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Abstract With increasing life spans, breast cancer (BC) survivors may face the possibility of developing second primary cancer (SPC), which can considerably shorten survival. Lung cancer (LC) is a common SPC among BC survivors. This study explored the association between these two cancers through Mendelian randomization (MR) analysis. A bidirectional two-sample MR analysis was conducted with BC genome-wide association study (GWAS) data from the Breast Cancer Association Consortium (BCAC) included 228,951 individuals and the GWAS summary statistics from the Transdisciplinary Research in Cancer of the Lung (TRICL) of LC included 112,781 individuals. The IVW method and MR-RAPS method showed a causal effect of overall BC on lung adenocarcinoma (LUAD) (IVW: OR = 1.060, 95% CI = 1.008–1.116, P = 0.024; MR-RAPS: OR = 1.059, 95% CI = 1.005–1.116, P = 0.033), which indicated that patients with BC had an increased risk of LUAD. However, there is no strong evidence for a causal effect of LUAD on BC. Our study revealed a causal effect of BC on second primary LUAD, suggesting that we should intensify screening for second primary LC in BC survivors. Early intervention and treatment for patients with second primary LC are needed to reduce mortality in BC survivors.

Abstract Background Incorporating backfill cohorts in phase I oncology trials is a recently developed strategy for dose optimization. However, the efficacy assessment window is long in general, causing a lag in identifying ineffective doses and more patients being backfilled to those doses. There is necessity to investigate how to use patient-reported outcomes (PRO) to determine doses for backfill cohorts. Methods We propose a unified Bayesian design framework, called ‘Backfill-QoL’, to utilize patient-reported quality of life (QoL) data into phase I oncology trials with backfill cohorts, including methods for trial monitoring, algorithm for dose-finding, and criteria for dose selection. Simulation studies and sensitivity analyses are conducted to evaluate the proposed Backfill-QoL design. Results The simulation studies demonstrate that the Backfill-QoL design is more efficient than traditional dose-expansion strategy, and fewer patients would be allocated to doses with unacceptable QoL profiles. A user-friendly Windows desktop application is developed and freely available for implementing the proposed design. Conclusions The Backfill-QoL design enables continuous monitoring of safety, efficacy and QoL outcomes, and the recommended phase II dose (RP2D) can be identified in a more patient-centered perspective.

Abstract Systems with broken continuous symmetry in ideal lattices cannot be rectified through rearrangement or deformation. Topological metamaterials featuring nontrivial, artificially induced phase transitions have emerged as pivotal constituents for engineering these topological defects, which, until now, have mostly been experimentally realized in linear or planar configurations. Buckminster Fuller lent his name to the C60 ball-shaped carbon allotrope, which is not only the roundest molecule in existence but also embodies 3D topological defects. Here, we construct a C540 metamaterial composed of interspersed pentagons in a hexagonal network of hollow tubes and cavities. By 3D printing this giant closed-cage topology, the nontrivial state-confinements can be fully controlled and visualized, which, in contrast, in synthesized or naturally found fullerenes, is highly challenging. Thanks to our macroscopic metamaterials approach, we are able to map in real-space topological pentagon states probed by sound waves. Our results show how a seemingly unrelated approach can unveil deep physical understanding in carbon allotropes and potentially in a plethora of other complex systems in the near future.

Abstract Objective To evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States. Methods We used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use. Results The decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16–2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Conclusion When patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making. Trial registration ClinicalTrials.gov NCT03985449; registered 6 June 2019.

Abstract Diabetic cardiomyopathy (DCM) is a cardiovascular complication of diabetes mellitus with a poor prognosis and is the leading cause of death in diabetic patients. Sleep deficiency is not only recognized as an important risk factor for the development of type 2 DM, but is also associated with increased morbidity and mortality of cardiovascular disease. The underlying role and mechanisms of sleep restriction (SR) in DCM are far from clear. The KK/Upj-Ay mouse model of T2 DM was used as a study subject, and the small animal ultrasound imaging system was used to detect the function of the heart; immunopathological staining was used to clarify the histo-structural pathological alterations of the heart; and TUNEL staining, qPCR, transmission electron microscopy (TEM), and ELISA kits were used to detect apoptosis, oxidative stress, inflammation, and mitochondrial damage, and related molecular alterations. SR led to a significant increase in mortality, cardiac hypertrophy, necrosis, glycogen deposition and fibrosis further deteriorated in DM KK mice. SR increased cardiomyocyte death in KK mice through the Bax/Bcl2 pathway. In addition to this, SR not only exacerbated the inflammatory response, but also aggravated mitochondrial damage and promoted oxidative stress in KK mice through the PRDM16-PGC-1α pathway. Overall, SR exacerbates structural alterations and dysfunction through inflammation, oxidative stress, and apoptosis in DM KK mice, increasing the risk of death. Clinicians and diabetic patients are prompted to pay attention to sleep habits to avoid accelerating the transition of DCM to heart failure and inducing death due to poor sleep habits.

Abstract Objective This study aims to analyze the clinical features, Radiological findings and diagnostic characteristics (tissue biopsy, flow cytometry and cerebrospinal fluid cytology) of primary central nervous system lymphoma (PCNSL). To improve the diagnosis of the disease. Methods A total of 19 patients with primary central nervous system lymphoma admitted to the Second Hospital of Hebei Medical University from 2014 to 2023 were selected. The clinical data of the patients were retrospectively analyzed. Combined with the relevant literature, the clinical characteristics of PCNSL patients were analyzed to assist the diagnosis. Result Most of the patients were middle-aged and elderly patients (65 years old), and the main clinical manifestations showed no obvious specificity, including headache, dizziness and limb weakness. Radiological findings showed that common site of currence were located in the brain parenchyma. The PCNSL subtype of 19 patients was all diffuse large B cell subtype by cytology, flow cytometry or histopathology. Six cases were diagnosed by biopsy pathology and 11 cases were diagnosed by flow cytometry of cerebrospinal fluid. In all patients diagnosed with PCNSL by clinical cytology (CSF cytology and flow cytometry), abnormal cells were found on CSF examination. Conclusion The pathological type of primary central nervous system lymphoma was diffuse large B-cell subtype, with diverse clinical manifestations and multiple. Both tissue directed biopsy and flow cytometry could effectively assist clinical diagnosis. Early and timely diagnosis and intervention are of great significance for delaying the disease process and reducing the economic burden of patients and families.

Abstract Due to varying energy demands and supply levels in different regions, the distribution of power load exhibits an imbalanced state. It contributes to increased power loss and poses a threat to the security constraints of the electrical grid. Simultaneously, the global energy transition has led to a continuous increase in the proportion of renewable energy integrated into the grid. Electric vehicles (EVs), serving as representative of renewable energy, further magnify this load imbalance with their charging requirements, which poses a significant challenge to the stable operation of the grid. Therefore, to ensure the smooth operation of the grid under the context of renewable energy integration, the authors investigate the coordinated strategies of EV charging scheduling and route planning. The authors first model the coupling of the transportation network with the smart grid as a cyber‐physical system. Subsequently, the authors simulate and analyse the daily charging load curve of the network, capturing the travel characteristics of EVs. Based on this, the authors research the EV charging scheduling in both individual and collective travel scenarios during peak and off‐peak hours. For the off‐peak travel period of EVs, a charging schedule strategy based on travel plans is proposed, which reduces the time cost of EV owners' travel. Furthermore, for the collective travel of a large number of EVs within the system, a multi‐EV charging scheduling strategy based on charging station load balancing is presented. This strategy effectively balances the load levels of various charging stations while reducing the overall system travel time. Ultimately, through experimental results, the authors demonstrate that by deploying appropriate charging scheduling strategies, EVs cease to be a burden on the grid and can be transformed into tools for balancing the loads across different regions.

Abstract Polyorchidism is an uncommon congenital condition often discovered incidentally, which may significantly impact male fertility. We present a case of a 34-year-old man with unilateral polyorchidism and associated severe asthenozoospermia and teratozoospermia. Despite normal hormonal levels and no detected genetic anomalies, the patient’s sperm showed mitochondrial damage, and his fertility remained compromised after conservative management and assisted reproductive attempts. This case underscores the intricate relationship between polyorchidism and male infertility, highlighting the need for personalized management strategies and further research into its etiology and impact.

Abstract Backgrounds Acute transplant rejection is a major component of poor prognoses for organ transplantation. Owing to the multiple complex mechanisms involved, new treatments are still under exploration. Endometrial regenerative cells (ERCs) have been widely used in various refractory immune-related diseases, but the role of ERC-derived exosomes (ERC-Exos) in alleviating transplant rejection has not been extensively studied. Signaling lymphocyte activation molecule family 6 (SLAMF6) plays an important role in regulating immune responses. In this study, we explored the main mechanism by which ERC-Exos loaded with siSLAMF6 can alleviate allogeneic transplant rejection. Methods C57BL/6 mouse recipients of BALB/c mouse kidney transplants were randomly divided into four groups and treated with exosomes. The graft pathology was evaluated by H&E staining. Splenic and transplanted heart immune cell populations were analyzed by flow cytometry. Recipient serum cytokine profiles were determined by enzyme-linked immunosorbent assay (ELISA). The proliferation and differentiation capacity of CD4+ T cell populations were evaluated in vitro. The α-2,6-sialylation levels in the CD4+ T cells were determined by SNA blotting. Results In vivo, mice treated with ERC-siSLAMF6 Exo achieved significantly prolonged allograft survival. The serum cytokine profiles of the recipients were significantly altered in the ERC-siSLAMF6 Exo-treated recipients. In vitro, we found that ERC-siSLAMF6-Exo considerably downregulated α-2,6-sialyltransferase (ST6GAL1) expression in CD4+ T cells, and significantly reduced α-2,6-sialylation levels. Through desialylation, ERC-siSLAMF6 Exo therapy significantly decreased CD4+ T cell proliferation and inhibited CD4+ T cell differentiation into Th1 and Th17 cells while promoting regulatory T cell (Treg) differentiation. Conclusions Our study indicated that ERC-Exos loaded with siSLAMF6 reduce the amount of sialic acid connected to α-2,6 at the end of the N-glycan chain on the CD4+ T cell surface, increase the number of therapeutic exosomes endocytosed into CD4+ T cells, and inhibit the activation of T cell receptor signaling pathways, which prolongs allograft survival. This study confirms the feasibility of using ERC-Exos as natural carriers combined with gene therapy, which could be used as a potential therapeutic strategy to alleviate allograft rejection.

Abiotic and biotic stressors adversely affect plant survival, biomass generation, and crop yields. As the global availability of arable land declines and the impacts of global warming intensify, such stressors may have increasingly pronounced effects on agricultural productivity. Currently, researchers face the overarching challenge of comprehensively enhancing plant resilience to abiotic and biotic stressors. The secondary cell wall plays a crucial role in bolstering the stress resistance of plants. To increase plant resistance to stress through genetic manipulation of the secondary cell wall, we cloned a cell wall protein designated glycine-rich protein-like (GhGRPL) from cotton fibers, and found that it is specifically expressed during the period of secondary cell wall biosynthesis. Notably, this protein differs from its Arabidopsis homolog, AtGRP, since its glycine-rich domain is deficient in glycine residues. GhGRPL is involved in secondary cell wall deposition. Upregulation of GhGRPL enhances lignin accumulation and, consequently, the thickness of the secondary cell walls, thereby increasing the plant's resistance to abiotic stressors, such as drought and salinity, and biotic threats, including Verticillium dahliae infection. Conversely, interference with GhGRPL expression in cotton reduces lignin accumulation and compromises that resistance. Taken together, our findings elucidate the role of GhGRPL in regulating secondary cell wall development through its influence on lignin deposition, which, in turn, reinforces cell wall robustness and impermeability. These findings highlight the promising near-future prospect of adopting GhGRPL as a viable, effective approach for enhancing plant resilience to abiotic and biotic stress factors.

Abstract Objective To evaluate the prediction value of Dual-energy CT (DECT)-based quantitative parameters and radiomics model in preoperatively predicting muscle invasion in bladder cancer (BCa). Materials and methods A retrospective study was performed on 126 patients with BCa who underwent DECT urography (DECTU) in our hospital. Patients were randomly divided into training and test cohorts with a ratio of 7:3. Quantitative parameters derived from DECTU were identified through univariate and multivariate logistic regression analysis to construct a DECT model. Radiomics features were extracted from the 40, 70, 100 keV and iodine-based material-decomposition (IMD) images in the venous phase to construct radiomics models from individual and combined images using a support vector machine classifier, and the optimal performing model was chosen as the final radiomics model. Subsequently, a fusion model combining the DECT parameters and the radiomics model was established. The diagnostic performances of all three models were evaluated through receiver operating characteristic (ROC) curves and the clinical usefulness was estimated using decision curve analysis (DCA). Results The normalized iodine concentration (NIC) in DECT was an independent factor in diagnosing muscle invasion of BCa. The optimal multi-image radiomics model had predictive performance with an area-under-the-curve (AUC) of 0.867 in the test cohort, better than the AUC = 0.704 with NIC. The fusion model showed an increased level of performance, although the difference in AUC (0.893) was not statistically significant. Additionally, it demonstrated superior performance in DCA. For lesions smaller than 3 cm, the fusion model showed a high predictive capability, achieving an AUC value of 0.911. There was a slight improvement in model performance, although the difference was not statistically significant. This improvement was observed when comparing the AUC values of the DECT and radiomics models, which were 0.726 and 0.884, respectively. Conclusion The proposed fusion model combing NIC and the optimal multi-image radiomics model in DECT showed good diagnostic capability in predicting muscle invasiveness of BCa.

Abstract There are no studies exploring the correlation between sleep duration and abdominal aortic calcification (AAC). This study aims to investigate this relationship and its significance. Additionally, given the higher prevalence of sleep disorders and AAC in patients with chronic kidney disease (CKD), we conducted further studies in this population. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. Sleep duration was assessed by a sleep questionnaire and categorized into 2–5, 6–8, and ≥ 9 h. The AAC-24 score is determined using the Kauppila scoring system and used for AAC assessment. Multivariable linear and logistic regression analysis were used to explore the relationship between sleep duration and AAC. Among the 2,996 participants, 14.29% reported nightly short sleep (2–5 h), 77.64% reported intermediate sleep (6–8 h), and 8.08% reported long sleep (≥ 9 h). After adjusting for potential confounding factors, among male participants with CKD, long sleep (≥ 9 h) significantly increased AAC-24 scores compared with intermediate sleep (6–8 h) (β: 2.12; 95% CI: 0.75, 3.50), and the risk of severe AAC (SAAC) was increased by 1.55 times (OR: 2.55; 95% CI: 1.02, 6.36). And among female CKD and non-CKD participants, sleep duration was not associated with AAC. Long sleep duration increases the risk of AAC among male adults with CKD. Prospective studies are needed to confirm this finding.

Background: Streptococcus agalactiae is a recognized pathogen that primarily affects infants and pregnant women. However, its increasingly important role in causing invasive infections among non-pregnant adults has become a significant health concern due to the severity and variety of its clinical impacts. Methods: Nonduplicate S. agalactiae clinical strains associated with clinical infections (n = 139) were isolated from non-pregnant adults in Shandong, China. Antibiotic susceptibility testing, whole-genome sequencing and genomic analyses were conducted to characterize the genome and identify resistance features of these strains. Results: The strains exhibited universal susceptibility to penicillin, ampicillin, cefotaxime, meropenem, linezolid and vancomycin. Notably, high resistance rates were observed for erythromycin (91.4%), clindamycin (89.2%), levofloxacin (84.2%), tetracycline (54.0%) and, to a lesser extent, chloramphenicol (12.9%). Serotyping revealed seven serotypes and one non-typeable strain. Serotypes Ia, Ib, III and V predominated, representing 95.7% of the strains. Nineteen sequence types were categorized into seven clonal complexes, with CC10 being the most prevalent at 48.9%. The resistance genes mreA (100%), ermB (70.5%) and tetM (46.0%) were commonly detected. All the isolates carried at least one pilus backbone determinant and one alpha-like protein gene, with the PI-1+PI-2a and the bca gene being the most frequent at 84.2% and 54.7%, respectively. Conclusions: While S. agalactiae strains in non-pregnant adults retain sensitivity to β-lactam antibiotics, the elevated resistance to erythromycin, clindamycin, levofloxacin and tetracycline is concerning. Given the growing elderly population worldwide, the burden of S. agalactiae infections is significant. Continuous surveillance of serotype distribution and antibiotic resistance patterns is imperative for targeted prevention and therapeutic strategies.

This study elucidated the optimization conditions, GC-MS analysis conditions, total antioxidant activity, and components closely related to antioxidant activity for supercritical extraction of active ingredients in Huoluo Xiaoling Dan (HLXLD). The yield, octyl acetate content, and total antioxidant activity of HLXLD under different conditions were obtained through orthogonal experiments, and the optimal supercritical extraction conditions were determined to be 45°C, 25 MPa, and 4 h. The supercritical extract was subjected to GC-MS analysis and matched with the WILEY and NIST databases, resulting in the qualitative identification of 37 chemical components with a matching degree above 60. The similarity evaluation system of traditional Chinese medicine fingerprint was used to evaluate all orthogonal experimental samples, with a similarity ranging from 0.522 to 0.989. Thirteen common characteristic peaks were selected, and the quantification of these peaks was performed using peak area normalization method. The combination of the content of common characteristic peaks in different samples and their total antioxidant activity was analyzed using multivariate statistical methods such as principal component analysis and multiple regression equation. It was found that five components, F3, F2, F5, F7 and F12, among the common characteristic peaks were closely related to antioxidant activity.

Abstract Infection of piglets with Glaesserella parasuis (G. parasuis) induces host immunosuppression. However, the mechanism underlying the immunosuppression of piglets remains unclear. Activation of the PD-1/PD-L1 axis has been shown to trigger host immunosuppression. Baicalin possesses anti-inflammatory and immunomodulatory functions. However, whether baicalin inhibits PD-1/PD-L1 activation and thus alleviates host immunosuppression has not been investigated. In this study, the effect of baicalin on the attenuation of piglet immunosuppression induced by G. parasuis was evaluated. Seventy piglets were randomly divided into the control group, infection group, levamisole group, BMS-1 group, 25 mg/kg baicalin group, 50 mg/kg baicalin group and 100 mg/kg baicalin group. Following pretreatment with levamisole, BMS-1 or baicalin, the piglets were challenged with 1 × 108 CFU of G. parasuis. Our results showed that baicalin, levamisole and BMS-1 modified routine blood indicators and biochemical parameters; downregulated IL-1β, IL-10, IL-18, TNF-α and IFN-γ mRNA expression; and upregulated IL-2 and IL-8 mRNA expression in blood. Baicalin, levamisole and BMS-1 increased the proportions of CD3+ T cells, CD3+CD4+ T cells, CD3+CD8+ T cells and CD3–CD21+ B cells in the splenocyte population, increased the proportions of CD3+ T cells, CD3+CD4+ T cells and CD3+CD8+ T cells in the blood, and inhibited PD-1/PD-L1 and TIM-3 activation. Baicalin, levamisole and BMS-1 reduced p-PI3K, p-Akt, and p-mTOR expression, the p-MEK1/2/MEK1/2 and p-ERK1/2/ERK1/2 ratios and increased RAS expression. Baicalin, levamisole and BMS-1 provided substantial protection against G. parasuis challenge and relieved tissue histopathological damage. Our findings might provide new strategies for controlling G. parasuis infection and other immunosuppressive diseases.

Abstract Novelty and appropriateness are two fundamental components of creativity. However, the way in which novelty and appropriateness are separated at behavioral and neural levels remains poorly understood. In the present study, we aim to distinguish behavioral and neural bases of novelty and appropriateness of creative idea generation. In alignment with two established theories of creative thinking, which respectively, emphasize semantic association and executive control, behavioral results indicate that novelty relies more on associative abilities, while appropriateness relies more on executive functions. Next, employing a connectome predictive modeling (CPM) approach in resting-state fMRI data, we define two functional network-based models—dominated by interactions within the default network and by interactions within the limbic network—that respectively, predict novelty and appropriateness (i.e., cross-brain prediction). Furthermore, the generalizability and specificity of the two functional connectivity patterns are verified in additional resting-state fMRI and task fMRI. Finally, the two functional connectivity patterns, respectively mediate the relationship between semantic association/executive control and novelty/appropriateness. These findings provide global and predictive distinctions between novelty and appropriateness in creative idea generation.

Abstract Percutaneous coronary intervention (PCI) addresses myocardial ischaemia, but a significant subset of patients encounter major adverse cardiovascular events (MACE) post‐treatment. This meta‐analysis investigated the relationship between the post‐PCI triglyceride‐glucose (TyG) index and MACE. Comprehensive searches of the Embase, PubMed, Cochrane Library, and Web of Science databases were conducted up to 3 March 2023, using relevant keywords. The effect size was determined based on I2 statistic using random‐effects models. Cluster‐robust standard errors crafted the dose–response curve, and the GRADE Evaluation Scale was employed to rate the quality of evidence. The group with the highest TyG index had significantly higher post‐PCI MACE rates than the lowest index group, with hazard ratios (HRs) of 2.04 (95% CI 1.65–2.52; I2 = 77%). Each unit increase in TyG index corresponded to HRs of 1.82 for MACE (95% CI 1.34–2.46; I2 = 92%), 2.57 for non‐fatal MI (95% CI 1.49–4.41; I2 = 63%), and 2.06 for revascularization (95% CI 1.23–3.50; I2 = 90%). A linear relationship between TyG index and MACE risk was established (R2 = 0.6114). For all‐cause mortality, the HR was 1.93 (95% CI 1.35–2.75; I2 = 50%), indicating a higher mortality risk with elevated TyG index. The GRADE assessment yielded high certainty for non‐fatal MI but low certainty for all‐cause mortality, revascularization, and MACE. The TyG index may predict risks of post‐PCI MACE, all‐cause mortality, non‐fatal MI, and revascularization, with varied levels of certainty. A potential linear association between the TyG index and MACE post‐PCI was identified. Future research should validate these findings.

ObjectiveThe value of robotic pancreaticoduodenectomy (RPD) compared with laparoscopic pancreaticoduodenectomy (LPD) for pancreatic and periampullary tumors is controversial. This study aims to assess the available literature and compare the short outcomes of RPD and LPD.MethodsThe PubMed, Cochrane Library, Embase, and Web of Science databases were searched to identify available research published up to 24 July, 2024. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.ResultsSeventeen studies with a total of 9417 patients (RPD group: 3334 patients; LPD group: 6083 patients) were included in this meta-analysis. The RPD group had lower overall morbidity (RR, 0.79), conversion (RR, 0.29) and blood transfusion rates (RR, 0.61), shorter length of stay (MD, -0.72 days), and higher number of harvested lymph nodes (MD, 0.62) than the LPD group. There were no significant differences in 90-day mortality (RR, 0.89), major complications (RR, 0.87), operative time (MD, -3.74 mins), blood loss (MD, -24.14 mL), reoperation (RR, 0.94), bile leak (RR, 0.62), postoperative pancreatic hemorrhage (RR, 0.96), postoperative pancreatic fistula (RR, 0.74), delayed gastric emptying (RR, 1.24), and R0 resection (RR, 1.00) between the groups.ConclusionsCompared with LPD, RPD for pancreatic and periampullary tumors could be safe and effective, and it has superior surgical outcomes. Further randomized controlled trials to verify the potential advantages of RPD over LPD are necessary.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=581133, identifier CRD42024581133.

Drug-related problems (DRPs) are prevalent in critically ill patients and may significantly increase mortality risks. The participation of critical care pharmacists (CCPs) in the medical team has demonstrated a benefit to healthcare quality. Research indicates that CCP medication order evaluations can reduce DRPs, while their participation in rounds can reduce adverse drug events and shorten hospital stays. Pharmacist medication reconciliation often proves more effective than physicians, and CCPs play a crucial role in antimicrobial management and reducing treatment costs. Despite these benefits, there is a noticeable lack of practical guidance for implementing CCP roles effectively. Their workflow heavily influences the efficiency of CCPs. Integrating results from the literature with our practical experience, we have detailed workflows and critical entry points that CCPs can refer to. Pharmacists should be proactive rather than passive consultants. Pre-round medication order evaluations are crucial for determining the depth of a pharmacist’s involvement in patient care. These evaluations should cover the following aspects: medication indication, dosage, treatment duration, detection of DRPs, implementation of therapeutic drug monitoring, dosing of sedatives and analgesics, and pharmaceutical cost containment. Beyond identifying medication issues, a primary task during rounds is gathering additional information and building trust with the medical team. Post-round responsibilities for CCPs include patient and caregiver education on medication, medication reconciliation for transitioning patients, and follow-up care for post-ICU patients. Establishing a rationalized and standardized workflow is essential to minimize daily work omissions and maximize the pharmacist’s value. A multidisciplinary pharmacist-led team can significantly promote the rational use of antibiotics. Participation in post-ICU outpatient follow-ups can reduce drug-induced injuries after discharge. This review provides a detailed overview of the tasks performed by CCPs before, during, and after medical rounds, serving as a valuable reference for establishing an efficient workflow for CCPs.

Abstract Robust and reliable piezo‐ionic materials that are both crack resistant and self‐healable like biological skin hold great promise for applications inflexible electronics and intelligent systems with prolonged service lives. However, such a combination of high toughness, superior crack resistance, autonomous self‐healing and effective control of ion dynamics is rarely seen in artificial iontronic skin because these features are seemingly incompatible in materials design. Here, we resolve this perennial mismatch through a molecularly engineered strategy of implanting carboxyl‐functionalized groups into the dynamic hard domain structure of synthesized poly(urethane‐urea). This design provides an ultra‐high fracture energy of 211.27 kJ m−2 that is over 123.54 times that of tough human skin, while maintaining skin‐like stretchability, elasticity, and autonomous self‐healing with a 96.40% healing efficiency. Moreover, the carboxyl anion group allows the dynamic confinement of ionic fluids though electrostatic interaction, thereby ensuring a remarkable pressure sensitivity of 7.03 kPa−1 for the tactile sensors. As such, we successfully demonstrated the enormous potential ability of this skin‐like piezo‐ionic sensor for biomedical monitoring and robotic item identification, which indicates promising future uses in flexible electronics and human–machine interactions.

The disorderly expansion of human production-living construction activities into aquatic ecological sensitive areas has triggered severe production-living-ecological space (PLES) conflicts. However, research on the risk-triggering mechanisms of PLES conflicts in lake network regions and multidimensional scenario simulation techniques is relatively lacking. To address these issues, this study constructs an integrated model chain by coupling the Markov-GMOP-PLUS model to achieve a quantified diagnosis and simulated regulation of spatial conflict strength index (SCSI) under sustainable development goals. Applying it to the Dongting Lake region reveals that: (1) The overall PLES exhibited a distribution pattern where “ecological space encompasses production space, with living space interspersed within”. The category conversion mainly reflected the encroachment of agricultural production space on the plain water ecological space, with a conversion area of up to 899.48 km2. (2) The distinctive “high in the north, low in the south” PLES conflict pattern was closely aligned with the land use structure and water system distribution, with conflict hotspots persistently clustering in the core lake network regions amid rapid urbanization. Among these, the growth rate of severe conflicts in the last ten years was 3.86 times that of the previous ten years. (3) The sustainable development scenario showcased the most effective conflict mitigation by curtailing production-living space expansion and ecological space encroachment. This scenario reversed the growth trend in conflict high-value zones and the reduction trend in low-value zones, with change rates of −3.30 % and 7.05 %, respectively, compared to 2020. This study provides a scientific basis for formulating sustainable land-use policies in lake network regions.

Water resources are important supporting elements in the ecological environment and socio-economic system of sustainable development. The purpose of this study is to evaluate the comprehensive resilience level of the water resources–ecology–socioeconomic system against external disturbances in the Anhui and Shandong sections of the Huaihe River Basin. The comprehensive index system is constructed with the characteristic dimensions of resistance, resilience, and adaptability. Use the game theory combination weighting-VIKOR method to quantify the resilience level, and use the kernel density analysis and Markov chain to explore the spatial and temporal evolution characteristics and transition probability. The results show that (1) the resilience index of the composite system in the Huaihe River Basin shows an increasing trend, and the resilience level of the Anhui section is generally higher than that of the Shandong section. (2) The resilience level gradually evolved into the spatial distribution characteristics of high in the west and low in the east, high in the south and low in the north during the study period. (3) The resilience grade has strong robustness, and the probability of transferring to the higher grade is greater than that of transferring to the lower grade. HIGHLIGHTS Enriches the research on the resilience of river basin composite systems.; Exploring the evolution law of watershed ecological resilience from the spatial dimension.;

Abstract Hedgehog (Hh) signaling relies on the primary cilium, a cell surface organelle that serves as a signaling hub for the cell. Using proximity labeling and quantitative proteomics, we identify Numb as a ciliary protein that positively regulates Hh signaling. Numb localizes to the ciliary pocket and acts as an endocytic adaptor to incorporate Ptch1 into clathrin-coated vesicles, thereby promoting Ptch1 exit from the cilium, a key step in Hh signaling activation. Numb loss impedes Sonic hedgehog (Shh)-induced Ptch1 exit from the cilium, resulting in reduced Hh signaling. Numb loss in spinal neural progenitors reduces Shh-induced differentiation into cell fates reliant on high Hh activity. Genetic ablation of Numb in the developing cerebellum impairs the proliferation of granule cell precursors, a Hh-dependent process, resulting in reduced cerebellar size. This study highlights Numb as a regulator of ciliary Ptch1 levels during Hh signal activation and demonstrates the key role of ciliary pocket-mediated endocytosis in cell signaling.

Abstract Background/Purpose Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. Methods We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment. Results Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (− 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU

Abstract Predicting carbon prices is crucial for the growth of China's carbon trading industry. This paper proposes a residual correction model that considers multiple influencing factors. First, the best historical data and main external factors input by the model are determined by using the partial autocorrelation function and Spearman correlation analysis, and the carbon price forecasting index system is constructed. Second, the whale optimization algorithm (WOA) is utilized to determine the optimal parameters of the extreme gradient boosting (XGBoost), and the WOA‐XGBoost model is built to perform preliminary carbon price forecasts and obtain the residual series. Finally, the carbon price residual series undergoes decomposition into multiple components utilizing the complete ensemble empirical mode decomposition for subsequent forecasting and the aggregation of outcomes. Experiments are conducted to predict two carbon trading markets in Hubei and Guangzhou, and a feature importance analysis is performed. The results indicate that the proposed hybrid model consistently outperforms the comparative models in terms of prediction accuracy. Furthermore, it is revealed that historical carbon prices and European Union carbon prices are the key factors influencing the prediction of carbon market prices.

Abstract Background Mycoplasma pneumoniae infections have increased in China recently, causing some evidence of familial clustering. The purpose of this study was to compare the clinical features of parents and children in cases of familial clustering of Mycoplasma pneumoniae infection. Methods A retrospective analysis was performed on the cases of familial clustering of Mycoplasma pneumoniae infection, and the clinical characteristics of parents and children were compared. Results We identified 63 families, of these, 57 (65.5%) adults and 65 (94.2%) children required hospitalization. Fifty-seven adults (mean age 35.1 ± 4.6 years, 80.7% female) and 55 children (mean age 6.3 ± 3.9 years, 54.5% female) were included in the analysis. The incidence of mycoplasma infection in adults had increased gradually over the past year, while the rate in children had spiked sharply since June 2023. The clinical symptoms were similar in the two groups, mainly fever and cough. The peak temperature of children was higher than that of adults (39.1 ± 0.7℃ vs 38.6 ± 0.7℃, p = 0.004). Elevated lactate dehydrogenase was more common in children than in adults (77.8% vs 11.3%, p

Abstract Ancient Chinese architecture drawing is a unique form of ancient Chinese art. Porcine blood hydrogels are distinctive ingredients used to prepare the composite material of the substrate layer for architecture drawing. This investigation was focused on the mechanism for porcine blood hydrogel formation. Based on the traditional Chinese recipe for the preparation of porcine blood-lime mortar, samples with different ratios of porcine blood and lime water were prepared, and the molecular-scale interactions between the lime water and proteins in the porcine blood were examined with FTIR spectroscopy, Raman spectroscopy, XRD, XPS, fluorescence spectroscopy, contact angle and rheology studies. The mechanical properties and morphological features of the samples were detected with a rheometer, universal material testing machine and SEM. The results indicated that an appropriate amount of lime water was required for gelation of the porcine blood. With the appropriate alkalinity, sufficient carboxyl groups on the fibrin chains were deprotonated, and coordination with Ca2+ ions formed enough cross-links for support networks within the structure of the porcine blood hydrogel. Complexation of deprotonated carboxyl groups on the fibrin chains with Ca2+ ions led to the formation of a hydrophobic surface due alterations of the fibrin conformation and increased the adhesive properties of the hydrogel. With the hydrogel used as an ingredient in the preparation of a substrate layer composite, it is suggested that the hydrophobic surface of the hydrogel facilitated mixing with hydrophobic tung oil during preparation of the composite material, and strong adhesion of the hydrogel increased the mechanical strength and crack resistance of the substrate layer.

Commercial pilots endure multiple stressors in their daily and occupational lives which are detrimental to psychological well-being and cognitive functioning. The Quick coherence technique (QCT) is an effective intervention tool to improve stress resilience and psychophysiological balance based on a five-minute paced breathing exercise with heart rate variability (HRV) biofeedback. The current research reports on the application of QCT training within an international airline to improve commercial pilots’ psychological health and support cognitive functions. Forty-four commercial pilots volunteered in a one-month training programme to practise self-regulated QCT in day-to-day life and flight operations. Pilots’ stress index, HRV time-domain and frequency-domain parameters were collected to examine the influence of QCT practice on the stress resilience process. The results demonstrated that the QCT improved psychophysiological indicators associated with stress resilience and cognitive functions, in both day-to-day life and flight operation settings. HRV fluctuations, as measured through changes in RMSSD and LF/HF, revealed that the resilience processes were primarily controlled by the sympathetic nervous system activities that are important in promoting pilots’ energy mobilization and cognitive functions, thus QCT has huge potential in facilitating flight performance and aviation safety. These findings provide scientific evidence for implementing QCT as an effective mental support programme and controlled rest strategy to improve pilots’ psychological health, stress management, and operational performance.

During Hedgehog (Hh) signal transduction in development and disease, the atypical G protein-coupled receptor (GPCR) SMOOTHENED (SMO) communicates with GLI transcription factors by binding the protein kinase A catalytic subunit (PKA-C) and physically blocking its enzymatic activity. Here, we show that GPCR kinase 2 (GRK2) orchestrates this process during endogenous mouse and zebrafish Hh pathway activation in the primary cilium. Upon SMO activation, GRK2 rapidly relocalizes from the ciliary base to the shaft, triggering SMO phosphorylation and PKA-C interaction. Reconstitution studies reveal that GRK2 phosphorylation enables active SMO to bind PKA-C directly. Lastly, the SMO-GRK2-PKA pathway underlies Hh signal transduction in a range of cellular and in vivo models. Thus, GRK2 phosphorylation of ciliary SMO and the ensuing PKA-C binding and inactivation are critical initiating events for the intracellular steps in Hh signaling. More broadly, our study suggests an expanded role for GRKs in enabling direct GPCR interactions with diverse intracellular effectors.

Abstract Covalent triazine frameworks (CTFs) are promising battery electrodes owing to their designable functional groups, tunable pore sizes, and exceptional stability. However, their practical use is limited because of the difficulty in establishing stable ion adsorption/desorption sites. In this study, a melt‐salt‐stripping process utilizing molten trichloro iron (FeCl3) is used to delaminate the layer‐stacked structure of fluorinated covalent triazine framework (FCTF) and generate iron‐based ion storage active sites. This process increases the interlayer spacing and uniformly deposits iron‐containing materials, enhancing electron and ion transport. The resultant melt‐FeCl3‐stripped FCTF (Fe@FCTF) shows excellent performance as a potassium ion battery with a high capacity of 447 mAh g−1 at 0.1 A g−1 and 257 mAh g−1 at 1.6 A g−1 and good cycling stability. Notably, molten‐salt stripping is also effective in improving the CTF's Na+ and Li+ storage properties. A stepwise reaction mechanism of K/Na/Li chelation with C═N functional groups is proposed and verified by in situ X‐ray diffraction testing (XRD), ex‐situ X‐ray photoelectron spectroscopy (XPS), and theoretical calculations, illustrating that pyrazines and iron coordination groups play the main roles in reacting with K+/Na+/Li+ cations. These results conclude that the Fe@FCTF is a suitable anode material for potassium‐ion batteries (PIBs), sodium‐ion batteries (SIBs), and lithium‐ion batteries (LIBs).

Studies on odontogenesis are of great importance to treat dental abnormalities and tooth loss. However, the odontogenesis process was poorly studied in humans, especially at the early developmental stages. Here, we combined RNA sequencing (RNA-seq) with Laser-capture microdissection (LCM) to establish a spatiotemporal transcriptomic investigation for human deciduous tooth germs at the crucial developmental stage to offer new perspectives to understand tooth development and instruct tooth regeneration. Several hallmark events, including angiogenesis, ossification, axonogenesis, and extracellular matrix (ECM) organization, were identified during odontogenesis in human dental epithelium and mesenchyme from the cap stage to the early bell stage. ECM played an essential role in the shift of tooth-inductive capability. Species comparisons demonstrated these hallmark events both in humans and mice. This study reveals the hallmark events during odontogenesis, enriching the transcriptomic research on human tooth development at the early stage.

PurposeSARS-CoV-2 can invade the thyroid gland. This study was to delineate the risk of thyroid dysfunction amidst the prevalence of the Omicron variant, and to investigate the correlation between thyroid function and Coronavirus disease 2019 (COVID-19) outcomes. The study also aimed to ascertain whether thyroid dysfunction persisted during COVID-19 recovery phase.MethodsThis was a retrospective cohort study. COVID-19 patients from the Renmin Hospital of Wuhan University, China during the epidemic of Omicron variants were included, and their thyroid function were analyzed in groups.ResultsA history of thyroid disease was not associated with COVID-19 outcomes. COVID-19 can lead to a bimodal distribution of thyroid dysfunction. The severity of COVID-19 was inversely proportional to the levels of thyroid- stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), leading to a higher prevalence of thyroid dysfunction. Severe COVID-19 was a risk factor for euthyroid sick syndrome (ESS) (OR=22.5, 95% CI, 12.1 - 45.6). Neutrophil to lymphocyte ratio mediated the association between severe COVID-19 and ESS (mediation effect ratio = 41.3%, p < 0.001). ESS and decreased indicators of thyroid function were associated with COVID-19 mortality, while high levels of FT3 and FT4 exhibited a protective effect against death. This effect was more significant in women (p < 0.05). During the recovery period, hyperthyroidism was quite uncommon, while a small percentage of individuals (7.7%) continued to exhibit hypothyroidism.ConclusionCOVID-19 severity was linked to thyroid dysfunction. Severe COVID-19 increased the risk of ESS, which was associated with COVID-19 mortality. Post-recovery, hyperthyroidism was rare, but some individuals continued to have hypothyroidism.

BackgroundStatins were regarded as a main medication for managing hypercholesterolemia. Administration of statin therapy could reduce the incidence of cardiovascular disease in individuals diagnosed with type 2 diabetes mellitus (DM), which was recognized by multipal clinical guidelines. But previous studies had conflicting results on whether the long-term use of statins could benefit the renal function in diabetic patients.AimTo evaluate the association between statin treatment and Chronic Kidney Disease in DM patients.MethodsThis is a retrospective disproportionality analysis and cohort study based on real-world data. All DM cases reported in US Food and Drug Administration adverse event reporting system (FAERS) between the first quarter of 2004 and the fourth quarter of 2022 were included. Disproportionality analyses were conducted by estimating the reporting odds ratio (ROR) and the information component (IC). We further compared the CKD odds ratio (OR) between the statins group and the other primary suspected drug group among the included diabetes mellitus cases.ResultsWe finally included 593647 DM cases from FAERS, 5113 (5.31%) CKD cases in the statins group and 8810 (1.77%) CKD cases in the control group. Data analysis showed that the statins group showed a significant CKD signal (ROR: 3.11, 95% CI: 3.00–3.22; IC: 1.18, 95% CI: 1.07–1.29). In case group with two or more statins treatment history, the CKD signal was even stronger (ROR: 19.56, 95% CI: 18.10–21.13; IC: 3.70, 95% CI:3.44–3.93) compared with cases with one statin treatment history.ConclusionThe impact of statin therapy on the progression of renal disease in individuals diagnosed with type 2 diabetes mellitus (DM) remains inconclusive. After data mining on the current FAERS dataset, we discovered significant signals between statin treatment and CKD in diabetic patients. Furthermore, the incidence rate of CKD was higher among DM patients who used statins compared to those who did not.

Abstract This study uses precipitation oxygen isotopes (δ18Op) to examine key dynamics that deliver moisture to the southern slope of central Himalayas over different seasons. Results show that the majority of pre‐monsoon δ18Op values are relatively high and controlled by the westerlies and local moisture. However, some abnormally low δ18Op values coincide with higher precipitation amounts during the pre‐monsoon season due to moisture driven northwards from the Bay of Bengal and Arabian Sea to central Himalayas by anomalous circulations (quasi‐anticyclone, anticyclone, or/and westerlies trough). The size and location of the quasi‐anticyclone also influences the magnitude of the δ18Op decrease. In comparison, the monsoon δ18Op values are lower due to the combined effects of the Indian summer monsoon and convection. Our findings indicate that researchers need to consider the signals of abnormally low δ18Op values during the pre‐monsoon season when attempting to interpret ice core and tree‐ring records from central Himalayas.

Abstract Background Specialty palliative care interdisciplinary teams (IDT) can play an important role in supporting patients and family members during acute care decision-making. Despite guidelines and evidence emphasizing decision-making support as a key domain of specialty palliative care, little is known about how decision-making support is actually implemented by specialty palliative care IDTs. This study aims to (1) describe the structure and processes of inpatient decision-making support delivered by specialty palliative care IDT, and (2) examine the perspectives of IDT members on their role in this decision-support. Methods A team of clinician and non-clinician researchers will conduct non-participant observation ethnography at a single medical center in northern New England. The ethnography will focus on the work of IDT members in supporting decision making, particularly elements of specialty palliative care that have limited descriptions in the literature (e.g. systems and processes of care). Observations of formal and informal interactions between IDT members and clinical encounters will be conducted at one site over four months. Participants include patients, care partners, non-specialty palliative care providers, and specialty palliative care IDT members. Additionally, we will conduct semi-structured interviews with IDT members across three geographically diverse specialty palliative care teams across the United States to explore providers’ first-person perspective on their roles and function in decision-making support for hospitalized patients. Field notes and transcripts from observation and interviews will be uploaded to Dedoose software for management and thematic analysis following an inductive approach. Discussion To our knowledge, this will be the first observational study of the roles of interdisciplinary specialty palliative care teams. Results from this research will support further investigation into implementation of decision-making support across different types of medical teams.

Artemisia argyi Lévl. et Vant. is a traditional Chinese medicinal plant that is widely distributed across Asia, Europe, and the Americas, especially in East Asian countries such as China, Japan, South Korea, and Mongolia. The widespread application of A. argyi in medicine, foods, and folk customs gives it great economic value and strong cultural relevance in China. It has been used in treating diseases for over 2000 years, with modern pharmacological research validating diverse functions (including anti-inflammatory, anti-tumor, antioxidant, and analgesic activities) of metabolites produced by A. argyi. Surges in clinical demand have led to the formation of a domesticated A. argyi industry, which has produced a relatively mature artificial planting technology system and comprehensive quality evaluation standards in China. In recent years, the assembly and release of A. argyi chloroplast and chromosome-scale nuclear genomes have enabled identification of key genes in the biosynthetic pathways of various important active compounds. In addition, non-medicinal applications of A. argyi have received widespread attention due to the plant's promising herbicidal, antibacterial, and preservative effects, which could allow its use in place of chemical products. We here review recent progress in A. argyi research with a focus on botanical characteristics, artificial cultivation methods, quality evaluation, genomic and molecular research, pharmacological effects, and non-medicinal value development. This review lays a strong foundation for future research to develop and increase the value of A. argyi and other traditionally medicinal plants.

Hyperspectral images have gained great achievements in many fields, but their low spatial resolution limits the effectiveness in applications. Hyperspectral image super-resolution has emerged as a popular research trend, where high-resolution hyperspectral images are obtained via combining low-resolution hyperspectral images with high-resolution multispectral images. In this process of multimodality data fusion, it is crucial to ensure effective cross-modality information interaction. To generate higher quality fusion results, a crossed dual-branch U-Net is proposed in this article. In specific, we adopt U-Net architecture and introduce a spectral–spatial feature interaction module to capture cross-modality interaction information between two input images. To narrow the gap between downsampling and upsampling processes, a spectral–spatial parallel Transformer is designed as skip connection. This novel design simultaneously learns the long-range dependencies both on spatial and spectral information and provides detailed information for final fusion. In the fusion stage, we adopt a progressive upsampling strategy to refine the generated images. Extensive experiments on several public datasets are conducted to prove the performance of the proposed network.

Abstract Background Vitamin D plays an important role in the health of adolescents, whereas vitamin D status of Chinese college students was seldom studied in China. To explore the vitamin D status and its relationship with ethnicity and geographic location in Chinese college students. Methods The freshmen were taken a physical examination by trained medical personnel after they reported to university. Demographic information including age, gender, ethnicity, region of original residence was collected using a questionnaire survey. Serum 25(OH)D3 concentrations were measured using a liquid chromatograph mass spectrometer. Multiple regression analyses were used to explore the factors that influence serum 25(OH)D3 levels. Results Totally 3220 freshmen who came from 26 provinces, autonomous districts or municipalities were recruited, with a mean age of 18.75 ± 1.18 years and 70.2% of them were female. The mean serum 25(OH)D3 levels were 18.51 ± 6.54 ng/mL, and the proportion of vitamin D deficiency (

Increased urbanization and climate change globally have increased the frequency of extreme weather, especially rainstorms and flooding. Low impact development (LID) has been adopted for several decades to reduce urban pluvial flooding and cope with urban climate change. However, LID hasn't been widely used due to the lack of sustainable funding. In this article, a discrete choice experiment method was used to understand public preferences and willingness to pay (WTP) for the functions of LID facilities. Four attributes were selected, and after that, 958 and 646 valid questionnaires were collected in the pilot sponge cities of Zhengzhou and Hebi, respectively. The results showed that respondents showed a significant WTP for LID facilities, with a desire to support rainwater drainage, recreation and entertainment, and the landscape environment. Experience of flooding had a significant effect on Zhengzhou respondents, but not on Hebi respondents. We have concluded that rainwater drainage should still be considered the most important function of LID facilities. At the same time, educational level and flood experiences may not affect the public's WTP. This article can provide a reference for cities that would like to implement LID and create a stormwater fee system to adapt to global change. HIGHLIGHTS Explorations of public preferences and willingness to pay (WTP) for LID facilities in China.; Respondents had a significant WTP for LID facilities functions.; Rainwater drainage should still be considered the most important function of LID facilities.; Flood experience may not be the direct influencing factor for the public's WTP for LID facilities.; Education level is not a factor affecting the public's WTP.;

Land use imbalances are a critical driving factor contributing to regional disparities in carbon storage (CS). As a significant component of China’s Yangtze River Economic Belt, Hunan Province has undergone substantial shifts in land use types, resulting in an uneven distribution of ecosystem CS and sequestration capacity. Therefore, within the framework of the “dual carbon” strategy, examining the effects of land use changes driven by regional resource imbalances on CS holds practical importance for advancing regional sustainable development. This study focuses on Hunan Province, utilizing the PLUS-InVEST model to assess the spatiotemporal evolution of CS under land use changes from 1990 to 2020. Additionally, multiple scenario-based development modes were employed to predict county-level CS. The results indicate the following: (1) From 1990 to 2020, Hunan Province experienced continuous urban expansion, with forest land and cultivated land, which are core ecological land types, being converted into construction land. (2) Over these 30 years, the province’s total CS increased by 2.47 × 108 t, with significant spatial differentiation. High-value zones were concentrated in bands along the province’s borders, while lower values were observed in the central and northern regions. The highest CS values were recorded in forested areas at the province’s periphery, whereas the lowest values were observed in the northern water bodies. (3) The scenario-based predictions revealed notable differences, with the ecological protection scenario demonstrating a substantial carbon sink effect. By prioritizing forest and cultivated land, CS could be maximized. This research provides valuable insights for enhancing CS and optimizing land use structures in regions facing resource imbalances.

Background Evidence for the relationship between remnant cholesterol (RC) and incident atrial fibrillation (AF) risk remains sparse and limited. Methods and Results Participants were enrolled between 2006 and 2010 and followed up to 2021. The multivariable Cox proportional hazards model was used to examine the relationship between RC quartiles and risk of incident AF. Subgroup analyses and sensitivity analyses were performed to explore the potential modification of the association and the robustness of the main findings. A total of 422 316 participants (mean age, 56 years; 54% women) were included for analyses. During a median follow‐up of 11.9 years (first quartile–third quartile, 11.6–13.2 years), there were 24 774 AF events documented with an incidence of 4.92 events per 1000 person‐years (95% CI, 4.86–4.98). Participants in higher RC quartiles had a lower risk of incident AF than those in the lowest quartile (first quartile): hazard ratio (HR)=0.96 (95% CI, 0.91–1.00) for second quartile; HR=0.92 (95% CI, 0.88–0.96) for third quartile; and HR=0.85 (95% CI, 0.81–0.89) for fourth quartile (P for trend

IntroductionGerminated brown rice is a functional food with a promising potential for alleviating metabolic diseases. This study aimed to explore the hypolipidemic effects of autoclaving-treated germinated brown rice (AGBR) and the underlying mechanisms involving gut microbiota.MethodsDietary intervention with AGBR or polished rice (PR) was implemented in patients with hyperlipidemia for 3 months, and blood lipids were analyzed. Nutritional characteristics of AGBR and PR were measured and compared. Additionally, 16S rDNA sequencing was performed to reveal the differences in gut microbiota between the AGBR and PR groups.ResultsAGBR relieves hyperlipidemia in patients, as evidenced by reduced levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein-B, and elevated levels of high-density lipoprotein cholesterol and apolipoprotein-A1. In terms of nutrition, AGBR had significantly higher concentrations of free amino acids (10/16 species), γ-aminobutyric acid, resistant starch, soluble dietary fiber, and flavonoids (11/13 species) than PR. In addition, higher microbial abundance, diversity, and uniformity were observed in the AGBR group than in the PR group. At the phylum level, AGBR reduced Firmicutes, Proteobacteria, Desulfobacterota, and Synergistota, and elevated Bacteroidota and Verrucomicrobiota. At the genus level, AGBR elevated Bacteroides, Faecalibacterium, Dialister, Prevotella, and Bifidobacterium, and reduced Escherichia-Shigella, Blautia, Romboutsia, and Turicibacter.DiscussionAGBR contributes to the remission of hyperlipidemia by modulating the gut microbiota.

Background: There is an interest in performing de-escalating axillary surgery after neoadjuvant chemotherapy (NAC). However, the significance of residual axillary node disease after NAC has not been well studied. Objectives: To investigate the pathological residual axillary lymph node tumor burden (ypN) of patients with initial clinical nodal stage cN0-1 breast cancer after NAC and determine its prognostic value. Design: Initial cN0-1 breast cancer patients who received NAC followed by axillary surgery at the First Hospital of Jilin University and the First Affiliated Hospital of Xi’an Jiaotong University between January 2011 and December 2019 were included. Methods: Survival outcomes were compared according to different clinical and pathological stage and nodal response to NAC. The main outcomes were disease-free survival (DFS) and overall survival (OS). Factors associated with survival were defined by Cox regression analysis. Results: A total of 911 patients were included, among whom 260 had cN0 and 651 had cN1 tumors. After NAC, 410 patients were ypN0, and another 501 were ypN+. The median follow-up time was 63 months. There was no significant difference in DFS or OS between the cN0 and cN1 groups in hormone receptor positive (HR+)/human epidermal growth factor receptor 2 positive (HER2+) and HR−/HER2− subtypes; instead, ypN status was significantly related to DFS and OS. In HR+/HER2− subtype, both cN and ypN stages did not show significant survival differences, but the ypN number and the nodal response to NAC showed significant prognostic value ( p

This study explored sentence processing in two typologically distinct languages: Korean, a verb-final language, and Tongan, a verb-initial language. The first experiment revealed that in Korean, sentences arranged in the scrambled OSV (Object, Subject, Verb) order were processed more slowly than those in the canonical SOV order, highlighting a scrambling effect. It also found that sentences with subject topicalization in the SOV order were processed as swiftly as those in the canonical form, whereas sentences with object topicalization in the OSV order were processed with speeds and accuracy comparable to scrambled sentences. However, since topicalization and scrambling in Korean use the same OSV order, independently distinguishing the effects of topicalization is challenging. In contrast, Tongan allows for a clear separation of word orders for topicalization and scrambling, facilitating an independent evaluation of topicalization effects. The second experiment, employing a maze task, confirmed that Tongan’s canonical VSO order was processed more efficiently than the VOS scrambled order, thereby verifying a scrambling effect. The third experiment investigated the effects of both scrambling and topicalization in Tongan, finding that the canonical VSO order was processed most efficiently in terms of speed and accuracy, unlike the VOS scrambled and SVO topicalized orders. Notably, the OVS object-topicalized order was processed as efficiently as the VSO canonical order, while the SVO subject-topicalized order was slower than VSO but faster than VOS. By independently assessing the effects of topicalization apart from scrambling, this study demonstrates that both subject and object topicalization in Tongan facilitate sentence processing, contradicting the predictions based on movement-based anticipation.

Background and aim: Solid organ transplantation remains a life-saving therapeutic option for patients with end-stage organ dysfunction. Acute cellular rejection (ACR), dominated by dendritic cells (DCs) and CD4+ T cells, is a major cause of post-transplant mortality. Inhibiting DC maturation and directing the differentiation of CD4+ T cells toward immunosuppression are keys to inhibiting ACR. We propose that oxymatrine (OMT), a quinolizidine alkaloid, either alone or in combination with rapamycin (RAPA), attenuates ACR by inhibiting the mTOR–HIF–1α pathway. Methods: Graft damage was assessed using haematoxylin and eosin staining. Intragraft CD11c+ and CD4+ cell infiltrations were detected using immunohistochemical staining. The proportions of mature DCs, T helper (Th) 1, Th17, and Treg cells in the spleen; donor-specific antibody (DSA) secretion in the serum; mTOR–HIF–1α expression in the grafts; and CD4+ cells and bone marrow-derived DCs (BMDCs) were evaluated using flow cytometry. Results: OMT, either alone or in combination with RAPA, significantly alleviated pathological damage; decreased CD4+ and CD11c+ cell infiltration in cardiac allografts; reduced the proportion of mature DCs, Th1 and Th17 cells; increased the proportion of Tregs in recipient spleens; downregulated DSA production; and inhibited mTOR and HIF-1α expression in the grafts. OMT suppresses mTOR and HIF-1α expression in BMDCs and CD4+ T cells in vitro. Conclusions: Our study suggests that OMT-based therapy can significantly attenuate acute cardiac allograft rejection by inhibiting DC maturation and CD4+ T cell responses. This process may be related to the inhibition of the mTOR–HIF–1α signaling pathway by OMT.

IntroductionCognitive impairment (CI) is a common complication of end-stage renal disease (ESRD) that is associated with structural and functional changes in the brain. However, whether a joint structural and functional alteration pattern exists that is related to CI in ESRD is unclear.MethodsIn this study, instead of looking at brain structure and function separately, we aim to investigate the covariant characteristics of both functional and structural aspects. Specifically, we took the fusion analysis approach, namely, multimodal canonical correlation analysis and joint independent component analysis (mCCA+jICA), to jointly study the discriminative features in gray matter volume (GMV) measured by T1-weighted (T1w) MRI, fractional anisotropy (FA) in white matter measured by diffusion MRI, and the amplitude of low-frequency fluctuation (ALFF) measured by blood oxygenation-level-dependent (BOLD) MRI in 78 ESRD patients versus 64 healthy controls (HCs), followed by a mediation effect analysis to explore the relationship between neuroimaging findings, cognitive impairments and uremic toxins.ResultsTwo joint group-discriminative independent components (ICs) were found to show covariant abnormalities across FA, GMV, and ALFF (all p

The bonding performance between new and old concrete affects the reliability and service life of the repair structure. However, the bonding interface is complex and has many influencing factors, so selecting appropriate repair materials and evaluation methods for repair structures under different service environments is important. This paper presents a comprehensive overview of the factors that influence bonding properties. These include the choice of repair materials, the condition of the existing concrete, the type of interfacial agents used, the service environment, and the testing methods employed. The paper concludes by examining the challenges and opportunities in developing interface bonding properties to provide insights and research directions for future theoretical analysis and experimental research.

BackgroundCardiac arrhythmias are very common in patients with obstructive sleep apnea (OSA), especially atrial fibrillation (AF) and nonsustained ventricular tachycardia (NVST). Cardiac autonomic dysfunction and structural remodeling caused by OSA provide the milieu for cardiac arrhythmia development. This study aimed to determine whether OSA is associated with various cardiac arrhythmias and investigate potential pathophysiologic pathways between them.MethodsThe analysis covered 600 patients with clinical suspicion of OSA hospitalized in Renmin Hospital of Wuhan University between January 2020 and May 2023. After undergoing sleep apnea monitor, all subjects received laboratory tests, Holter electrocardiography, and Echocardiography.ResultsCompared with those without OSA and adjusting for potential confounders, subjects with moderate OSA had three times the odds of AF (odds ratio [OR] 3.055; 95% confidence interval [CI], 1.002–9.316; p = 0.048). Subjects with severe OSA had three times the odds of AF (OR 3.881; 95% CI, 1.306–11.534; p = 0.015) and NSVT (OR 3.690; 95% CI, 0.809–16.036; p = 0.046). There were significant linear trends for the association between OSA severity with AF and NVST (p