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Abstract Background High-frequency ventilation (HFV) is commonly used in neonatal intensive care units to provide respiratory support for critically ill neonates. Currently, there is no standardized procedure for weaning from HFV. Two commonly used strategies are transitioning from HFV to conventional mechanical ventilation (CMV) before extubation (HFV-CMV) and extubation after decreasing mean airway pressure during HFV (HFV-HFV). The impact of these strategies on neonatal cerebral oxygenation and hemodynamics remains incompletely understood. Methods We will conduct a prospective, single-center, randomized controlled trial to investigate the effects of two different HFV weaning strategies (HFV-CMV, HFV-HFV) on neonatal cerebral oxygenation and hemodynamics. The patients enrolled in the trial will be randomly allocated to either the HFV-CMV group or the HFV-HFV group in a 1:1 ratio. The primary outcome will be cerebral oxygen saturation (ScO2) before and after the intervention. Second outcomes are cerebral fractional tissue oxygen extraction, heart rate, blood pressure, and the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia. We hypothesize that HFV-CMV results in positive impact on neonatal cerebral oxygenation compared to HFV-HFV. This study aims to identify a better weaning strategy for HFV and contribute evidence-based data to enhance its clinical application in newborns, potentially improving the care and outcomes for neonates receiving HFV. Discussion This study aims to assessing the impact of different HFV weaning strategies on neonatal cerebral oxygenation and hemodynamics, as well as the relationship between the duration of HFV under different strategies and neurological complications, to identify better weaning methods for HFV. We hope to contribute evidence-based data to enhance clinical application of HFV in newborns, potentially improving the care and outcomes for neonates receiving HFV. Trial registration Chinese Clinical Trial Registry: ChiCTR2400088628. Registered on August 22, 2024, https://www.chictr.org.cn/bin/project/edit?pid=235926 .

Abstract Background Neonatal septic shock represents a critical and life-threatening condition that necessitates immediate and personalized interventions. Prior research endeavors have been undertaken to inform the optimization of neonatal septic shock management, yet substantial heterogeneity prevails in the selection, measurement, and reporting of outcomes across relevant studies. The heterogeneity in outcome selections and measures impedes the comparability of results and the synthesis of evidence, thus contributing to suboptimal utilization of research findings. This protocol presents the methodology for identifying and developing a Core Outcome Set for Neonatal Septic Shock Management (COS-NSS), intended for use in both research and routine clinical practice. A rigorous four-stage approach will be employed to develop the COS-NSS. In Stage 1, a scoping review will be conducted to compile a list of currently reported outcomes for neonatal septic shock management. Stage 2 will involve an expert stakeholder meeting using a semi-structured discussion approach to elucidate all identified outcomes and outcome domains, as well as to gather any additional outcomes. Moving to Stage 3, a two-round e-Delphi survey involving a wide variety of stakeholders will be undertaken to elicit diverse perspectives on the level of importance assigned to each proposed outcome. Finally, in Stage 4, the results of the Delphi study will be discussed in a consensus meeting to determine and agree on the final list of outcomes that will constitute the COS-NSS. Discussion The stagewise approach integrates research evidence with multi-stakeholder perspectives to establish standardized outcomes that would improve consistency across neonatal septic shock trials. The development and uptake of the COS-NSS will facilitate effective comparison of studies, allowing for study synthesis and generation of high-quality evidence, thus ultimately fostering enhanced medical care for neonates suffering from septic shock. Trial registration Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: 2766 . Registered on July 19th, 2023.

Abstract Mid-infrared (MIR) fiber lasers are important for a wide range of applications in sensing, spectroscopy, imaging, defense, and security. Some progress has been made in the research of MIR fiber lasers based on soft glass fibers, however, the emission range of rare-earth ions and the robustness of the host materials are still a major challenge for MIR fiber lasers. The large number of gases provide a variety of optical transitions in the MIR band. When combined with recent advances in low-loss hollow-core fiber (HCF), there is a great opportunity for gas-filled fiber lasers to further extend the radiation to the MIR region. Here, a 4.8-μm CO-filled silica-based HCF laser is reported for the first time. This is enabled by an in-house manufactured broadband low-loss HCF with a measured loss of 1.81 dB/m at 4.8 μm. A maximum MIR output power of 46 mW and a tuning range of 180 nm (from 4644 to 4824 nm) are obtained by using an advanced 2.33-μm narrow-linewidth fiber laser. This demonstration represents the longest-wavelength silica-based fiber laser to date, while the absorption loss of bulk silica at 4824 nm is up to 13, 000 dB/m. Further wavelength expansion could be achieved by changing the pump absorption line and optimizing the laser structure.

Abstract. Background:. Very low birth weight (VLBW) infants are the key populations in neonatology, wherein morbidity and mortality remain major challenges. The study aimed to analyze the clinical characteristics of VLBW infants. Methods:. A retrospective cohort study was conducted in West China Second Hospital between January 2016 and December 2021. Neonates with a birth weight of

Abstract Objective The purpose of this study was to compare the analgesic effects of intercostal nerve block (ICNB) and local anesthetic infiltration (LAI) on postoperative pain and recovery following thoracoscopic resection of pulmonary bullae. Methods A total of 160 patients undergoing thoracoscopic pulmonary bullae resection were randomly assigned to receive either ICNB (n = 80) or LAI (n = 80). An experienced anesthesiologist administered ultrasound guided ICNB at the T4 and T7 levels with 5 mL of 0.375% ropivacaine hydrochloride for the ICNB group. Instead, the LAI group received 10 mL of the same concentration of ropivacaine hydrochloride at the same concentration used for ICNB for infiltration anesthesia at the incision sites. Out of the initial cohort, 146 patients completed the study (ICNB group, n = 71; LAI group, n = 75). The collected data included preoperative clinical characteristics, visual analog scale (VAS) scores for pain at various time points post-surgery (6, 12, 24, 48, and 72 h). Additionally, the Quality of Recovery-15 (QoR-15) questionnaire was administered 24 h after surgery, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results No significant differences were found in drainage volume, use of additional analgesics, duration of chest tube placement, or hospital stay between the two groups. However, the ICNB group had significantly lower VAS scores and QoR-15 scores 24 h postoperatively (p

Abstract Background Oral mucositis (OM) is a prevalent and painful complication in patients undergoing anticancer treatment, which significantly impacts patients’ quality of life (QoL) and adherence to therapy. The use of oral probiotics as a preventive strategy for OM has shown promise, but the clinical evidence remains inconclusive. This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy of probiotics in preventing OM caused by radiotherapy and/or chemotherapy. Methods A comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted up to January 31, 2024, to identify eligible RCTs. The primary outcomes were the incidences of severe OM and all-grade OM. Secondary outcomes included rates of anticancer treatment completion, clinical response, requirement for enteral nutrition, time course of OM, body weight loss, QoL, and adverse events (AEs). Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results A total of 12 RCTs involving 1,376 patients were included in the quantitative analysis. Probiotics administration significantly reduced the risk of severe OM (RR = 0.61, 95%CI: 0.53–0.72, P

Abstract Background Colorectal cancer is the third most common cancer and the second leading cause of cancer death. There are limited therapeutic options for the treatment of locally advanced or metastatic colorectal cancers which fail first-line chemotherapy. Phase I/II studies showed that the combined application of the raltitrexed and irinotecan has significant synergistic effect and acceptable toxicity. However, most of these previous studies have relatively small sample size. Methods This is a prospective open-label, single-arm, multi-center, Phase II trial. Brief inclusion criteria: patients were aged 18 to 75 years with locally advanced or metastatic colorectal cancer after failure of 5-FU and oxaliplatin therapy. Enrolled patients received raltitrexed (3 mg/m2, d1) and irinotecan (180 mg/m2, d1) each 21-day cycle until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival, and the secondary endpoints were disease control rate, objective response rate, overall survival and safety. Results A total of 108 patients were enrolled between September 2016 and May 2020. The median age was 61 years, ECOG 1 score accounts for 67.6%, the rest were ECOG 0. A total of 502 cycles were completed, with an average of 4.6 cycles and a median of 4 cycles. 108 patients were evaluated, with an objective response rate of 17.6%, and disease control rate of 76.9%. The median follow-up time was 27 months (range:3.1–61.0 m) at data cut-off on March 2023. Median progression-free survival was 4.9 months (95% CI 4.1–5.7) and median overall survival was 13.1 months (95% CI 12.2–15.5). The most common adverse events that were elevated are alanine aminotransferase increased, aspartate aminotransferase increased, fatigue, diarrhoea, neutrocytopenia, thrombocytopenia, hypohemoglobin, and leukocytopenia. Most of the adverse events were Grade I/II, which were relieved after symptomatic treatment, and there were no treatment-related cardiotoxicities and deaths. Conclusions The combination of raltitrexed and irinotecan as second-line treatment for mCRC could be a reliable option after failure of standard 5-Fu-first-line chemotherapy in locally advanced or metastatic colorectal cancers, especially for patients with 5-FU intolerance (cardiac events or DPD deficiency patients). Trial registration ClinicalTrials.gov identifier: NCT03053167, registration date was 14/2/2017.

Context The use of traditional Chinese medicine (TCM) for breast cancer patients inhibits tumor cell growth and proliferation, alleviates adverse reactions, and inhibits tumor recurrence and metastasis post-surgery. An assessment of its historical efficacy and an examination of the latest research trends are imperative to thoroughly leverage the potential of TCM for breast cancer treatment.Objective This study analyzes the published literature on TCM for breast cancer treatment using bibliometric analysis to determine the current state, identify hot spots, and discern trends, providing insight into research in this field.Methods TCM-based breast cancer treatment publications between 2003 and 2022 were retrieved from the Web of Science, China National Knowledge Infrastructure, Wanfang, and Duxiu databases. Visual analysis was performed using VOSviewer (V1.6.19) and CiteSpace (V6.3.R1) software. Examined metrics included the annual publication count, literature and journal, national and institutional contributions, author co-occurrence, keyword co-occurrence, keywords timeline, and keywords with citation bursts in this research field.Results and conclusion A total of 1080 English publications and 2617 Chinese publications were included in the analysis. China was the leading contributor of publications. High-frequency keywords such as ‘apoptosis’, ‘expression’, ‘in vivo’, ‘chemotherapy’, ‘triple-negative breast cancer’, and ‘lymphedema’ were identified from English and Chinese publications; ‘epithelial mesenchymal transition’ and ‘network pharmacology’ emerged as hotspots. The development of modern science, technology, and in-depth research can result in broader prospects for the research and application of TCM in breast cancer treatment, resulting in more effective solutions for the treatment of breast cancer and other malignant tumors.

Abstract Background Retroperitoneal infantile hemangioma (RIH), a type of primary retroperitoneal tumors, are exceptionally rare in clinical practice. Infantile hemangiomas typically manifest on the skin’s surface. RIHs are exceptionally rare and typically small. In adults, these tumors often manifest without specific clinical symptoms or detectable signs for a definitive diagnosis. This case report details a patient diagnosed with RIH. We recommend complete excision of the tumor after a comprehensive evaluation, followed by postoperative pathology, to achieve a conclusive diagnosis. We believe that managing critical retroperitoneal structures and vessels intraoperatively presents a significant challenge for all procedures involving primary retroperitoneal tumors. Case summary A 47-year-old male was diagnosed with gallstones and underwent surgery 3 months ago at other institution for unexplained nausea and vomiting. Follow-up imaging 2 months after surgery revealed a retroperitoneal mass below the left renal pole. Upon presentation to our hospital, the patient continued to experience intermittent nausea and vomiting, with no other significant symptoms or signs. Considering the patient’s 8-year history of hypertension, a paraganglioma was initially suspected. We performed the laparoscopic mass resection after a detailed assessment. However, postoperative pathology revealed it a capillary hemangioma (old term)/infantile hemangioma. Conclusion RIHs are exceedingly rare benign tumor. The possibility of malignancy should be ruled out, and surgical resection is recommended following a thorough evaluation, with the diagnosis confirmed through pathological examination.

Abstract Objective To construct a nomogram for predicting the responsiveness of cardiac resynchronization therapy (CRT) in patients with chronic heart failure and verify its predictive efficacy. Method A retrospective study was conducted including 109 patients with chronic heart failure who successfully received CRT from January 2018 to December 2022. According to patients after six months of the CRT preoperative improving acuity in the left ventricular ejection fraction is 5% or at least improve grade 1 NYHA heart function classification, divided into responsive group and non-responsive group. Clinical data of patients were collected, and LASSO regression analysis and multivariate logistic regression analysis were used to explore relative factors. A nomogram was constructed, and the predictive performance of the nomogram was evaluated using the calibration curve and decision curve analysis (DCA). Results Among the 109 patients, 61 were assigned to the CRT-responsive group, while 48 were assigned to the non-responsive group. LASSO regression analysis showed that left ventricular end-systolic volume, diffuse fibrosis, and left bundle branch block (LBBB) were independent factors for CRT responsiveness in patients with heart failure (P

Iron is an essential nutrient for maintaining red blood cell metabolism and assisting bone marrow hematopoiesis. Iron deficiency can cause various diseases, such as anemia, stunted growth, and premature birth in pregnant women. As a new iron supplement product, peptide iron chelate has been used as a new ideal iron supplement in recent years because of its advantages of high absorption rate, safety, and no side effects. This paper mainly reviews the preparation of foodborne peptides and peptide iron chelates and the factors affecting their chelation activity, explored the iron-binding mechanism of peptides, summarizes their binding sites and chelation patterns, further analyzes their conformational changes and intermolecular forces, and summarizes how they promote iron bioavailability. The aim is to provide a reference for developing and applying iron peptide chelates in functional foods and new iron supplements.

Abstract The physical characteristics of classrooms can significantly impact the physical and mental health as well as the learning performance of college students. This study investigates the effects of classroom size and ceiling height on learning performance using virtual reality technology. Four classroom settings were created: two small classrooms (40.5 m2) with ceiling heights of 3.0 m and 3.9 m, and two large classrooms (62.1 m2) with ceiling heights of 3.9 m and 4.8 m. 34 students participated in task tests while their subjective evaluations and physiological data were recorded. Results showed higher subjective ratings in larger classrooms with the same ceiling height. Classroom size did not significantly affect task test scores. However, there is a significant difference in Task test scores for ceilings of different heights with the same size classroom. The task test improved by 17.3% in the Big and High Room (BHR) and by 20.1% in the Small and Low Room (SLR). Physiological data revealed significant effects of ceiling height, with HRV-nLF/nHF and EEG-β power increasing by 26.5% and 53.9% in BHR, and by 10.7% and 22.8% in SLR, respectively. This study concludes that classroom size and ceiling height plays a crucial role in learning performance and provides insights for classroom design. It also establishes a framework for future research on the interplay between heart rate variability, EEG, and learning performance.

Abstract Potentially toxic metal(loid) assessment of tea and tea garden soil is a vital guarantee of tea safety and is very necessary. This study analyzed the distribution of seven potentially toxic metal(loid)s in different organs of the tea plants and soil at various depths in the Yangai tea farm of Guiyang City, Guizhou Province, China. Although soil potentially toxic metal(loid) in the study area is safe, there should be attention to the health risks of Cu, Ni, As, and Pb in the later stages of tea garden management. Soil As and Pb are primarily from anthropogenic sources, soil Zn is mainly affected by natural sources and human activities, and soil with other potentially toxic metal(loid) is predominantly from natural sources. Tea plants might be the enrichment of Zn and the exclusion or tolerance of As, Cu, Ni, and Pb. The tea plant has a strong ability for absorbing Cd and preferentially storing it in its roots, stems, and mature leaves. Although the Cd and other potentially toxic metal(loid)s content of tea in Guizhou Province is generally within the range of edible safety, with the increase of tea planting years, it is essential to take corresponding measures to prevent the potential health risks of Cd and other potentially toxic metal(loid)s in tea.

Abstract Background Innate/adaptive immunity is the key to anti-tumor therapy. However, its causal relationship to Gastrointestinal (GI) cancer remains unclear. Methods Immunity genes were extracted from the MSigDB database. The Genome-wide association studies (GWAS) summary data of GI cancer were integrated with expression quantitative trait loci (eQTL) and DNA methylation quantitative trait loci (mQTL) associated with genes. Summary-data-based Mendelian randomization (SMR) and co-localization analysis were used to reveal causal relationships between genes and GI cancer. Two-sample MR analysis was used for sensitivity analysis. Single cell analysis clarified the enrichment of genes. Results Three-step SMR analysis showed that a putative mechanism, cg17294865 CpG site regulating HLA-DRA expression was negatively associated with gastric cancer risk. HLA-DRA was significantly differentially expressed in monocyte/macrophage and myeloid cells in gastric cancer. Conclusion This study provides evidence that upregulating the expression level of HLA-DRA can reduce the risk of gastric cancer.

Abstract Factor-dependent termination uses molecular motors to remodel transcription machineries, but the associated mechanisms, especially in eukaryotes, are poorly understood. Here we use single-molecule fluorescence assays to characterize in real time the composition and the catalytic states of Saccharomyces cerevisiae transcription termination complexes remodeled by Sen1 helicase. We confirm that Sen1 takes the RNA transcript as its substrate and translocates along it by hydrolyzing multiple ATPs to form an intermediate with a stalled RNA polymerase II (Pol II) transcription elongation complex (TEC). We show that this intermediate dissociates upon hydrolysis of a single ATP leading to dissociation of Sen1 and RNA, after which Sen1 remains bound to the RNA. We find that Pol II ends up in a variety of states: dissociating from the DNA substrate, which is facilitated by transcription bubble rewinding, being retained to the DNA substrate, or diffusing along the DNA substrate. Our results provide a complete quantitative framework for understanding the mechanism of Sen1-dependent transcription termination in eukaryotes.

BackgroundHealth care students often endure numerous stressors throughout their undergraduate education that can have lasting negative effects on their mental well-being. Positive Intelligence (PQ) is a digital mental fitness program designed to enhance self-mastery and help individuals reach their potential by strengthening various “mental muscles.” ObjectiveThis study aims to evaluate the effectiveness of a 6-week app-delivered PQ program in reducing perceived stress, increasing self-compassion, and decreasing rumination tendencies among health care undergraduates. We hypothesized that students would show reductions in perceived stress, increases in self-compassion, and decreases in rumination tendencies by the end of the PQ program, compared with their preprogram scores. We adopted an exploratory approach for the 5-month follow-up due to the limited research consensus on the sustained effects of app-based programs over varying periods. MethodsThe PQ program includes weekly hour-long videos, weekly group meetings, and daily 15-minute app-guided practices. Participants were first-year students from the occupational therapy program at a university in Singapore. Participants completed surveys measuring self-compassion, perceived stress, and rumination levels before and after the PQ program, and again at a 5-month follow-up. Data were analyzed using repeated measures ANOVA to assess differences across the pretest, immediate posttest, and follow-up posttest. ResultsOut of 87 students enrolled in the study, the final sample consisted of 64 students (n=47, 73%, female; mean age 23 years, SD 5.06 years) with complete data. At the end of the 6 weeks, students exhibited significant increases in self-compassion (before the intervention: mean 3.07, SD 0.35; after the intervention: mean 3.34, SD 0.35; P

A 20L spherical explosion testing system was used to characterize the explosion characteristics of brown coal powder and its mixing with different explosion suppressants. and the free radical reaction mechanism was studied through numerical simulation. Research has shown that sodium bicarbonate (NaHCO3) has a low decomposition temperature and a fast reaction rate in the early stages. A significant amount of phosphorous groups are produced when ammonium dihydrogen phosphate (NH4H2PO4) and melamine polyphosphate (MPP) react, consumes explosive free radicals and blocks heat transmission between coal dust, delaying and inhibiting explosion. In the explosive reaction, H and O free radicals are continually consumed during the breakdown of cyanuric acid melamine (MCA). Finally, the suppression mechanism of different explosion suppressants on coal powder explosions was revealed, and specific recommendations were made for the selection and application of explosive suppressants.

Background: Triple-negative breast cancer (TNBC) is a subtype of breast cancer characterized by poor prognosis due to the absence of effective targeted therapies. Emerging evidence indicates that the gut microbiota and its metabolites play a key role in the occurrence and development of TNBC. This study aimed to explore the metabolic changes and potential mechanisms associated with TNBC. Objectives: This study aimed to explore the potential relationship between targeted metabolites and the gut microbiota in TNBC. Design: We recruited 8 participants, including 4 with TNBC and 4 with benign fibroadenomas as controls. Methods: The gut microbiota was analyzed using metagenomics on fecal samples. Liquid chromatography–mass spectrometry (LC-MS) was employed to identify differential metabolites in serum and fecal samples. The correlation between the gut microbiota and metabolites was analyzed using Spearman’s correlation analysis. Results: Analysis of altered serum metabolites in the TNBC group revealed changes, particularly in carboxylic acids and derivatives, benzene, and substituted derivatives. Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathway analysis revealed significant enrichment in 18 pathways. Regarding fecal metabolites, differences between the 2 groups also included carboxylic acids and derivatives, benzene, and substituted derivatives, with 28 metabolic pathways enriched based on KEGG pathway analysis. Metagenomics analysis showed differences in the relative abundance of Anaerococcus , Fischerella , and Schizosaccharomyces at the genus level, which have been previously associated with breast cancer. Furthermore, 4 serum metabolites—L-glutamine, citrate, creatinine, and creatine—along with 9 fecal metabolites, were associated with the aforementioned microbiota. Conclusion: Our findings highlight distinct metabolite profiles in the serum and feces of patients with TNBC. The identification of gut microbiota and their associated metabolites provides new insights into the pathophysiological mechanisms underlying TNBC.

GASMAN software, a simulation tool for inhalational anesthetics’ pharmacokinetics and pharmacodynamics, has become essential in both anesthesia education and clinical practice. This review explores its applications, highlighting its effectiveness in enhancing medical education and its impact on clinical anesthesia management. In educational settings, GASMAN software facilitates a deeper understanding of anesthetic pharmacology through interactive and visual simulations, thereby improving students’ learning outcomes and engagement. Clinically, it aids anesthesiologists in optimizing anesthetic dosing, enhancing patient safety, and supporting real-time decision-making during surgeries. Despite its advantages, GASMAN software faces limitations such as the absence of physiological feedback and the need for continuous data model updates. Future directions include technical enhancements, integration with advanced patient simulators, and broader dissemination through educational partnerships. This review emphasizes the significant contributions of GASMAN software to anesthesia education and clinical practice and suggests pathways for future improvements and wider adoption.

Abstract This study delves into the effectiveness of combining remimazolam with low-dose propofol in pediatric fiberoptic bronchoscopy. Ninety children scheduled for fiberoptic bronchoscopy in our hospital were enrolled as research participants. Based on the intraoperative anesthetic drug regimen, the children were divided into three groups: group R (remimazolam 0.2–0.4 mg/kg), group P (propofol 1–3 mg/kg), and group RP (remimazolam0.2 mg/kg, propofol 0.5 mg/kg). Immediately post-anesthesia, group P exhibited lower blood pressure and heart rate (HR) compared to both group R and group RP (P

Abstract Background Artificial intelligence is a growing phenomenon that will soon facilitate wide-scale changes in many professions, and is expected to play an important role in the field of medical education. This study explored the realistic feelings and experiences of nursing undergraduates participating in different stages of artificial intelligence + project task driven learning, and provide a basis for artificial intelligence participation in nursing teaching. Methods We conducted face-to-face semi-structured interviews with nursing undergraduates participating in Nursing Research Course which adopts artificial intelligence + project task driven learning from a medical university in Ningxia from September to November 2023, to understand their experience of using artificial intelligence for learning and the emotional changes at different stages. The interview guide included items about their personal experience and feelings of completing project tasks through dialogue with artificial intelligence, and suggestions for course content. Thematic analysis was used to analyze interview data. This study followed the COREQ checklist. Results According to the interview data, three themes were summarized. Undergraduate nursing students have different experiences in participating in artificial intelligence + project task driven learning at different stages, mainly manifested as diverse emotional experiences under initial knowledge deficiency, the individual growth supported by external forces during the adaptation period, and the expectations and suggestions after the birth of the results in the end period. Conclusions Nursing undergraduates can actively adapt to the integration of artificial intelligence into nursing teaching, dynamically observe students’ learning experience, strengthen positive guidance, and provide support for personalized teaching models, better leveraging the advantages of artificial intelligence participation in teaching.

Abstract Objective To systematically evaluate the difference in clinical efficacy between two surgical approaches, oblique lateral approach and intervertebral foraminal approach, in the treatment of degenerative lumbar spondylolisthesis. Methods English databases, including PubMed, Cochrane, Embase, and Web of Science, were systematically searched using keywords such as "oblique lumbar interbody fusion" and "transforaminal lumbar interbody fusion." Concurrently, Chinese databases, including CNKI, WanFang data, VIP, and CBM, were also queried using corresponding Chinese terms. The search spanned from January 2014 to February 2024, focusing on published studies in both Chinese and English that compared the clinical efficacy of OLIF and TLIF. The literature screening was conducted by reviewing titles, abstracts, and full texts. Literature meeting the inclusion criteria underwent quality assessment, and relevant data were extracted. Statistical analysis and a meta-analysis of the observational data for both surgical groups were performed using Excel and RevMan 5.4 software. Findings revealed a total of 14 studies meeting the inclusion criteria, encompassing 877 patients. Of these, 414 patients were in the OLIF group, while 463 were in the TLIF group. Meta-analysis of the statistical data revealed that compared to TLIF, OLIF had a shorter average surgical duration (P 0.05) and fusion rates (P > 0.05). Conclusion When treating degenerative lumbar spondylolisthesis, OLIF demonstrates significant advantages over TLIF in terms of shorter surgical duration, reduced intraoperative bleeding, shorter hospital stay, superior improvement in postoperative VAS and ODI scores, better restoration of disc height, and more effective correction of lumbar lordosis.

Abstract Background Malnutrition is a common geriatric syndrome that is closely associated with adverse clinical outcomes and poses significant harm to older adults. Early assessment of nutritional status plays a crucial role in preventing and intervening in cases of malnutrition. However, there is currently a lack of measurable methods and biomarkers to evaluate malnutrition in older adults accurately. The aim of this study is to investigate the independent correlation between serum levels of amino acids and malnutrition in older adults, and to identify effective metabolomics biomarkers that can aid in the early detection of geriatric malnutrition. Methods A total of 254 geriatric medical examination participants from Beijing Hospital were included in the study, consisting of 182 individuals with normal nutritional status (Normal group) and 72 patients at risk of malnutrition or already malnourished (MN group). Malnutrition was assessed using the Mini-Nutritional Assessment Short-Form (MNA-SF). Demographic data were collected, and muscle-related and lipid indexes were determined. Serum amino acid concentrations were measured using isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS). The correlation between serum amino acid levels and malnutrition was analyzed using non-parametric tests, partial correlation analysis, linear regression, and logistic regression. Results The geriatric MN group exhibited significantly lower serum aromatic amino acid levels (P

Introduction: Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG). Method: Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children’s HRQoL using PedsQL 4.0 Generic Core Scales. Results: Majority of the children were aged 4–6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P

A series of triazolopyridine-based dual JAK/HDAC inhibitors were rationally designed and synthesised by merging different pharmacophores into one molecule. All triazolopyridine derivatives exhibited potent inhibitory activities against both targets and the best compound 4-(((5-(benzo[d][1, 3]dioxol-5-yl)-[1, 2, 4]triazolo[1, 5-a]pyridin-2-yl)amino)methyl)-N-hydroxybenzamide (19) was dug out. 19 was proved to be a pan-HDAC and JAK1/2 dual inhibitor and displayed high cytotoxicity against two cancer cell lines MDA-MB-231 and RPMI-8226 with IC50 values in submicromolar range. Docking simulation revealed that 19 fitted well into the active sites of HDAC and JAK proteins. Moreover, 19 exhibited better metabolic stability in vitro than SAHA. Our study demonstrated that compound 19 was a promising candidate for further preclinical studies.

ABSTRACTBackground The atherogenic index of plasma (AIP) is a novel metabolic biomarker of atherosclerosis. Nevertheless, the association between the AIP and new-onset hypertension has not been elucidated in the Chinese population.Methods Prospective data were obtained from 3150 participants aged ≥ 18 years in the China Health and Nutrition Survey from 2009 to 2015. The AIP is a logarithmically transformed ratio of triglycerides to high-density lipoprotein cholesterol in molar concentration. Cox regression analysis was used to determine the association of AIP index with new-onset hypertension.Results After the six-year follow-up, 1054 (33.4%) participants developed new-onset hypertension. The participants were divided into AIP quartile groups (Q1-Q4). Compared with those in Q1, subjects in Q3–4 had nearly 1.35 times the risk of new-onset hypertension after full adjustment [Q3: hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.13–1.62; Q4: HR: 1.35, 95% CI: 1.13–1.64]. The risks of new-onset hypertension were nearly 1.30 times higher in subjects in Q2–4 than in subjects in Q1 (p

ABSTRACTThis study employed laser directed energy deposition (DED) with in-situ ultrasonic vibration to obtain AA7075 deposits. The results showed that with ultrasonic treatment, the grain morphology of DED produced AA7075 was changed from columnar grains with an average area of 1751 µm2 to equiaxed grains of 118.2 µm2, representing a reduction of about 93%. Also, the application of ultrasonic treatment led to the increase of average hardness from 93.1 HV to 110.2 HV, and the increase of average ultimate tensile strength from 226.8 MPa to 314.7 MPa, representing relative increases of 18.36% and 38%, respectively. However, it did not result in a significant reduction of ductility. It is believed that ultrasonic vibration promotes the formation of additional nucleation sites due to cavitation and acoustic streaming, as well as the formation of secondary phase particles at grain boundaries. Both mechanisms effectively augment the mechanical properties of DED produced AA7075.

BackgroundChimeric antigen receptor T-cell (CAR-T) therapy, a rapidly emerging treatment for cancer that has gained momentum since its approval by the FDA in 2017, involves the genetic engineering of patients’ T cells to target tumors. Although significant therapeutic benefits have been observed, life-threatening adverse pulmonary events have been reported.MethodsUsing SAS 9.4 with MedDRA 26.1, we retrospectively analyzed data from the Food and Drug Administration’s Adverse Event Reporting System (FAERS) database, covering the period from 2017 to 2023. The analysis included the Reporting Odds Ratio Proportional Reporting Ratio Information Component and Empirical Bayes Geometric Mean to assess the association between CAR-T cell therapy and adverse pulmonary events (PAEs).ResultsThe FAERS database recorded 9,400 adverse events (AEs) pertaining to CAR-T therapies, of which 940 (10%) were PAEs. Among these CAR-T cell-related AEs, hypoxia was the most frequently reported (344 cases), followed by respiratory failure (127 cases). Notably, different CAR-T cell treatments demonstrated varying degrees of association with PAEs. Specifically, Tisa-cel was associated with severe events including respiratory failure and hypoxia, whereas Axi-cel was strongly correlated with both hypoxia and tachypnea. Additionally, other CAR-T therapies, namely, Brexu-cel, Liso-cel, Ide-cel, and Cilta-cel, have also been linked to distinct PAEs. Notably, the majority of these PAEs occurred within the first 30 days post-treatment. The fatality rates varied among the different CAR-T therapies, with Tisa-cel exhibiting the highest fatality rate (43.6%), followed by Ide-cel (18.8%).ConclusionThis study comprehensively analyzed the PAEs reported in the FAERS database among recipients of CAR-T cell therapy, revealing conditions such as hypoxia, respiratory failure, pleural effusion, and atelectasis. These CAR-T cell therapy-associated events are clinically significant and merit the attention of clinicians and researchers.

Summary: The Streptomyces antibiotic regulatory proteins (SARPs) are ubiquitously distributed transcription activators in Streptomyces and control antibiotics biosynthesis and morphological differentiation. However, the molecular mechanism behind SARP-dependent transcription initiation remains elusive. We here solve the cryo-EM structure of an AfsR-loading RNA polymerase (RNAP)-promoter intermediate complex (AfsR-RPi) including the Streptomyces coelicolor RNAP, a large SARP member AfsR, and its target promoter DNA that retains the upstream portion straight. The structure reveals that one dimeric N-terminal AfsR-SARP domain (AfsR-SARP) specifically engages with the same face of the AfsR-binding sites by the conserved DNA-binding domains (DBDs), replacing σHrdBR4 to bind the suboptimal −35 element, and shortens the spacer between the −10 and −35 elements. Notably, the AfsR-SARPs also recruit RNAP through extensively interacting with its conserved domains (β flap, σHrdBR4, and αCTD). Thus, these macromolecular snapshots support a general model and provide valuable clues for SARP-dependent transcription activation in Streptomyces.

BackgroundThe effects of blood transfusions on splanchnic oxygenation and complications related to blood transfusions, including red blood cell (RBC) transfusions, in premature infants undergoing enteral feeding, to provide clinical evidence for a management protocol for premature infants during the peri-transfusion period.MethodsThis single-blind, randomized, controlled trial enrolled sixty eligible preterm infants who were randomly divided into the withholding feeding group (n = 30) or feeding group (n = 30). Enteral feeding was withheld for 8 h, beginning from the start of transfusion infants in the feeding group were fed according to the pre-transfusion feeding approach during and after RBC transfusion.ResultsBaseline characteristics of those in the withholding and feeding groups were as follows: gestational age (weeks) 27.52 (24.86–30.14) and 27.13 (25.43–30.14); birth weight (g), 1,027 (620–1,450) and 1,027 (620–1,270); blood transfusion day, 48 (14–79) and 39 (10–78); and hemoglobin before blood transfusion (g/L), 81.67 (±10.56) and 85.93 (±14.77). No significant differences were observed between groups at baseline. No significant differences were observed in the average splanchnic tissue oxygenation changes or clinical results at any time. One patient in the withholding feeding group experienced transfusion-associated necrotizing enterocolitis.ConclusionsNo differences in splanchnic oxygenation observed these feeding protocols. This study suggests the feasibility of a sizable trial to evaluate clinical outcomes. The risks of mesenteric ischemia and transfusion-related necrotizing enterocolitis for premature infants were not increased by enteral feeding during RBC transfusion.Clinical trial registrationChiCTR2200055726 (https://www.chictr.org.cn/).

ObjectiveTo observe the effect of Pseudomonas aeruginosa mannose-sensitive hemagglutinin (PA-MSHA) on the prognosis and the incidence of lymphatic leakage in patients undergoing radical cystectomy (RC).MethodA total of 129 patients who underwent RC in Lanzhou University Second Hospital from 2013 to 2022 were enrolled in this study. They were divided into 43 patients treated with PA-MSHA and 86 patients in the control group. Inverse probability of treatment weighting (IPTW) was applied to reduce potential selection bias. Kaplan-Meier method and Cox regression analysis were used to analyze the effect of PA-MSHA on the survival of patients and the incidence of postoperative lymphatic leakage.ResultsThe PA-MSHA group exhibited improved overall survival (OS) and cancer-specific survival (CSS) rates compared to the control group. The 3-year and 5-year overall survival (OS) rates for the PA-MSHA group were 69.1% and 53.2%, respectively, compared to 55.6% and 45.3% for the control group (Log-rank=3.218, P=0.072). The 3-year and 5-year cancer-specific survival (CSS) rates for the PA-MSHA group were 73.3% and 56.5%, respectively, compared to 58.0% and 47.3% for the control group (Log-rank=3.218, P=0.072). Additionally, the 3-year and 5-year progression-free survival (PFS) rates for the PA-MSHA group were 74.4% and 56.8%, respectively, compared to 57.1% and 52.2% for the control group (Log-rank=2.016, P=0.156). Multivariate Cox regression analysis indicates that lymph node metastasis and distant metastasis are poor prognostic factors for patients, while the use of PA-MSHA can improve patients’ OS (HR: 0.547, 95%CI: 0.304–0.983, P=0.044), PFS (HR: 0.469, 95%CI: 0.229–0.959, P=0.038) and CSS (HR: 0.484, 95%CI: 0.257–0.908, P=0.024). The same trend was observed in the cohort After IPTW adjustment. Although there was no significant difference in the incidence of postoperative lymphatic leakage [18.6% (8/35) vs. 15.1% (84.9%), P=0.613] and pelvic drainage volume [470 (440) ml vs. 462.5 (430) ml, P=0.814] between PA-MSHA group and control group, PA-MSHA could shorten the median retention time of drainage tube (7.0 d vs 9.0 d) (P=0.021).ConclusionPA-MSHA may improve radical cystectomy in patients with OS, PFS, and CSS, shorten the pelvic drainage tube retention time.

Abstract Background Hypertension and frailty often occur concurrently, exhibiting increasing prevalence in the older population. In this study, we analyzed the frailty status among older adults with hypertension and the impact of their interaction on death risk. Method This prospective cohort survey study included data from older people in an urban community in Beijing collected between 2009 and 2020 using the cluster random sampling method. The participants were older adults who were ≥ 60 years old at the time of investigation and had lived at the place of investigation for > 1 year. The survey variables comprised those related to health and frailty status assessed during the 2009 baseline survey, along with death-related information as outcome variables in 2020. Additionally, a frailty index (FI) model was used to examine the frailty status among the older adults at baseline. The effects of hypertension prevalence on the age-related frailty changes as well as on mortality for varying degrees of frailty were further analyzed. Lastly, Cox regression and Kaplan–Meier curves were applied to evaluate the impact of the interaction between hypertension and frailty on death risk. Results Ultimately, 1197 older individuals aged between 60 and 101 years(average age at baseline: 74.8 ± 8.6 years) were included .Among them, 475 individuals were men (mean age:74.8 ± 8.8 years), and 722 were women (mean age:74.8 ± 8.4 years).Frailty was identified in 151 individuals, leading to a prevalence rate of 12.6%(151/1197),while hypertension was detected in 593 (prevalence rate:49.5% [593/1197]).A total of 443 deaths were recorded by 2020, resulting in a mortality rate of 37.0% (443/1197).Moreover, FI values and mortality rates were higher at any age in older adults with hypertension compared with those without hypertension. Survival time analysis showed that the median survival time of older adults with hypertension and frailty was the shortest (39.0[95%CI: 35.6–42.3] months)when compared with that of older adults without hypertension but with frailty (52.9 [95%CI: 46.6-59.3] months), those with hypertension but without frailty (102.7 [95%CI: 98.7–106.8] months), and those without hypertension and frailty (127.9 [95%CI: 113.5–134.7] months),with log-rank x 2 = 999.686 and P

Over the past two decades, Qatar has undergone significant economic growth and development, yet little information is available on long-term trends in seawater quality around the Qatar Peninsula. This study analyzed spatiotemporal variations of remotely sensed optical water quality (OWQ) parameters in Qatari coastal waters between 2002 and 2022. These OWQ parameters, including chlorophyll-a concentration (Chla), turbidity (Turb), and Secchi disk depth (SDD), along with sea surface temperature, were derived from Moderate-resolution Imaging Spectroradiometer (MODIS)/Aquaobservations after applying an optically shallow-water mask. Additionally, changes in floating algae scum density, an indicator of harmful algal blooms (HABs), were derived from MultiSpectral Instrument (MSI)observations. Strong nearshore–offshore gradients were generally observed for all OWQ parameters (multiannual mean Chla ∼ 0.6–3 mg m−3; Turb ∼ 0.2–3 FNU; and SDD ∼ 5–12 m). SDD was typically greatest in late spring and summer when Chla and Turb were relatively low. OWQ variability in the main territorial sea was mainly driven by suspended sediments, while in the broader Exclusive Economic Zonewas driven by algal blooms. HABs dominated by Margalefidinium polykrikoides, Noctiluca scintillans, and Trichodesmium spp. were frequently observed in deeper (>20 m) waters. Despite Qatar's massive economic development in recent years, declines in Chla and Turb and increased SDD were observed. Qatari coastal waters, however, are warming at a rate of 0.64 °C/decade, ∼2–3 times faster than neighboring Red Sea and Northern Arabian Sea waters, and ∼8 times faster than the global oceans. This thermal stress may pose future challenges for marine ecosystems and the services they provide.

Abstract Background This study aimed to assess and compare procalcitonin (PCT) and C-reactive protein (CRP) levels between COVID-19 and non-COVID-19 sepsis patients. Additionally, we evaluated the diagnostic efficiency of PCT and CRP in distinguishing between Gram-positive (GP) and Gram-negative (GN) bacterial infections. Moreover, we explored the associations of PCT with specific pathogens in this context. Methods The study included 121 consecutive sepsis patients who underwent blood culture testing during the COVID-19 epidemic. PCT and CRP were measured, and reverse transcriptase-polymerase chain reaction (RT-PCR) was employed for the detection of COVID-19 nucleic acid. The Mann-Whitney U-test was used to compare PCT and CRP between the COVID-19 and non-COVID-19 groups. Receiver operating characteristic (ROC) curves were generated to compare PCT and CRP levels in the GN group versus the GP group for assessing the diagnostic efficiency. The kruskal-Wallis H test was applied to assess the impact of specific pathogen groups on PCT concentrations. Results A total of 121 sepsis patients were categorized into a COVID-19 group (n = 25) and a non-COVID-19 group (n = 96). No significant differences in age and gender were observed between the COVID-19 and non-COVID-19 groups. The comparison of biomarkers between these groups showed no statistically significant differences. The optimal cut-off values for PCT and CRP in differentiating between GP and GN infections were 1.03 ng/mL and 34.02 mg/L, respectively. The area under the ROC curve was 0.689 (95% confidence interval (CI) 0.591–0.786) for PCT and 0.611 (95% CI 0.505–0.717) for CRP. The diagnostic accuracy was 69.42% for PCT and 58.69% for CRP. The study found a significant difference in PCT levels among specific groups of pathogens (P

Highlights The engineering design principles for enhancing interfacial contact between the electrodes (Li anodes and S cathode) and solid-state electrolytes in solid-state Li–S batteries are classified and discussed. Research progresses of experimental strategies for reducing interfacial impedance in solid-state Li–S batteries are summarized. Challenges and future perspectives of rational interfacial strategies in solid-state Li–S batteries are highlighted.

Abstract Oxidative stress is the primary cause of ischaemic stroke and is closely related to circadian rhythm. However, the mechanism by which circadian rhythm regulates oxidative stress in ischaemic stroke remains elusive. The Silent Information Regulator 1 (SIRT1) controls circadian rhythm by activating the transcription of the circadian clock core protein Basic Helix-Loop-Helix ARNT Like 1 (BMAL1) through deacetylation. Studies have shown that the SIRT1-BMAL1 pathway can regulate oxidative stress. To investigate its correlation with oxidative stress, we examined the expression levels and influencing factors of SIRT1-BMAL1 at different times in ischaemic stroke patients and analyzed their clinical indexes, oxidative stress, and inflammatory factor indicators. The expression levels of oxidative stress and inflammatory factor indicators, including malondialdehyde (MDA), superoxide dismutase (SOD), interleukin-6 (IL-6), and tumor necrosis factor-a (TNF-α), SIRT1, and BMAL1, were detected in ischaemic stroke patients within 4.5 h of onset and in non-stroke patients. Patients were divided into four subgroups based on onset time: subgroup 1 (0:00–05:59); subgroup 2 (06:00–11:59); subgroup 3 (12:00–17: 59); and subgroup 4 (18:00–23:59). Our results showed higher MDA, IL-6, and TNF-α levels, and lower SOD, SIRT1, and BMAL1 levels in ischaemic stroke patients compared to control patients (P 0.05). Our findings suggest that the SIRT1-BMAL1 pathway may be involved in early oxidative stress in ischaemic stroke, which may be related to MPO.

Abstract Background Bisphenol A (BPA) levels are high in women with polycystic ovary syndrome (PCOS). The mechanism by which BPA induces abnormal glucose metabolism in PCOS patients is largely unknown. Methods Serum and urine samples were collected from women with and without PCOS (control) at the reproductive medicine center with informed consent. Non-PCOS patients who received in vitro fertilization were recruited for collection of ovarian follicular fluid and granular cells. Wild-type C57BL/6 and AhR −/− mice were used to verify the effects of BPA on PCOS. Real-time PCR, western blotting, and ELISA were conducted to analyze the function of BPA. Chip-qPCR verified the role of AhR in GLUT4 transcription. Flow cytometry was performed to determine glucose uptake. Results A positive correlation was observed between BPA concentration and serum BPA levels in PCOS patients. BPA aggravated the changes in PCOS with abnormal glucose metabolism, impaired fertility, and increased body fat. Mechanistically, we showed that BPA activated AhR and led to decreased glucose transport via GLUT4 downregulation in ovarian granular cells. Therefore, the use of inhibitors or knockout of AhR could effectively rescue BPA-induced metabolic disorders in PCOS mice. Conclusions Our results revealed that BPA suppressed GLUT4 expression and induced abnormal glucose metabolism by activating AhR, causing insulin resistance, and is thus a potential contributor to the development of PCOS. Therefore, AhR could be a potential new therapeutic target for PCOS. Video Abstract

With a gradual increase in breast cancer incidence and mortality rates and an urgent need to improve patient prognosis and cosmetology, magnetic resonance imaging (MRI)-guided radiofrequency ablation (RFA) therapy has attracted wide attention as a new treatment method for breast cancer. MRI-RFA results in a higher complete ablation rate and extremely low recurrence and complication rates. Thus, it may be used as an independent treatment for breast cancer or adjuvant to breast-conserving surgery to reduce the extent of breast resection. Furthermore, with MRI guidance, accurate control of RFA can be achieved, and breast cancer treatment can enter a new stage of minimally invasive, safe, and comprehensive therapy. With progress in MR thermometry technology, the applications of MRI are expected to broaden.

Abstract Elevated Gamma-glutamyl transferase (GGT) levels are often suggestive of cholelithiasis, and previous studies have indicated that GGT is highly expressed in the urinary system. Therefore, we hypothesized that there may be an association between GGT levels and calculus of kidney (CK) incidence. To investigate this potential causal relationship, we employed Mendelian randomization (MR) analysis. Additionally, we analyzed the levels of other liver enzymes, including alanine transaminase (ALT) and alkaline phosphatase (ALP). The relationship between GGT levels and CK incidence was analyzed using two-sample Mendelian randomization. Summary Genome-Wide Association Studies data were utilized for this analysis. 33 single nucleotide polymorphisms known to be associated with GGT levels were employed as instrumental variables. We employed several MR methods including IVW (inverse variance weighting), MR-Egger, weighted median, weighted mode, and MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier). Furthermore, we conducted tests for horizontal multivariate validity, heterogeneity, and performed leave-one-out analysis to ensure the stability of the results. Overall, several MR methods yielded statistically significant results with a p-value

Roll-on/roll-off vessels (RO/RO vessels) are playing an increasingly critical role in international automobile transport, facilitating the efficient movement of vehicles and heavy machinery across continents. Despite this growing significance, there is still limited research specifically focused on the RO/RO shipping network and its impact on global trade. This paper studies the global RO/RO shipping network using AIS data on RO/RO vessels collected from 2020 to 2023. We construct a method based on the complex network theory and the graph feature extraction method to quantitatively assess the features of the RO/RO shipping network. This method assesses the complexity, sparsity, homogeneity, modularity, and hierarchy of the RO/RO shipping network across various ports and countries and employs the graph convolutional neural network (GCN) model to extract network features for community detection. This process enables the identification of port clusters that are frequently linked to RO/RO vessels, as well as regional transport modes. The paper’s findings support these conclusions: (1) From 2020 to 2023, the number of nodes in the RO/RO shipping network increased by 22%, primarily concentrated in African countries. The RO/RO shipping network underwent restructuring after the pandemic, with major complex network parameters showing an upward trend. (2) The RO/RO shipping network is complex, with a stable graph density of 0.106 from 2020 to 2023. The average degree increased by 7% to 4.224. Modularity decreased by 6.5% from 0.431 in 2022 to 0.403, while the hierarchy coefficient rose to 0.575, suggesting that post-pandemic, community routes have become more diverse, reflecting the reconstruction and maturation of the overall network. (3) The model yielded a silhouette coefficient of 0.548 and a Davies–Bouldin index of 0.559 using an improved automatic feature extraction method. In comparison between 2020 and 2023, the changes in the two indicators are small. This shows that GINs can effectively extract network features and give us results that we can understand for community detection. (4) In 2023, key communities divide the RO/RO shipping network, with one community handling 39% of global routes (primarily Europe–Asia), another community handling 23% (serving Asia–Pacific, Africa, and the Middle East), and a third community managing 38% (linking Asia, Europe, and South America).

The study of chlorophyll fluorescence parameters is very important for understanding plant photosynthesis. Monitoring cotton chlorophyll fluorescence parameters via spectral technology can aid in understanding the photosynthesis, growth, and stress of cotton fields in real time and provide support for cotton growth regulation and planting management. In this study, cotton plot experiments with different water treatments were set up to obtain the spectral reflectance of the cotton canopy, the maximum photochemical quantum yield (Fv/Fm), and the photochemical quenching coefficient (qP) of leaves at different growth stages. Support vector machine regression (SVR), random forest regression (RFR), and artificial neural network regression (ANNR) were used to establish a fluorescence parameter inversion model of the cotton canopy leaves. The results show that the original spectrum was transformed by multivariate scattering correction (MSC), the standard normal variable (SNV), and continuous wavelet transform (CWT), and the model constructed with Fv/Fm passed accuracy verification. The SNV-SVR model at the budding stage, the MSC-SVR model at the early flowering stage, the SNV-SVR model at the full flowering stage, the MSC-SVR model at the flowering stage, and the CWT-SVR model at the full boll stage had the highest estimation accuracy. The accuracies of the three spectral preprocessing and qP models were verified, and the MSC-SVR model at the budding stage, SNV-SVR model at the early flowering stage, MSC-SVR model at the full flowering stage, SNV-SVR model at the flowering stage, and CWT-SVR model at the full boll stage presented the highest estimation accuracies.

The volatility and uncertainty associated with the high proportion of wind and PV output in the new power system significantly impact the power and energy balance, making it challenging to accurately assess the risks related to renewable energy abandonment and supply guarantee. Therefore, a probabilistic power and energy balance risk analysis method based on distributed robust optimization is proposed. Firstly, the affine factor and the flexible ramp reserve capacity of thermal power are combined to establish a probabilistic index, which serves to characterize the risk associated with the power and energy balance. Drawing upon the principles of the conditional value at risk theory, the risk indexes of the load shedding power and curtailment power under a certain confidence probability are proposed. Secondly, the probability distribution fuzzy sets of uncertain variables are constructed using the distributionally robust method to measure the Wasserstein distance between different probability distributions. Finally, aiming at minimizing the operation cost of thermal power, the risk cost of power abandonment, and the risk cost of load shedding, a distributed robust optimal scheduling model based on a flexible ramp reserve of thermal power is established.

Objectives Despite the publication of hundreds of trials on obstetric anaesthesia, the management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for obstetric anaesthesia.Design This is a systematic review and quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) II methodology.Data sources Data sources include PubMed and Embase (8 June 2023), three Chinese academic databases, six guideline databases (7 June 2023) and Google and Google scholar (1 August 2023).Eligibility criteria We included the latest version of international and national/regional clinical practice guidelines and consensus statements for the anaesthetic management of pregnant patients during labour, non-operative delivery, operative delivery and selected aspects of perioperative monitoring, postpartum care and analgesia, published in English or Chinese.Data extraction and synthesis Two reviewers independently screened the searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.Results Twenty-two guidance documents (14 clinical practice guidelines and 8 consensus statements) were included. Included documents performed well in the domains of scope and purpose (median 76.4%, IQR 69.4%–79.2%) and clarity of presentation (median 72.2%, IQR 61.1%–80.6%), but were unsatisfactory in applicability (median 21.9%, IQR 13.5%–27.1%) and editorial independence (median 47.9%, IQR 6.3%–73.2%). The majority of obstetric anaesthesia guidelines or consensus centred on different topics. Less than 30% of them specifically addressed the management of obstetric anaesthesia perioperatively. Recommendations were concordant on the perioperative preparation, and on some indications for the choice of anaesthesia method. Substantially different recommendations were provided for some items, especially for preoperative blood type and screen, and for the types and doses of neuraxial administration.Conclusions The methodological quality in guidance documents for obstetric anaesthesia necessitates enhancement. Despite numerous trials in this area, evidence gaps persist for specific clinical queries in this field. One potential approach to mitigate these challenges involves the endorsement of standardised guidance development methods and the synthesis of robust clinical evidence, aimed at diminishing difference in recommendations.

IntroductionIntestinal microorganisms play an important role in the health of both humans and animals, with their composition being influenced by changes in the host’s environment.MethodsWe evaluated the longitudinal changes in the fecal microbial community of rats at different altitudes across various time points. Rats were airlifted to high altitude (3,650 m) and acclimatized for 42 days (HAC), before being by airlifted back to low altitude (500 m) and de-acclimatized for 28 days (HADA); meanwhile, the control group included rats living at low altitude (500 m; LA). We investigated changes in the gut microbiota at 12 time points during high-altitude acclimatization and de-acclimatization, employing 16S rRNA gene sequencing technology alongside physiological indices, such as weight and daily autonomous activity time.ResultsA significant increase in the Chao1 index was observed on day 14 in the HAC and HADA groups compared to that in the LA group, indicating clear differences in species richness. Moreover, the principal coordinate analysis revealed that the bacterial community structures of HAC and HADA differed from those in LA. Long-term high-altitude acclimatization and de- acclimatization resulted in the reduced abundance of the probiotic Lactobacillus. Altitude and age significantly influenced intestinal microbiota composition, with changes in ambient oxygen content and atmospheric partial pressure being considered key causal factors of altitude-dependent alterations in microbiota composition. High-altitude may be linked to an increase in anaerobic bacterial abundance and a decrease in non-anaerobic bacterial abundance.DiscussionIn this study, the hypobaric hypoxic conditions at high-altitude increased the abundance of anaerobes, while reducing the abundance of probiotics; these changes in bacterial community structure may, ultimately, affect host health. Overall, gaining a comprehensive understanding of the intestinal microbiota alterations during high-altitude acclimatization and de-acclimatization is essential for the development of effective prevention and treatment strategies to better protect the health of individuals traveling between high- and low-altitude areas.

Introduction Various approaches are employed to expedite the passage of meconium in preterm infants within the neonatal intensive care unit (NICU), with glycerine enemas being the most frequently used. Due to the potential risk of high osmolality-induced harm to the intestinal mucosa, diluted glycerine enema solutions are commonly used in clinical practice. The challenge lies in the current lack of knowledge regarding the safest and most effective concentration of glycerine enema. This research aims to ascertain the safety of different concentrations of glycerine enema solution in preterm infants.Methods and analysis This study protocol is for a single-centre, two-arm, parallel-group, double-blind and non-inferiority randomised controlled trial. Participants will be recruited from a NICU in a teriary class A hospital in China, and eligible infants will be randomly allocated to either the glycerine (mL): saline (mL) group in a 3:7 ratio or the 1:9 ratio group. The enema procedure will adhere to the standardised operational protocols. Primary outcomes encompass necrotising enterocolitis and rectal bleeding, while secondary outcomes encompass feeding parameters, meconium passage outcomes and splanchnic regional oxygen saturation. Analyses will compare the two trial arms based on an intention-to-treat allocation.Ethics and dissemination This trial is approved by the ethics committee of the Medical Ethics Committee of West China Second University Hospital of Sichuan University. The results will be published in a peer-reviewed journal.Trial registration number ChiCTR2300079199.

BackgroundAcupuncture is a widely used clinical treatment method, and studies have confirmed its therapeutic effects on stroke patients. It can also reduce the burden on patients and society. Acupuncture treatment is a complementary and preventive treatment for stroke. However, there has yet to be a visual bibliometric analysis of the field of acupuncture for stroke rat models. This study explores future trends, research hotspots, and frontiers in acupuncture for stroke rat models over the past 20 years through investigation and visualization.MethodsWe collected literature data on acupuncture treatment of stroke in rats from the Web of Science Core Collection (WOSCC) database from January 1, 2004, to December 31, 2023. Import into CiteSpace (version 6.2.R4) and RStudio for analysis by author, country/region, affiliation, annual publication, keywords, and journal visualization.ResultsA total of 379 articles were retrieved, including articles from 16 countries, 258 research institutions, and 123 academic journals. The countries and institutions with the most publications were the People’s Republic of China (338) and the Fujian University of Traditional Chinese Medicine (43). Tao, Jing had the highest number of co-citations (144). The keywords and co-citation clustering show the main research directions in the field, including “artery occlusion,” “neural regeneration,” “stimulation,” “rapid tolerance,” “receptor,” “signaling pathway,” “apoptosis,” “oxidative stress,” “inflammatory response,” “endogenous neurogenesis,” “tolerance of local cerebral ischemic tissues,” “proliferation of reactive astrocytes” and “neuroprotective effect.” The intervention combines classical acupuncture treatment and modern technology (electricity) with electroacupuncture as a new intervention modality.ConclusionThis study demonstrates the increasing research on acupuncture for treating stroke in rat models. The country/region with the most publications is the People’s Republic of China. However, international cooperation still needs to be improved, and future researchers must strengthen international cooperation. In addition, in future studies, researchers should improve the overall quality of research results in this area and enhance research protocols.

An aging population is one of the main features of China's current population structure, and it is a key area that needs attention to achieve high-quality population development. Because of its unique geographical environment, economic conditions, and sociocultural background, the study of population aging in the karst region of southwest China is particularly important. However, there is a lack of research exploring the regional differentiation of population aging and its influencing factors in the karst regions of southwest China. In light of this, we chose Anshun City, located in Guizhou Province's southwest area, as the case study area. We used the Lorenz curve and spatial autocorrelation to study the differences in the spatial distribution pattern of population aging and introduced multi-scale geographical weighted regression to explore its influencing factors. The results show that Anshun City's older people population proportion (OPP) is generally high with more than 7% of the older people there, making it part of an aging society. The OPP appeared high in the east and low in the west in spatial distribution; the older people population density (OPD) revealed a gradually increasing trend from south to north. At the township scale, both the OPP and the OPD showed significant spatial positive correlation, and the spatial agglomeration characteristics were obvious. OPD and OPP have a positive spatial correlation at the global level, and townships with similar OPP or OPD were spatially adjacent. The spatial distribution characteristics of population aging are the consequence of complex contributions such as natural, social, economic, and karst factors. Further, the spatial distribution pattern of aging is determined by a variety of influencing factors, which have different directions and intensities. Therefore, it is necessary to formulate and implement corresponding policies and strategies to deal with the aging problem in the future.

ObjectiveIn this study, we investigated the characteristics of the intestinal microbiota of preterm infants, and then analyzed the effects of probiotics supplementation on intestinal microbiota in preterm infants.MethodsThis study enrolled 64 infants born between 26 and 32 weeks gestational age (GA) and 22 full-term infants. 34 premature infants received oral probiotic supplementation for 28 days. Stool samples were obtained on the first day (D1) and the 28th day (D28) after birth for each infant. Total bacterial DNA was extracted and sequenced using the Illumina MiSeq Sequencing System, specifically targeting the V3-V4 hyper-variable regions of the 16S rDNA gene. The sequencing results were then used to compare and analyze the composition and diversity index of the intestinal microbiota.ResultsThere was no significant difference in meconium bacterial colonization rate between premature and full-term infants after birth (p > 0.05). At D1, the relative abundance of Bifidobacterium, Bacteroides, and Lactobacillus in the stool of preterm infants was lower than that of full-term infants, and the relative abundance of Acinetobacter was higher than that of full-term infants. The Shannon index and Chao1 index of intestinal microbiota in preterm infants are lower than those in full-term infants (p < 0.05). Supplementation of probiotics can increase the relative abundance of Enterococcus and Enterobacter, and reduce the relative abundance of Escherichia and Clostridium in premature infants. The Chao1 index of intestinal microbiota decreased in preterm infants after probiotic supplementation (p < 0.05).ConclusionThe characteristics of intestinal microbiota in preterm infants differ from those in full-term infants. Probiotic supplementation can reduce the relative abundance of potential pathogenic bacteria and increase the abundance of beneficial microbiota in premature infants.