impact of BCF on human health.

Recycled aggregate concrete is a promising low carbon material, which need further analysis on the durability. To investigate the influence of sulfate erosion on recycled concrete made with high-belite sulfoaluminate cement (HBCSA), this study utilized compressive strength and microhardness test to evaluate the effect of sulfate on ITZ. Then by using backscattered electron imaging, scanning electron microscope and energy spectrometry, the mechanism for the microstructural changes that occurred before and after sulfate erosion is revealed. Results showed that after 60 days of sulfate erosion, both aggregate-new mortar and new–old mortar interfaces display reduced microhardness and widened transition zones. Specifically, in the C30 group post-erosion, the microhardness values for the aggregate-new mortar interface ranged from 50.3 to 66.9 MPa, while the new–old mortar interface exhibited a range of 47–77 MPa. Besides, the new–old mortar interface exhibit marginally superior sulfate resistance to the aggregate–new mortar interface at the same concrete strength grade. Moreover, sulfate resistance improvs across all interfaces with increasing strength class. For instance, in the aggregate-new mortar interface, the maximum microhardness post-erosion for C40 showed a 51.6 % increase compared to C30. Through microstructure analysis, it is found that after sulfate erosion, the aggregate–new mortar and new–old mortar interfaces of HBCSA recycled concrete are both enriched with abundant ettringite and gypsum, which causes considerable swelling erosive product formation and even cracking. The less formed cracks in new–old mortar interfaces results in the better sulfate resistance. The finding is helpful for the future research on the high sulfate resistant recycled aggregate concrete.

This study used recycled aggregate (RA) and mineral additions to design large-pore sandy recycled concrete (LPSRC) using a design porosity (DP) of 25 %, 20 %, and 15 %. Thus, the related effects of recycled coarse aggregate (RCA), recycled fine aggregate (RFA) and fly ash (FA) on the compressive strength, frost resistance (using slow and fast freezing methods), and sulfate attack properties of LPSRC were systematically studied. Moreover, to reduce the error between the design and theoretical porosity values, the bulk density ratio adjustment method was employed to design the theoretical porosity. The results of binarization analysis demonstrated that the deviation of the actual porosity caused by the sidewall effect was ∼2 %, which should be considered during DP design and performance evaluation. The compressive strength of the LPSRC after 56 curing days increased by 35.9 % on average as the DP was reduced from 25 % to 15 %. In a freeze–thaw cycle test, the slow freezing method was more accurate for evaluating the frost resistance of the LPSRC. Under the same conditions, the mass loss rate of the LPSRC calculated using the slow and fast freezing methods was 3.2 % and 7.62 %, respectively. This distinction is pivotal for establishing reliable frost resistance criteria for LPSRC in cold-weather applications, complementing previous research in the field. In terms of sulfate deterioration resistance, compressive strength corrosion factors decreased with increasing DP. Additionally, damage was mainly concentrated at the contact interface between RCA and the cement matrix, while the aggregate itself showed relatively little damage, suggesting RCA application has a positive effect on improving preparation of the LPSRC. Specifically, as DP increased from 15 % to 25 %, the average reduction in the compressive strength corrosion factors for LPSRC after 30 and 60 times of dry–wet cycle were 9.64 % and 8.37 %, respectively, illustrating a clear correlation between higher DP and reduced sulfate resistance. This study contributed to the LPSRC design and production using RCA, RCF and FA, that positively impacts to the sustainable development of the construction industry and helps to evaluate the effectiveness of RA in macroporous concrete. Moreover, the strategic implementation of design porosity has been shown to optimize the structural integrity and performance of the concrete, achieving a balance between strength and workability, which is crucial for the concrete's durability and its ability to adapt to various environmental conditions.

To mitigate environmental damage from mineral aggregate extraction, bio-based materials have garnered research interest as potential replacements for natural mineral aggregates. This work utilized waste wood as filler to prepare lightweight foam concrete with thermal insulation, low-temperature and corrosion resistance properties. The feasibility of using wood aggregate-based foam concrete (WFC) was explored in terms of dry density, softening coefficient, compressive strength, thermal conductivity, chloride ion permeability, freezing resistance, and sulfate attack resistance. Results showed that simultaneous addition of waste wood aggregate (WA) and foam effectively reduced WFC bulk weight and thermal conductivity while enhancing water resistance. However, the porous morphology of WA and foam caused the reduction of mechanical properties. In terms of durability, the addition of WA can increase the energy absorption capacity when WFC is subjected to expansion stress, reduce the damage to the structure, and have an inhibiting effect on the cracking of WFC caused by sulfate attack and freeze-thaw cycles. Nevertheless, WA's high water absorption loosened the matrix in WFC's interfacial transition zone (ITZ), increasing harmful pores and negatively affecting durability. In addition, in order to predict the mechanical properties of WFC and the resistance to sulfate attack, this study established a function model for the relationship between the compressive strength (Maintenance specimens of the same age and Specimen of sulfate attack) and the WA dosage. In conclusion, The use of waste wood for the preparation of WFC is more advantageous and sustainable than conventional foam concrete for the insulation of precast walls and coastal structures.

Abstract Objective An emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes. Method This was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured. Results Of the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed. Conclusion Compared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.

Soil temperature (ST) plays a critical role in ecosystems. Monitoring high-resolution ST profiles remains challenging due to the inherent heterogeneity of ST in space, time, and depth. To address this challenge, in this study, we integrate remote sensing techniques and deep learning methods to retrieve spatiotemporal continuous ST from 2011 to 2020 at four depths (5, 10, 20, and 40 cm) over the central Tibetan Plateau (TP). Landsat and MODIS observations were fused to obtain land surface properties at different resolutions. The fused variables were integrated with in-situ ST and soil moisture (SM) measurements to estimate spatiotemporally continuous (0.0005°, 0.0025°, and 0.0125°) ST profile through deep learning-based training models. The deep belief network (DBN) was applied to estimate ST: (a) from layer to layer (LW-DBN), and (b) from land surface properties directly (Direct-DBN). The ten-fold cross-validation indicates that both approaches achieve promising results (R2 > 0.836, MAE

Although pesticides have been widely used worldwide to enhance crop yield and product quality, most pesticides are harmful to the environment and human health. Plants absorb pesticides mainly from air and soil. Therefore, the soil-plant pathway is essential for pesticide absorption. Bioconcentration factor (BCF) has extensively been applied to evaluate potential plant contamination by pesticides from soil. Hence, this study developed a simplified plant transpiration-based plant uptake model (PT-model) to estimate plant pesticides’ BCF from soil based on plant transpiration. Remote sensing techniques were employed to generate spatiotemporal continuous plant transpiration via evapotranspiration. Pesticide BCF mapping was achieved by integrating PT-model with Moderate Resolution Imaging Spectroradiometer (MODIS) remotely sensed data. The results were compared with a verified model driven by relative humidity and air temperature (RA-model), which has been confirmed by findings from previous studies. The estimated BCF was within the boundaries of the RA-model, indicating the simulation’s overall acceptability. In this study, the BCF temporal trend estimated by the proposed method agreed with the RA-model assimilating meteorology datasets, while the spatial distribution was partially inconsistent. Overall, the proposed method generates the spatiotemporal patterns of pesticide BCF with relatively consistent results supported by previous records and findings.

Abstract Background This study aimed to investigate the effect of the pathological staging of acute histological chorioamnionitis (HCA) on laboratory indicators and to conduct further studies to reassess the threshold values used by clinicians to identify acute HCA in febrile parturients undergoing epidural analgesia. Methods A retrospective study of febrile mothers receiving epidural analgesia at Nanjing Maternal and Child Health Care Hospital from January 1, 2018 to December 31, 2018. The participants were grouped by the progression of acute HCA, and the laboratory parameters were compared between groups. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and monocyte-leukocyte ratio (M%), alone or in combination, to identify acute HCA in febrile parturients undergoing epidural analgesia was assessed using logistic regression and ROC curves. Results The area under the curve (AUC) of the best logistic regression model predicting HCA climbed to 0.706 (CRP + MLR). Maternal CRP, NLR, and MLR significantly and progressively increased with the progression of acute HCA (p

The benchmarking of CO2 emissions serves as the foundation for the accurate assessment of the environmental impact of air traffic. To calculate the environmental benchmarks of arrival traffic flows with Point Merge System (PMS) patterns, this study proposes a 4D trajectory optimization method that combines data-driven and optimal control models. First, the predominant arrival routes of traffic flows are identified using the trajectory spectral clustering method, which provides the horizontal reference for 4D trajectory optimization. Second, an optimal control model for vertical profiles with point merging topology is established, with the objective of minimizing the fuel–time cost. Finally, considering the complex structure of the PMS, a flexible and adaptable genetic algorithm-based vertical profile nonlinear optimization model is created. The experimental results demonstrate that the proposed method is adaptable to variations in aircraft type and cost index parameters, enabling the generation of different 4D trajectories. The results also indicate an environmental efficiency gap of approximately 10% between the actual CO2 emissions of the arrival traffic flow example and the obtained benchmark. With this benchmark trajectory generation methodology, the environmental performance of PMSs and associated arrival aircraft scheduling designs can be assessed on the basis of reliable data.

Mesotrione, topramezone, tembotrione, and sulcotrione are four types of 4-hydroxyphenylpyruvate dioxidase (HPPD) inhibitor herbicides that are extensively employed in agricultural practices, but their usage also leads to environmental pollution and poses risks to human health. A probe (E)−1-((2-(pyridin-2-yl) hydrazineylidene) methyl) naphthalen-2-ol (CHMN) based on chelation enhancement (CHEF) effect synthesized. CHMN was first chelated with Zn2+ to form a probe system with green, which can be further used to detect mesotrione, topramezone, tembotrione and sulcotrione in complicated environment. CHMN-Zn2+ detection of four pesticides was accurate, with an excellent linear relationship between 0 and 100 μM. The detection limits were LODmesotrione = 7.79 μM, LODtopramezone = 1.91 μM, LODtembotrione = 1.38 μM and LODsulcotrione = 2.43 μM. The detection time is 1 min, and it is successfully applied in real water sample and bioimaging. This work can provide a novel method for studying the migration and behavior of environmental pollutants.

Abstract Objective We aimed to evaluate the genotype–phenotype relationship in two Chinese family members with enlarged vestibular aqueduct (EVA). Methods We collected blood samples and clinical data from each pedigree family member. Genomic DNA was isolated from peripheral leukocytes using standard methods. Targeted next‐generation sequencing and Sanger sequencing were performed to find the pathogenic mutation in this family. Minigene assays were used to verify whether the novel intronic mutation SLC26A4c.765+4A>G influenced mRNA splicing. Results Hearing loss in the patients with EVA was diagnosed using auditory tests and imaging examinations. Two pathogenic mutations, c.765+4A>G and c.919‐2A>G were detected in SLC26A4. In vitro minigene analysis confirmed that c.765+4A>G variant could cause aberrant splicing, resulting in skipping over exon 6. Conclusions The SLC26A4c.765+4A>G mutation is the causative variant in the Chinese family with EVA. Particular attention should be paid to intronic variants.

Abstract Head neck squamous cell carcinoma (HNSCC) is one of the most common malignant tumors which ranks the sixth incidence in the world. Although treatments for HNSCC have improved significantly in recent years, its recurrence rate and mortality rate remain high. Myosin genes have been studied in a variety of tumors, however its role in HNSCC has not been elucidated. GSE58911 and GSE30784 gene expression profile analysis were performed to detect significantly dys-regulated myosin genes in HNSCC. The Cancer Genome Atlas (TCGA) HNSCC database was used to verify the dys-regulated myosin genes and study the relationship between these genes and prognosis in HNSCC. The results showed that MYL1, MYL2, MYL3, MYH2, and MYH7 were down-regulated, while MYH10 was up-regulated in patients with HNSCC. Interestingly, MYL1, MYL2, MYH1, MYH2, and MYH7 were shown to be unfavorable prognostic markers in HNSCC. It is also worth noting that MYL1 was a specific unfavorable prognostic biomarker in HNSCC. MYL1, MYL2, MYL3, MYH2, MYH7, and MYH10 promoted CD4 + T cells activation in HNSCC. MYL1 was proved to be down-regulated in HNSCC tissues compared to normal tissues at protein levels. MYL1 overexpression had no effect on proliferation, but significantly promoted migration of Fadu cells. MYL1 increased EGF and EGFR protein expression levels. Moreover, there is a positive correlation between MYL1 expression and Tcm CD8 cells, Tcm CD4 + cells, NK cells, Mast cells, NKT cells, Tfh cells and Treg cells in HNSCC. Overall, MYL1 facilitates tumor metastasis and correlates with tumor immune infiltration in HNSCC and these effects may be associated with the EGF/EGFR pathway.

Physiological signal index can accurately reflect the degree of fatigue, but the contact detection method will greatly affect the driver's driving. This paper presents a non-contact method for detecting tired driving. It uses cameras and other devices to collect information about the driver's face. By recording facial changes over a period and processing the captured video, pulse waves are extracted. Then the frequency domain index and nonlinear index of heart rate variability were extracted by pulse wave characteristics. Finally, the experiment proves that the method can clearly judge whether the driver is tired. In this study, the Imaging Photoplethysmography (IPPG) technology was used to realise non-contact driver fatigue detection. Compared with the non-contact detection method through identifying drivers' blinking and yawning, the physiological signal adopted in this paper is more convincing. Compared with other methods that detect physiological signals to judge driver fatigue, the method in this paper has the advantages of being non-contact, fast, convenient and available for the cockpit environment.

Abstract Background With the application of chromosome microarray, next-generation sequencing and other highly sensitive genetic techniques in disease diagnosis, the detection of mosaicism has become increasingly prevalent. This study involved a retrospective analysis of SNP array testing on 4512 prenatal diagnosis samples, wherein the characterization of mosaicism was explored and insights were gained into the underlying mechanisms thereof. Results Using SNP array, a total of 44 cases of mosaicism were identified among 4512 prenatal diagnostic cases; resulting in a detection rate of approximately 1.0%. The prevalence of mosaicism was 4.1% for chorionic villus sample, 0.4% for amniotic fluid, and 1.3% for umbilical cord blood. Of these cases, 29 were mosaic aneuploidy and 15 were mosaic segmental duplication/deletion. Three cases of mosaic trisomy 16 and three cases of mosaic trisomy 22 were diagnosed in the CVS samples, while four cases of mosaic trisomy 21 were detected in amniotic fluid and umbilical cord blood samples. The distribution pattern of mosaicism suggested trisomy rescue as the underlying mechanism. Structurally rearranged chromosomes were observed, including three cases with supernumerary marker chromosomes, three cases with dicentric chromosomes, and one case with a ring chromosome. All mosaic segmental duplication/deletion cases were the result of mitotic non-disjunction, with the exception of one case involving mosaic11q segmental duplication. Conclusion Improved utilization of SNP arrays enables the characterization of mosaicism and facilitates the estimation of disease mechanisms and recurrence.

With the increasing implementation of early lung cancer screening and the increasing emphasis on physical examinations, the early-stage lung cancer detection rate continues to rise. Visceral pleural invasion (VPI), which denotes the tumor’s breach of the elastic layer or reaching the surface of the visceral pleura, stands as a pivotal factor that impacts the prognosis of patients with non-small cell lung cancer (NSCLC) and directly influences the pathological staging of early-stage cases. According to the latest 9th edition of the TNM staging system for NSCLC, even when the tumor diameter is less than 3 cm, the final T stage remains T2a if VPI is present. There is considerable controversy within the guidelines regarding treatment options for stage IB NSCLC, especially among patients exhibiting VPI. Moreover, the precise determination of VPI is important in guiding treatment selection and prognostic evaluation in individuals with NSCLC. This article aims to provide a comprehensive review of the current status and advancements in studies pertaining to stage IB NSCLC accompanied by VPI.

Summary: Background: The occult lymph node metastasis (LNM) of laryngeal squamous cell carcinoma (LSCC) affects the treatment and prognosis of patients. This study aimed to comprehensively compare the performance of the three-dimensional and two-dimensional deep learning models, radiomics model, and the fusion models for predicting occult LNM in LSCC. Methods: In this retrospective diagnostic study, a total of 553 patients with clinical N0 stage LSCC, who underwent surgical treatment without distant metastasis and multiple primary cancers, were consecutively enrolled from four Chinese medical centres between January 01, 2016 and December 30, 2020. The participant data were manually retrieved from medical records, imaging databases, and pathology reports. The study cohort was divided into a training set (n = 300), an internal test set (n = 89), and two external test sets (n = 120 and 44, respectively). The three-dimensional deep learning (3D DL), two-dimensional deep learning (2D DL), and radiomics model were developed using CT images of the primary tumor. The clinical model was constructed based on clinical and radiological features. Two fusion strategies were utilized to develop the fusion model: the feature-based DLRad_FB model and the decision-based DLRad_DB model. The discriminative ability and correlation of 3D DL, 2D DL and radiomics features were analysed comprehensively. The performances of the predictive models were evaluated based on the pathological diagnosis. Findings: The 3D DL features had superior discriminative ability and lower internal redundancy compared to 2D DL and radiomics features. The DLRad_DB model achieved the highest AUC (0.89–0.90) among all the study sets, significantly outperforming the clinical model (AUC = 0.73–0.78, P = 0.0001–0.042, Delong test). Compared to the DLRad_DB model, the AUC values for the DLRad_FB, 3D DL, 2D DL, and radiomics models were 0.82–0.84 (P = 0.025–0.46), 0.86–0.89 (P = 0.75–0.97), 0.83–0.86 (P = 0.029–0.66), and 0.79–0.82 (P = 0.0072–0.10), respectively in the study sets. Additionally, the DLRad_DB model exhibited the best sensitivity (82–88%) and specificity (79–85%) in the test sets. Interpretation: The decision-based fusion model DLRad_DB, which combines 3D DL, 2D DL, radiomics, and clinical data, can be utilized to predict occult LNM in LSCC. This has the potential to minimize unnecessary lymph node dissection and prophylactic radiotherapy in patients with cN0 disease. Funding: National Natural Science Foundation of China, Natural Science Foundation of Shandong Province.

BackgroundThe influences of blood lipids and lipid-regulatory medications on the risk of bladder cancer have long been suspected, and previous findings remain controversial. We aimed to assess the causality between blood lipids or lipid-regulatory medications and bladder cancer susceptibility by means of a comprehensive Mendelian Randomization (MR) study.MethodsGenetic proxies from genome-wide association studies (GWAS) of four blood lipid traits and lipid-lowering variants in genes encoding the targets of lipid-regulatory medications were employed. The largest ever GWAS data of blood lipids and bladder cancer involving up to 440,546 and 205,771 individuals of European ancestry were extracted from UK Biobank and FinnGen Project Round 6, respectively. A two-sample bidirectional MR study was performed using the inverse variance weighted as the main method. The heterogeneity, horizontal pleiotropy, MR Steiger, and leave-one-out analyses were also conducted as sensitivity tests.ResultsThere was indicative evidence that genetically predicted low-density lipoprotein cholesterol (LDL-C) affected bladder cancer susceptibility based on 146 single nucleotide polymorphisms (SNPs) with an odds ratio (OR) of 0.776 (95% confidence interval [CI] = 0.625–0.965, p = 0.022). However, this result became non-significant after two SNPs that possibly drove the effect were removed as demonstrated by leave-one-out analysis. The reversed MR analysis suggested that bladder cancer could not affect serum lipid levels. No causal relationship was found between the lipid-lowering effect of lipid-regulatory medications (fibrates, probucol, statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors, and evinacumab) and the risk of bladder cancer. No heterogeneity or pleiotropy was found (all p > 0.05).ConclusionThis MR study revealed for the first time, using the most recent and comprehensive GWAS data to date, that genetically predicted total cholesterol (TC) and the lipid-lowering effect of lipid-regulatory medications had no causal association with bladder cancer susceptibility. We also verified claims from early studies that low-density lipoprotein cholesterol (HDL-C), LDL-C, and triglyceride (TG) are not related to bladder cancer susceptibility either. The current study indicated that lipid metabolism may not be as important in the tumorigenesis of bladder cancer as previously believed.

ObjectiveAs the frontoparietal network underlies recovery from coma, a limited frontoparietal montage was used, and the prognostic values of EEG features for comatose patients were assessed.MethodsCollected with a limited frontoparietal EEG montage, continuous EEG recordings of 81 comatose patients in ICU were used retrospectively. By the 60-day Glasgow outcome scale (GOS), the patients were dichotomized into favorable and unfavorable outcome groups. Temporal-, frequency-, and spatial-domain features were automatically extracted for comparison. Partial correlation analysis was applied to eliminate redundant factors, and multiple correspondence analysis was used to explore discrimination between groups. Prognostic characteristics were calculated to assess the performance of EEG feature-based predictors established by logistic regression. Analyses were performed on all-patients group, strokes subgroup, and traumatic brain injury (TBI) subgroup.ResultsBy analysis of all patients, raised burst suppression ratio (BSR), suppressed root mean square (RMS), raised power ratio of β to α rhythm (β/α), and suppressed phase-lag index between F3 and P4 (PLI [F3, P4]) were associated with unfavorable outcome, and yielded AUC of 0.790, 0.811, 0.722, and 0.844, respectively. For the strokes subgroup, the significant variables were BSR, RMS, θ/total, θ/δ, and PLI (F3, P4), while for the TBI subgroup, only PLI (F3, P4) was significant. BSR combined with PLI (F3, P4) gave the best predictor by cross-validation analysis in the all-patients group (AUC = 0.889, 95% CI: 0.819–0.960).ConclusionFeatures extracted from limited frontoparietal montage EEG served as valuable coma prognostic tools, where PLI (F3, P4) was always significant. Combining PLI (F3, P4) with features in other domains may achieve better performance.SignificanceA limited-montage EEG coupled with an automated algorithm is valuable for coma prognosis.

Background: Propofol combined with alfentanil is suitable for intravenous anesthesia for day-case hysteroscopy. Objective: To investigate the median effective dose (ED 50 ) and 95% effective dose (ED 95 ) of alfentanil compounded with propofol for day-case hysteroscopy. Design: In all, 29 patients who volunteered for painless hysteroscopy in 2022 were recruited. 1.5 mg/kg propofol was given as a sedative to all patients. The trial was conducted using the modified Dixon sequential method, with an initial dose of 10 μg/kg of alfentanil, and the subject’s alfentanil dose depended on whether the prior hysteroscopy had failed, which was defined as inadequate cervical dilatation and hysteroscope placement with the patient exhibiting body movement, frowning, or a MOAA/S score >1. If the hysteroscopy failed (i.e. a positive response), the subsequent subject’s alfentanil dosage was raised, and conversely (i.e. a negative response), the dose was decreased, with the adjacent dose ratio always being 1:1.2. The formal test begins with the first crossover wave and lasts until seven crossover waves materialize. Methods: The probit method was used to calculate the ED 50 , ED 95 , and corresponding 95% confidence intervals (CIs) of alfentanil compounded with propofol for hysteroscopy. Results: The ED 50 and ED 95 of alfentanil combined with propofol for day-case hysteroscopy were 5.701 (95% CI: 3.841–7.069) μg/kg and 8.817 (95% CI: 7.307–20.868) μg/kg, respectively. Conclusion: Alfentanil at 8.817 μg/kg in conjunction with propofol is a successful and safe approach for day-case painless hysteroscopy. Trial registration: The trial registry name: Modified sequential method to determine the half-effective dose of alfentanil compounded with propofol for ambulatory hysteroscopy. The URL of registration is https://www.chictr.org.cn/showproj.html?proj=171786 , where the full trial protocol can be accessed. Registration number: ChiCTR2200061619.

Abstract Achieving controllable fine-tuning of defects in catalysts at the atomic level has become a zealous pursuit in catalysis-related fields. However, the generation of defects is quite random, and their flexible manipulation lacks theoretical basis. Herein, we present a facile and highly controllable thermal tuning strategy that enables fine control of nanodefects via subtle manipulation of atomic/lattice arrangements in electrocatalysts. Such thermal tuning endows common carbon materials with record high efficiency in electrocatalytic degradation of pollutants. Systematic characterization and calculations demonstrate that an optimal thermal tuning can bring about enhanced electrocatalytic efficiency by manipulating the N-centered annulation–volatilization reactions and C-based sp 3/sp 2 configuration alteration. Benefiting from this tuning strategy, the optimized electrocatalytic anodic membrane successfully achieves >99% pollutant (propranolol) degradation during a flow-through (~2.5 s for contact time), high-flux (424.5 L m−2 h−1), and long-term (>720 min) electrocatalytic filtration test at a very low energy consumption (0.029 ± 0.010 kWh m−3 order−1). Our findings highlight a controllable preparation approach of catalysts while also elucidating the molecular level mechanisms involved.

Intrusion detection systems can detect potential attacks and raise alerts on time. However, dimensionality curses and zero-day attacks pose challenges to intrusion detection systems. From a data perspective, the dimensionality curse leads to the low efficiency of intrusion detection systems. From the attack perspective, the increasing number of zero-day attacks overwhelms the intrusion detection system. To address these problems, this paper proposes a novel detection framework based on light gradient boosting machine (LightGBM) and autoencoder. The recursive feature elimination (RFE) method is first used for dimensionality reduction in this framework. Then a focal loss (FL) function is introduced into the LightGBM classifier to boost the learning of difficult samples. Finally, a two-stage prediction step with LightGBM and autoencoder is performed. In the first stage, pre-decision is conducted with LightGBM. In the second stage, a residual is used to make a secondary decision for samples with a normal class. The experiments were performed on the NSL-KDD and UNSWNB15 datasets, and compared with the classical method. It was found that the proposed method is superior to other methods and reduces the time overhead. In addition, the existing advanced methods were also compared in this study, and the results show that the proposed method is above 90% for accuracy, recall, and F1 score on both datasets. It is further concluded that our method is valid when compared with other advanced techniques.