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Abstract Background Heart failure (HF) with improved ejection fraction (EF, HFimpEF) is a distinct HF subtype, characterized by left ventricular (LV) reverse remodeling and myocardial functional recovery. Multiple cardiometabolic factors are implicated in this process. Epicardial adipose tissue (EAT), emerging as an endocrine and paracrine organ, contributes to the onset and progression of HF. However, the relation between EAT and the incidence of HFimpEF is still unclear. Methods A total of 203 hospitalized HF patients with reduced EF (HFrEF, LVEF ≤ 40%) who underwent coronary CT angiography (CCTA) during index hospitalization were consecutively enrolled between November 2011 and December 2022. Routine follow-up and repeat echocardiograms were performed. The incidence of HFimpEF was defined as (1) an absolute LVEF improvement ≥ 10% and (2) a second LVEF > 40% (at least 3 months apart). EAT volume and density were semiautomatically quantified on non-enhanced series of CCTA scans. Results During a median follow-up of 8.6 (4.9 ~ 13.3) months, 104 (51.2%) patients developed HFimpEF. Compared with HFrEF patients, HFimpEF patients had lower EAT volume (115.36 [IQR 87.08 ~ 154.78] mL vs. 169.67 [IQR 137.22 ~ 218.89] mL, P

The development of health-promoting hospitals is an important part of the Healthy China Initiative, facilitating the transformation of medical institutions from a primary focus on medical and surgical treatments to a patient-centered approach prioritizing public health. To promote the scientific, standardized, and sustainable development of health-promoting hospitals, the Shanghai Municipal Center for Health Promotion, together with Shanghai General Hospital and other institutions, has jointly developed the Standards for the Development of Health⁃promoting Hospitals (Standards) in accordance with the principles of scientific rigor, feasibility, and advancing with the times. The Standards outlines the requirements for the development of health-promoting hospitals across four aspects: organizational and institutional guarantees, creation of a healthy environment, implementation of health education and promotion, and evaluation. It is applicable to all levels and types of public medical institutions in Shanghai, and can also be referred to and implemented by other medical institutions. The introduction of the Standards is of great significance for promoting the formation of a long-term mechanism in health-promoting hospitals. This paper introduces the basis, principles, main content, precautions, and implementation suggestions of the Standards. Taking into account relevant policies and standards, it interprets the technical aspects in the process of developing health-promoting hospitals, which is helpful for medical institutions and their management to better understand and apply the standards in their work.

Abstract Purpose To investigate the associations between the most popular social media platform WeChat usage and cognitive performance among the middle-aged and older Chinese population using data from a nationally representative survey. Methods In total, 17,472 participants (≥ 45 years old) from the China Health and Retirement Longitudinal Study (CHARLS, Wave 4, 2018) were analyzed. Cognitive performance including episodic memory and executive function was assessed using Mini-Mental Status Examination (MMSE). Other confounding variables included socio-economic characteristics, medical status, and lifestyle-related information. Multiple linear regression models were used to test the association between cognitive performance and WeChat usage by introducing covariates hierarchically. Subgroup analyses of age and gender were conducted to estimate the robustness of the primary findings. Results After adjusting for multiple confounders across all linear models, WeChat usage is significantly associated with executive function, episodic memory, and global cognitive performance (all p values

Objective The objective is to investigate the impact of wheel polygonalization on metro bogies, thereby strengthening the control requirements for wheel polygonalization, and enhancing the operational quality and safety performance of bogies. Method Based on the introduction of the concept of wheel polygonalization and the mathematical expression of polygonalization using methods such as wheel off roundness testing, modal testing, vibration testing, and stress testing, type of metro is comparativety tested. Result & Conclusion According to the test data: wheel polygonalization can cause main frequency vibration of the axle box position; wheel polygonalization can amplify the magnitude of axle box vibration, with the test object containing obvious wheel polygonalization resulting in an 18% increase in axle box vibration; when the excitation frequency of wheel polygonalization is close to the structural modal frequency, the structural stress will increase significantly, with the stress at key measuing points increasing by more than twice, indicating that wheel polygonalization has a significant impact on structural strength.

Phosphine is a major fumigant for insects control in stored products. However, the current fumigation with aluminum phosphide to generate phosphine is facing many challenges, such as require manual operation, fumigation produce can’t be automatically performed, and management of residue contaminants. To address these issues, the study utilizes a combination of pure phosphine gas from cylinders and nitrogen from a membrane separation nitrogen generator. Phosphine and nitrogen are mixed at predetermined ratios, and the resulting gas mixture is delivered directly into sealed grain storage facilities via a controlled release device and circulated within the grain piles to ensure fumigant evenly distribution. This maintains effective phosphine concentrations within the storage facility. The exposure duration lasted for 13 days, during which phosphine concentrations were monitored, and the total mortality rate of adult insects within the grain piles was recorded. Within 9 hours of treatment initiation, gas concentrations reached 736 mL/m3, peaking at 1 160 mL/m3, with an effective average concentration above 200 mL/m3 sustained for 10 days. The gas circulated and distributed uniformly within the treated space, enabling effective control of major stored commodity pests within a relatively short exposure period.

ObjectiveTo investigate the current situation of health communication carried out by medical institutions in Shanghai through new media platforms such as WeChat， Weibo， Toutiao， Douyin， Kuaishou， Bilibili and WeChat Videos， and to propose targeted measures.MethodsBased on the systematic collection of new media accounts of medical institutions in Shanghai， and through the combination of keyword screening and manual audit， health communication data of medical institutions on new media platforms were determined.ResultsData from 1 117 new media accounts of 162 medical institutions in Shanghai were collected， including 610 WeChat official accounts， 105 WeChat video accounts， 89 Weibo accounts， 18 Bilibili accounts， 198 Douyin accounts， 37 Toutiao accounts， and 60 Kuaishou accounts， totaling 111 853 posts. After keyword sorting and manual screening， a total of 66 761 health science posts were collected， with WeChat Official Accounts， Douyin， and Weibo having the top three highest number of posts. Video-based new media such as Douyin， WeChat Videos， Kuaishou， and Bilibili had a better communication impact than text and image-based new media like WeChat Official Accounts， Weibo， and Toutiao. Among them， Douyin and Toutiao were the best platforms for video and text-image-based new media， respectively.ConclusionMedical institutions in Shanghai recognize the importance of new media in health communication and have made full use of various media platforms to carry out health communication，having a certain impact on health education. In the future， medical institutions should choose appropriate platforms based on target audiences and content characteristics， fully leverage the advantages of various platforms， explore innovative communication strategies， promote the dissemination of health knowledge， and enhance the health literacy of the public.

Atherosclerosis (AS), the main contributor to acute cardiovascular events, such as myocardial infarction and ischemic stroke, is characterized by necrotic core formation and plaque instability induced by cell death. The mechanisms of cell death in AS have recently been identified and elucidated. Ferroptosis, a novel iron-dependent form of cell death, has been proven to participate in atherosclerotic progression by increasing endothelial reactive oxygen species (ROS) levels and lipid peroxidation. Furthermore, accumulated intracellular iron activates various signaling pathways or risk factors for AS, such as abnormal lipid metabolism, oxidative stress, and inflammation, which can eventually lead to the disordered function of macrophages, vascular smooth muscle cells, and vascular endothelial cells. However, the molecular pathways through which ferroptosis affects AS development and progression are not entirely understood. This review systematically summarizes the interactions between AS and ferroptosis and provides a feasible approach for inhibiting AS progression from the perspective of ferroptosis.

To address the current issues of insufficient precision in scenario division and limited applicability of models in energy storage planning， the paper proposes a method for refined energy storage planning based on multi-layer clustering of load scenarios. Firstly， an analysis method is introduced that considers the spatiotemporal coupling characteristics of load using association analysis and clustering， along with a multi-layer clustering method considering load spatiotemporal characteristics. Secondly， for typical load scenarios， a refined energy storage planning model is constructed that comprehensively considers carbon emissions， lifecycle costs， penalties for curtailed wind and solar power， and the coordination of energy storage and distributed energy sources. Finally， a case study is conducted on an actual distribution network， resulting in optimal coordinated configurations of energy storage and distributed energy sources for different load scenarios. This validates the feasibility and effectiveness of the proposed model and method.

Abstract Aims To find potential relation between retrobulbar vessels and fundus microvessels and to detect sensitive and effective clinical indicators in predicting the progress of diabetic retinopathy (DR), ocular hemodynamics were measured using superb microvascular imaging (SMI) and ultrawide-field optical coherence tomography angiography (UWF-OCTA). Methods Observational, cross-sectional study evaluating ocular hemodynamics in patients with DR by SMI (Aplio i900, Canon Medical) and UWF-OCTA (BM-400 K BMizar, Tupai Medical Technology). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the central retinal artery (CRA), posterior ciliary artery (PCA), and ophthalmic artery (OA) were measured by SMI. UWF-OCTA evaluated the fundus vascular parameters. A correlation analysis was used to determine the correlation between SMI and UWF-OCTA parameters. Results One hundred thirty-nine eyes of 139 diabetic patients were included: 29 without DR (NDR), 36 with mild to moderate nonproliferative DR (M-NPDR), 37 with severe NPDR (S-NPDR), and 37 with proliferative DR (PDR). PSV and EDV of retrobulbar vessels decreased from NDR to S-NPDR while increasing PDR. RI of OA showed a decreasing trend in the progression of DR, but other vessels didn’t show the same trend. ROC curve analysis showed that CRAPSV, CRAEDV, PCAEDV, OAPSV, and OAEDV had diagnostic value distinguishing M-NPDR and S-NPDR. The correlation analysis observed a significant association between the SMI parameters of CRA and PCA and UWF-OCTA parameters. CRA hemodynamics were more associated with fundus vascular parameters, especially the retina, in the NDR group than in the M-NPDR group. In contrast, PCA consistently correlated with fundus vascular parameters, especially in the choroid, from the NDR to the M-NPDR group. However, OA showed a poor correlation with OCTA parameters. Conclusion The velocity of retrobulbar vessels, mainly the CRA, may serve as a valuable predictor for assessing the progress of DR. The use of SMI in diabetic patients may help identify patients at risk of developing retinopathy.

Purpose: Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors. Methods: We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends. Results: A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. “Diabetic macular edema,” “retinopathy,” “ranibizumab,” and “optical coherence tomography angiography” were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, “deep learning” (AAY:2020.83), “optical coherence tomography angiography” (AAY:2019.59), “intravitreal Aflibercept” (AAY:2019.29), and “dexamethasone implant” (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run. Conclusion: In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow-up of DME patients, such as deep learning systems, are still research hotspots.

The focus of this article is to explore the Bohr inequality for a specific subset of harmonic starlike mappings introduced by Ghosh and Vasudevarao (Some basic properties of certain subclass of harmonic univalent functions, Complex Var. Elliptic Equ. 63 (2018), no. 12, 1687–1703.). This set is denoted as ℬH0(M)≔{f=h+g¯∈ℋ0:∣zh″(z)∣≤M−∣zg″(z)∣}{{\mathcal{ {\mathcal B} }}}_{H}^{0}\left(M):= \{f=h+\overline{g}\in {{\mathcal{ {\mathcal H} }}}_{0}:| z{h}^{^{\prime\prime} }\left(z)| \le M-| z{g}^{^{\prime\prime} }\left(z)| \} for z∈Dz\in {\mathbb{D}}, where 0

AimsTo investigate the association between socioeconomic position (SEP) and sensory impairments (SIs).MethodsWe used data from the China Health and Retirement Longitudinal Study (CHARLS) (2015). Logistic regressions estimated the odds ratio for associations of SEP with SIs. In addition, Mendelian randomization (MR) analysis was conducted to assess the causal relationship between them with the inverse variance weighting (IVW) estimator. MR-Egger, simple median, weighted median, maximum likelihood, and robust adjusted profile score were employed for sensitivity analyses.ResultsIn the observational survey, we enrolled 19,690 individuals aged 45 and above. SEP was negatively associated with SIs. Adjusted odds of vision impairment were higher for illiterate (1.50; 95%CI: 1.19, 1.91), less than elementary school diploma (1.76; 95%CI: 1.39, 2.25), middle school diploma (1.53; 95%CI: 1.21, 1.93) and lower income (all p

Abstract Background The triglyceride glucose-body mass (TyG-BMI) index is acknowledged as both a reliable indicator of the risk of cardiovascular disease and an accurate surrogate biomarker for evaluating insulin resistance (IR). The importance of the TyG-BMI index among people with heart failure (HF), however, requires more investigation. The objective of this study was to inquire about the relationship between HF patients’ TyG-BMI index and their risk of 360-day mortality. Methods The Medical Information Mart for Intensive Care (MIMIC-IV) database provided the study’s patient data, which were divided into quartiles according to their TyG-BMI index. The endpoint was mortality from all causes within 360 days. Kaplan-Meier analysis was used to compare this primary endpoint amongst the four groups indicated above. The association between the TyG-BMI index and the endpoint was investigated using restricted cubic splines and Cox proportional hazards analysis. Results The study enrolled a total of 423 patients with HF (59.2% male), of whom 70 patients (16.9%) died within 360 days. Patients with higher TyG-BMI indexes had significantly lower mortality risks, according to the Kaplan-Meier analysis (log-rank P = 0.003). Furthermore, the restricted cubic spline analysis illustrated a decrease in the risk of all-cause mortality with an increasing TyG-BMI index. Additionally, multivariable Cox proportional hazards analyses showed that the risk of 360-day death from all causes was considerably higher in the lowest quartile of TyG-BMI. In comparison to the lowest TyG-BMI group, the fully adjusted Cox model yielded a hazard ratio (HR) of 0.24 (95% CI: 0.10, 0.59; p = 0.002) for 360-day mortality. Conclusions In patients diagnosed with HF, a lower TyG-BMI index is strongly related to a higher risk of 360-day mortality. This index can be employed to categorize the risk levels of patients with HF and predict their one-year all-cause mortality .

Hyperlipidemia is a metabolic disorder, which is a major risk factor for atherosclerosis, stroke, and coronary heart disease. Although lipid-lowering treatments have been extensively studied, safer treatments with fewer adverse effects are needed. Rhubarb is a traditional Chinese medicine that has lipid-lowering, anti-inflammatory, and antioxidant properties. Disturbance in lipid metabolism is the basis of tissue damage caused by hyperlipidemia and plays a key role in the development of hyperlipidemia; however, the molecular mechanisms by which rhubarb regulates lipid metabolism to lower lipid levels are yet to be elucidated. We conducted this study to summarize the phytochemical constituents of Rheum officinale and provide a comprehensive review of the molecular mechanisms underlying the regulation of lipid metabolism during hyperlipidemia treatment. It was found that rhubarb extracts, including emodin, rhubarb acid, and rhubarb phenol, regulate total cholesterol, triglyceride, TNF-α, and IL-1β levels through signaling pathways such as C/EBP α, 3T3-L1, PPAR α, and AMPK, thereby improving the hyperlipidemic state. This suggests that rhubarb is a natural drug with lipid-lowering potential, and an in-depth exploration of its lipid-lowering mechanism can provide new ideas for the prevention and treatment of hyperlipidemia.

Different chemical treatment methods were employed to modify the surface of cotton stalk fibers, which were then utilized as fillers in composite materials. These treated fibers were incorporated into polylactic acid/polypropylene melt blends using the melt blending technique. Results indicated that increasing the surface roughness of cotton stalk fibers could enhance the overall mechanical properties of the composite materials, albeit potentially leading to poor fiber–matrix compatibility. Conversely, a smooth fiber surface was found to improve compatibility with polylactic acid, while Si-O-C silane coating increased fiber regularity and interfacial interaction with the matrix, thereby enhancing heat resistance. The mechanical properties and thermal stability of the composite materials made from alkali/silane-treated fibers exhibited the most significant improvement. Furthermore, better dispersion of fibers in the matrix and more regular fiber orientation were conducive to increasing the overall crystallinity of the composite materials. However, such fiber distribution was not favorable for enhancing impact resistance, although this drawback could be mitigated by increasing the surface roughness of the reinforcing fibers.

BackgroundAn increase in deaths has been perceived during the pandemic, which cannot be explained only by COVID-19. The actual number of deaths far exceeds the recorded data on deaths directly related to SARS-CoV-2 infection. Data from early and short-lived pandemic studies show a dramatic shift in cardiovascular mortality. Grounded in the post-pandemic era, macroscopic big data on cardiovascular mortality during the pandemic need to be further reviewed and studied, which is crucial for cardiovascular disease prevention and control.MethodsWe retrieved and collected data associated with cardiovascular disease mortality from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform based on the ICD-10 codes. We applied regression analysis to characterize overall cardiovascular disease mortality trends from 2010 to 2023 and built a time series model to predict mortality for 2020–2023 based on mortality data from 2010 to 2019 in order to affirm the existence of the excess deaths by evaluating observed vs. predicted mortality. We also conducted subgroup analyses by sex, age and race/ethnicity for the purpose of obtaining more specific sociodemographic information.ResultsAll-cause age-standardised mortality rates (ASMRs) for CVD dramatically increased between 2019 and 2021[annual percentage change (APC) 11.27%, p

Liupanshui City in Guizhou Province represents a karst mountainous region with a delicate geological environment. The area has a long history of coal mining, and several coal mines have been progressively closed in recent years. However, even after closure of coal mines, the fractured rock mass in the mined-out areas continues to undergo deformation over a specific period. In karst mountainous regions, this deformation is affected by various factors including elevation, slope, precipitation, and vegetation. In this study, we employed SBAS-InSAR technology to construct a time series of surface deformation data from January 2019 to May 2022 within Liupanshui City’s LuJiaZhai-DaPingDi Minefield. Subsequently, this data was comprehensively analyzed in conjunction with time series vegetation cover, monthly precipitation, elevation, and slope data from the identical period. The key findings of this research are as follows: 1) After the closure of the mine, the subsidence area gradually stabilized, yet the volume of subsidence continues to increase. The subsidence area primarily occurs near the MaiZiGou Coal Mine air-mining area, which had a relatively short closure time, as well as in higher elevation areas in the southern and eastern parts of the minefield. Specifically, the maximum cumulative subsidence and the subsidence rate during the study period reached −60.3 mm and −21.83 mm/a, respectively. 2) Surface deformation is closely linked to slope, vegetation type, and rainfall, with subsidence rates and amounts noticeably higher during the rainy season than in the dry season. 3) Surface vegetation cover types display varied effects on deformation, with grassland or shrub areas being more sensitive to precipitation than forests. Forests, especially pine and fir, show a delayed subsidence response to rain, typically 2–3 months post-rainy season onset. This inhibitory effect lessens with increasing slope, particularly beyond a 25° threshold, where responsiveness to precipitation and associated subsidence significantly increase. The findings of this study hold substantial scientific implications for the restoration and management of closed mining areas, as well as the prevention of geological hazards in karst complex mountainous regions.

The in-depth integration of big data technology and red cultural resources promotes the integration of red cultural resources into the integrated construction of the Civic and Political Science curriculum. In this paper, we use information gained to extract the text features of red cultural resources, combine TF*IDF to calculate the weights of feature items, represent the text to the vector space model, put forward the automatic classification algorithm of decision tree red cultural resources text, and build the framework system of red cultural resources text classification. Teaching stage and political appearance are used as independent variables, respectively, to explore the differences in the teaching effect of Civics courses at different stages of universities, secondary schools, and elementary schools as well as among CPC members, members of the League, and the people, and focuses on analyzing the utilization rate of the red cultural resources of Civics course teaching as well as the students’ participation degree. The results show that only 0.0537 students think that the school functionaries are not working correctly, and there exist 0.4308 students who believe that the classroom teaching is not innovative enough. Combining red cultural resources and the integrated teaching of Civic and Political Science courses requires more excavation of red cultural resources and connotations and the formation of characteristic teaching.

The excavation and sorting out of the thinking political elements of college courses directly determines the transmission content, promotion mode, and final effect of the course thinking political. In order to study the role of information fusion technology in the excavation of Civic Science elements in college courses, this paper investigates the current situation of college course Civic Science construction and practices the method of excavating Civic Science elements by information fusion with the help of specific course examples. From the results, both courses have achieved good results. Regarding the mining effect, 56.2% of the students in the first course thought the effect was obvious, and 54.1% of the students in the second course gave the same evaluation. Students who thought the effect was very bad were 3.5% for the first course and 2.8% for the second course. Compared with the research results, the students who think the effect is very good in a comprehensive view have relatively increased by 21.74%, and those who think the effect is very poor have relatively decreased by 25%. In terms of the role of Civic Education, there was a significant increase in students’ educational ratings in the classroom after the element mining method with the help of information integration. The average score of students’ ratings for the first course increased by 5.5 points, a 9.12% increase in comparison, with the highest score being 68.5 points. For the second course, the average student rating increased by 5 points, or 7.95%, with the highest score being 69.5. To sum up, the excavation of Civic and Political elements of college courses based on information fusion technology can effectively improve the excavation effect and the nurturing effect of Civic and Political elements, logically associate Civic and Political elements with professional education, organically integrate them in classroom teaching, and provide conceptual support and material guarantee for the positive development of Civic and Political courses.

Objective:. To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget’s disease (EMPD). Background:. Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical resection with clear margins remains the preferred management method. The use of mapping biopsies might be beneficial, particularly in lowering disease recurrence. Methods:. Available literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology before a fixed-effect meta-analysis was performed to identify the presence of a correlation between performing mapping biopsies and positive margins on permanent sections as well as disease-free survival. Additional study results not included in the quantitative assessment were qualitatively assessed and reported. Results:. A total of 12 studies were shortlisted for final analysis. 294 patients who underwent mapping biopsies and 48 patients who did not undergo mapping biopsies were included in the assessment. Forest plot analysis revealed a pooled rate ratio of 0.50 (95% CI, 0.32–0.77) in the prevalence of positive margins in patients with mapping biopsies performed as compared to patients without. The pooled rate ratio of the prevalence of disease-free survival in patients with mapping biopsies performed as compared to patients without was 1.38 (95% CI, 1.03–1.84). Qualitative assessment of the remaining selected studies revealed equivocal results. Conclusions:. Mapping biopsies are able to improve EMPD surgical excision outcomes but given the rarity of the disease and heterogeneity of mapping biopsy procedures, further confirmation with randomized controlled trials or a larger patient pool is necessary.

The active contour model, also known as the snake model, is an elegant approach for image segmentation and motion tracking. The gradient vector flow (GVF) is an effective external force for active contours. However, the GVF model is based on isotropic diffusion and does not take the image structure into account. The GVF snake cannot converge to very deep concavities and blob-like concavities and fails to preserve weak edges neighboring strong ones. To address these limitations, we first propose the directionally weakened diffusion (DWD), which is anisotropic by incorporating the image structure in a subtle way. Using the DWD, a novel external force called directionally weakened gradient vector flow (DWGVF) is proposed for active contours. In addition, two spatiotemporally varying weights are employed to make the DWGVF robust to noise. The DWGVF snake has been assessed on both synthetic and real images. Experimental results show that the DWGVF snake provides much better results in terms of noise robustness, weak edge preserving, and convergence of various concavities when compared with the well-known GVF, the generalized GVF (GGVF) snake.

Summary: Coronavirus disease 2019 (COVID-19) remains a significant public health threat due to the ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants to evade the immune system and cause breakthrough infections. Although pathogenic coronaviruses such as SARS-CoV-2 and Middle East respiratory syndrome (MERS)-CoV lead to severe respiratory infections, how these viruses affect the chromatin proteomic composition upon infection remains largely uncharacterized. Here, we use our recently developed integrative DNA And Protein Tagging methodology to identify changes in host chromatin accessibility states and chromatin proteomic composition upon infection with pathogenic coronaviruses. SARS-CoV-2 infection induces TP53 stabilization on chromatin, which contributes to its host cytopathic effect. We mapped this TP53 stabilization to the SARS-CoV-2 spike and its propensity to form syncytia, a consequence of cell-cell fusion. Differences in SARS-CoV-2 spike variant-induced syncytia formation modify chromatin accessibility, cellular senescence, and inflammatory cytokine release via TP53. Our findings suggest that differences in syncytia formation alter senescence-associated inflammation, which varies among SARS-CoV-2 variants.

The control of information is a defining feature of the information age, and the optical modulator likewise has a crucial role in optical networks. The transmission, processing, and storage of data have demanded low energy consumption and high speed for photonic systems, promoting the development of electro-optic modulators to all-optical modulators. Although these all-optical modulation methods eliminate the photoelectric conversion, the disadvantage of volatile materials requiring continuous power supply when processing and retaining data in new materials-based devices increase energy consumption. We propose a Ge2Sb2Te5 (GST) integrated all-optical, nonvolatile optical modulator for in-fiber operation. The pulse-induced GST phase transition changes the reflectivity of the fiber end face, and this difference affects the result of the interference, achieving a modulation of output light intensity in interference spectra. The experimental results reveal that the device has obtained 13 dB interference intensity contrast in the telecommunications bands, and its response to a pump pulse is around 100 ns. Furthermore, we demonstrated the operation of the device as a scalar multiplication unit and a logic operation unit. The signal can be transmitted, processed, and stored in the fiber without photoelectric conversion. With the benefits of the switching power consumption of less than 100 nJ and the nonvolatile nature of GST, the device will be more energy-efficient in synchronous processing and storing. This in-fiber operating modulator lays the foundation for developing all-optical devices and networks.

The treatment of waste plastics has gradually become a hot topic in the current scientific community. In response to the needs for high-impact performance R-PP-based composites, carbon fiber (CF)-reinforced polyolefin elastomer (POE)/recycled polypropylene (R-PP) composite (CF/POE/R-PP) was prepared by the mechanical blending method, and its mechanical and thermal properties were systematically studied. It was found that the CF could effectively improve the bending and notch impact strength as well as enhance the thermal stability of POE/R-PP. Furthermore, a stable and dispersed composite interface formed by the combination of maleic anhydride-grafted polypropylene (PP-g-MAH) with the surface of CF and the fusion alkyl chains in R-PP and POE further enhanced the CF’s reinforcing effect. As a result, the addition of 9 wt.% CF successfully improved the heat resistance of the composite material, and the residual carbon content increased by 97.84% after sintering. The composite toughening of POE and CF effectively improved the impact strength of the composite material, with a maximum increase of over 1000%. This study ultimately resulted in a high-impact-resistant composite material.

Abstract MicroRNAs play a critical regulatory role in different cancers, but their functions in renal cell carcinoma (RCC) have not been elucidated. Reportedly, miR-142-3p is involved in the tumorigenesis and the development of RCC in vitro and is clinically correlated with the poor prognosis of RCC patients. However, the molecular target of miR-142-3p and the underlying mechanism are unclear. In this study, we found that miR-142-3p was upregulated in RCC tumor tissues and downregulated in exosomes compared to normal tissues. The expression of miR-142-3p was inversely associated with the survival of patients with kidney renal clear cell carcinoma (KIRC). RhoBTB3 was reduced in RCC, and miR-142-3p plays an inverse function with RhoBTB3 in KIRC. The direct interaction between RhoBTB3 and miR-142-3p was demonstrated by a dual luciferase reporter assay. miR-142-3p promoted metastasis in the xenograft model, and the suppression of miR-142-3p upregulated RhoBTB3 protein expression and inhibited the mRNAs and proteins of HIF1A, VEGFA, and GGT1. Also, the miR-142-3p overexpression upregulated the mRNA of HIF1A, VEGFA, and GGT1. In conclusion, miR-142-3p functions as an oncogene in RCC, especially in KIRC, by targeting RhoBTB3 to regulate HIF-1 signaling and GGT/GSH pathways, which needs further exploration.

Background This prospective randomized controlled study was designed to evaluate the effect of S-ketamine with sufentanil given intraoperatively and postoperatively on recovery of gastrointestinal (GI) function and postoperative pain in gynecological patients undergoing open abdomen surgery. Methods One hundred gynecological patients undergoing open abdomen surgery were randomized into an S-ketamine group (group S) or placebo group (0.9% saline; group C). Anesthesia was maintained with S-ketamine, sevoflurane, and remifentanil-propofol target-controlled infusion in group S and with sevoflurane and remifentanil-propofol target-controlled infusion in group C. All patients were connected to patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery with sufentanil, ketorolac tromethamine, and tropisetron in group C and additional S-ketamine in group S. The primary outcome was the time of first postoperative flatus, and the secondary outcome was postoperative pain score of patients. Postoperative sufentanil consumption within the first postoperative 24 h and adverse events such as nausea and vomiting were recorded. Results The time of first postoperative flatus in group S was significantly shorter (mean ± SD, 50.3 ± 13.5 h) than that in group C (mean ± SD, 56.5 ± 14.3 h, p = 0.042). The patient’s visual analog scale (VAS) pain score 24 h after surgery at rest was significantly lower in group S than in group C (p = 0.032). There were no differences in sufentanil consumption within the first postoperative 24 h, postoperative complications related to PCIA between the two groups. Conclusions S-ketamine accelerated postoperative GI recovery and reduced 24 h postoperative pain in patients undergoing open gynecological surgery. Trial registration ChiCTR2200055180. Registered on 02/01/2022. It is a secondary analysis of the same trial.

Abstract Background To determine the predictive value of quantitative morphological parameters for pigment epithelial detachment (PED) of neovascular age-related macular degeneration (nAMD) patients. Methods One eye from each of 159 patients with nAMD were studied. Polypoidal choroidal vasculopathy (PCV) group included 77 eyes, and non-PCV group 82. Patients received conbercept 0.05 ml (0.5 mg) in a 3 + ProReNata (PRN) treatment regimen. Correlations between retinal morphologic parameters at baseline and best-corrected visual acuity (BCVA) gain at 3 or 12 months after treatment (structure–function correlations) were assessed. Optical coherence tomography (OCT) scans were used to assess retinal morphologic features including intraretinal cystoid fluid (IRC), subretinal fluid (SRF), PED or PED type (PEDT), and vitreomacular adhesion (VMA). Greatest height (PEDH) and width of PED (PEDW), and volume of PED (PEDV) at baseline were also measured. Results For non-PCV group, BCVA gain from 3 or 12 months after treatment was negatively correlated with PEDV at baseline (r = -0.329, -0.312, P = 0.027, 0.037). BCVA gain at 12 months after treatment was negatively correlated with PEDW at baseline (r = -0.305, P = 0.044). For PCV group, there were no correlations with PEDV, PEDH, PEDW, and PEDT in BCVA gain between baseline and 3 or 12 months after treatment (P > 0.05). SRF, IRC, VMA at baseline did not correlate with short-term and long-term BCVA gain in patients with nAMD (P > 0.05). Conclusion For patients with non-PCV, PEDV at baseline was negatively correlated with short-term and long-term BCVA gain, and PEDW was negatively correlated with long-term BCVA gain. On the contrary, quantitative morphological parameters for PED at baseline had no correlation with BCVA gain in patients with PCV.

BackgroundA substantial portion of heart failure (HF) patients adherent to guideline-directed medical therapies have experienced improved ejection fraction (EF), termed HFimpEF. Glycemic variability (GV) has emerged as a critical cardiometabolic factor. However, the relation between long-term GV and the incidence of HFimpEF is still unclear.MethodsA total of 591 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) admitted from January 2013 to December 2020 were consecutively enrolled. Repeat echocardiograms were performed at baseline and after around 12 months. The incidence of HFimpEF, defined as (1) an absolute EF improvement ≥10% and (2) a second EF > 40% and its association with long-term fasting plasma glucose (FPG) variability were analyzed.ResultsDuring a mean follow-up of 12.2 ± 0.6 months, 218 (42.0%) patients developed HFimpEF. Multivariate analysis showed FPG variability was independently associated with the incidence of HFimpEF after adjustment for baseline HbA1c, mean FPG during follow-up and other traditional risk factors (odds ratio [OR] for highest vs. lowest quartile of CV of FPG: 0.487 [95% CI 0.257~0.910]). Evaluation of GV by alternative measures yielded similar results. Subgroup analysis revealed that long-term GV was associated with HFimpEF irrespective of glycemic levels and diabetic conditions.ConclusionsThis study reveals that greater FPG variability is associated with compromised development of HFimpEF. A more stable control of glycemic levels might provide favorable effects on myocardial functional recovery in HF patients even without diabetes.

Light chain amyloidosis (AL) is a kind of rare disease. The misfolding of the light chain of monoclonal immunoglobulin forms amyloid substances and deposit in different tissues and organs, resulting in organ dysfunction. The heart involvement is represented as light chain cardiac amyloidosis (AL-CA), leading to heart failure, arrhythmia, myocardial infarction, valvular and pericardial diseases. Cardiac involvement is crucial for the risk stratification and prognosis prediction of patients with AL. The median survival time of AL-CA patients is 24 months and only 6 months for the heart failure patients. In recent years, the prognosis of patients with AL-CA has been significantly improved, thanks to the advancement in diagnosis & treatment strategies of cardiac amyloidosis, the milestone in the breakthroughs in targeted therapy of AL, and the improvement of coordinated multidisciplinary treatment. This paper focuses on the cardiovascular involvement of AL and briefly illustrates the pathogenesis, clinical manifestations, and the diagnosis and treatment of AL-CA.

Fabry disease is an X-linked inherited lysosomal storage disorder caused by mutations of the GLA gene, resulting in the decreased a-galactosidase A activity and the accumulation of its substrate globotriasylceramide (GL-3) in the heart, kidney and other organs. The main clinical manifestations of cardiac involvement in Fabry disease are left ventricular hypertrophy (LVH), myocardial fibrosis, heart failure and arrhythmia, which limit quality of life and represent the most common causes of death. Following the development of enzyme activity and genetics testing, diagnosis of Fabry disease is no longer difficult. The application of enzyme replacement therapy (ERT) has also significantly slow disease progression. Therefore, early diagnosis and treatment have become essential in the management of Fabry disease cardiac involvement. Electrocardiogram, echocardiography and cardiac magnetic resonance(CMR) allow early detection of suspected patients. In addition, with the approval of oral chaperone therapy and substrate reduction therapy, the Fabry disease specific treatment landscape is evolving. This article will review the general features, pathophysiology, diagnosis and treatment of Fabry disease with cardiac involvement.

In this letter, a high performance quasi-vertical GaN-on-Si Schottky barrier diode (SBD) was fabricated by combing in-situ p-GaN layer with hydrogen plasma treatment and controlled diffusion as edge terminations (ETs), where the main junction region of Schottky contact is emerged by pattern etching the top p-GaN layer. The p-n junction with higher barrier height can screen the Schottky contact from high electric field induced by field crowding effect. The hydrogen plasma treatment and controlled diffusion applied to the p-GaN layer further reduces the electric field crowding effect near the p-n junction edge via a gradient junction termination extension structure. As a result, the breakdown voltage of the edge p-GaN terminated SBD with H treatment and diffusion is significantly boosted from 140 V in conventional SBD to 500 V with optimized fabrication process. The on/off current ratio of the diode is as high as 1011@±3 V. The forward current density is 1.45 kA/cm2@3 V and the specific on-resistance is 1.57 $\text{m}\Omega \cdot $ cm2.

In silicon carbide (SiC) planar insulated-gate bipolar transistor (IGBT), a large distance between neighboring p-bodies is beneficial to enhance the on-state conductivity modulation, but will expose the gate oxide to high electric field in off-state. With p-bodies placed closer, the gate oxide field is reduced, but the conductivity modulation is suppressed. In this work, a new SiC planar IGBT with oxide shield is proposed and studied by TCAD simulations. The proposed SiC IGBT achieves improved trade-off between on-state voltage drop $(V_{\mathrm{ ON}})$ and maximum gate oxide electric field $(E_{\text {ox-m}})$ . When a quite larger distance between neighboring p-bodies is adopted in the proposed SiC IGBT, a low $V_{\mathrm{ ON}}$ is obtained, while the $E_{\text {ox-m}}$ can be kept at a small value with the oxide shielding structures protecting the gate oxide. Switching characteristics are also studied, and the proposed SiC-IGBT delivers much better trade-off between turn-off energy loss $(E_{\mathrm{ OFF}})$ and $V_{\mathrm{ ON}}$ than the conventional SiC planar IGBT.

To solve the time-consuming and laborious problem of manual winding and unwinding water pipes by field workers during irrigation or pesticide spraying in agricultural production, an automatic pipe winding machine for winding and unwinding water pipes was designed. The guiding mechanism, pipe winding mechanism, and pipe arrangement mechanism of the pipe winding machine are designed, and the automatic deviation correction control method of pipe arrangement based on PID and the constant tension control method of pipe winding and unwinding is put forward, and the control system of the automatic pipe winding machine is developed. By making a prototype of an automatic pipe winding machine, the effects of pipe winding and unwinding and the constant tension control of the automatic winding machine are tested and analyzed. The test results show that under the condition of 4.0 km/h speed, the maximum angle error of the automatic pipe winding machine is 3.32°, the average absolute error is 0.95°, and the water pipes are arranged neatly and tightly. The maximum relative error of the water pipe tension is 9.3%, and the maximum relative error under the 0~4.0 km/h velocity step variable condition is 16.3%. The speed of the pipe winding and unwinding can adapt to the change of the vehicle’s speed automatically, and the tension of the pipe is within a reasonable range. The performance of the pipe arrangement and pipe coiling of the automatic pipe winding machine can meet the operating requirements.

Identification of host determinants of coronavirus infection informs mechanisms of pathogenesis and may provide novel therapeutic targets. Here, we demonstrate that the histone demethylase KDM6A promotes infection of diverse coronaviruses, including SARS-CoV, SARS-CoV-2, MERS-CoV and mouse hepatitis virus (MHV) in a demethylase activity-independent manner. Mechanistic studies reveal that KDM6A promotes viral entry by regulating expression of multiple coronavirus receptors, including ACE2, DPP4 and Ceacam1. Importantly, the TPR domain of KDM6A is required for recruitment of the histone methyltransferase KMT2D and histone deacetylase p300. Together this KDM6A-KMT2D-p300 complex localizes to the proximal and distal enhancers of ACE2 and regulates receptor expression. Notably, small molecule inhibition of p300 catalytic activity abrogates ACE2 and DPP4 expression and confers resistance to all major SARS-CoV-2 variants and MERS-CoV in primary human airway and intestinal epithelial cells. These data highlight the role for KDM6A-KMT2D-p300 complex activities in conferring diverse coronaviruses susceptibility and reveal a potential pan-coronavirus therapeutic target to combat current and emerging coronaviruses. One Sentence Summary: The KDM6A/KMT2D/EP300 axis promotes expression of multiple viral receptors and represents a potential drug target for diverse coronaviruses.

Identifying host genes essential for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has the potential to reveal novel drug targets and further our understanding of Coronavirus Disease 2019 (COVID-19). We previously performed a genome-wide CRISPR/Cas9 screen to identify proviral host factors for highly pathogenic human coronaviruses. Few host factors were required by diverse coronaviruses across multiple cell types, but DYRK1A was one such exception. Although its role in coronavirus infection was previously undescribed, DYRK1A encodes Dual Specificity Tyrosine Phosphorylation Regulated Kinase 1A and is known to regulate cell proliferation and neuronal development. Here, we demonstrate that DYRK1A regulates ACE2 and DPP4 transcription independent of its catalytic kinase function to support SARS-CoV, SARS-CoV-2, and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) entry. We show that DYRK1A promotes DNA accessibility at the ACE2 promoter and a putative distal enhancer, facilitating transcription and gene expression. Finally, we validate that the proviral activity of DYRK1A is conserved across species using cells of nonhuman primate and human origin. In summary, we report that DYRK1A is a novel regulator of ACE2 and DPP4 expression that may dictate susceptibility to multiple highly pathogenic human coronaviruses.

AimsOur aim was to investigate the prevalence, incidence, and persistence of visual impairment (VI) and their correlates among the Chinese population with diabetes mellitus (DM) over 3 years.Materials and methodsThe China Health and Retirement Longitudinal Survey is the first nationally representative longitudinal survey of the Chinese population. A cross-sectional analysis of prevalent VI in 2015 consisted of 2,173 participants with DM. A longitudinal observation of incident and persistent VI consisted of 1,633 participants from 2015 to 2018. Risk factors of VI were identified via univariate and multivariate logistic regression analyses.ResultsAmong our study population with DM, 11.8% reported VI in 2015, 4.5% had persistent VI from 2015 to 2018, and 8.9% developed VI in 2018. Factors identified to be correlated to VI (p < 0.05) were older age, being a woman, lower educational attainment, living in a rural area, application of DM medication and non-pharmacological treatment, receiving DM-related tests, use of spectacles, and poorer health status.ConclusionThis most recent national data provides a baseline for future public health initiatives on VI among the Chinese population with DM. With multiple risk factors identified, these could provide concurrent targets for various public health strategies and interventions with the aim of reducing the burden of VI among the population with DM in China.

Background: Probiotics adjuvant therapy might enhance the efficacy of the conventional medications of bipolar disorder type Ⅰ (BD-Ⅰ). Methods: A randomized double-blind placebo-controlled design was implemented in this study. We randomly assigned 98 patients with depressive BD-Ⅰ to receive the combined treatment of probiotics (Bifidobacterium animals subsp. lactis BAMA-B06/BAu-B0111, 2 g/day) (N = 49) and conventional medications, or conventional medications along with placebo (maltodextrin, 2 g/day) (N = 49). Primary endpoints were the change from baseline to 30 days in the scores of 17-item Hamilton Depression Rating Scale. Results: Compared with control group, HAMD-14 scores were further decreased significantly and the increase trend of fasting blood glucose were suppressed in treatment group. Subsequent correlation analysis revealed there were close associations between the relative abundance of Firmicutes, serum levels of fasting blood glucose and HAMD-14 scores. Conclusions: Probiotics adjuvant therapy can enhance the efficacy of the conventional medications of depressive BD-Ⅰ and reduce the metabolic side effects.

The monitoring of the overflow concentration of the thickener is the key to realize intelligent dosing of coal slurry. The overflow concentration monitoring method based on the sensor will lead to the delay of flocculant regulation. In order to solve the above problem, a prediction method of overflow concentration of thickener based on improved sparrow search algorithm (ISSA) and long-short term memory (LSTM) is proposed. Firstly, the correlation analysis and pretreatment of multi-parameter time series in the process of concentration production are carried out to obtain the input variables. Secondly, the multi-strategies are combined to improve sparrow search algorithm (SSA). Tent chaotic map is introduced to initialize the sparrow population to ensure population diversity and speed up algorithm convergence. The optimization process of SSA is improved by using the spiral predation strategy to balance both local development and global search capabilities. The firefly perturbation strategy is used to perturb the sparrow search results to improve the global search performance and avoid the algorithm falling into local optimization. Thirdly, ISSA is used to optimize the hyperparameters of the two-layer LSTM network model. Finally, the overflow concentration prediction model based on ISSA-LSTM is established for on-line monitoring. The experimental results show the following points. ① The Ackley function and Rastigin function are selected as test functions. It is concluded that ISSA's global optimization capability and convergence speed are better than those of the particle swarm optimization (PSO) algorithm, whale optimization algorithm (WOA) and standard SSA. ② Among the three improved strategies, the spiral predation strategy plays a leading role in improving the performance of ISSA. The chaotic map and the firefly perturbation strategy coordinate the convergence speed and global search capability of the algorithm to further improve the optimization performance of the algorithm. ③ ISSA is used to optimize the hyperparameters of LSTM, which solves the problem of under-fitting or over-fitting when the values are determined by subjective experience. The prediction precision of overflow concentration of the ISSA-LSTM model reaches 97.26%, which is higher than that of double-layer LSTM, SSA-LSTM, and least square support vector machine (LSSVM) models. ④ Data pretreatment can improve the precision of the model, and the prediction precision of overflow concentration after noise reduction is improved by 30.25% compared with that before noise reduction.

Background DSA is an irreplaceable diagnostic method for cerebral vascular disease. It is sensitive to intracranial macrovascular disease, but not to distal blood perfusion. In order to quantitatively assess the perfusion area of the feeding artery, this study is the first to propose an imaging method of the internal carotid artery (ICA) perfusion area relying on deconvolution algorithm and cross⁃correlation (CC) algorithm. Methods Four patients with cerebral vascular disease and 2 healthy subjects who underwent DSA examination in Luwan Branch of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2020 to May 2021 were enrolled. The arterial input function (AIF) of the ICA was extracted, and a deconvolution algorithm was used to calculate the time to peak (Tmax) for each pixel. Then the CC algorithm was used to obtain the CC map related to the perfusion of the ICA at each pixel point of the whole brain. Area of interest (ROI) of AIF were randomly selected for 2 healthy subjects, calculated the root mean square error (RMSE) of the CC map for reliability analysis. The CC map was drawn for 4 patients with cerebral vascular disease for validity analysis. Results Reliability analysis showed that the RMSE values of Towne's and lateral views of the CC map and Tmax map of the left and right ICA in a healthy subject were 0.008±0.011, 0.022±0.002, 0.015±0.007, 0.004±0.008, and (0.108±0.181) s, (0.181±0.214) s, (0.301±0.230) s, (0.035±0.092) s; another healthy subject were 0.015±0.023, 0.007±0.011, 0.007±0.011, 0.005±0.012, and (0.172±0.275) s, (0.092±0.174) s, (0.087±0.156) s, (0.079±0.153) s. The averaged RMSE value of Tmax map was lower than the temporal resolution of DSA, indicating that the reliability of the CC map of the AIF value box in different ROIs of the ICA was high. Validity analysis showed that the CC map and Tmax map of the patient with acute ischemic stroke treated by intravenous thrombolysis bridging to mechanical thrombectomy can fully display the perfusion changes of the ICA after successful thrombectomy. Postoperative DSA in the patient with subacute ischemic stroke after endovascular therapy showed recanalization of the occluded artery, while the CC map showed no significant change in the perfusion of the ICA. The DSA of the patient with middle cerebral artery (MCA) stenosis without related ischemic events showed severe MCA stenosis, but the CC map showed that the ICA was well perfused, and no endovascular treatment was required. The DSA of the patient with acute ischemic stroke without MCA stenosis showed no MCA stenosis, but only sparse ICA⁃related perfusion was seen on the CC map. Conclusions The CC map and Tmax map based on DSA images have good reliability in different ROIs of AIF. The CC map can provide quantitative information on the perfusion area of the feeding arteries, which is helpful for accurate diagnosis and appropriate treatment decisions.

Crushed or chewed potent P2Y12 inhibitors are commonly used in the hope of bridging the gap of platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The study aimed to investigate the efficacy and safety of this alternative oral administration strategy by performing a meta-analysis of available randomized clinical trials (RCTs). PubMed, Embase, the Cochrane Library and Web of Science medical literature databases were searched for RCTs comparing crushed/chewed vs. integral administration of loading dose potent P2Y12 inhibitors in patients with STEMI undergoing pPCI with no language restrictions from inception to January 20th, 2021. The primary efficacy endpoints of high on treatment platelet reactivity (HPR) and P2Y12 reaction units (PRU) at 1 hour together with safety and additional clinical endpoints were evaluated by pooled odds ratio (OR) or mean differences (MD) with 95% confidence intervals (95% CI). A total of 973 patents in six RCTs were eligible for analysis, while 876 patients present baseline and procedural characteristics. HPR and PRU at 1 hour were significantly reduced in the group receiving crushed/chewed P2Y12 inhibitors compared with integral tablets (OR 0.28, 95% CI 0.16 to 0.49, P

Abstract Introduction Pharmacists are frequent users of mobile medical apps (MMA) for drug information (DI) and clinical decision-making purposes. However, the wide range of available MMA may be of variable credibility and results in heterogeneous recommendations. The need for subscription may also influence choice of apps. Objective The objective of this study was to determine the usage pattern of MMA among hospital pharmacists, including their perceptions and factors affecting their choice of apps. Methods This cross-sectional study required respondents to fill in an online questionnaire. The questionnaire included sections on respondents' demographic data, MMA usage pattern, perceived usefulness and opinion on subscription fees. Items were adapted from available literature and validated locally. It was made accessible for 6 weeks starting November 2019 for all pharmacists working in the 23 public hospitals in Sarawak to response (universal sampling). Collected data were analysed using descriptive and inferential statistics. Results A response rate of 37.2% was achieved (n = 162). Respondents were heavily reliant on MMA, with 78.4% accessing them multiple times daily. The majority also agreed that MMA contain correct and up-to-date information. A median of 5 apps were downloaded, suggesting an ultimate app catering for all DI needs was lacking. The Malaysian Drug Formulary was the most downloaded app (88.3%), whereas Lexicomp® was the most “well-rounded” in terms of functionality. Clinical pharmacists were significantly more likely to purchase MMA, in particular UpToDate® (p

Abstract. Background:. So far, there is a paucity of real-world data on the syphilis serological responses to the first-line treatment during pregnancy, and there is no relevant study on the necessity of anti-syphilis treatment during pregnancy for those patients who have been treated for syphilis before pregnancy for the prevention of mother-to-child transmission, which might provide valuable insight into treatment effectiveness and optimal management of pregnant women with syphilis. Methods:. A retrospective study on 10 years of real-world data was performed for accumulative 410 Chinese pregnant women with syphilis. The descriptive statistics were conducted in the study, and toluidine red unheated serum test (TRUST) titer responses to penicillin treatment in syphilis-infected pregnant women, and the associations with congenital syphilis were investigated. We divided the patients into two groups according to the history of anti-syphilis treatment before pregnancy (patients diagnosed with syphilis who had received anti-syphilis treatment before pregnancy, and patients screened and diagnosed with syphilis during pregnancy who had no previous history of anti-syphilis treatment). Results:. The rate of congenital syphilis in this study was 6.2% (25/406). There was no significant difference in the rate of congenital syphilis between patients who received anti-syphilis treatment before pregnancy and those who did not. Secondary syphilis and high baseline serum TRUST titer (≥1:8) in pregnant women were independent risk factors for congenital syphilis. Conclusions:. For the prevention of congenital syphilis, anti-syphilis treatment during pregnancy for syphilis seropositive pregnant women is needed, regardless of whether the patient has received anti-syphilis treatment before pregnancy, especially for those patients with secondary syphilis or high baseline serum TRUST titer, thus, timely surveillance, early diagnosis to timely treatment, and close syphilis reexamination during posttreatment follow-up, may help to reduce the above-mentioned risk factors for congenital syphilis.

PurposeThe aim of this study is to investigate the cross-sectional and longitudinal associations between sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI), and dual sensory impairments (DSI) with social isolation in the middle-aged and older Chinese population.MethodsData were obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 11,674 Chinese older adults aged over 45 were included at baseline 2011, and 6,859 participants who accomplished all four interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and social isolation measurements including social disconnectedness and self-perceived loneliness were collected. Assessment of social disconnectedness included the number of types of social activities in which they participated and the frequency of such participation. Loneliness referred to the subjective perception of loneliness. Other covariates included socio-demographic characteristics, medical conditions, and lifestyle-related factors. The impacts of baseline sensory status on social disconnectedness and loneliness were assessed using univariate and multivariate generalized linear models. A generalized linear model with generalized estimation equations (GEE) was used to assess the association between time-varying sensory statuses with social disconnectedness or loneliness over 8 years after being adjusted with multi-confounding factors.ResultsParticipants with SIs had significantly higher levels of social disconnectedness and self-perceived loneliness, compared to those who were free of SI. All kinds of SIs were significantly associated with loneliness according to both cross-sectional and longitudinal data. The correlations between DSI and social disconnectedness or loneliness at baseline and over 8 years were also noticed. SHI was found to be significantly associated with both frequency and types of social activities according to cross-sectional data and with the frequency of social activity participation in longitudinal analysis. SVI was only associated with the types of social activities at baseline (all p-values < 0.05).ConclusionSensory impairments, especially dual sensory impairments, have explicitly detrimental effects on social isolation among the older Chinese population. Over time, single hearing impairment specifically jeopardizes their frequency rather than types of social activities participation.

Abstract Uncertain characteristics along with unknown exterior disturbances are fundamental issues in the path‐following control of autonomous ground vehicles (AGVs). Here, a novel robust non‐singular terminal sliding mode (NTSM) control method based on a recurrent neural network (RNN) structure is proposed to enhance the path‐following performance of AGVs. First, based on the dynamic model and path‐following model of AGVs, the robust NTSM steering controller is proposed to ensure that the lateral offset converges to zero within a limited time, and concurrently suppresses the chattering phenomenon that occurs in the regular sliding mode control (SMC) strategy. Then, the RNN is applied to approximate the unknown dynamics section of the system online. With an implied feedback loop, its study ability precedes the regular neural network to catch up with the dynamic response. In addition, the adaptive learning algorithms of the parameters in the RNN are derived using the Lyapunov stability theorem and Taylor linearisation technique to ensure the stability of the closed‐loop system. Finally, the robustness and effectiveness of the proposed control approach against parametric uncertainties and unknown external disturbances are verified in the Simulink‐CarSim simulation platform by comparison with selected reported control methods.

Abstract Background We report a case of bradycardia improved by surgical resection of the paratracheal lymph nodes, which has rarely been reported in the literature. Case presentation A 41-year-old male patient with pre-operative sinus bradycardia was diagnosed with right upper lobe adenocarcinoma. He planned to undergo VATS right upper lobectomy and mediastinal lymph node dissection. Consultation indicated that there was no need to place a temporary pacemaker. Severe sinus bradycardia occurred during induction of anesthesia and heart rate (HR) fell significantly from 52 to 28 bpm. There was no response to atropine. Isoproterenol was administered continuously for two hours at 0.01 µg per kg per minute to keep the patient’s HR around 50 bpm. During the operation, it was noted that the right upper mediastinal lymph nodes (group R2 and R4) were calcified and very close to the vagus nerve. After resection of the lymph nodes, the patient’s HR returned to 60–68 bpm without isoproterenol. There were no post-operative complications and the patient was discharged on the 5th post-operative day. The pathological findings indicated invasive adenocarcinoma with no lymph node metastases. One month after surgery, 24-h Holter monitoring revealed sinus rhythm without bradycardia. Six months after surgery no sinus bradycardia has occurred thus far. Conclusions Patients with persistent sinus bradycardia pre-operation caused by vagus nerve compression deserve attention. Guidelines on placement of temporary pacemakers and intraoperative anesthesia management may be improved by additional clinical experience.

Despite effective vaccines against SARS-CoV-2, therapeutic options such as anti-virals and neutralizing antibodies are critical in treating disease, especially given the breakthrough infections of emerging VOCs. Here, Peng et al. generate two potent monoclonal antibodies and a bispecific antibody with two antigenrecognition variable regions targeting SARS-CoV-2 spike, provide CryoEM structures and show in vitro and in vivo efficacy of a humanized antibody against wildtype virus and delta variant.

Endobronchial lipoma (EL) is a rare benign tumor characterized by tracheobronchial smooth-surfaced mass, often resulting in bronchial obstruction without standard guidelines for management. This study seeks to clarify the clinical features and interventions of EL, aiming to improve its diagnosis and outcomes. A retrospective review was conducted on 28516 outpatients treated between January 2015 and December 2019 at the Department of Respiratory and Critical Care Medicine of the Second Affiliated Hospital of Air Force Medical University to collect patients diagnosed with EL. Their clinical, bronchoscopic, chest imaging, and histopathological features along with management were analyzed. Among the patients reviewed, nine were histopathologically diagnosed with EL, comprising seven males and two females. All EL patients exhibited noticeable symptoms, including cough (in eight patients), dyspnea (in six patients), fever (in three patients), expectoration (in two patients), chest pain (in two patients), hemoptysis (in one patient), and fatigue (in one patient). Chest CT abnormalities included endobronchial mass (in four patients), inflammatory exudation (in three patients), atelectasis (in three patients), and infiltration or consolidation (in two patients). In three patients, imaging showed fat density, directly leading to the diagnosis of EL. The EL lesions were distributed with six in the right lung and three in the left lung, all located within the first three subdivisions of the tracheobronchial tree. Treatment approaches varied, with one patient undergoing combined bronchoscopic resection and surgery. The remaining patients received bronchoscopic intervention such as electrosurgical snare resection, argon plasma coagulation (APC), cryotherapy, and holmium laser. Histopathological analysis confirmed the EL diagnosis. Finally, the mass removal restored bronchus patency. Taken together, EL symptoms lack specificity, necessitating reliance on histopathology for EL accurate diagnosis. Bronchoscopic interventions emerge as the preferred option for EL management, surpassing surgical approaches.