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Channel is the navigable area for ships in rivers and canals. The analyses of flow details and experiences of engineers are extensively used for the design of channel nowadays, without thorough consideration of the fluid-structure interaction between flow and ships. In this paper, an inland channel design method based on ship hydrodynamic response is proposed. First of all, the secondary development is undertaken based on Fluent for the problem of ship-flow interaction, in which flow domain is simulated by using the finite volume method, and governing equations of ship are embedded through user defined function (UDF) and solved by using the fourth-order Runge-Kutta method. The dynamic mesh technique is adopted to update the changing computation domains. The hydrodynamic motion response of freely drifting ships in inland waterway is simulated, as well as trajectory. Then, the weighted least square method is used for curve fitting from the drifting trajectories of different ships, by which the channel boundaries are designed. The weight coefficients are obtained through the statistic of sailing frequencies of different ships. Dongliu route with typical navigation obstructions of curve and branch is chosen for the verification of the channel design method. It is found that the channel designed by the method with consideration of ship-flow interaction is consistent with the existing one. Besides, the analyses of flow details and ship responses indicate that ships sailing in this channel can avoid the influences of oblique flow and make use of the energy of flow, which maintains the sailing safety and economy.

The past few decades have seen a boom in English-medium instruction (EMI) in Chinese universities. Despite growing research interest in EMI policy and practices in China, little is known about how students' motivation to study in the EMI programs is influenced by EMI policy and its implementation at the meso and micro levels. This study addresses this gap by examining an EMI program at a Chinese medical college. Through a survey of 118 students and interviews with 10 students and 6 teachers, we investigated students' EMI learning motivation, how and why it changed over time, and different stakeholders' perceptions of the EMI implementation. The questionnaire and interview data were triangulated with textual analysis results of institutional EMI policy documents. It was found that students' motivation generally declined over the course of EMI study and was often influenced by implementation factors such as pedagogical practices, assessment-related policies, and incentive strategies. Interactions and contradictions between the EMI policy goals, EMI implementation at different levels and students' motivation change were also analyzed through the Activity Theory lens to shed light on how higher education institutions could better sustain students' EMI motivation and enhance the quality of EMI programs.

BackgroundEfficient and reliable diagnosis of early osteonecrosis of the femoral head (ONFH) based on MRI is crucial for the formulation of clinical treatment plans. This study aimed to apply artificial intelligence (AI) to achieve automatic diagnosis and visualization of early ONFH, thereby improving the success rate of hip-preserving treatments.MethodThis retrospective study constructed a multicenter dataset using MRI data of 381 femoral heads from 209 patients with ONFH collected from four institutions (including 239 early ONFH cases and 142 non-ONFH cases). The dataset was divided into training, validation, and internal and external test datasets. This study developed a 3D ensemble framework to automatically diagnose early osteonecrosis of the femoral head based on MRI and utilized 3D Grad-CAM to visualize its decision-making process. Finally, the diagnostic performance of the framework was experimentally evaluated on the MRI dataset and compared with the diagnostic results of three orthopedic surgeons.ResultsOn the internal test dataset, the 3D-ONFHNet framework achieved overall diagnostic performance with an accuracy of 93.83%, sensitivity of 89.44%, specificity of 95.56%, F1-score of 87.67%, and AUC of 95.41%. On the two external test datasets, the framework achieved overall diagnostic accuracies of 87.76% and 87.60%, respectively. Compared to three orthopedic surgeons, the diagnostic performance of the 3D-ONFHNet framework was comparable to that of senior orthopedic surgeons and superior to that of junior orthopedic surgeons.ConclusionsThe framework proposed in this study can generate staging results for early ONFH and provide visualizations of internal signal changes within the femoral head. It assists orthopedic surgeons in screening for early ONFH on MRI in a clinical setting, facilitating preoperative planning and subsequent treatment strategies. This framework not only enhances diagnostic efficiency but also offers valuable diagnostic references for physicians.

Lake health assessment is the basis for lake ecosystem management and protection. A comprehensive index system is essential for diagnosing these problems. However, previous assessments may have neglected the integrity of lake ecosystems and assessed lake health from a partial perspective. Selecting the optimum indicators and constructing the index system in a rational and scientific way are key to lake health. Here, ecosystem integrity and services were incorporated into the lake assessment framework to guide the selection and arrangement of indices. Under this framework, a multilevel and multi-index system was constructed, which can provide a comprehensive diagnosis of lake ecosystems. The index system consists of five dimensions: organism structural integrity, habitat structural integrity, matter process integrity, hydrological process integrity, and social services function. Each dimension contained several basic indices, and a total of 16 indicators were selected for the basic index layer. Furthermore, the reference state was carefully selected and used to set the health level and health scores. In addition, a fuzzy binary comparison method was used to assign the optimum weights for each index. The framework was applied to Lake Baiyangdian to provide a comprehensive diagnosis. The overall status of the lake was sub-healthy. Structural and process integrity were impaired to some extent and assessed as unhealthy and sub-healthy, whereas services were assessed as healthy. The framework proposed a rational and balanced way to construct a comprehensive index system and incorporated social services, which is more accurate and reliable to provide a diagnosis result. It can also be widely applied, benefiting lake ecosystem management and protection and increasing public awareness of lake health.

Background/Aims: The histological characteristics and natural history of precirrhotic primary biliary cholangitis (PBC) with portal hypertension (PH) are unclear. Our aim was to clarify the prevalence, risk factors, and histological characteristics of precirrhotic PBC patients with PH. Methods: This retrospective study compared the clinical features, histological characteristics, and response to ursodeoxycholic acid (UDCA) between the PH and non-PH groups of precirrhotic PBC patients. Results: Out of 165 precirrhotic PBC patients, 40 (24.2%) also had PH. According to histological stage 1, 2 and 3 disease, 5.3% (1/19), 17.3% (17/98), and 45.8% (22/48) of patients also had PH, respectively. Precirrhotic PBC with PH was significantly positively correlated with bile duct loss, degree of cytokeratin 7 positivity, and degree of fibrosis in the portal area, but significantly negatively correlated with lymphoid follicular aggregation. Compared to the non-PH group, patients in the PH group showed a higher prevalence of obliterative portal venopathy, incomplete septal fibrosis, portal tract abnormalities and non-zonal sinusoidal dilatation (p

Abstract Background The National Medical Licensing Examination (NMLE) is the only objective, standardized metric to evaluate whether a medical student possessing the professional knowledge and skills necessary to work as a physician. However, the overall pass rate of NMLE in our hospital in 2021 was much lower than that of Peking Union Medical College Hospital, which was required to be further improved. Methods To find the reasons for the unsatisfactory performance in 2021, the quality improvement team (QIT) organized regular face-to-face meetings for in-depth discussion and questionnaire, and analyzed the data by “Plato analysis” and “Brainstorming method”. After finding out the reasons, the “Plan-Do-Check-Action” (PDCA) cycle was continued to identify and solve problems, which included the formulation and implementation of specific training plans by creating the “Gantt charts”, the check of effects, and continuous improvements from 2021 to 2022. Detailed information about the performance of students in 2021 and 2022, and the attendance, assessment, evaluation and suggestions from our hospital were provided by the relevant departments, and the pass rate-associated data was collected online. Results After the PDCA plan, the pass rate of NMLE in our hospital increased by 10.89% from 80.15% in 2021 to 91.04% in 2022 (P = 0.0109), with the pass rate of skill examination from 95.59% in 2021 to 99.25% in 2022 (P = 0.0581) and theoretical examination from 84.5% in 2021 to 93.13% in 2022 (P = 0.027). Additionally, the mean scores of all examinees increased with the theoretical examination score increasing from 377.0 ± 98.76 in 2021 to 407.6 ± 71.94 in 2022 (P = 0.004). Conclusions Our results showed a success application of the PDCA plan in our hospital which improved the pass rate of the NMLE in 2022, and the PDCA plan may provide a practical framework for future medical education and further improve the pass rate of NMLE in the next year.

The application of multidisciplinary techniques in the management of endocrine-related cancers is crucial for harnessing the advantages of multiple disciplines and their coordinated efforts in eliminating tumors. Due to the malignant characteristics of cancer cells, they possess the capacity to develop resistance to traditional treatments such as chemotherapy and radiotherapy. Nevertheless, despite diligent endeavors to enhance the prediction of outcomes, the overall survival rate for individuals afflicted with endocrine-related malignancy remains quite miserable. Hence, it is imperative to investigate innovative therapy strategies. The latest advancements in therapeutic tactics have offered novel approaches for the therapy of various endocrine tumors. This paper examines the advancements in nano-drug delivery techniques and the utilization of nanomaterials for precise cancer cures through targeted therapy. This review provides a thorough analysis of the potential of combined drug delivery strategies in the treatment of thyroid cancer, adrenal gland tumors, and pancreatic cancer. The objective of this study is to gain a deeper understanding of current therapeutic approaches, stimulate the development of new drug DDS, and improve the effectiveness of treatment for patients with these diseases. The intracellular uptake of pharmaceuticals into cancer cells can be significantly improved through the implantation of synthetic or natural substances into nanoparticles, resulting in a substantial reduction in the development of endocrine malignancies.

BackgroundWith the advancement of transcranial electrical stimulation (tES) technology, an increasing number of stimulation devices and treatment protocols have emerged. However, safety and tolerability remain critical concerns before new strategies can be implemented. Particularly, the use of gel particle electrodes brings new challenges to the safety and tolerability of tES, which hinders its widespread adoption and further research.ObjectiveOur study utilized a specially designed and validated transcranial electrical stimulation stimulator along with preconfigured gel particle electrodes placed at F3 and F4 in the prefrontal lobes. We aimed to assess the tolerance and safety of these electrodes in healthy subjects by administering different durations and types of tES.MethodsEach participant underwent ten sessions of either transcranial direct current stimulation (tDCS) or transcranial alternating current stimulation (tACS), with session durations varying. In the experiment, we collected various measurement data from participants, including self-report questionnaire data and behavioral keystroke data. Tolerability was evaluated through adverse events (AEs), the relationship of adverse events with tES (AEs-rela), the Self-Rating Anxiety Scale (SAS), and the Visual Analog Mood Scale-Revised (VAMS-R). Safety was assessed using the Visual Analog Scale (VAS), the Skin Sensation Rating (SSR), Montreal Cognitive Assessment (MoCA), and Stroop task. These data were analyzed to determine the impact of different parameters on the tolerability and safety of tES.ResultsThere were no significant changes in the results of the MoCA and SAS scales before and after the experiment. However, significant differences were observed in VAS, SSR, AEs, and AEs-rela between tDCS and tACS. Additionally, fatigue increased, and energy levels decreased on VAMS-R with longer durations. No significant differences were found in other neuropsychological tests.ConclusionOur study revealed significant differences in tolerability and safety between tDCS and tACS, underscoring the importance of considering the stimulation type when evaluating these factors. Although tolerance and safety did not vary significantly across different stimulation durations in this study, future research may benefit from exploring shorter durations to further assess tolerability and safety efficiently.

Alfalfa (Medicago sativa L.) grassland is prone to degradation following multi-year maintenance. Yet, its mechanism regarding the stoichiometry of carbon (C) and nitrogen (N) across plant–soil system is still unclear. To address this issue, the method of space-for-time sampling was employed to investigate alfalfa grasslands with five planting years (5-, 8-, 10-, 15-, and 20-year periods) in the semiarid Loess Plateau. The results showed that the alfalfa above- and underground biomass decreased steadily decrease after the fifth to eighth years, showing a degradation tendency with the extension of planting duration. The mean weight diameter of aggregate registered an increase with planting years. However, the C and N stocks decreased with planting years in five soil aggregate fractions. Specifically, they were the highest in the fifth year and then started to gradually decrease along the 8th, 10th, 15th, and 20th year. Redundancy and correlation analysis confirmed that the C and N stocks of soil aggregates were closely positively associated with those of plant. Overall, the highest stability of soil physical structure was found during the period from the fifth to eighth year, and, afterward, the stability declined. In conclusion, alfalfa plantation improved soil structure stability but aggravated soil C and N stocks, and biomass and soil aggregate indicators accounted for alfalfa field degradation after a certain year of plantation.

Microwave dielectric ceramics, owing to their ability to serve as dielectrics in microwave circuits, are widely used in communications, navigation, radar, satellite, and other fields as a key foundational material in modern communications technology.Grounded in an analysis of the current state of microwave dielectric ceramics and their corresponding industry both in China and abroad,this study identifies the challenges faced in the development of these ceramics in China and proposes a strategy for the independent development of microwave dielectric ceramics, encompassing development goals, strategies, key directions, and a development roadmap.The study aims to promote the development of microwave dielectric ceramics, facilitate the shift of the product structure from mid- to high-end products, and achieve breakthroughs in high-performance microwave dielectric ceramics preparation techniques and the independent production of upstream high-purity raw materials. Recommendations for research include strengthening the basic research and application foundations of microwave dielectric ceramics, enhancing innovative research and development in key areas of microwave communications, actively planning for 6G dielectric ceramics, and strengthening the development of the industry’s ecosystem.

Abstract Background Metabolic disorders (MetDs) have been demonstrated to be closely linked to numerous diseases. However, the precise association between MetDs and pulmonary tuberculosis (PTB) remains poorly understood. Method Summary statistics for exposure and outcomes from genome-wide association studies (GWASs) for exposures and outcomes were obtained from the BioBank Japan Project (BBJ) Gene–exposure dataset. The 14 clinical factors were categorized into three groups: metabolic laboratory markers, blood pressure, and the MetS diagnostic factors. The causal relationship between metabolic factors and PTB were analyzed using two-sample Mendelian Randomization (MR). Additionally, the direct effects on the risk of PTB were investigated through multivariable MR. The primary method employed was the inverse variance-weighted (IVW) model. The sensitivity of this MR analysis was evaluated using MR-Egger regression and the MR-PRESSO global test. Results According to the two-sample MR, HDL-C, HbA1c, TP, and DM were positively correlated with the incidence of active TB. According to the multivariable MR, HDL-C (IVW: OR 2.798, 95% CI 1.484–5.274, P = 0.001), LDL (IVW: OR 4.027, 95% CI 1.140–14.219, P = 0.03) and TG (IVW: OR 2.548, 95% CI 1.269–5.115, P = 0.009) were positively correlated with the occurrence of PTB. TC (OR 0.131, 95% CI 0.028–0.607, P = 0.009) was negatively correlated with the occurrence of PTB. We selected BMI, DM, HDL-C, SBP, and TG as the diagnostic factors for metabolic syndrome. DM (IVW, OR 1.219, 95% CI 1.040–1.429 P = 0.014) and HDL-C (IVW, OR 1.380, 95% CI 1.035–1.841, P = 0.028) were directly correlated with the occurrence of PTB. Conclusions This MR study demonstrated that metabolic disorders, mainly hyperglycemia, and dyslipidemia, are associated with the incidence of active pulmonary tuberculosis.

Abstract Background Numerous studies have been conducted to investigate the relationship between ABO and Rhesus (Rh) blood groups and various health outcomes. However, a comprehensive evaluation of the robustness of these associations is still lacking. Methods We searched PubMed, Web of Science, Embase, Scopus, Cochrane, and several regional databases from their inception until Feb 16, 2024, with the aim of identifying systematic reviews with meta-analyses of observational studies exploring associations between ABO and Rh blood groups and diverse health outcomes. For each association, we calculated the summary effect sizes, corresponding 95% confidence intervals, 95% prediction interval, heterogeneity, small-study effect, and evaluation of excess significance bias. The evidence was evaluated on a grading scale that ranged from convincing (Class I) to weak (Class IV). We assessed the certainty of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria (GRADE). We also evaluated the methodological quality of included studies using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). AMSTAR contains 11 items, which were scored as high (8–11), moderate (4–7), and low (0–3) quality. We have gotten the registration for protocol on the PROSPERO database (CRD42023409547). Results The current umbrella review included 51 systematic reviews with meta-analysis articles with 270 associations. We re-calculated each association and found only one convincing evidence (Class I) for an association between blood group B and type 2 diabetes mellitus risk compared with the non-B blood group. It had a summary odds ratio of 1.28 (95% confidence interval: 1.17, 1.40), was supported by 6870 cases with small heterogeneity (I 2 = 13%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger’s test > 0.10, but the largest study effect was not more conservative than the summary effect size) or excess of significance (P

Abstract Optical field imaging technology does not require a complicated optical path layout and thus reduces hardware costs. Given that only one single exposure of a single camera can obtain three-dimensional information, this paper proposes an improved calibration method for depth measurement based on the theoretical model of optical field imaging. Specifically, the calibration time can be reduced since the Gaussian fitting can reduce the number of refocused images used to obtain the optimal refocusing coefficient calibration. Moreover, the proposed method achieves the same effect as the multiple refocusing calibration strategy but requires less image processing time during calibration. At the same time, this method's depth resolution is analyzed in detail.