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Abstract Objective The objective of this study was to examine the psychometric properties of the EQ-5D-Y-3 L, Patient Reported Outcomes Measurement System 25-item version profile v2.0 (PROMIS-25), and Pediatric Quality of Life Inventory™ version 4.0 Generic Core Scale (PedsQL 4.0) in Chinese pediatric patients with spinal muscular atrophy (SMA). Methods The data used in this study were obtained via a web-based cross-sectional survey. Parents of pediatric patients with SMA completed the proxy-reported EQ-5D-Y-3 L, PedsQL 4.0, and PROMIS-25 measures. Information about socioeconomic and health status was also obtained. The ceiling and floor effects, factorial structure, convergent validity, and known-group validity of the three measures were assessed. Results Three hundred and sixty-three parents of children aged from 5 to 12 completed the questionnaires. Strong floor effects were observed for the physical function components of the PROMIS-25 (41.3%) and PedsQL 4.0 (67.8%). For EQ-5D-Y-3 L, 84.6% of the respondents reported having “a lot of” problems with the dimensions “walking” and “looking after myself.” Minimal ceiling or floor effects were observed for the EQ-5D-Y-3 L index value. The confirmatory factor analysis supported a six-factor structure for the PROMIS-25, but did not support a four-factor structure for the PedsQL 4.0. All hypothesized correlations of the dimensions among the three measures were confirmed, with coefficients ranging from 0.28 to 0.68. Analysis of variance showed that EQ-5D-Y-3 L demonstrated better known-group validity than the other two measures in 14 out of 16 comparisons. Conclusions The EQ-5D-Y-3 L showed better discriminant power than the other two measures. The physical health dimensions of all three measures showed the significant floor effects. These findings provide valuable insights into the effectiveness of these measures at capturing and quantifying the impact of SMA on patients’ health-related quality of life.

Abstract Background Although it is widely acknowledged that access to civil justice (ATJ) is a key social determinant of health (SDOH), the existing literature lacks empirical evidence supporting ATJ as a SDOH for specific dimensions of health. Methods A legal epidemiological, cross-sectional, postal survey was conducted on n = 908 randomly sampled participants in Hong Kong in March 2023. Data collected were perceptions of the civil justice system, health, and sociodemographics. Perceived ATJ was assessed using a modified version of the Inaccessibility of Justice scale (IOJ) and Perceived Inequality of Justice scale (PIJ), i.e. the “modified IOJ-PIJ”, consisting of 12 of the original 13 items from both scales divided into two subdomains: “procedural fairness”, and “outcome neutrality”. For health data, quality of life was assessed using the Hong Kong version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF(HK)), psychological distress (including symptoms of anxiety and depression) was assessed using the four-Item Patient Health Questionnaire (PHQ-4), and having comorbidities was assessed using Sangha’s Self-Administered Comorbidity Questionnaire (SCQ). Structural equation modelling (SEM) was used to investigate the relationships between perceived ATJ and the measured health outcomes. Results SEM demonstrated that both subdomains for ATJ had significantly negative associations (B 0; p 0; p

Solemyidae is an ancient group of protobranch bivalves that typically inhabit unusual environments, such as deep-sea chemosynthetic environments, and are symbiotic with chemoautotrophic and gill-hosted bacteria. In May 2018, a living solemyid bivalve was collected using a remotely operated vehicle at a depth of 1,390 m from the Haima cold seep in the northwestern slope of the South China Sea. Through a comprehensive taxonomic approach combining morphological observations and molecular phylogeny reconstruction of concatenated mitochondrial COI,16S rRNA and 18S rRNA gene sequences, a new species, Acharax haimaensis sp. nov. is identified and described. The discovery of this new species contributes to the diversity of known solemyids in deep-sea chemosynthetic environments.

Abstract Background Myasthenia gravis (MG), a rare chronic neuromuscular disorder, is characterized by progressive physical decline and requires long-term pharmacological treatment. Due to the decline of physical and social abilities, MG patients are in great need of social support, including tangible and emotional support. This study aims to examine the association between social support and medication adherence and the possible mediating effects of mental health and self-efficacy among MG patients. Methods A cross-sectional analysis of a nationwide MG registry was conducted on 865 patients under oral medication treatment in China between June and July 2022. Validated scales were used to measure the respondent’s mental distress (Four-item Patient Health Questionnaire), social support (Modified Medical Outcomes Study Social Support Scale), self-efficacy for medication use (Self-efficacy for Appropriate Medication Use Scale), and medication adherence (Morisky Medication Adherence Scale, MMAS). Results The association between social support and medication adherence and possible mediating effects of mental distress and self-efficacy were tested by structural equation model, with significant demographic and disease-related factors adjusted. The respondents showed a very low level of medication adherence (71.2% poor adherence; 1.4% high adherence; mean MMAS = 4.65). The level of social support was positively associated with medication adherence, and such association was fully mediated by two indirect pathways: through self-efficacy (β = 0.07, proportion mediated = 63.8%); and through mental distress and then self-efficacy (β = 0.01, proportion mediated = 6.7%). Conclusion Provision of social support and interventions on mental health with emphasis on improving self-efficacy for medication use may effectively improve medication adherence among MG patients.

BackgroundRare diseases (RDs) affect millions of individuals collectively worldwide, contributing to significant burdens on patients and families in various aspects. However, there is a lack of evidence on the underlying patterns of burdens among diverse RDs for informing targeted social and health policies to address the unmet needs of this vulnerable population. ObjectiveThis study aimed to examine the underlying patterns of the health and economic burden of 33 different RDs in China and identify the potential determinants. MethodsA nationwide internet-based cross-sectional survey was conducted in China between 2019 and 2020. Physical and mental health burden was measured by health-related quality of life. Economic burden was evaluated based on the proportions of direct medical, direct nonmedical, and indirect costs relative to household income. We used cluster analysis to identify patterns of health and economic burdens and conducted multinomial logistic regression to explore potential predictors of cluster membership. ResultsThe study included 8454 adults and 8491 children affected by 33 RDs. The following 3 clusters were identified: “extremely high burden” (representing 92/8454, 1.1% and 19/8491, 0.2% of adult and pediatric patients, respectively), “overall high burden” (5933/8454, 70.2% and 4864/8491, 57.3%, respectively), and “overall low burden” (2429/8454, 28.7% and 3608/8491, 42.5%, respectively). Wilson disease, Marfan syndrome, and Langerhans cell histiocytosis more likely resulted in an “extremely high burden” than others. Poverty was significantly associated with being in this extremely high burden group. Diseases causing neuromuscular symptoms and requiring long-term treatment (eg, amyotrophic lateral sclerosis, spinocerebellar ataxia, and Dravet syndrome) were prevalent in the “overall high burden” group. Key predictors of this group included older age, lower socioeconomic status, diagnostic delay, and comorbidity. ConclusionsThis study provides novel and valuable evidence on the burden of RDs in developing regions like China. The findings reveal significant disparities in the impact of RDs, emphasizing the need for targeted health care interventions and policies.

BackgroundElectronic mental health literacy (eMHL) is critical for accessing and effectively using digital mental health resources. However, there is a paucity of research on how eMHL varies across age groups. ObjectiveThis study aimed to investigate differences in eMHL among young, middle-aged, and older adults; provide insights into the needs, behaviors, and attitudes of different age groups in relation to digital mental health resources; and ultimately, inform the improvement of mental health services. MethodsA qualitative investigation was conducted to examine the differences in eMHL across different age demographics in the Chinese population in 2023. The study sample comprised 3 distinct age groups: 18-34 years, 35-64 years, and 65 years and older. Participants were recruited through purposive sampling to ensure a diverse representation of the population. Data were collected through semistructured one-on-one interviews, which allowed for in-depth exploration of individual experiences and perceptions. The gathered data were subsequently subjected to rigorous thematic analysis to enable the identification and interpretation of recurring patterns and themes. ResultsThe principal outcomes derived from these interviews were synthesized into 5 distinct dimensions: emotional needs, use of digital mental health resources, assessment of digital mental health information, engagement with social media to regulate emotions, and coping strategies. These dimensions were uniformly observed across the 3 age groups. ConclusionsWe identified differences in knowledge, skills, and attitudes regarding the use of web-based information for managing mental health problems between the 3 age groups. The findings highlight the importance of age-specific strategies for improving eMHL.

Objective This study aimed to develop and validate robust predictive models for patients with oesophageal cancer who achieved a pathological complete response (pCR) and those who did not (non-pCR) after neoadjuvant therapy and oesophagectomy.Design Clinicopathological data of 6517 primary oesophageal cancer patients who underwent neoadjuvant therapy and oesophagectomy were obtained from the National Cancer Database for the training cohort. An independent cohort of 444 Chinese patients served as the validation set. Two distinct multivariable Cox models of overall survival (OS) were constructed for pCR and non-pCR patients, respectively, and were presented using web-based dynamic nomograms (graphical representation of predicted OS based on the clinical characteristics that a patient could input into the website). The calibration plot, concordance index and decision curve analysis were employed to assess calibration, discrimination and clinical usefulness of the predictive models.Results In total, 13 and 15 variables were used to predict OS for pCR and non-pCR patients undergoing neoadjuvant therapy followed by oesophagectomy, respectively. Key predictors included demographic characteristics, pretreatment clinical stage, surgical approach, pathological information and postoperative treatments. The predictive models for pCR and non-pCR patients demonstrated good calibration and clinical utility, with acceptable discrimination that surpassed that of the current tumour, node, metastases staging system.Conclusions The web-based dynamic nomograms for pCR (https://predict-survival.shinyapps.io/pCR-eso/) and non-pCR patients (https://predict-survival.shinyapps.io/non-pCR-eso/) developed in this study can facilitate the calculation of OS probability for individual patients undergoing neoadjuvant therapy and radical oesophagectomy, aiding clinicians and patients in making personalised treatment decisions.

Abstract Background Noninvasive biomarkers for the assessment of response to chemotherapy in advanced breast cancer (BCa) are essential for optimized therapeutic decision-making. We evaluated the potential of soluble Periostin (POSTN) in circulation as a novel biomarker for chemotherapy efficacy monitoring. Methods Two hundred and thirty-one patients with different stages of BCa were included. Of those patients, 58 patients with inoperable metastatic disease receiving HER2-targeted or non-targeted chemotherapy were enrolled to assess the performances of markers in recapitulating the chemotherapy efficacy assessed by imaging. POSTN, together with CA153 or CEA at different time points (C0, C2, and C4) were determined. Results POSTN levels were significantly associated with tumor volume (P

Abstract The molecular profiles and tumor immune microenvironment (TIME) of multiple primary lung cancers (MPLCs) presenting as concurrent lung adenocarcinoma (ADC) and squamous cell carcinoma (SQCC) remain unknown. We aimed to clarify these factors. We performed whole-exome sequencing (WES), RNA sequencing (RNA-Seq), and multiplex immunohistochemistry (mIHC) for five patients with concurrent ADC and SQCC. We found the genetic mutations were similar between ADC and SQCC groups. RNA-Seq revealed that the gene expression and pathways enriched in ADC and SQCC groups were quite different. Gene set enrichment analysis (GSVA) showed that nine gene sets were significantly differentially expressed between the ADC and SQCC groups (p

PCB layouts with different polygon shapes and insulation distances were prepared and their surface flashover voltage subjected to different ramping rates were measured at different temperatures and different low gas pressures for emulated high-altitude conditions. The dependence of the surface flashover voltage on effects of gas pressure, surface insulation distance, temperature, and polygon shape was studied. Modulation efforts which include tailoring the local surface conductivity and local topography modification were performed to increase the flashover of PCB, and the related mechanism was studied. The results showed that the voltage ramping rate plays an important role in determining flashover voltage. The flashover voltage is lower when the sample is subjected to a rapid voltage ramping rate than with a slow ramping rate. This phenomenon is more prominent towards ambient pressure. The increase in temperature results in a decrease in flashover voltage at 100 kPa, while at 20 kPa and 10 kPa, the influence of temperature on flashover becomes less significant. Through-holes designed in the PCB have a positive role in increasing flashover voltage at lower pressures. However, at 100 kPa, the holes no longer contribute to any higher flashover voltage. Modification of local surface conductivity has no contribution in increasing the flashover voltage, while a surface coating with a surface conductivity of $10^{-10}$ S dramatically decreases the flashover voltage. The work presented in this paper provides a reference for the design and modification of PCB layouts for use in future aerospace hybrid propulsion systems.

Background Given the rapid advancement in technology, the Internet has grown to play a significant role in the field of healthcare. Individuals can now access a profusion of easily available materials for self-management of their health. The purpose of this review is to describe Web/App-based interventions that are primarily or secondarily designed to improve mental health literacy (MHL) and to investigate the effectiveness of online interventions for improving mental health. Materials and Method A scoping review was conducted by searching five databases: PsycINFO, EMBASE, PubMed, CINAHL, and Web of Science. The search was limited to peer-reviewed journals published in English between 2000 and 2022. Studies focusing on enhancements of MHL or its constituent components were included. Results Twenty-four studies met the inclusion criteria. The interventions primarily targeted patients or individuals exhibiting symptoms of mental disorders, with a higher representation of female participants. All the interventions yielded positive outcomes. The included studies were categorized according to three themes: knowledge, attitude, and self-care skills. Although numerous studies have focused on knowledge improvement, research on interventions targeting self-care skills is scarce. Furthermore, existing literature on knowledge enhancement is limited in terms of the coverage of risk factors. Conclusion This review indicates gaps in web/app interventions including limited evidence on risk factors, inconsistent help-seeking awareness, and inadequate self-care skills training. Further research is critically needed to address these deficiencies and promote comprehensive MHL.

Background The economic burden of Pompe disease (PD) is under-researched. This study aimed to fill this gap and provide evidence-based suggestions for policy improvement based on policy simulation.Methods Data were derived from a nationally based cross-sectional survey on rare diseases in early 2018. Answers from 92 PD patients were used for data analysis and simulation. Catastrophic health expenditure (CHE) and impoverishment due to illness (IDI) were adopted to measure PD patients’ economic burden. Two typical reimbursement patterns, a dosage-based model and a cost-based model, in China were simulated.Results Twenty-four pediatric and 68 adult PD patients were investigated. Families with pediatric PD patients on average had lower annual household incomes than families with adult PD patients (RMB 37 890 vs. RMB 66 120). The direct medical expense and out-of-pocket expenses were almost double for pediatric patients compared with adult patients (RMB 120 050 vs. RMB 66 350; RMB 112 710 vs. RMB 57 940, respectively). The direct non-medical expense for patients was almost six times the expense of adult patients (RMB 73 790 vs. RMB 13 080, respectively). About 88.24% of families with pediatric PD patients and 67.21% of families with adult PD patients suffered from CHE. Around 84.21% of families with pediatric PD patients and 45.90% of families with adult PD patients were forced to live in poverty due to illness. The simulation indicated that, although the two current reimbursement schemes helped reduce CHE, they almost had no effect on reducing IDI; the dosage-based model was more sensitive to changes in policy parameters.Conclusion Our study highlighted the alarmingly high disease burden faced by PD patients with first-hand patientreported evidence. Our series of simulations could be a good reference for China and other countries to improve their reimbursement policy regarding PD.

Abstract Objectives Spinal muscular atrophy (SMA) is a rare monogenic neuromuscular disorder caused by loss of function mutations. Measuring health-related quality of life to support economic evaluations in this population is encouraged. However, empirical evidence on the performance of preference-based measures (PBMs) in individuals with SMA is limited. This study aimed to assess the psychometric properties of the EQ-5D-5L and the Patient-Reported Outcomes Measure Information System Preference measure (PROPr) in individuals with SMA. Methods The data used in this study were obtained via a web-based, cross-sectional survey. All participants completed the self-reporting EQ-5D-5L and PROMIS-29 questionnaires. Information about their socioeconomic and health status was also obtained. Ceiling and floor effects, convergent and divergent validity, known-group validity, and the agreement between the two measures were assessed. Results Strong ceiling and floor effects were observed for four dimensions of the EQ-5D-5L and three subscales, including pain intensity, pain interference, and physical function, of the PROMIS-29. All hypothesized associations between EQ-5D-5L/PROMIS-29 and other neuromuscular questions were confirmed, supporting good convergent validity. Moreover, both EQ-5D-5L and PROPr scores differentiated between impaired functional groups, demonstrating good discriminative ability. Poor agreement between the EQ-5D-5L and PROPr utility scores was observed. Conclusions The EQ-5D-5L and PROPr both appear to be valid PBMs for individuals with SMA. However, PROPr yielded considerably lower utility scores than EQ-5D-5L and their agreement was poor. Therefore, these two PBMs may not be used interchangeably in economic evaluations of SMA-related interventions.

Abstract Skin wound healing often leads to scar formation, presenting physical and psychological challenges for patients. Advancements in messenger RNA (mRNA) modifications offer a potential solution for pulsatile cytokine delivery to create a favorable wound‐healing microenvironment, thereby preventing cutaneous fibrosis. This study aimed to investigate the effectiveness of human adipose‐derived stem cells (hADSCs) enriched with N1‐methylpseudouridine (m1ψ) modified transforming growth factor‐β3 (TGF‐β3) and interleukin‐10 (IL‐10) mRNA in promoting scar‐free healing in preclinical models. The results demonstrated that the modified mRNA (modRNA)‐loaded hADSCs efficiently and temporarily secreted TGF‐β3 and IL‐10 proteins. In a dorsal injury model, hADSCs loaded with modRNA TGF‐β3 and IL‐10 exhibited multidimensional therapeutic effects, including improved collagen deposition, extracellular matrix organization, and neovascularization. In vitro experiments confirmed the ability of these cells to markedly inhibit the proliferation and migration of keloid fibroblasts, and reverse the myofibroblast phenotype. Finally, collagen degradation mediated by matrix metalloproteinase upregulation was observed in an ex vivo keloid explant culture model. In conclusion, the synergistic effects of the modRNA TGF‐β3, IL‐10, and hADSCs hold promise for establishing a scar‐free wound‐healing microenvironment, representing a robust foundation for the management of wounds in populations susceptible to scar formation.

Abstract Background Alternative splicing complexity plays a vital role in carcinogenesis and cancer progression. Improved understanding of novel splicing events and the underlying regulatory mechanisms may contribute new insights into developing new therapeutic strategies for colorectal cancer (CRC). Methods Here, we combined long-read sequencing technology with short-read RNA-seq methods to investigate the transcriptome complexity in CRC. By using experiment assays, we explored the function of newly identified splicing isoform TIMP1 Δ4-5. Moreover, a CRISPR/dCasRx-based strategy to induce the TIMP1 exon 4–5 exclusion was introduced to inhibit neoplasm growth. Results A total of 90,703 transcripts were identified, of which > 62% were novel compared with current transcriptome annotations. These novel transcripts were more likely to be sample specific, expressed at relatively lower levels with more exons, and oncogenes displayed a characteristic to generate more transcripts in CRC. Clinical outcome data analysis showed that 1472 differentially expressed alternative splicing events (DEAS) were tightly associated with CRC patients’ prognosis, and many novel isoforms were likely to be important determinants for patient survival. Among these, newly identified splicing isoform TIMP1 Δ4-5 was significantly downregulated in CRC. Further in vitro and in vivo assays demonstrated that ectopic expression of TIMP1 Δ4-5 significantly suppresses tumor cell growth and metastasis. Serine/arginine-rich splicing factor 1 (SRSF1) acts as a onco-splicing regulator through sustaining the inclusion of TIMP1 exon 4–5. Furthermore, CRISPR/dCasRx-based strategies designed to induce TIMP1 exon 4–5 exclusion have the potential to restrain the CRC growth. Conclusions This data provides a rich resource for deeper studies of gastrointestinal malignancies. Newly identified splicing isoform TIMP1 Δ4-5 plays an important role in mediating CRC progression and may be a potential therapy target in CRC.

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a newly defined refractory adult-onset autoinflammatory syndrome caused by somatic mutations in the ubiquitin-like modifier-activating enzyme 1 (UBA1) gene in hematopoietic stem and progenitor cells, resulting in a shift in UBA1 isoform expression. Thus, patients develop a spectrum of systemic inflammatory manifestations and hematologic symptoms. To date, patients respond poorly to immune suppressive drugs, except high-dose glucocorticoids, and no treatment guidelines have been established. Given the high mortality rate, VEXAS syndrome needs to be taken seriously by physicians in all specialties. This article aims to describe the key features, pathogenesis, and clinical manifestations of VEXAS syndrome to better understand the targeted treatment and improve the prognosis of VEXAS syndrome.

BackgroundThe urban heat island effect has a significant negative impact on human health. Urban green space can effectively improve the urban thermal environment while enhancing human thermal comfort. ObjectiveTo investigate the effects of vegetation configuration structure on temperature and humidity and on human thermal comfort, with a view to providing reference for the landscape planning of urban reserve, preventing and reducing the impact of urban heat island effect on the health of urban residents. MethodsThe study was carried out on a typical clear and cloudless summer day without extreme weather in a university reserve area in Hefei. The numerical simulation accuracy of ENVI-met software was verified by measured data. Based on the quantitative definition of vegetation configuration structure scheme from vertical and horizontal perspectives, nine simulation scenarios were established based on three aspects including vegetation configuration type (grass, shrub + grass, tree + grass, tree + shrub + grass), planting layout (column planting, uniform spot planting), and planting density [the aspect ratio of trees (ART) between plants was 0.75, 1.13, 1.50, and 2.25, respectively] to quantitatively evaluate the cooling and humidifying effects and human thermal comfort [physiological equivalent temperature (PET)] of the vegetation configurations. ResultsThe change trends of the cooling and humidifying effects of all the simulated scenarios were consistent, basically first increasing and then decreasing. Among all the simulated scenarios, the cooling and humidifying effects of scenario 8 (tree + grass, ART=2.25, uniform spot planting) were the best, with the greatest cooling of 1.36 ℃ and humidification of 6.29% in comparison to the worst scenario 1 in the reserve area. The human thermal comfort of scenario 9 (tree + shrub + grass, ART=2.25, uniform spot planting) was the best, with the PET of 35.37 ℃. The order of improvement effect of different vegetation configurations on thermal comfort from strong to weak was tree + shrub + grass structure (scenario 9) > tree + grass structure (scenario 8) > shrub + grass structure (scenario 2) > grass structure (scenario 1). At 15:00, the PET value of tree + shrub + grass structure (scenario 9) decreased by 7.44 ℃ in comparison to that of grass structure (scenario 1). The higher the planting density among trees, the higher the difference in temperature and relative humidity between the simulated and the original scenarios. In case of holding the same amount of greenery, uniform spot planting showed better human comfort when the vegetation was planted sparsely, but the difference between the PET value of scenario 3 (tree + grass, ART=0.75, uniform spot planting) and scenario 5 (tree + grass, ART=1.5, column planting) was only 0.15 ℃; when the vegetation was planted densely, column planting was more favorable to wind circulation and more effective in reducing the temperature of the site, with a lower PET value of 0.87 ℃ for scenario 7 (tree + grass, ART=2.25, column planting) than for scenario 4 (tree + grass, ART=1.13, uniform spot planting). ConclusionUrban green space has obvious cooling and humidifying effects in summer. The human comfort of tree + shrub + grass structure with uniform spot planting is optimal, and the cooling and humidifying effects of tree + grass structure with uniform spot planting are the most obvious. The optimization of vegetation configuration structure is crucial for reducing urban heat island, improving human thermal comfort, and promoting residents’ health.

Abstract Background Early neurological deterioration (END) sometimes occurs in patients with penetrating artery territory infarction (PATI) and leads to poor prognosis. In this study, we analyzed clinical and neuroimaging characteristics of PATI, and focused on the infarct patterns on diffusion-weighted imaging (DWI). We tried to investigate whether the “island sign” pattern is associated with END. Methods We enrolled consecutive patients admitted with acute PATI within 48 h after onset from May 2020 to July 2022. They were divided into with and without the “island sign” pattern on DWI. According to infarct location, all the patients were classified into two groups: the territories of the lenticulostriate arteries (LSA) and paramedian pontine arteries (PPA). The patients in each group were further divided into two groups according to whether they developed END or not. Through analyzing the clinical and neuroimaging characteristics of the patients, we tried to identify the factors that might associated with the “island sign” pattern and the potential predictors of END within the LSA and PPA groups. Results Out of the 113 patients enrolled in this study, END was found in 17 patients (27.9%) in the LSA group and 20 patients (38.5%) in the PPA group. The “island sign” was found in 26 (23%) patients. In the multivariate analysis, the independent predictors of END in the LSA group were the “island sign” (OR 4.88 95% CI 1.03–23.2 P = 0.045) and high initial National Institute of Health Stroke Scale (NIHSS) (OR 1.79 95% CI 1.08–2.98 P = 0.024) and in the PPA group was the presence of lesions extending to the ventral pontine surface (OR 7.53 95% CI 1.75–32.37 P = 0.007). Conclusions The predictive factors for END were different in the LSA and PPA groups. The “island sign” was particularly associated with END in the LSA group.

Photo-assisted SCR (PSCR) offers a potential solution for removal of NO at room temperature. MnTiOx as PSCR catalyst exhibits superior performance with NO removal of 100% at the room temperature. Electron paramagnetic resonance (EPR) analysis revealed the presence of numerous oxygen vacancies on MnTiOx. Optical carrier density functional theory (DFT) calculations showed that the three-dimensional orbital hybridization of Mn and Ti is significantly enhanced under light irradiation. The MnTiOx catalyst exhibited excellent electron–hole separation ability, which can adsorbe NH3 and dissociate to form NH2 fragments and H atoms. In-situ diffuse reflectance infrared fourier-transform spectroscopy (DRIFTS) indicated that the optical carrier enhanced NH3 adsorption on MnTiOx, which makes it possess excellent PSCR activity. This work provided an additional strategy to NO removal with PSCR catalysts and showed potential for use in photocatalysis.

Abstract Objective This study assesses the association between health-related quality of life (HRQoL) for pediatric patients with osteogenesis imperfecta (OI) and their caregivers’ eHealth literacy (eHL), financial well-being, and mental health along with the impact of eHealth literacy on the financial well-being and mental health of OI caregivers. Methods Participants were recruited from a member pool of two OI patient organizations in China. Information about patients’ HRQoL and their caregivers’ eHL, financial well-being, and mental health was collected. Structure equation modeling (SEM) was used to estimate the relationship between the measures. The robust weighted least square mean and variance adjusted estimator was used. Three criteria, the comparative fit index, the Tucker-Lewis index, and the root mean square error of approximation, were used to evaluate the goodness-of-fit of the model. Results A total of 166 caregivers completed the questionnaires. Around 28.3% indicated that pediatric OI patients experienced problems related to mobility, and 25.3% reported difficulty doing usual activities. Around 52.4% of caregivers reported that their care receivers have some emotional problems while 8.4% reported that their care receivers have “a lot of” emotional problems. ‘Some problems’ on all dimensions on EQ-5D-Y was the most frequently reported health state (13.9%), and around 10.0% have no problems on all dimensions on EQ-5D-Y. Caregivers tended to show a significantly high eHL, financial well-being, and mental health when their care receivers reported no problems with usual activities and emotions. The SEM demonstrated a significant and positive relationship between eHL, financial well-being, and mental health. Conclusion OI caregivers with high eHL reported satisfactory financial well-being and mental health; their care receivers rarely reported living with poor HRQoL. Providing multicomponent and easy-to-learn training to improve caregivers’ eHL should be highly encouraged.

Due to advancements in information technology and growing eco-tourism demand, National Park Network Attention (NPNA) has emerged as a novel indicator of tourism appeal and ecological value recognition. Utilizing Baidu search index (accessed in 2023) data from 2013 to 2022, this study employs time series analysis, index analysis, and spatial statistics to measure and differentiate the spatial and temporal aspects of NPNA across 31 provinces, regions, and municipalities in mainland China, while systematically assessing the impact of various factors from both source and destination perspectives. Over the period of 2013 to 2022, NPNA has increased annually, peaking around holidays and during spring and autumn, demonstrating pronounced seasonality and precursor effects, while exhibiting volatility due to external events. Influenced by factors from both source and destination perspectives, the spatial distribution of NPNA displays a trend of being “high in the east and low in the west” and “high in the south and low in the north”, though regional disparities are diminishing. The population size in the source areas remains the dominant factor influencing NPNA, while the concept of national parks is not yet widely recognized. The destination’s tourism resource endowment, media publicity, accessibility, and level of informatization are significant influences. An effective integration of resources and marketing is essential for boosting NPNA. The findings provide valuable insights for optimizing the spatial layout of national parks, enhancing the tourism service system, innovating communication and promotional strategies, and improving national park governance effectiveness.

BackgroundRare diseases (RDs) affect millions of people worldwide, and these diseases can severely impact the health-related quality of life (HRQoL) of those affected. Despite this, there is a lack of research measuring HRQoL using the EQ-5D-5L, which is one of the most widely used generic preference-based instruments to measure HRQoL in populations living with RDs. ObjectiveThis study aimed to measure HRQoL using the EQ-5D-5L in a large number of patients with various types of RDs in China, and to examine the relationship between respondents’ socioeconomic characteristics and preference-based health utility scores. MethodsThe data used in this study were obtained from a web-based survey conducted in China. The survey aimed to explore and understand the health and socioeconomic status of patients with RDs in China. We recruited registered and eligible members, including patients or their primary caregivers, from 33 RD patient associations to complete the questionnaires via their internal social networks. HRQoL was measured using the EQ-5D-5L utility score, which was calculated based on an established Chinese value set. Utility scores have been presented based on demographics and disease-related information. Univariate linear regression analysis was used to assess the differences in the EQ-5D-5L utility scores between subgroups. ResultsA total of 12,502 respondents completed the questionnaire and provided valid responses, including 6919 self-completed respondents and 5583 proxy-completed respondents. Data from 10,102 participants over the age of 12 years were elicited for analysis. Among patients with RDs, 65.3% (6599/10,102), 47.5% (4799/10,102), 47.0% (4746/10,102), 24.8% (2506/10,102), and 18.4% (1855/10,102) reported no problems for “self-care,” “usual activities,” “mobility,” “pain/discomfort,” and “anxiety/depression,” respectively. A full health state was reported by 6.0% (413/6902) and 9.2% (295/3200) of self- and proxy-completed patients, respectively. Among self-completed patients, 69.9% (4826/6902) and 50.4% (3478/6902) reported no problems for “self-care” and “usual activities,” respectively, whereas only 17.7% (1223/6902) reported problems for “anxiety/depression.” Proxy-completed respondents showed a higher proportion of reporting extreme problems than self-completed respondents in all 5 dimensions. The mean utility scores reported by self- and proxy-completed respondents were 0.691 and 0.590, respectively. Different types of caregivers reported different utility scores, and among them, proxy-completed (mother) respondents reported the highest mean utility score. ConclusionsThe establishment of a normative profile for RD patients can facilitate patients’ adaptation and assess the effectiveness of interventions to improve the HRQoL and well-being of this population. Differences between self- and proxy-completed HRQoL assessed by the EQ-5D-5L have been identified in this study. This finding highlights the importance of incorporating perspectives from both patients and their proxies in clinical practice. Further development of the patient cohort is necessary to assess long-term changes in HRQoL in the RD population.

Objectives To investigate factors concerning patients regarding biological/target synthetic disease-modifying antirheumatic drugs (b/ts DMARDs) in treating inflammatory arthritis (IA).Design This study consists of a systematic review and a cross-sectional survey in Hong Kong. A systematic review of literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted on PubMed, Web of Science, Cochrane and Embase between 1 January 2000 and 1 January 2022. Content analysis was conducted to summarise factors grouped by four themes—social aspects (SA), clinical aspects (CA), medicine characteristics (MC) and financial aspects (FA) in the decision-making process. One cross-sectional survey among Hong Kong patients with IA was conducted to add to global evidence.Setting A systematic review of global evidence and a patient-based survey in Hong Kong to complement scarce evidence in Asia regions.Results The systematic review resulted in 34 studies. The four themes were presented in descending order consistently but varied with frequency throughout decision-making processes. During decision-making involving medication initiation, preference and discontinuation, MC (reported frequency: 83%, 86%, 78%), SA (56%, 43%, 78%) and FA (39%, 33%, 56%) were the three most frequently reported factors, whereas CA was less studied. Local survey also revealed that MC factors such as treatment efficacy and the probability of severe adverse events, and SA factors such as the availability of government or charity subsidy, influenced patients’ initiation and preference for b/ts DMARDs. Meanwhile, self-estimated improvement in disease conditions (SA), drug side effects (MC) and drug costs (FA) were associated with treatment discontinuation.Conclusions Global and local evidence consistently indicate that MC and SA are important considerations in patients’ decisions regarding novel DMARDs. Health policies that reduce patients’ financial burden and enhances healthcare professionals’ engagement in decision-making and treatment delivery should be in place with an efficient healthcare system for managing IA optimistically.

A new species of the spionid genus Lindaspio Blake & Maciolek, 1992 was collected from a cold seep near the Hainan Island at a depth of 1758 m. Morphologically, Lindaspio polybranchiata sp. nov. differs from the congeners in having a narrow, folded caruncle and more neuropodial branchiae (from chaetiger 20). The 18S, COI, and 16S sequences of the new species have been submitted to GenBank. It is the first record of the genus Lindaspio from Chinese waters. A key to all species of Lindaspio is given.

Abstract Introduction Health literacy (HL) refers to individuals' abilities to process and use health information to promote health. This study aimed to develop the first HL measurement tool for the Chinese Hong Kong population. Methods A two‐phase methodology was adopted. In Phase I, evidence synthesis with a deductive method was conducted to formulate the item list from the literature. In Phase II, a modified e‐Delphi survey was conducted among stakeholders (i.e., healthcare providers and healthcare consumers) to confirm the content validity of the item list. The stakeholders were invited to rate the relevance of each draft item on a 4‐point scale and provide suggestions for revisions, removal or adding new items. Results In Phase I, a total of 34 items covering functional, interactive and critical HL were generated. In Phase II, to obtain a balanced view from experts and laypeople, healthcare professionals (n = 12) and consumers (n = 12) were invited to participate in the Delphi panel. The response rates of the three rounds were 100%. After the third round, the consensus was reached for 31 items, and no further comments for adding or revising items were received. All items exhibited excellent content validity (item content validity index: 0.79–1.00; K*: 0.74–1.00). Conclusions A Health Literacy Scale for Hong Kong was developed. Compared with existing HL scales, the scale fully operationalized the skills involved in functional, interactive and critical HL. The Delphi study shows evidence supporting the high content validity of all items in the scale. In future studies, these items should undergo rigorous testing to examine their psychometric properties in our target population groups. By illuminating the details in the development process, this paper provides a deeper understanding of the scale's scope and limitations for others who are interested in using this tool. Patient or Public Contribution Public as healthcare consumers, in addition to healthcare providers, were involved in developing a new HL scale for this study. The input from the public contributed to examining the scale's content validity by judging whether all items reflected the skills that they need to find and use health‐related information in their daily life.

With ever-increasing power-density requirements, technologies such as energy storage systems and electric-vehicles can benefit greatly from interfacing medium-voltage (MV)-AC grid like 13.8kV or 30kV using high-AC/low-DC voltage converter. Using modular high-AC/low-DC voltage converter can help increase power-density and efficiency, while reducing total conversion steps and providing flexibility. Full-bridge modular multilevel converters (FB-MMC) and solid-state transformers are existing solutions for such operations, but suffer from limitations of high semiconductor requirements, large submodule capacitors and/or many high-frequency transformers. Three new hybrid-MMC (HMMC) topologies are proposed in this paper as alternative solutions for such high-AC/low-DC voltage operations. Each of the three developed HMMCs utilizes a unique combination of low-frequency high-voltage switches and fast-switching low-voltage switch based submodules to generate multilevel-AC voltage. HMMCs are compared extensively to state-of-the-art FB-MMC and are shown to have semiconductor savings of over 27%, 38% lower submodule capacitor size, and 53% lower losses for 13.8-kV-AC/6-kV-DC operation. Due to these benefits like higher efficiency, significantly smaller submodule capacitance requirements, and fewer semiconductors, HMMCs can be an excellent option for high-AC/low-DC applications. Practical considerations like snubber and DC split-capacitor requirement are also elaborated for developing and commercializing HMMCs. Comparison results are verified using a 17.5 kW three-phase MV laboratory prototype.

Objective To evaluate the feasibility and effectiveness of colonoscopy, fecal immunochemical test(FIT) and risk-adapted screening strategies in population-based colorectal cancer screening. Methods Based on the randomized controlled trial of colorectal cancer screening(TARGET-C) which was carried out in 6 centers of 5 provinces in China from May 2018 to May 2021, the participants who met the inclusion criteria of the study were randomly assigned to one of the following screening intervention groups in a ratio of 1∶2∶2, which were colonoscopy group, FIT group and risk-adapted screening group(participants evaluated to be at high risk were recommended to undertake colonoscopy, those at low risk were recommended to undertake FIT and FIT positive people received colonoscopy). The 3 groups received different schemes of colorectal cancer screening, in which the colonoscopy group only received baseline screening, whereas the FIT group and the risk-adapted screening group received annual follow-up screening on the basis of baseline screening. The main outcome was the detection rate for advanced colorectal neoplasm(including colorectal cancer and advanced adenoma). The participation rate, detection rate for any neoplasm and resource load of colonoscopy among different screening groups were further analyzed. Results A total of 19 373 participants meeting the inclusion and exclusion criteria were enrolled, including 8082 males(41.7%) and 11 291 females(58.3%), with an average age of (60.5±6.5) years. Among them, 3883 were in the colonoscopy group, 7793 in the FIT group, and 7697 in the risk-adapted screening group. After 1 or 3 rounds of screening(2 rounds of follow-up screening completed in FIT group and risk-adapted screening group), the overall participation was the highest for the FIT group(99.3%), followed by the risk-adapted screening group(89.2%) and the coloscopy group(42.3%). According to the intention-to-treat analysis, the detection rates of advanced neoplasm in the colonoscopy group was higher than that in the FIT group(2.76% vs. 2.17%, ORcolonoscopy vs FIT=1.30, 95% CI: 1.01-1.65, P=0.037); there were no statistically significant differences regarding the detection rates of advanced neoplasm between the colonoscopy group and the risk-adapted screening group(2.76% vs. 2.35%, ORcolonoscopy vs risk-adapted screening=1.19, 95% CI: 0.93-1.51, P=0.156), and between the risk-adapted screening group and the FIT group(2.35% vs. 2.17%, ORrisk-adapted screening vs FIT=1.09, 95% CI: 0.88-1.34, P=0.440). The number of colonoscopies needed to be performed to detect one advanced neoplasm was used as an indicator to evaluate the resource load of colonoscopy. The number was the highest for the coloscopy group(15.4), followed by the risk-adapted screening group(10.2) and the FIT group(7.8). Conclusions The risk-adapted screening strategy is feasible and effective in population-based colorectal cancer screening, and could serve as an effective supplement to the traditional colonoscopy and FIT-based colorectal cancer screening strategies.

Abstract Background Alexithymia is a common psychological disorder. However, few studies have investigated its prevalence and predictors in patients with chronic obstructive pulmonary disease (COPD). Therefore, we aimed to determine the prevalence and predictors of alexithymia in Chinese patients. Methods This cross-sectional study included 842 COPD patients to assess the prevalence and predictors of alexithymia using the 20-item Toronto Alexithymia Scale (TAS-20). We used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression, the modified British Medical Research Council dyspnea Rating Scale (mMRC) to assess dyspnea, St. George's Respiratory Questionnaire (SGRQ) to assess quality of life, and the age-adjusted Charlson comorbidity index (ACCI) to assess comorbidities. Alexithymia-related predictors were identified using univariate and multivariate logistic regression analyses. Results The prevalence of alexithymia in COPD patients was 23.6% (199/842). Multivariate analysis showed that age [odds ratio (OR) 0.886; 95% confidence interval (CI) 0.794–0.998], body mass index (OR 0.879; 95% CI 0.781–0.989), HADS-anxiety (OR 1.238; 95% CI 1.097–1.396), HADS-depression (OR 1.178; 95% CI 1.034–1.340), mMRC (OR 1.297; 95% CI 1.274–1.320), SGRQ (OR 1.627; 95% CI 1.401–1.890), ACCI (OR 1.165; 95% CI 1.051–1.280), and GOLD grade (OR 1.296; 95% CI 1.256–1.337) were independent predictors for alexithymia in patients with COPD. Conclusions The prevalence of alexithymia was high in Chinese COPD patients. Anxiety, depression, dyspnea, quality of life, comorbidities, and disease severity are independent risk factors, and age and BMI are predictive factors for alexithymia in COPD patients.

Mycoplasma ovipneumoniae (M. ovipneumoniae) causes a fatal infection in goats, leading to significant economic losses in the small-ruminant industry worldwide. The present study aimed to characterize the strains of M. ovipneumoniae infecting goats with pneumonia in Anhui Province, China. From November 2021 to January 2023, among 20 flocks, a total of 1320 samples (600 samples of unvaccinated blood, 400 nasal swabs, 200 samples of pleural fluid, and 120 samples of lung tissue) were obtained from goats with typical signs of pneumonia, such as a low growth rate, appetite suppression, increased temperature, discharge from the nose, and a cough. Necropsied goats showed increased pleural fluid, fibrinous pleuropneumonia, and attached localized pleural adhesions. M. ovipneumoniae isolated from the samples were subjected to an indirect hemagglutination test (IHA), PCR amplicon sequencing, phylogenetic analysis, and biochemical identification tests. The overall positivity rate of M. ovipneumoniae was 27.50%. Mycoplasmas were obtained from 80 (20.0%) nasal swabs, 21 (10.5%) pleural fluid samples, and 15 (12.5%) lung samples. PCR amplicon (288 bp) sequencing identified eight strains of M. ovipneumoniae. In a phylogenetic tree, the isolated strains were homologous to the standard strain M. ovipneumoniae Y-98 and most similar to M. ovipneumoniae FJ-SM. Local strains of M. ovipneumoniae were isolated from goats in Anhui province. The identified genomic features and population structure will promote further study of M. ovipneumoniae pathogenesis and could form the basis for vaccine and therapy development.

We report the detection of a pair of massive quiescent galaxies likely in the process of merging at the center of the spectroscopically confirmed, extremely massive protocluster BOSS1244 at z = 2.24 ± 0.02. These galaxies, BOSS1244-QG1 and BOSS1244-QG2, were detected with Hubble Space Telescope grism slitless spectroscopic observations. These two quiescent galaxies are among the brightest member galaxies, with z = 2.223–2.255 in BOSS1244, and reside at redshifts z = 2.244 and z = 2.242, with a half-light radius of 6.76 ± 0.50 kpc and 2.72 ± 0.16 kpc, respectively. BOSS1244-QG1 and BOSS1244-QG2 are separated by a projected distance of about 70 physical kpc, implying that the two galaxies likely merge to form a massive brightest cluster galaxy (BCG) with size and mass similar to the most massive BCGs in the local Universe. We thus infer that BCG formation through dry major mergers may happen earlier than the full assembly of a cluster core, which broadens our previous understanding of the coevolution of mature galaxy clusters and BCGs in the nearby Universe. Moreover, we find a strong density–star formation relation over a scale of ∼18 comoving Mpc in BOSS1244, i.e., star formation activity decreases as density increases, implying that the quenching of star formation in BCGs and their progenitors is likely governed by environment-related processes before the virialization of the cluster core.

Abstract Digital PCR (dPCR) is an important tool for precise nucleic acid quantification in clinical setting, but the limited multiplexing capability restricts its applications for quantitative gene panel profiling. Here, this work describes melt‐encoded‐tags for expanded optical readout in digital PCR (METEOR‐dPCR), a simple two‐step assay that enables simultaneous quantification of a large panel of arbitrary genes in a dPCR platform. Target genes are quantitatively converted into DNA tags with unique melting temperatures through a ligation approach. These tags are then counted and distinguished by their melt‐curve profiles on a dPCR platform. A multiplexing capacity of M^N, where M is the number of resolvable melting temperature and N is the number of fluorescence channel, can be achieved. This work validates METEOR‐dPCR with simultaneous DNA copy number profiling of 60 targets using dPCR in cancer cells, and demonstrates its sensitivity for estimating tumor fraction in mixed tumor and normal DNA samples. The rapid, quantitative, and highly multiplexed METEOR‐dPCR assay will have wide appeal for many clinical applications.

BackgroundThrough contrastive analysis, we aimed to identify the white matter brain regions that show microstructural changes in patients with neuropathic pain (NP) after spinal cord injury (SCI).MethodsWe categorized patients with SCI into NP (n = 30) and non-NP (n = 15) groups. We extracted diffusion tensor maps of fractional anisotropy (FA) and mean (MD), axial (AD), and radial (RD) diffusivity. A randomization-based method in tract-based spatial statistics was used to perform voxel-wise group comparisons among the FA, MD, AD, and RD for nonparametric permutation tests.ResultsAtlas-based analysis located significantly different regions (p

Rapidly solidified zirconia toughened alumina (ZTA) eutectic bioceramics are promising load-bearing materials that meet the needs for durability and aging resistance for biomedical applications. However, one of the major problems is their poor bioactivity which may lead to aseptic loosening after long-term service. To solve this problem, calcium phosphate (Ca-P) coatings are in-situ synthesized on rapidly solidified ZTA eutectic bioceramics by laser cladding technology with mixed powders of CaHPO4 ∙ 2H2O and CaCO3 after granulation as precursors. X-ray diffraction results show that Ca-P coatings are mainly composed of Ca0.2Zr0.8O1.8, AlPO4, Ca4P2O9, Ca3(PO4)2 and Ca2P2O7. The amount of calcium phosphates reaches a maximum when using a laser power of 800 W and a scanning rate of 650 mm/min. Cross-sectional morphologies and energy dispersive spectrometer analysis indicate excellent interfacial bonding between the substrate and coating. In vitro tests prove that Ca-P cladded samples can induce apatite with flake-like morphology similar to those on the bioceramic coatings cladded on titatinum alloy precipitation and promote MC3T3-E1 cell proliferation. This work reveals that laser cladding has the potential to improve the biomineralization of solidified ZTA eutectic bioceramics enabling prolonged clinical service life.

BackgroundColorectal cancer is the third most common cancer worldwide. Colonoscopy is the gold standard for colorectal cancer screening. However, the colonoscopy participation rate in China is much lower than that in Europe and the United States. As only non-sedated colonoscopies are offered in colorectal cancer screening programs in China, the absence of sedation may contribute to this gap.MethodsTo explore the effect of free and partially participant-paid sedated colonoscopy on improving colorectal screening participation, we conducted a cross-sectional study under the framework of the Cancer Screening Program in Urban China in Xuzhou from May 2017 to December 2020. The Quanshan district was set as the control group and provided free non-sedated colonoscopy, the Yunlong district was set as a partial cost coverage group and offered partially participant-paid sedated colonoscopy, and the Gulou district was set as the full cost coverage group and offered free sedation colonoscopies. Multivariate logistic regression was used for multivariate analysis of colonoscopy participation and colorectal lesion detection rates between the groups.ResultsFrom May 2017 to May 2020, 81,358 participants were recruited and completed questionnaire, 7,868 subjects who met high-risk conditions for CRC were invited to undergo colonoscopy. The colonoscopy participation rates in the control group, partially cost coverage, and full cost coverage groups were 17.33% (594/3,428), 25.66% (542/2,112), and 34.41% (801/2,328), respectively. Subjects in the partial and full cost coverage groups had 1.66-fold (95% CI: 1.48–1.86) and 2.49-fold (95% CI: 2.23–2.76) increased rates compared with those in the control group. The adjusted PARs for the partially and the full cost coverage group was 9.08 (95% CI: 6.88–11.28) and 18.97 (95% CI: 16.51–21.42), respectively. The detection rates of CAN in the control, partial-cost coverage, and full-cost coverage groups were 3.54% (21/594), 2.95% (16/542), and 5.12% (41/801), respectively. There were no significant differences in the detection rates between the group. However, sedated colonoscopy increases costs.ConclusionSedated colonoscopy increased colonoscopy participation rates in both the partial and full cost-covered groups. A partial cost coverage strategy may be a good way to increase colorectal cancer participation rates and quickly establish a colorectal cancer screening strategy in underfunded areas.

This study was conducted to evaluate the effects of different additives on the fermentation quality and bacterial community of silage prepared from fresh-cut whole-plant quinoa (WPQ). Fresh-cut WPQ without wilting process was directly ensiled with one of the following additives: (i) untreated (control); (ii) fibrolytic enzyme (E); (iii) molasses (M); (iv) LAB inoculant (L); (v) a combination of fibrolytic enzyme and LAB inoculant (EL); and (vi) a combination of molasses and LAB inoculant (ML). The fermentation quality and bacterial community after 60 days of ensiling were analysed. The results showed that control silage was dominated by enterobacteria (>50%), with high pH value (5.25), acetic acid (77.9 g/kg DM) and NH3–N production (261 g/kg TN). Adding E, EL and ML shifted the fermentation pattern towards increased intensity of lactic acid production, as indicated by increased lactic acid content (>62.4 g/kg DM), lactic/acetic acid ratio (>1.12) and relative abundance of Lactobacillus (>62.0%), and decreased pH value (

The work aimed to evaluate the effect of different levels of soy sauce residue (SSR) replacement on chemical compositions, fermentation quality and in vitro digestibility of total mixed ration (TMR) silages. The experiment followed a completely randomised design, and four treatments were designed according to different mixing ration of SSR, Napier grass and concentrate (based on fresh weight): (1) 65% Napier grass + 35% concentrate (control); (2)15% SSR + 55% Napier grass + 30% concentrate (SS15); (3) 25% SSR + 50% Napier grass + 25% concentrate (SS25); (4) 35% SSR + 45% Napier grass + 20% concentrate (SS35). TMR was ensiled in a laboratory silo (10 L) after mixing. All silos were opened after 60 days of ensiling and then were sampled for chemical compositions, fermentation quality and in vitro digestibility analysis. All TMR silages were preserved well, as indicated by the low butyric acid (BA; 80.0). However, SS25 and SS35 significantly (P 0.05) difference in vitro neutral detergent fibre digestibility (IVNDFD) among all TMR silages. In conclusion, SS35 replacement was recommended for TMR silage making.Highlights Ensiling is an effective method to utilise soy sauce residue. Soy sauce residue replacement had no unfavourable effect on the fermentation quality of the total mixed ration. 35% soy sauce residue replacement improved the in vitro digestibility of total mixed ration silages.

The experiment was conducted to evaluate the effects of brewers’ spent grains (BSG) on the fermentation quality, chemical composition and in vitro parameters of mixed silage prepared with corn stalk, dried apple pomace and sweet potato vine. In the experiment, a ternary mixture of corn stalk, sweet potato vine and dried apple pomace (50/30/20) was ensiled with 0%, 10%, 15% and 20% BSG on a fresh weight (FW) basis for 1, 3, 5, 7, 14 and 30 days, respectively. The application of BSG significantly (p

Chemical additives have been widely used to restrain the growth of undesirable microorganisms, and they were ideal additives to well preserve silages. The work aimed at evaluating the effects of four chemical additives on fermentation quality, aerobic stability and in vitro ruminal digestibility of the fermented total mixed ration (FTMR). The TMR was treated with: (1) no additive (control); (2) sodium diacetate; (3) calcium propionate; (4) sodium benzoate (SB); (5) potassium sorbate (PS) on a fresh weight (FW) basis. After 60 days of ensiling, the silos were opened and sampled to determine fermentation quality, in vitro rumen parameters, and then the 60-day FTMR were subjected to a 9-day aerobic stability test. Chemical additives significantly (p

Abstract Background Cervical squamous cell carcinoma (CESC) is the most common histological type of cervical cancer which is the major cause of death in women worldwide. Although squamous cell carcinoma antigen (SCC-Ag) is widely used to detect CESC, it is not sensitive and specific enough to predict the disease. Methods We investigated serum CXC motif chemokine 10 (CXCL10) as potential diagnostic biomarker in detecting CESC in this study. Serum levels of CXCL10 and SCC-Ag were measured by ELISA or automated immunoassay in 345 participants, including 189 patients with different stages of CESC, 75 patients with cervical intraepithelial neoplasia, and 81 healthy individuals. Performances of CXCL10 and SCC-Ag as single biomarkers were analyzed by the ROC curves. The changes of serum levels of CXCL10 and SCC-Ag in 10 longitudinal followed-up CESC patients with partial response (PR) during chemoradiotherapy or chemotherapy were evaluated. Results The two markers showed similar diagnostic capacity in distinguishing both CESC early stage from healthy controls (AUCCXCL10 = 0.740, AUCSCC-Ag = 0.710) and all CESC from healthy controls (AUCCXCL10 = 0.775, AUCSCC-Ag =0.793). Moreover, CXCL10 showed ability in distinguishing cervical intraepithelial neoplasia from healthy control (AUCCXCL10 = 0.727) and cervical cancer SCC-Ag-negative from healthy control. (AUCCXCL10 = 0.739). The combination of CXCL10 and SCC-Ag displayed significant improvement of AUCs than individual SCC-Ag or CXCL10 in the analysis groups (healthy vs all cervical cancer, healthy vs cervical cancer early stage). The AUCs were improved to 0.877 (AUCSCC-Ag = 0.793, P

Abstract Background Increasing evidences have revealed the tumor immune microenvironment not only has vital impacts on the origin, progression, and metastasis of tumors significantly but also influences the response to immunotherapy. Nonetheless, to date, the well-rounded expression pattern of immune-related genes in cutaneous melanoma and the comprehensive characterization of tumor immune microenvironment remain not clearly elucidated. Method We comprehensively evaluated the well-rounded expression pattern of immune-related genes of 686 patients with cutaneous melanoma based on immune-related genes with prognostic value and systematically correlated the expression pattern of these genes with the comprehensive characterization of tumor immune microenvironment. The IRGscore was constructed to quantify immunological function of individual using principal component analysis algorithms. Result Three distinct immune subtypes were determined with obvious survival differences. Melanoma patients with high IRGscore was characterized by comprehensive suppression of immune function, showing much poorer prognosis and efficacy for immunotherapy, while the low IRGscore means the robust activation of immune function and the better effect of immunotherapy, which may be responsible for a better prognosis. Besides, the prognostic ability of IRGscore was further validated by the independent dataset of stomach cancers. Furthermore, the predictive effect of immunotherapeutic benefits of IRGscore was demonstrated by the independent dataset of melanoma patients accepting immunotherapy and another predictive model for immunotherapy. Conclusion IRGscore could serve as an independent immunotherapeutic and prognostic predictor, thereby facilitating the identification of appropriate candidates with cutaneous melanoma for immunotherapy and the formulation of individualized therapeutic approaches.

Abstract Background Colorectal cancer is one of the most common cancers in the world. Several studies suggest using the Asia-Pacific colorectal screening (APCS) score and its modified versions to select high-risk populations for early colonoscopy, but external validation remains rare, and which score should be selected for CRC screening in China is unclear. Validation of multiple scores in the same population might help to choose the best performing score. Methods We conducted a cross-sectional study under the framework of Cancer Screening Program in Urban China, data from asymptomatic colorectal cancer screening in Xuzhou was used to validate the APCS score, the colorectal neoplasia predict (CNP) score, the Korean colorectal screening (KCS) score, the Modified APCS score and the 8-point risk score in predicting colorectal advanced neoplasia (CAN). Results 1804 subjects were included in the analysis and 112 CAN (6.21%) was detected. In each score, the detection rate of CAN was higher in the high-risk group than in the non-high-risk group (P

Abstract Background Breast cancer (BCa) is the leading cause of cancer deaths among women. Reliable biomarkers for early diagnosis and metastasis prediction are essential to improve the prognosis of BCa. This study aimed to evaluate serum periostin (POSTN) as a novel biomarker complementing CA153 (carbohydrate antigen 153) and CEA (carcinoembryonic antigen) for BCa diagnosis and metastasis prediction. Methods To assess the potential of soluble POSTN as a circulating biomarker, 242 participants, including 173 patients with different stages of BCa and 69 healthy individuals, were enrolled in this study. Soluble POSTN, together with CA153 and CEA, were determined in serum by enzyme linked immunosorbent assay (ELISA) or electrochemiluminescence immunoassays. Results Serum POSTN levels in locoregional BCa patients were significantly higher than that in healthy controls. Receiver operating curve (ROC) analysis revealed that, to distinguish health controls from locoregional BCa, POSTN was observed with the highest AUC (area under curve) (AUCPOSTN = 0.72 [0.65 – 0.79], AUCCA153 = 0.57 [0.49 – 0.64], AUCCEA = 0.62 [0.55 – 0.69]), and both CA153 and CEA were observed with significantly improved AUCs by combination with POSTN (AUCPOSTN + CA153 = 0.74 [0.67 – 0.80], P

The relationships between epibiotic bacteria on deep-sea hosts and host lifestyle factors are of particular interest in the field of deep-sea chemoautotrophic environmental adaptations. The squat lobsters Shinkaia crosnieri and Munidopsis verrilli are both dominant species in cold-seep ecosystems, and they have different distributions and feeding behaviors. These species may have evolved to have distinct epibiotic microbiota. Here, we compared the epibiotic bacterial communities on the M. verrilli carapace (MVcarapace), S. crosnieri carapace (SCcarapace), and S. crosnieri ventral plumose setae (SCsetae). The epibiotic bacteria on SCsetae were dense and diverse and had a multi-layer configuration, while those on MVcarapace and SCcarapace were sparse and had a monolayer configuration. Chemoautotrophic bacteria had the highest relative abundance in all epibiotic bacterial communities. The relative abundance of amplicon sequence variant 3 (ASV3; unknown species in order Thiotrichales), which is associated with sulfide oxidation, was significantly higher in SCsetae than MVcarapace and SCcarapace. Thiotrichales species seemed to be specifically enriched on SCsetae, potentially due to the synthetic substrate supply, adhesion preference, and host behaviors. We hypothesize that the S. crosnieri episymbionts use chemical fluxes near cold seeps more efficiently, thereby supporting the host’s nutrient strategies, resulting in a different distribution of the two species of squat lobster.

Ensiling density has significant importance for the quality and preservation of silage. Appropriate ensiling density could improve the nutritional value, extend the storage time of silage and reduce the risk of mold and spoilage. This work aimed to evaluate the effect of ensiling densities on the fermentation quality and aerobic stability of rice straw. The rice straw was obtained after threshing, then chopped and ensiled into a 10 L laboratory silo with three ensiling densities (high density at 700 g/L, medium density at 600 g/L and low density at 500 g/L). Five silos per density were opened after 3, 5, 7, 14, 30 and 60 days of ensiling, and then, the fermentation quality and aerobic stability were analyzed. During ensiling, high density had the highest lactic acid content, and the lowest pH and ammonia nitrogen. There was no difference (p > 0.05) in the propionic acid, butyric acid and ethanol contents among all silage, and the contents of propionic acid and butyric acid were trace amounts. On day 60 of ensiling, the Flieg’s point of high density and medium density were higher than the low density. During aerobic exposure, the continuous lactic acid decrease and pH increase were observed in all silage. The aerobic bacteria and yeasts count in the high density and medium density were lower than that in the low density. The aerobic stability of the high density (26 h) and the medium density (24 h) were higher than that of the low density (13 h). It was suggested that if the ensiling density is higher than 600 g/L, it could effectively improve the fermentation quality and aerobic stability of rice straw.

Petrolisthes lamarckii (Leach, 1821) and P. haswelli Miers, 1884 are a pair of sister species of porcelain crabs, both of which are common in the intertidal zone of southern China, typically found under rocks and in the crevices of coral reefs. However, the distribution, genetic relationship and diversity of the two species in China have not been rigorously studied. Meanwhile, P. lamarckii is considered as a complex of cryptic species due to their diverse morphological features. In this study, we identified 127 specimens of the P. lamarckii–P. haswelli complex (LH complex) and recognised a new species through morphological and molecular analysis. Furthermore, we constructed a time-calibrated phylogeny of the LH complex using three mitochondrial and two nuclear genes from all three species, finding that the divergence of the LH complex can be traced back to the Miocene epoch, and that the genetic diversity increased during the Mid-Pleistocene transition period. Glacial refugia formed during the Pleistocene climatic oscillations has been regarded as one of the contributing factors to the diversification of marine organisms in the north-western Pacific. Petrolisthes haswelli demonstrates a wide distribution along the southern coast of China, while other lineages display more restricted distributions. The research on the demographic history and gene flow of P. haswelli revealed that the Chinese coastal populations experienced an expansion event approximately 12.5 thousand years ago (Kya) and the asymmetrical gene flows were observed between the two sides of the Taiwan Strait and Qiongzhou Strait, respectively, which is likely influenced by the restriction of ocean currents.

Al2O3/ZrO2 composites are currently popular for orthopaedic and dental restorations. However, the long-term reliability of Al2O3/ZrO2 implants should be further improved by reducing the aging sensitivity and enhancing the osteointegration performance. In this paper, melt-grown Al2O3/ZrO2 eutectics with bioactive Ca-P coatings are successfully prepared by successive laser cladding technique. The processing strategy is studied to show that the laser power has a significant influence on the phase constituent, surface morphology and mechanical properties of Ca-P coatings. The aggravated elements interdiffusion and strong metallurgical bonding between coating and substrate is found with increased laser power from 50 W to 70 W under the same laser energy density, which leads to reduced bioactivity and enhanced adhesion strength of Ca-P coating (3.5 ± 1.1 N to 14.9 ± 1.4 N). The bioactivity of Al2O3/ZrO2 eutectics is greatly improved by the coating of highest content of 55.9% Ca-P phase under the optimized parameters with laser power of 50 W and scanning rate of 50 mm/s. A thick bone-like apatite layer with Ca/P of 1.71 similar to that of bone can be observed on the coating surface after soaking tests. Thus, laser cladding is a potential and efficient strategy to modify Al2O3/ZrO2 eutectics with desired biological properties, which may be applied as load-bearing implants for clinical application.

BackgroundIncreasing prenatal screening options and limited consultation time have made it difficult for pregnant women to participate in shared decision-making. Interactive digital decision aids (IDDAs) could integrate interactive technology into health care to a facilitate higher-quality decision-making process. ObjectiveThe objective of this study was to assess the effectiveness of IDDAs on pregnant women’s decision-making regarding prenatal screening. MethodsWe searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists of included studies until August 2021. We included the randomized controlled trials (RCTs) that compared the use of IDDAs (fulfilling basic criteria of International Patient Decision Aid Standards Collaboration and these were interactive and digital) as an adjunct to standard care with standard care alone and involved pregnant women themselves in prenatal screening decision-making. Data on primary outcomes, that is, knowledge and decisional conflict, and secondary outcomes were extracted, and meta-analyses were conducted based on standardized mean differences (SMDs). Subgroup analysis based on knowledge was performed. The Cochrane risk-of-bias tool was used for risk-of-bias assessment. ResultsEight RCTs were identified from 10,283 references, of which 7 were included in quantitative synthesis. Analyses showed that IDDAs increased knowledge (SMD 0.58, 95% CI 0.26-0.90) and decreased decisional conflict (SMD –0.15, 95% CI –0.25 to –0.05). Substantial heterogeneity in knowledge was identified, which could not be completely resolved through subgroup analysis. ConclusionsIDDAs can improve certain aspects of decision-making in prenatal screening among pregnant women, but the results require cautious interpretation.

BackgroundWhile many studies evaluated the reliability of digital mobility metrics as a proxy of SARS-CoV-2 transmission potential, none examined the relationship between dining-out behavior and the superspreading potential of COVID-19. ObjectiveWe employed the mobility proxy of dining out in eateries to examine this association in Hong Kong with COVID-19 outbreaks highly characterized by superspreading events. MethodsWe retrieved the illness onset date and contact-tracing history of all laboratory-confirmed cases of COVID-19 from February 16, 2020, to April 30, 2021. We estimated the time-varying reproduction number (Rt) and dispersion parameter (k), a measure of superspreading potential, and related them to the mobility proxy of dining out in eateries. We compared the relative contribution to the superspreading potential with other common proxies derived by Google LLC and Apple Inc. ResultsA total of 6391 clusters involving 8375 cases were used in the estimation. A high correlation between dining-out mobility and superspreading potential was observed. Compared to other mobility proxies derived by Google and Apple, the mobility of dining-out behavior explained the highest variability of k (ΔR-sq=9.7%, 95% credible interval: 5.7% to 13.2%) and Rt (ΔR-sq=15.7%, 95% credible interval: 13.6% to 17.7%). ConclusionsWe demonstrated that there was a strong link between dining-out behaviors and the superspreading potential of COVID-19. The methodological innovation suggests a further development using digital mobility proxies of dining-out patterns to generate early warnings of superspreading events.

BackgroundStudies have shown increasing COVID-19 vaccination hesitancy among migrant populations in certain settings compared to the general population. Hong Kong has a growing migrant population with diverse ethnic backgrounds. Apart from individual-level factors, little is known about the migrants’ preference related to COVID-19 vaccines. ObjectiveThis study aims to investigate which COVID-19 vaccine–related attributes combined with individual factors may lead to vaccine acceptance or refusal among the migrant population in Hong Kong. MethodsAn online discrete choice experiment (DCE) was conducted among adults, including Chinese people, non-Chinese Asian migrants (South, Southeast and Northeast Asians), and non-Asian migrants (Europeans, Americans, and Africans) in Hong Kong from February 26 to April 26, 2021. The participants were recruited using quota sampling and sent a link to a web survey. The vaccination attributes included in 8 choice sets in each of the 4 blocks were vaccine brand, safety and efficacy, vaccine uptake by people around, professionals’ recommendation, vaccination venue, and quarantine exemption for vaccinated travelers. A nested logistic model (NLM) and a latent-class logit (LCL) model were used for statistical analysis. ResultsA total of 208 (response rate 62.1%) migrant participants were included. Among the migrants, those with longer local residential years (n=31, 27.7%, for ≥10 years, n=7, 20.6%, for 7-9 years, n=2, 6.7%, for 4-6 years, and n=3, 9.7%, for ≤3 years; P=.03), lower education level (n=28, 28.3%, vs n=15, 13.9%, P=.01), and lower income (n=33, 25.2%, vs n=10, 13.2%, P=.04) were more likely to refuse COVID-19 vaccination irrespective of vaccination attributes. The BioNTech vaccine compared with Sinovac (adjusted odds ratio [AOR]=1.75, 95% CI 1.14-2.68), vaccine with 90% (AOR=1.44, 95% CI 1.09-1.91) and 70% efficacy (AOR=1.21, 95% CI 1.03-1.44) compared with 50% efficacy, vaccine with fewer serious adverse events (1/100,000 compared with 1/10,000; AOR=1.12, 95% CI 1.00-1.24), and quarantine exemption for cross-border travelers (AOR=1.14, 95% CI 1.01-1.30) were the vaccine attributes that could increase the likelihood of vaccination among migrants. For individual-level factors, full-time homemakers (AOR=0.44, 95% CI 0.29-0.66), those with chronic conditions (AOR=0.61, 95% CI 0.41-0.91) and more children, and those who frequently received vaccine-related information from the workplace (AOR=0.42, 95% CI 0.31-0.57) were found to be reluctant to accept the vaccine. Those with a higher income (AOR=1.79, 95% CI 1.26-2.52), those knowing anyone infected with COVID-19 (AOR=1.73, 95% CI 1.25-2.38), those having greater perceived susceptibility of COVID-19 infection (AOR=3.42, 95% CI 2.52-4.64), those who received the influenza vaccine (AOR=2.15, 95% CI 1.45-3.19), and those who frequently received information from social media (AOR=1.52, 95% CI 1.12-2.05) were more likely to accept the vaccine. ConclusionsThis study implies that migrants have COVID-19 vaccination preference heterogeneity and that more targeted and tailored approaches are needed to promote vaccine acceptance for different subgroups of the migrant population in Hong Kong. Vaccination promotion strategies are needed for low-education and low-income migrant groups, migrants with chronic diseases, the working migrant population, homemakers, and parents.