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Background: Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID-19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health-related outcomes within an adolescent cohort followed during the pandemic. Methods: During 3 semi-annual follow-up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self-efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting. Results: Relative to in-person instruction, students in remote instruction reported lower academic self-efficacy (Beta: -0.11; 95% confidence interval [CI]: -0.22, -0.01) and school connectedness (Beta: -0.37; 95% CI: -0.48, -0.25), greater odds of past 30-day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30-day e-cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86). Conclusions: Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.

Abstract The mechanism of THz generation in ferromagnet/metal (F/M) bilayers has been typically ascribed to the inverse spin Hall effect (ISHE). Here, we fabricated Pt/Fe/Cr/Fe/Pt multilayers containing two back-to-back spintronic THz emitters separated by a thin (t Cr≤ 3nm) wedge-shaped Cr spacer. In such an arrangement, magnetization alignment of the two Fe films can be controlled by the interplay between Cr-mediated interlayer exchange coupling (IEC) and an external magnetic field. This in turn results in a strong variation of the THz amplitude A, with A ↑ ↓ reaching up to 14 times A ↑ ↑ (arrows indicate the relative alignment of the magnetization of the two magnetic layers). This observed functionality is ascribed to the interference of THz transients generated by two closely spaced THz emitters. Moreover, the magnetic field dependence A(H) shows a strong asymmetry that points to an additional performance modulation of the THz emitter via IEC and multilayer design.

Abstract Background Vascular calcification is a crucial pathophysiological process associated with age-related cardiovascular diseases. Elabela, a recently identified peptide, has emerged as a significant player in the regulation of cardiovascular function and homeostasis. However, the effects and underlying mechanisms of Elabela on age-related vascular calcification remain largely unexplored. Methods In-vivo vascular calcifications of C57BL/6J mice (8-week-old) and young (8-week-old) or aged (72-week-old) SD rats were injected with vitamin D3 (VitD3) or saline, respectively. Furthermore, the VitD3-overloaded mice received Elabela (1 mg/kg/d), peroxisome proliferators-activated receptor-γ (PPAR-γ) activator Rosiglitazone (5 mg/kg/d) or copper-ionophore Elesclomol (20 mg/kg/d), respectively. As for in-vitro studies, primary rat vascular smooth muscle cells (VSMCs) were isolated from aortas and cultured for explore the role and underlying mechanism of Elabela in vascular calcification. Results There were marked increases in FDX1 and Slc31a1 levels in both aortas and VSMCs during vascular calcification, coinciding with a rise in copper levels and a decrease in Elabela levels. Alizarin red and von-Kossa staining indicated that the administration of Elabela effectively hindered the progression of vascular cuproptosis and arterial calcification in VitD3-overloaded mice and rat arterial rings models. Moreover, Elabela significantly suppressed osteogenic differentiation and calcium deposition in VSMCs and strikingly reversed high phosphate-induced augmentation of FDX1 expression, DLAT aggregation as well as intracellular copper ion levels. More importantly, Elabela exhibited remarkable abilities to prevent mitochondrial dysfunctions in primary rat VSMCs by maintaining mitochondrial membrane potential, inhibiting mitochondrial division, reducing mitochondrial ROS production and increasing ATP levels. Interestingly, Elabela mitigated cellular senescence and production of pro-inflammatory cytokines including IL-1α, IL-1β, IL-6, IL-18 and TNF-α, respectively. Furthermore, Elabela upregulated the protein levels of PPAR-γ in VitD3-overloaded mice. Administrating PPAR-γ inhibitor GW9662 or blocking the efflux of intracellular copper abolished the protective effect of Elabela on vascular calcification by enhancing levels of FDX1, Slc31a1, Runx2, and BMP2. Conclusion Elabela plays a crucial role in protecting against vascular cuproptosis and arterial calcification by activating the PPAR-γ /FDX1 signaling. Elabela supplementation and cuproptosis suppression serve as effective therapeutic approaches for managing vascular calcification and related cardiovascular disorders.

Abstract Alzheimer’s disease (AD), an age-related neurodegenerative disorder, is characterized by irreversible brain tissue degeneration. The amyloid-β (Aβ) cascade hypothesis stands as the predominant paradigm explaining AD pathogenesis. This study aimed to elucidate the mechanisms underlying Aβ-induced pyroptosis in AD. AD models were established using amyloid precursor protein/presenilin 1 (APP/PS1) transgenic mice and Aβ-treated BV-2 cells (5 µM, 24 h). NEK7 expression was evaluated in vitro and in vivo. Cell pyroptosis was assessed before and after NEK7 expression was inhibited in BV-2 cells. Adeno-associated virus (AAV) vectors carrying short hairpin RNA (shRNA) against NEK7 (AAV-sh-NEK7) were administered to mice to knockdown NEK7 in vivo. Spatial learning and memory abilities were evaluated using the Morris water maze test. The interaction between NEK7 and histone H4 lysine 12 lactylation (H4K12la) were then investigated. The results suggested that NEK7 expression was markedly elevated in both in vitro and in vivo AD models. Treatment with Aβ significantly reduced cell viability and enhanced pyroptosis in BV-2 cells; these effects were reversed by inhibiting NEK7. Furthermore, AD mice with NEK7 knockdown exhibited shorter escape latencies and increased time spent in the target quadrant, suggesting that NEK7 inhibition improved cognitive function and memory retention. Mechanistically, Aβ treatment induced histone lactylation in BV-2 cells, and suppression of lactylation attenuated NEK7 transcriptional activity and mRNA levels. In summary, elevated NEK7 expression promoted histone lactylation in BV-2 cells, thereby facilitating pyroptosis. Inhibition of NEK7 conferred protection against Aβ-induced cellular damage and enhanced cognitive performance and memory retention in AD model mice. Collectively, targeting NEK7 represents a potential therapeutic strategy for alleviating AD symptoms. Graphical abstract

Abstract Background To analyze the clinical manifestations, endoscopic features, pathological features, endoscopic resection, and prognosis of esophageal granular cell tumors (GCTs). Methods The present study retrospectively analyzed and followed up the clinical data of 62 patients diagnosed with esophageal GCTs who underwent endoscopic resection at Zhongshan Hospital of Fudan University between July 2007 and March 2022. The clinicopathological features, endoscopic diagnosis, and treatment experience of esophageal GCT patients were summarized. Results Among the 62 patients with esophageal GCT, there were 34 males and 28 females, with an average age of 49.3 ± 11.7 years. Only 11 patients had symptoms, such as epigastric discomfort, regurgitation or dysphagia. One patient had multiple lesions, and the rest had single lesions, totaling 63 lesions. Most lesions (53/63) were located in the median and lower esophagus, the diameters ranged from 3 to 22 mm. The endoscopic morphology of the GCTs was molar, flat, hemispherical, or irregular submucosal protuberance. Endoscopic ultrasound (EUS) was performed in 38 cases, most cases (31/38) were hypoechoic, and 32 cases were appeared as homogeneous lesions. There were no complications during or after the endoscopic operations, and the en bloc resection rate was 100%. The negative rate of microscopic incisional margin was 63.5% (40/63). No patients developed recurrence during the follow-up period. The follow-up duration was 21–197 months (100.5 months for average). Conclusion Esophageal GCT is a rare disease with no obvious symptoms and a good prognosis. Endoscopic resection is a safe and effective method of diagnosis and treatment for esophageal GCTs. A microscopic positive tumor margin may not increase the rate of recurrence.

Central Asia, a crucible of prehistoric and historical Trans-Eurasian interactions, has been pivotal in shaping cultural exchanges, population dynamics, and genetic admixture. Recent insights from ancient DNA studies have shed light on the extensive population turnover within this region, encompassing a spectrum of groups from Paleolithic hunter-gatherers to Holocene herders and the nomadic pastoralist empires of historical times. The genomic analysis of ancient pathogens across the Eurasian steppe has further deepened our understanding of pathogen origins, clonal expansions, and the intricate processes of host-pathogen coevolution in relation to varying pathogen exposures and their spread. We consolidate the latest findings pertaining to the ancient human and pathogen genomes of Central Asia, elucidating their profound influence on the genomic tapestry of contemporary Central Asians. A notable gap in the current genomic databases for Central Asia is underscored, particularly within the scope of genomics-driven precision medicine. We stress the urgent need for the development of extensive, region-specific genomic resources that hold promise for revealing the genetic blueprints underlying human traits and diseases, refining polygenic scoring models for predictive medicine, and bolstering genomic research endeavors across Central Asia.

Abstract Objective The aim of our study was to evaluate the indocyanine green (ICG) retention test as a noninvasive marker of esophageal varices(EV). Methods The clinical data of patients diagnosed with compensated liver cirrhosis in Tianjin Second People’s Hospital between January 2018 and January 2021 were analysed with SPSS 23.0. Result A total of 144 patients (88 M/56 F, 51.7 ± 11.06 years) were enrolled. The ICG retention at 15 min(ICG-r15), PVD, TBIL, Cholinesterase(CHE), AST to ALT ratio(ARR), APRI, splenic area, Lok index, Park index and liver stiffness measurement in the absent or small EV group were lower than those in the medium or large EV group, while the ICG disappareance rate(ICG-K), Effective hepatic blood flow(EHBF), ALB, PLT, and Platelet to Spleen Diameter Ratio(PSDR) were higher, and the differences were significant (P

The incidence of allergic diseases is gradually increasing， and multi-system allergic diseases often co-occur in the same patient. It is very important to conduct comprehensive diagnosis and treatment with high quality， high efficiency， reasonable and standardized. The multi-disciplinary diagnosis and treatment provides a new way to solve the complicated and difficult comorbidities of allergic comorbidity and multimorbidity， which is an effective supplement to the traditional diagnosis and treatment mode， and is also the development trend of the diagnosis and treatment of allergic diseases. At present， the multi-disciplinary treatment of allergic comorbidity and multimorbidity is still in the exploratory stage at home and abroad， and has not yet formed a mature system or a operation mode. Based on the clinical exploration and practical experience of allergic disease expert team of the Third Affiliated Hospital of Sun Yat-sen University， this paper expounds the construction and implementation of the multi-disciplinary treatment system for allergic comorbidity and multimorbidity from the aspects of implementation objectives， organizational structure， basic requirements， operation mode， procedure， system guarantee， quality control and so on. Establishing a standardized， mature and perfect multi-disciplinary treatment system for allergic comorbidity and multimorbidity and ensuring its effective operation and implementation will help to improve the level of multi-disciplinary diagnosis and treatment for allergic comorbidity and multimorbidity.

Abstract A copper-based metal-organic framework named NH2-Cu-MOF has been synthesized and utilized as an effective broad-spectrum antimicrobial material in this article. The obtained NH2-Cu-MOF exhibits satisfying antibacterial activity against both gram-positive bacteria (S. aureus and S. epidermidis) and gram-negative bacteria (E. coli and K. peneumoniae). Additionally, the biocompatibility of this NH2-Cu-MOF has been validated through animal studies, showing no significant adverse effects, thereby confirming its high biocompatibility. These findings prove that NH2-Cu-MOF has positive effects upon the treatment of bacteria-infected wounds, which holds great potential to be applied in biochemistry field.

Abstract Background Incremental peritoneal dialysis (IPD) refers to the use of less than standard full-dose peritoneal dialysis (SPD) in end-stage renal disease patients. While the use of IPD is being reported in the literature, its safety and efficacy vs. SPD is unclear. We hereby performed a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival and residual renal function (RRF) between IPD and SPD. Methods All comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from inception to 5th September 2023 and reporting on given outcomes were eligible. Results Ten studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken. Majority of studies found no difference in patient survival between IPD and SPD. Meta-analysis of crude mortality data also presented no significant difference. Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies. Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF while others found no such difference. Conclusion IPD may be a safe alternative to SPD in incident dialysis patients. There seems to be no difference in patient survival, peritonitis, and technique survival between the two modalities. However, the impact of IPD on RRF is still questionable. Evidence is heterogeneous and conflicting to derive firm conclusions.

Abstract Background At present, unequal allocation of medical resources represents a major problem for medical service management in China and many other countries. Equity of intensive care unit (ICU) bed allocation is essential for timely and equitable access to medical care for critically ill patients. This study analysed the equity of ICU bed allocation in 31 provincial regions in China, and the associated factors, to provide a theoretical basis for improvement in the allocation of ICU beds. Methods The equity of ICU bed allocation was investigated in 31 provincial regions in China in 2021. The Gini coefficient combined with Lorenz curves were used to analyse the current status of ICU bed allocation by both population and service area. The spatial heterogeneity and aggregation of ICU bed density were analysed using the Global Moran’s index. The spatial distribution pattern was visualized via LISA maps using the Local Moran’s index. Three grey correlation models were constructed to assess the key factors influencing ICU bed density. Finally, robustness analysis was performed to test the reliability of the results. Results The allocation of ICU beds in China was highly inequitable by service area (Gini = 0.68) and showed better balance by population distribution (Gini = 0.14). The distribution of ICU beds by service area was highly spatially clustered (Global Moran’s I = 0.22). The bed utilization rate exhibited the strongest association with ICU bed density by population. Registered nurses per 10,000 square kilometres was the strongest factor affecting ICU bed density by service area. Conclusions The allocation of ICU beds by population is better than by service area; the allocation by service area is less equitable in China. These findings emphasise the need to implement better measures to reduce ICU bed equity differences between regions and balance and coordinate medical resources. Service area size, bed utilization, the number of registered nurses and other key factors should be considered when performing regional health planning for ICU bed supply. This will increase the equitable access to critical medical services for all populations.

Abstract Exploring efficient and easily implementable prenatal screening strategies aims at birth defect prevention and control. However, there have been limited economic evaluations of non-invasive prenatal screening (NIPS) strategies in China. Furthermore, these studies were predominantly confined to local or geographically proximate provinces and lacked universality and representativeness. This study assesses the health economics of current prenatal screening strategies and NIPS as first-line screening programs, analyzing their efficacy to determine an optimal strategy. From the perspective of health economics, cost-effectiveness, cost-benefit, and single-factor sensitivity were conducted for five different screening strategies using a decision tree model. Among pregnant women aged

ObjectiveTo construct an early warning model of maintenance hemodialysis （MHD） capacity overload based upon basic dialysis data, ultrasound and routine blood biochemistry and examine its clinical effectiveness. Methods From January 2023 to December 2023, 603 patients on MHD were retrospectively reviewed. They were assigned into two sets of modeling （n = 402） and validation （n = 201） according to a ratio of 2:1. The relevant clinical were collected. And the influencing factors of MHD capacity overload in modeling set were analyzed by univariate and LASSO-Logistic regression. The risk prediction nomogram model was constructed. And consistency index, calibration curve, receiver operating characteristic （ROC） curve and decision curve were utilized for verifying the prediction model internally and externally. Results Serum albumin, Kt/V, RRF and left ventricular ejection fraction （LVEF） in overload group were lower than those in normal group. NT-proBNP, ultrasonic lung B-line and right atrial diameter were higher than those in normal group （P＜0.05）. LASSO results indicated that serum albumin, Kt/V, RRF, LVEF, NT-proBNP, ultrasonic lung B-line and right atrial internal diameter were Top 7 characteristic variables of volume overload in MHD. Logistic regression results revealed that Kt/V, serum albumin, RRF and LVEF were the protective factors for MHD volume overload. And NT-proBNP, ultrasonic lung B-line and right atrial diameter were the risk factors for MHD volume overload （P＜0.05）. The risk prediction nomogram model of capacity overload was constructed according to the influencing factors of Logistic regression. Consistency index in modeling and validation sets was 0.860 and 0.814, respectively. Calibration curve showed that the incidence of MHD capacity overload predicted by the model in modeling and validation sets was basically consistent with the actual incidence. ROC curve indicated that the area under the curve as predicted by the model in modeling and validation sets was 0.917（95%CI: 0.886-0.948） and 0.916（95%CI: 0.869-0.962）. Decision curve revealed that when the high-risk threshold of modeling set was 0-0.7 and the high risk threshold of validation set 0-0.7. The model had an excellent clinical net benefit. Conclusion In MHD patients, the occurrence of volume overload is affected by serum albumin, Kt/V, RRF, LVEF, NT-proBNP, ultrasonic lung B-line and right atrial diameter. The early warning model built according to the factors related to volume overload has excellent predictive capability and clinical benefit.

Abstract Background A comprehensive understanding of the genetic basis of rare diseases and their regulatory mechanisms is essential for human molecular genetics. However, the genetic mutant spectrum of pathogenic genes within the Chinese population remains underrepresented. Here, we reported previously unreported functional ABHD12 variants in two Chinese families and explored the correlation between genetic polymorphisms and phenotypes linked to PHARC syndrome. Methods Participants with biallelic pathogenic ABHD12 variants were recruited from the Chinese Deafness Genetics Cohort. These participants underwent whole-genome sequencing. Subsequently, a comprehensive literature review was conducted. Results Two Han Chinese families were identified, one with a compound heterozygous variant and the other with a novel homozygous variant in ABHD12. Among 65 PHARC patients, including 62 from the literature and 3 from this study, approximately 90% (57 out of 63) exhibited hearing loss, 82% (50 out of 61) had cataracts, 82% (46 out of 56) presented with retinitis pigmentosa, 79% (42 out of 53) experienced polyneuropathy, and 63% (36 out of 57) displayed ataxia. Seventeen different patterns were observed in the five main phenotypes of PHARC syndrome. A total of 33 pathogenic variants were identified in the ABHD12. Compared with other genotypes, individuals with biallelic truncating variants showed a higher incidence of polyneuropathy (p = 0.006), but no statistically significant differences were observed in the incidence of hearing loss, ataxia, retinitis pigmentosa and cataracts. Conclusions The diagnosis of PHARC syndrome is challenging because of its genetic heterogeneity. Therefore, exploring novel variants and establishing genotype-phenotype correlations can significantly enhance gene diagnosis and genetic counseling for this complex disease.

Abstract To enhance the energy efficiency and financial gains of the park integrated energy system (PIES). This paper constructs a bi-level optimization model of PIES-cloud energy storage (CES) based on source-load uncertainty. Firstly, the scheduling framework of PIES with refined power-to-gas (P2G), carbon capture and storage (CCS) and CES coupling is constructed. Moreover, a bi-level optimization model with the upper tier subject being the PIES operator and the lower tier subject being the CES operator is established under the ladder-type carbon price mechanism with reward and punishment (LCPMRP). Then a proposed entropy weight adaptive information gap decision theory method (EAIGDT) is proposed to eliminate the subjectivity factor and retain its non-probabilistic features while dealing with multiple source-load uncertainties, and according to the operator’s risk preference to build risk-averse (RA) and risk-seeking (RS) strategies, respectively. Finally, the measured data in a certain area of Xinjiang verifies the proposed optimal scheduling method. The results show that the method can effectively take into account the interests of various subjects and realise PIES low-carbon economic operation.

Abstract Studies have shown that the inhibition of phosphatase and tensin homolog deleted on chromosome 10 (PTEN)was neuroprotective against ischemia/reperfusion(I/R) injury. Bisperoxovanadium (bpV), a derivative of vanadate, is a well-established inhibitor of PTEN. However, its function islimited due to its general inadequacy in penetrating cell membranes. Mxene(Ti3C2Tx) is a novel two-dimensional lamellar nanomaterial with an excellent ability to penetrate the cell membrane. Yet, the effects of this nanomaterial on nervous system diseases have yet to be scrutinized. Here, Mxene(Ti3C2Tx) was used for the first time to carry bpV(HOpic), creating a new nanocomposite Mxene-bpV that was probed in a cerebral I/R injury model. The findings showed that this synthetic Mxene-bpV was adequately stable and can cross the cell membraneeasily. We observed that Mxene-bpV treatment significantly increased the survival rate of oxygen glucose deprivation/reperfusion(OGD/R)--insulted neurons, reduced infarct sizes and promoted the recovery of brain function after mice cerebral I/R injury. Crucially, Mxene-bpV treatment was more therapeutically efficient than bpV(HOpic) treatment alone over the same period. Mechanistically, Mxene-bpV inhibited the enzyme activity of PTEN in vitro and in vivo. It also promoted the expression of phospho-Akt (Ser473) by repressing PTEN and then activated the Akt pathway to boost cell survival. Additionally, in PTEN transgenic mice, Mxene-bpV suppressed I/R-induced inflammatory response by promoting M2 microglial polarization through PTEN inhibition. Collectively, the nanosynthetic Mxene-bpV inhibited PTEN’ enzymatic activity by activating Akt pathway and promoting M2 microglial polarization, and finally exerted neuroprotection against cerebral I/R injury. Graphical Abstract

Abstract The development of new antibiotics continues to pose challenges, particularly considering the growing threat of multidrug-resistant Staphylococcus aureus. Structurally diverse natural products provide a promising source of antibiotics. Herein, we outline a concise approach for the collective asymmetric total synthesis of polycyclic xanthene myrtucommulone D and five related congeners. The strategy involves rapid assembly of the challenging benzopyrano[2,3-a]xanthene core, highly diastereoselective establishment of three contiguous stereocenters through a retro-hemiketalization/double Michael cascade reaction, and a Mitsunobu-mediated chiral resolution approach with high optical purity and broad substrate scope. Quantum mechanical calculations provide insight into stereoselective construction mechanism of the three contiguous stereocenters. Additionally, this work leads to the discovery of an antibacterial agent against both drug-sensitive and drug-resistant S. aureus. This compound operates through a unique mechanism that promotes bacterial autolysis by activating the two-component sensory histidine kinase WalK. Our research holds potential for future antibacterial drug development.

A composite FeAl-LDH@BC obtained by successfully loading FeAl-LDH onto biochar (BC) is used to the Cr(VI)-contaminated soil remediation. The efforts of loading, initial pH, concentration and dosage are investigated. The results indicate that the immobilization process of Cr(VI) in soil could be well described by the pseudo-second-order kinetic model and maximum adsorption capacity of FeAl-LDH@BC is 42.78 mg/g at a temperature of 298 K. Additionally, The physicochemical properties of FeAl-LDH@BC are characterized by SEM, EDS, XRD, FTIR and XPS. The characterization results suggest that the immobilization mechanism involved adsorption and reduction. Cr(VI) is immobilized by adsorption to the layers of FeAl-LDH, the reduction of Cr(VI) to Cr(III) is then accomplished using Fe(II) as a reducing agent. In order to demonstrated the stability of composites for environmental restoration, the TCLP tests, dry-wet, freeze-thaw aging cycles, soil phytotoxicity tests, and microbial community are analyzed. The study shows that we provided a material for soil immobilization with high performance for the remediation of Cr(VI)-contaminated soil.

BackgroundVoriconazole, isavuconazole, and amphotericin (AmB) formulations are currently recommended to treat invasive pulmonary aspergillosis (IPA). We aimed to estimate the efficacy of different antifungal drugs in the initial treatment of IPA.MethodsWe included all available randomized controlled trials (RCTs) evaluating first-line treatments for IPA by searching PubMed, Medline, EMBASE, the Cochrane Library, and the ClinicalTrials.gov database. We performed a network meta-analysis to compare the relative efficacy of different drugs in treating IPA. The primary outcomes were the overall response and all-cause mortality (ACM).ResultsEight studies were identified that compared different drugs including voriconazole, isavuconazole, posaconazole, anidulafungin, liposomal AmB (L-AmB) at standard, high and low doses (3-5 mg/kg/d; 10 mg/kg/d; 1 mg/kg/d), AmB deoxycholate (dAmB) and amphotericin B colloidal dispersion (ABCD). We found that second-generation triazole antifungal drugs containing voriconazole, isavuconazole, and posaconazole exhibited significantly superior overall response to dAmB and ABCD. Voriconazole was ranked as the best drug on network rank analysis. We found no difference in efficacy between triazole antifungals and L-AmB. A combination of voriconazole with anidulafungin, isavuconazole and voriconazole showed significantly better safety than dAmB.ConclusionThe efficacy of second-generation triazole antifungal drugs for the first-line treatment of IPA is comparable with L-AmB and is better than both dAmB and ABCD. Isavuconazole may show better safety than voriconazole and posaconazole. Combination therapy with voriconazole and anidulafungin may serve as an alternative option for IPA patients with limited drug tolerance.Systematic review registrationhttps://inplasy.com/.

The study aims to explore the spatial association network characteristics of biased green innovation in the manufacturing sector and its core drivers. This study constructs a Malmquist-Luenberger decomposition index model to identify the input and output biases of green technological innovation (GIIM and GIOM) in the manufacturing industry. This study uses a modified gravity model and social network analysis method to conduct a robust assessment of GIIM spatial association network of 30 provinces in China from 2012 to 2021. The results show: (1) The GIIM association network structure is stable and has good accessibility, with close connections between provinces and blocks, and significant spillover effects between provinces. (2) The regional network shows a “core-periphery” spatial variation, with the core area expanding and the peripheral area shrinking. (3) The digital transformation characteristics of the network components and the intensity of environmental regulation have a significant impact on GIIM.

Summary: As environmental awareness grows, the agricultural sector must balance rising product demands with sustainable development. This study investigates the relationship between agricultural trade and green technological innovation, emphasizing how trade-induced efficiency improvements promote input-saving practices. Using panel data from 31 Chinese provinces between 2011 and 2021, our analysis reveals that agricultural trade significantly enhances resource use efficiency, particularly in rural areas where agriculture is concentrated. The findings provide empirical evidence of the positive effects of trade on green innovation and highlight the need for targeted policy interventions to support sustainable agricultural practices. This research underscores agricultural trade’s critical role in fostering green innovation and offers valuable insights for policymakers and agricultural businesses seeking to improve competitiveness and sustainability in an increasingly globalized economy.

ObjectivesDifferences in clinicopathological characteristics of extensive-stage small cell lung cancer (ES-SCLC) patients may influence the immune response. This study aims to evaluate the heterogeneity of response to first-line chemoimmunotherapy between subgroups in ES-SCLC to screen out suitable populations.Materials and methodsWe searched the PubMed, EMBASE, and Cochrane Library databases from inception to December 3, 2022 for randomized controlled trials (RCTs) of ES-SCLC chemoimmunotherapy. We also reviewed main conferences from January 1, 2021 to October 1, 2023. A trial-specific hazard ratio (HR) ratio for each subgroup was calculated, and these ratios were then pooled using the deft approach.ResultsA total of 9 RCTs with 4099 patients were finally included. The pooled ratios were 0.92 (95% CI = 0.77 to 1.09) for OS-HRs and 0.79 (95% CI = 0.55 to 1.13) for PFS-HRs in women versus men. The pooled ratios of OS-HRs and PFS-HRs in patients with positive versus negative PD-L1 expression were 1.26 (95% CI = 0.91 to 1.73) and 1.08 (95% CI = 0.77 to 1.52), respectively. The pooled ratios of OS-HRs and PFS-HRs in patients without versus with brain metastasis were 0.77 (95% CI = 0.59 to 1.01) and 0.71 (95% CI = 0.44 to 1.12). No statistically significant differences were also found in terms of subgroups for age, liver metastasis, smoking status, ECOG PS, LDH level, type of platinum salt and race.ConclusionWomen or patients with negative PD-L1 expression or with LDH ≤ ULN or without brain metastasis tend to benefit more from first-line chemoimmunotherapy in ES-SCLC. More trials are needed to prospectively validate the therapeutic heterogeneity among clinicopathological characteristics.Systematic review registrationhttps://inplasy.com/inplasy-2023-3-0064/ identifier, INPLASY202330064.

Abstract Background Job burnout is a prevalent and emerging challenge in the primary medical system, causing mass turnover, especially of primary medical staff. Little attention has been paid to the different dimensions of job burnout (emotional exhaustion, personality disintegration, and reduced sense of achievement), which may hinder efforts to tackle high turnover intention among primary medical staff. From the perspective of conservation of resources theory, social support and psychological capital are basic resources with potential to diminish job burnout and thus lower turnover intention. However, there is insufficient research evidence on the relationships between social support, psychological capital, and the three dimensions of job burnout within the primary medical system. Objectives Focusing on primary medical staff, this study conducts a path analysis to examine the correlations between two types of resources (social support and psychological capital) and the three dimensions of job burnout, and to test the impact of the latter on turnover intention. Based on the results, effective management strategies to improve the work stability of primary medical staff are proposed. Methods Multi-stage cluster random sampling was used to select participants in Anhui Province, China. Data were collected using a self-administered questionnaire containing measures of the main variables and demographic questions. In total, 1132 valid questionnaires were returned by primary medical staff. Structural equation modeling was used for path analysis of the data. Results Social support was negatively associated with emotional exhaustion (β = − 0.088, P = 0.020), personality disintegration (β = − 0.235, P

Abstract Background The global BOLERO-2 trial established the efficacy and safety of combination everolimus (EVE) and exemestane (EXE) in the treatment of estrogen receptor positive (ER +), HER2-, advanced breast cancer (ABC). BOLERO-5 investigated this combination in a Chinese population (NCT03312738). Methods BOLERO-5 is a randomized, double-blind, multicenter, placebo controlled, phase II trial comparing EVE (10 mg/day) or placebo (PBO) in combination with EXE (25 mg/day). The primary endpoint was progression-free survival (PFS) per investigator assessment. Secondary endpoints included PFS per blinded independent review committee (BIRC), overall survival (OS), overall response rate (ORR), clinical benefit rate (CBR), pharmacokinetics, and safety. Results A total of 159 patients were randomized to EVE + EXE (n = 80) or PBO + EXE (n = 79). By investigator assessment, treatment with EVE + EXE prolonged median PFS by 5.4 months (HR 0.52; 90% CI 0.38, 0.71), from 2.0 months (PBO + EXE; 90% CI 1.9, 3.6) to 7.4 months (EVE + EXE; 90% CI 5.5, 9.0). Similar results were observed following assessment by BIRC, with median PFS prolonged by 4.3 months. Treatment with EVE + EXE was also associated with improvements in ORR and CBR. No new safety signals were identified in BOLERO-5, with the incidence of adverse events in Chinese patients consistent with the safety profile of both drugs. Conclusion The efficacy and safety results of BOLERO-5 validate the findings from BOLERO-2, and further support the use of EVE + EXE in Chinese post-menopausal women with ER + , HER2- ABC. NCT03312738, registered 18 October 2017.

Objective Strengthen the legal, compliant, and rational use of medical equipment and further guide the rationalization of medical behaviors. Methods By utilizing the Internet of Things (IoT) and image analysis technology, collect real-time operation data of the equipment, establish a real-time running database for medical equipment, and cooperate with the 12 key links of the “whole life” of the equipment and the 8+6 management system framework to implement lean management of the efficiency, benefit, and effectiveness of medical equipment usage. ResultsIt realizes the improvement of the quality and efficiency of medical equipment, cost reduction and cost control, and provides data support for scientific decision-making. ConclusionThis study innovates the management model for the entire life cycle of medical equipment, providing a scientific approach to the management of hospital equipment.

The effects of aging rolling temperature （150，200，250，300 ℃） on microstructure ， texture and magnetic properties of low-temperature grain-oriented silicon steel were studied by aging rolling experiment at different temperatures for 5 min. The results show that the aging rolling temperatures has no obvious effect on the microstructure morphology of cold rolling and primary recrystallization of low-temperature grain-oriented silicon steel. However， the contents of ｛111｝ and Goss in the primary recrystallization microstructure increased and then decreased with the increase of aging roll⁃ ing temperature， and with the highest contents at 200 ℃ for ｛111｝ texture， while at 250 ℃ for Goss texture. And the proportion of primary recrystallization texture of ｛411｝ and ｛100｝ is relatively low. The increase of Goss and ｛111｝ texture and the decrease of ｛100｝ texture in the primary recrystallization microstructure resulted in perfect secondary recrystallization of the sample during high temperature annealing. After high temperature annealing， there were fewer fine grains and island grains， and the final sheets had excellent magnetic properties.