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ABSTRACT Objective The type of atlantodental space tissue in patients with atlantoaxial dislocation (AAD) can help doctors understand the possibility of reduction before surgery. However, relevant research on this topic is lacking. This study aimed to summarize cases of AAD, classified based on the atlantodental space using magnetic resonance imaging (MRI), and preliminarily explore its impact on the degree of reduction. Methods Preoperative T2‐weighted MRIs and dynamic digital radiographs of patients who underwent posterior reduction and fixation surgery for congenital AAD between September 2012 and February 2023 were collected. The patients were classified into flexible and inflexible tissue sign groups based on T2‐weighted imaging. Patients with an atlantodental interval

Abstract Background and objective Critical bedside ultrasound is widely used in clinical practice, and it can monitor renal perfusion. The reduction of renal perfusion and inflammatory injury are two contributing factors to sepsis-associated acute kidney injury (SA-AKI).The aim of this study was to examine whether the oXiris filter was useful in the continuous renal replacement therapy(CRRT) treatment of SA-AKI patients. Design, setting, participants, and measurements We performed a retrospective single-center observational study and enrolled two hundred and forty-three SA-AKI patients from January 2022 to December 2023, who were divided into the oXiris group (n = 88) and the control group (n = 155). The primary endpoints were the 28-day recovery of renal function and 28-day all-cause mortality. The secondary endpoints included renal Doppler markers (RRI, RVSI, and PDU), SOFA, vasoactive-inotropic score (VIS), inflammatory markers (PCT, CRP, IL-10 and TNFα), lactate level, and length of stay in ICU and hospital. Results For the primary endpoint, the rates of complete recovery, partial recovery, and dialysis dependence were observed to be 60.3%, 13.6%, and 26.1% in the oXiris group, respectively, compared to 63.9%, 15.5%, and 20.6% in the control group. The 28-day all-cause mortality was not different in the two groups (22.7% vs. 27.1%). For the secondary endpoint, the oXiris group exhibited greater reductions in VIS scores compared to the control group within the first 24 h (p = 0.001) and 48 h (p 0.05). The levels of RRI at T1 (p = 0.002) and T2 (p = 0.001) were lower in the oXiris group than in the control group. Even after adjusting for AKI stage, multivariable Cox regression analysis showed that SOFA and inflammatory factors (TNFα, IL-10, and IL-6), oXiris were significantly associated with a lower 28-day mortality among SA-AKI patients when compared to M150 [HR = 0.466, 95%CI 0.233–0.934, p = 0.031]. Conclusion Our findings suggest that the use of the oXiris filter in CRRT is associated with reduced inflammatory injury and improvement in renal perfusion. However, it is not associated with improved 28-day recovery of renal function and 28-day all-cause mortality.

Summary: Cdc25C undergoes a sudden and substantial gel mobility shift at M-phase onset, correlating with abrupt activation of both Cdc25C and Cdk1 activities. A positive feedback loop between Cdk1 and Cdc25C has been used to explain this hallmark phenomenon. Here, we demonstrate that the M-phase supershift and robust activation of Cdc25C are due to the site-comprehensive phosphorylation of its long intrinsically disordered regulatory domain without requiring Cdk1 or other major mitotic kinase activities. The phosphorylation process involves substrate-mediated assembly of phosphorylation machinery that catalyzes multisite phosphorylation continuously without substrate dissociation. In contrast to the site-comprehensive phosphorylation of Cdc25C occurring at M-phase onset, the site-specific phosphorylation of Cdc25C by Cdk1 or other major mitotic kinases generates slight gel mobility shifts and modest activation of Cdc25C prior to M-phase onset. These findings suggest a two-stage framework consisting of site-specific phosphorylation followed by site-comprehensive phosphorylation for Cdc25C regulation during M-phase induction.

Background Osteoarthritis (OA) is a common chronic joint disease that significantly affects an individual’s quality-of-life and frailty has become one of the common complications in OA patients as the disease progresses. The relationship between dietary patterns is not clear.Methods All participants are from the National Health and Nutrition Examination Survey (NHANES) and have been diagnosed with OA. The dietary inflammation index (DII) is calculated based on the dietary intake reported by the participants. Logistic regression analysis is used to investigate the relationship between DII and frailty. Restricted cubic splines are utilised to explore their nonlinear relationship. Mediation analysis is conducted to explore the role of inflammation in this relationship.Results A total of 2,530 OA patients were included in the study, with an average age of 64.46 (12.67) years. After adjusting for covariates, for each one standard deviation increase in DII, the risk of frailty increased by 15% (OR = 1.15, 95% CI = 1.03–1.28). Compared to patients with DII < –1, patients with DII > 1 had a significantly higher risk of frailty (OR = 1.50, 95% CI = 1.05-2.14).Conclusions The findings of this study indicate a positive association between DII and the risk of frailty in OA patients. These results underscore the potential impact of dietary interventions in improving the quality-of-life for OA patients.

Pathological neuropathic pain is a common complication following spinal cord injury. Due to its high incidence, prolonged duration, tenacity, and limited therapeutic efficacy, it has garnered increasing attention from both basic researchers and clinicians. The pathogenesis of neuropathic pain after spinal cord injury is multifaceted, involving factors such as structural and functional alterations of the central nervous system, pain signal transduction, and inflammatory effects, posing significant challenges to clinical management. Currently, drugs commonly employed in treating spinal cord injury induced neuropathic pain include analgesics, anticonvulsants, antidepressants, and antiepileptics. However, a subset of patients often experiences suboptimal therapeutic responses or severe adverse reactions. Therefore, emerging treatments are emphasizing a combination of pharmacological and non-pharmacological approaches to enhance neuropathic pain management. We provide a comprehensive review of past literature, which aims to aim both the mechanisms and clinical interventions for pathological neuropathic pain following spinal cord injury, offering novel insights for basic science research and clinical practice in spinal cord injury treatment.

Structural disorder is common in metal‐halide perovskites and important for understanding the functional properties of these materials. First‐principles methods can address structure variation on the atomistic scale, but they are often limited by the lack of structure‐sampling schemes required to characterize the disorder. Herein, structural disorder in the benchmark inorganic halide perovskites CsPbI3 and CsPbBr3 is computationally studied in terms of the three octahedral‐tilting angles. The subsequent variations in energetics and properties are described by 3D potential‐energy surfaces (PESs) and property landscapes, delivered by Bayesian optimization as implemented in the Bayesian optimization structure search code sampling density functional theory (DFT) calculations. The rapid convergence of the PES with about 200 DFT data points in 3D searches demonstrates the power of active learning and strategic sampling with Bayesian optimization. Further analysis indicates that disorder grows with increasing temperature and reveals that the material bandgap at finite temperatures is a statistical mean over disordered structures.

Abstract Background Intensive care unit-acquired weakness (ICU-AW) is very common in ICU patients. It is important to understand the status quo of knowledge, attitude and behavior of ICU nurses about ICU-AW. This survey aimed to investigate the knowledge, attitude and behavior of ICU nurses about ICU-AW, to provide useful implications for clinical care. Methods ICU nurses from two tertiary hospitals in China from October 10 to November 15, 2023 were included. The ICU-AW knowledge, attitude and behavior questionnaire of ICU nurses with 31 items were used for survey. SPSS24.0 statistical software was used for data analysis. Results A total of 364 ICU nurses were included for survey. The ICU-AW knowledge of ICU nurses was 21.96 ± 5.72 (

Abstract Diabetic foot ulcer (DFU) is a serious complication of diabetic patients which negatively affects their foot health. This study aimed to estimate the role and mechanism of the miR‐200 family in DNA damage of diabetic wound healing. Human foreskin fibroblasts (HFF‐1 cells) were stimulated with high glucose (HG). Db/db mice were utilized to conduct the DFU in vivo model. Cell viability was evaluated using 3‐(4,5‐dimethyl‐2‐thiazolyl)‐2,5‐diphenyl‐2‐H‐tetrazolium bromide assays. Superoxide dismutase activity was determined using detection kits. Reactive oxygen species determination was conducted via dichlorodihydrofluorescein‐diacetate assays. Enzyme‐linked immunosorbent assay was used to evaluate 8‐oxo‐7,8‐dihydro‐2′deoxyguanosine levels. Genes and protein expression were analyzed by quantitative real‐time polymerase chain reaction, western blotting, or immunohistochemical analyses. Luciferase reporter gene and RNA immunoprecipitation assays determined the interaction with miR‐200a/b/c‐3p and GLI family zinc finger protein 2 (GLI2) or ataxia telangiectasia mutated (ATM) kinase. HG repressed cell proliferation and DNA damage repair, promoted miR‐200a/b/c‐3p expression, and suppressed ATM and GLI2. MiR‐200a/b/c‐3p inhibition ameliorated HG‐induced cell proliferation and DNA damage repair repression. MiR‐200a/b/c‐3p targeted ATM. Then, the silenced ATM reversed the miR‐200a/b/c‐3p inhibition‐mediated alleviative effects under HG. Next, GLI2 overexpression alleviated the HG‐induced cell proliferation and DNA damage repair inhibition via miR‐200a/b/c‐3p. MiR‐200a/b/c‐3p inhibition significantly promoted DNA damage repair and wound healing in DFU mice. GLI2 promoted cell proliferation and DNA damage repair by regulating the miR‐200/ATM axis to enhance diabetic wound healing in DFU.

BackgroundCrisis situations bring about many challenges to researchers, public institutions, and governments in collecting data and conducting research in affected individuals. Recent developments in Web-based and smartphone technologies have offered government and nongovernment organizations a new system to disseminate and acquire information. However, research into this area is still lacking. The current study focuses largely on how new social networking websites and, in particular, smartphone technologies could have helped in the acquisition of crucial research data from the general population during the recent 2013 Southeast Asian Haze. This crisis lasted only for 1 week, and is unlike other crisis where there are large-scale consequential after-effects. ObjectiveTo determine whether respondents will make use of Internet, social media, and smartphone technologies to provide feedback regarding their physical and psychological wellbeing during a crisis, and if so, will these new mechanisms be as effective as conventional, technological, Internet-based website technologies. MethodsA Web-based database and a smartphone application were developed. Participants were recruited by snowball sampling. The participants were recruited either via a self-sponsored Facebook post featuring a direct link to the questionnaire on physical and psychological wellbeing and also a smartphone Web-based application; or via dissemination of the questionnaire link by emails, directed to the same group of participants. Information pertaining to physical and psychological wellbeing was collated. ResultsA total of 298 respondents took part in the survey. Most of them were between the ages of 20 to 29 years and had a university education. More individuals preferred the option of accessing and providing feedback to a survey on physical and psychological wellbeing via direct access to a Web-based questionnaire. Statistical analysis showed that demographic variables like age, gender, and educational levels did not influence the mechanism of access. In addition, the participants reported a mean number of 4.03 physical symptoms (SD 2.6). The total Impact of Event Scale–Revised (IES-R) score was 18.47 (SD 11.69), which indicated that the study population did experience psychological stress but not post-traumatic stress disorder. The perceived dangerous Pollutant Standards Index (PSI) level and the number of physical symptoms were associated with higher IES-R Score (P

PurposeTo evaluate and compare the diagnostic value of contrast-enhanced transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) for right to left shunt (RLS) in patent foramen ovale (PFO) by meta-analysis.MethodsThe literature included in the Cochrane Library, PubMed, and Embase were searched by using “contrast-enhanced transcranial Doppler (c-TCD), contrast-enhanced transthoracic echocardiography (c-TTE), patent foramen ovale (PFO), and right to left shunt (RLS)” as the keywords from inception through April 30, 2024. The diagnostic accuracy research quality assessment tool (QUADAS-2) was used to evaluate the quality of the included literature. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and Diagnostic odds ratio (DOR) were pooled, and a comprehensive ROC curve analysis was performed. Statistical software StataSE 12.0 and Meta-Disc 1.4 were used for data analysis.ResultsA total of 8,536 articles were retrieved, and 9 articles that met all inclusion criteria were included in this meta-analysis. The meta-analysis results show that the combined sensitivity, specificity, PLR, NLR, DOR, and area under the SROC curve of c-TCD for the diagnose of PFO-RLS were 0.91 (95% CI, 0.88–0.93), 0.87 (95% CI: 0.84–0.91), 6.0 (95% CI, 2.78–12.96), 0.10 (95% CI, 0.06–0.18), 91.61 (95% CI, 26.55–316.10), and 0.9681, respectively; the corresponding values of c-TTE were 0.86 (95% CI, 0.84–0.89), 0.88 (95% CI, 0.84–0.91), 5.21 (95% CI, 2.55–10.63), 0.16 (95% CI, 0.09–0.31), 71.43 (95% CI, 22.85–223.23), and 0.9532. The ROC curve shows that c-TCD has slightly higher diagnostic value for PFO than c-TTE, but there is no significant statistical difference (Z = 0.622, p > 0.05). Deek funnel pattern showed no significant publication bias.ConclusionBoth c-TCD and c-TTE have high diagnostic values for PFO-RLS. However, c-TCD has slightly higher sensitivity and lower specificity in diagnosing PFO-RLS compared to c-TTE.Systematic review registration: identifier [CRD42024544169].

Abstract Pancreatic ductal adenocarcinoma (PDAC) develops through step-wise genetic and molecular alterations including Kras mutation and inactivation of various apoptotic pathways. Here, we find that development of apoptotic resistance and metastasis of Kras G12D -driven PDAC in mice is accelerated by deleting Plk3, explaining the often-reduced Plk3 expression in human PDAC. Importantly, a 41-kDa Plk3 (p41Plk3) that contains the entire kinase domain at the N-terminus (1-353 aa) is activated by scission of the precursor p72Plk3 at Arg354 by metalloendopeptidase nardilysin (NRDC), and the resulting p32Plk3 C-terminal Polo-box domain (PBD) is removed by proteasome degradation, preventing the inhibition of p41Plk3 by PBD. We find that p41Plk3 is the activated form of Plk3 that regulates a feed-forward mechanism to promote apoptosis and suppress PDAC and metastasis. p41Plk3 phosphorylates c-Fos on Thr164, which in turn induces expression of Plk3 and pro-apoptotic genes. These findings uncover an NRDC-regulated post-translational mechanism that activates Plk3, establishing a prototypic regulation by scission mechanism.

ABSTRACT Background Umbilical cord‐derived mesenchymal stem cells (UCMSCs) could alleviate diabetes‐induced injury. Hence, this investigation aimed to explore the role and mechanism of UCMSCs‐derived exosomal circHIPK3 (exo‐circHIPK3) in diabetes mellitus (DM). Methods HFF‐1 cells were cultured in high glucose (HG) medium or normal medium, and treated with UCMSCs‐derived exo‐circHIPK3 or miR‐20b‐5p mimics or Unc‐51‐like autophagy activating kinase 1 (ULK1) overexpression vector. The surface markers of UCMSCs were analyzed using a flow cytometer. The differentiation potential of UCMSCs was evaluated using oil red O staining, alizarin red staining and alkaline phosphatase (ALP) staining. Cell proliferation was determined by 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assay. The miRNA expressions were analyzed by reverse transcription‐quantitative polymerase chain reaction (qRT‐PCR). Protein levels were quantified by western blot. An immunofluorescence staining was used for observing LC3 expression. The interaction between miR‐20b‐5p and circHIPK3, and between miR‐20b‐5b and ULK1 were identified by a RNA immunoprecipitation (RIP) assay and a luciferase reporter assay. Results Up‐regulation of circHIPK3 was found in UCMSCs‐derived exosomes. Exo‐circHIPK3 decreased the miR‐20b‐5p level while increasing the contents of ULK1 and autophagy‐related gene 13 (Atg13) in HG‐induced fibroblasts. In addition, exo‐circHIPK3 activated HG‐induced fibroblast autophagy and proliferation. Overexpressed miR‐20b‐5p promoted fibroblast injury by inhibiting cell autophagy via the ULK1/Atg13 axis in HG conditions of high glucose. Moreover, exo‐circHIPK3 enhanced autophagy and cell viability in HG‐induced fibroblasts through the miR‐20b‐5p/ULK1/Atg13 axis. Conclusion UCMSCs‐derived exosomal circHIPK3 promoted cell autophagy and proliferation and accelerated the fibroblast injury repair by the miR‐20b‐5p/ULK1/Atg13 axis.

Kidney disease is a serious public health problem and various kidney diseases could progress to end-stage renal disease. The many complications of end-stage renal disease. have a significant impact on the physical and mental health of patients. Ultrasound can be the test of choice for evaluating the kidney and perirenal tissue as it is real-time, available and non-radioactive. To overcome substantial interobserver variability in renal ultrasound interpretation, artificial intelligence (AI) has the potential to be a new method to help radiologists make clinical decisions. This review introduces the applications of AI in renal ultrasound, including automatic segmentation of the kidney, measurement of the renal volume, prediction of the kidney function, diagnosis of the kidney diseases. The advantages and disadvantages of the applications will also be presented clinicians to conduct research. Additionally, the challenges and future perspectives of AI are discussed.

ImportancePostoperative ileus is common after abdominal surgery, and small clinical studies have reported that intraoperative administration of dexmedetomidine may be associated with improvements in postoperative gastrointestinal function. However, findings have been inconsistent and study samples have been small. Further examination of the effects of intraoperative dexmedetomidine on postoperative gastrointestinal function is needed.ObjectiveTo evaluate the effects of intraoperative intravenous dexmedetomidine vs placebo on postoperative gastrointestinal function among older patients undergoing abdominal surgery.Design, setting, and participantsThis multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at the First Affiliated Hospital of Anhui Medical University in Hefei, China (lead site), and 12 other tertiary hospitals in Anhui Province, China. A total of 808 participants aged 60 years or older who were scheduled to receive abdominal surgery with an expected surgical duration of 1 to 6 hours were enrolled. The study was conducted from August 21, 2018, to December 9, 2019.InterventionsDexmedetomidine infusion (a loading dose of 0.5 μg/kg over 15 minutes followed by a maintenance dose of 0.2 μg/kg per hour) or placebo infusion (normal saline) during surgery.Main outcomes and measuresThe primary outcome was time to first flatus. Secondary outcomes were postoperative gastrointestinal function measured by the I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) scoring system, time to first feces, time to first oral feeding, incidence of delirium, pain scores, sleep quality, postoperative nausea and vomiting, hospital costs, and hospital length of stay.ResultsAmong 808 patients enrolled, 404 were randomized to receive intraoperative dexmedetomidine, and 404 were randomized to receive placebo. In total, 133 patients (60 in the dexmedetomidine group and 73 in the placebo group) were excluded because of protocol deviations, and 675 patients (344 in the dexmedetomidine group and 331 in the placebo group; mean [SD] age, 70.2 [6.1] years; 445 men [65.9%]) were included in the per-protocol analysis. The dexmedetomidine group had a significantly shorter time to first flatus (median, 65 hours [IQR, 48-78 hours] vs 78 hours [62-93 hours], respectively; P

Ecosystem services are an essential foundation for sustainable human development. In view of the severe soil erosion on the Loess Plateau (LP), it is important to explore the spatial and temporal characteristics of the supply-demand balance of soil conservation services (SCSs). In this study, the soil conservation ecosystem service supply-demand ratio was innovatively proposed to quantitatively assess the supply and demand balance of soil conservation. First, the InVEST model was used to spatially quantify the supply (soil retention) and demand (soil erosion) of soil conservation services (SCS) in the LP from 2005 to 2020. Meanwhile, the spatial variation characteristics of supply-demand matching were analyzed. Second, to predict the soil conservation ecosystem service supply-demand in the future, the InVEST-PLUS model was used to simulate the supply-demand balance under multiple scenarios in 2030. The natural development (NDS), ecological protection (EPS) and economic development scenarios (EDS) were coupled with shared socioeconomic pathways (SSPs) and representative concentration pathways (RCPs). The results showed that: (1) from 2005 to 2020, the annual average soil erosion modulus of LP increased by 60.58 (t/(hm²·a)); soil retention per unit area increased by 12.89 t/hm2; both increased from northwest to southeast, and the spatial matching pattern of supply-demand was mainly low-low and shifted to low-high each year; and (2) based on the LULC of LP simulated by the PLUS model, the kappa coefficient and overall accuracy were 86.29% and 91.14%, respectively. A total of 19.8% and 22.97% of the built-up land was expanded under the NDS and EDS scenarios, respectively, and a total of 17,515.65 km2 of forestland and grassland was expanded under the EPS scenario; (3) 2030. NDS-SSP245, 2030. EPS-SSP126 and 2030. EDS-SSP585 scenarios, moderate and high surpluses accounted for 11.40%, 14.34% and 10.80% of the total surplus area, respectively; compared to 2020, the high deficit increased by 49.67%, 43.29% and 56.65% respectively. The study provided innovations for the coupling degree of future ecosystem services simulated by the InVEST-PLUS model.