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Abstract Objective Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its advantages, including reduced postoperative pain and the absence of visible scarring. However, the anatomical specificity required for vNOTES may increase the risk of injury to nearby organs, such as the rectum and bladder. This study aims to evaluate the safety and potential benefits of vNOTES compared to transumbilical laparoendoscopic single-site surgery (LESS) for Hysterectomy. Methods The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), conducted in Chengdu, China, included 192 patients who underwent hysterectomy between May and October 2023. This study prospectively collected and compared perioperative and follow-up data between the two groups. Results The vNOTES group demonstrated shorter surgery times, postoperative flatus time, and hospital stays, but it also had a higher conversion rate. Specifically, the vNOTES approach reduced surgery duration by approximately 29.8 min (95% CI: -41.31, -18.34, P

Abstract Background Decompensated cirrhosis (DC) is prone to recurrent episodes of decompensation following the initial event. This study aimed to identify the risk factors for subsequent decompensation and assess their impact on the outcomes of patients hospitalized for DC. Methods Patients with DC were divided into two groups based on the occurrence of new decompensated events during hospitalization. Logistic regression analysis was employed to identify risk factors for new decompensation. The Cox proportional hazards model was used to evaluate the relationship between new decompensation and short-term mortality risk in these patients. Results The study cohort consisted of 339 patients with DC, with a median age of 57 years. During hospitalization, 83 patients (24.5%) experienced new decompensated events, with bacterial infections (BIs) being the most common (n = 46, 13.6%). Multivariate analysis revealed that the Model for End-Stage Liver Disease (MELD) score at admission (OR = 1.06, 95% CI: 1.02–1.11, P = 0.005) was the sole risk factor for new decompensation during hospitalization. Patients who experienced new decompensation had significantly higher 28-day (28.9% vs. 7.0%, P

C40H48Cu2N12O12, monoclinic, P21/n (no. 14), a = 10.9519(1) Å, b = 17.4351(2) Å, c = 24.4288(3) Å, β = 102.143(1)°, V = 4560.25(9) Å3, Z = 4, Rgt(F) = 0.0647, wRref(F2) = 0.1904, T = 120 K.

Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.

C28H36O2, monoclinic, P21/c (no. 14), a = 25.4751(13) Å, b = 7.4053(3) Å, c = 6.3520(3) Å, β = 93.923(5)°, V = 1,195.5(1) Å3, Z = 2, R gt(F) = 0.0650, wR ref(F 2) = 0.2007, T = 298 K.

[Introduction] In the face of energy scarcity and carbon reduction imperatives, the transition to clean energy centered on electricity is crucial. To achieve this, power system development must prioritize stability, automation and intelligence. Artificial intelligence (AI) technology is a key means to realize this goal. [Method] This paper introduced the carbon emissions of domestic and foreign power systems at first, and pointed out the difficulties and feasible solutions for low-carbon development of the power system in China on this basis. Then, the application and prospect of AI technology in power system development were discussed. [Result] In response to the transition to low-carbon and low-energy power systems, a series of low-carbon development routes, such as integration of capital and resources in the thermal power industry, low-carbon transition (such as the application of carbon capture technology), and promoting the consumption of and smooth replacement by clean energy, were proposed in this paper. It was also noted that AI technology will play a crucial role in automating, intelligentizing and optimizing power systems, with wide-ranging applications in power dispatching, relay protection, power equipment management, power system stability evaluation, and decision-making processes. [Conclusion] As third-generation AI technology continues to evolve and fourth-generation AI technology emerges, the application of AI technology in the power system will become increasingly widespread.

Abstract Laser-sustained plasma (LSP) source featuring high brightness and broadband spectral coverage is found to be powerful in various fields of scientific and industrial applications. However, the fundamental limit of low conversion efficiency constrains the system compactness and widespread applications of such broadband light sources. In this paper, we propose an innovative orthogonal LSP to break through the conversion efficiency limitation. Driven by the elevated conversion efficiency from absorbed laser power to ultraviolet (UV) emission, a compact broadband source (250–1650 nm) with UV spectral radiance exceeding 210 $${mW}/({{mm}}^{2}\,\cdot\, {sr}\,\cdot\, {nm})$$ m W / ( m m 2 ⋅ s r ⋅ n m ) is achieved with >100 W pump laser. With the plot of a two-dimensional refractive index model, we report an important conceptual advance that the orthogonal design eliminates the influence of the negative lensing effect on laser power density. Experimental results unambiguously demonstrate that we achieve a bright compact UV-VIS-NIR source with negligible thermal loss and the highest conversion efficiency to our knowledge. Significant enhancement of 4 dB contrast-to-noise ratio (CNR) in spectral single-pixel imaging has been demonstrated using the proposed ultrabroadband source. By establishing the quantitative link between pumping optics design and plasma absorption, this work presents a compact broadband source that combines superior conversion efficiency and unprecedented brightness, which is essential to high-speed inspection and spectroscopy applications.

Abstract Background This study aimed to develop a tool for predicting the early occurrence of acute kidney injury (AKI) in ICU hospitalized cirrhotic patients. Methods Eligible patients with cirrhosis were identified from the Medical Information Mart for Intensive Care database. Demographic data, laboratory examinations, and interventions were obtained. After splitting the population into training and validation cohorts, the least absolute shrinkage and selection operator regression model was used to select factors and construct the dynamic online nomogram. Calibration and discrimination were used to assess nomogram performance, and clinical utility was evaluated by decision curve analysis (DCA). Results A total of 1254 patients were included in the analysis, and 745 developed AKI. The mean arterial pressure, white blood cell count, total bilirubin level, Glasgow Coma Score, creatinine, heart rate, platelet count and albumin level were identified as predictors of AKI. The developed model had a good ability to differentiate AKI from non-AKI, with AUCs of 0.797 and 0.750 in the training and validation cohorts, respectively. Moreover, the nomogram model showed good calibration. DCA showed that the nomogram had a superior overall net benefit within wide and practical ranges of threshold probabilities. Conclusions The dynamic online nomogram can be an easy-to-use tool for predicting the early occurrence of AKI in critically ill patients with cirrhosis. Graphical Abstract

Abstract In order to augment the efficacy of the intelligent evaluation model for assessing the suitability of ice and snow tourism, this study refines the model by incorporating the Long Short-Term Memory (LSTM) network within the framework of the Internet of Things (IoT). The investigation commences with an elucidation of the application of IoT technology in environmental detection. After this, an analysis is conducted on the structure of LSTM and its merits in the realm of time series prediction. Ultimately, a novel model for appraising the suitability of ice and snow tourism is formulated. The efficacy of this model is substantiated through empirical experiments. The results of these experiments reveal that the refined model exhibits exceptional performance across diverse climatic conditions, encompassing mild, cold, humid, and arid climates. In regions characterized by mild climates, the predictive accuracy of the refined model progressively ascends from 88% in the initial quarter to 94% in the fourth quarter, surpassing the capabilities of conventional models. Consistently robust performance is demonstrated by the refined model throughout each quarter. In terms of operational efficiency, comparative analysis indicates that the refined model attains a moderate level, manifesting a 30–33 s runtime and maintaining a Central Processing Unit (CPU) usage rate between 40 and 43%. This observation implies that the refined model adeptly balances precision against resource consumption. Consequently, this study holds significance as a scholarly reference for the integration of IoT and LSTM networks in the domain of tourism evaluation.

Acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC) are life-threatening syndromes that can develop at the end-stage of chronic hepatitis B virus (HBV) infection. Both ACLF and DC are complicated by hepatic and extrahepatic pathogeneses. To better understand the compartment-specific metabolic modulations related to their pathogenesis, HBV-DC, HBV-ACLF patients, and controls (30 each) were analyzed by metabolomics using portal (Port), hepatic vein (Hep), and peripheral (Peri) serum. Compartment ratios of metabolites (RatioHep/Port, RatioPeri/Hep, and RatioPort/Peri) were calculated. The liver tissues (10 per group) were analyzed using transcriptomics and metabolomics. An additional 75 patients with ACLF, 20 with DC, and 20 with liver cirrhosis (LC) were used to confirm oxlipid dysregulation. Both multi-omics datasets suggest suppressed energy, amino acid, and pyrimidine metabolism in the ACLF/DC liver. The serum metabolomic variations were contributed primarily by disease rather than sampling compartments, as both HBV-ACLF and HBV-DC patients demonstrated abnormal profiles of amino acids and peptides, indoles, purines, steroids, and benzimidazoles. In ACLF/DC patients, impaired hepatic metabolism resulted in a highly correlated hepatic and portal vein serum metabolome and release of inflammatory lipids and heme metabolites from the liver. HBV-ACLF showed higher RatioPeri/Hep of extrahepatic inflammatory oxlipids, while HBV-DC patients showed higher RatioPort/Peri of gut microbial metabolites. An inflammatory oxlipid outburst was confirmed in the early stages of HBV-ACLF. The inflammatory effects of the selected oxlipids were confirmed in monocytes. These findings support a synergy between liver-specific mechanisms and systemic inflammation in ACLF/DC development, and that pro-inflammatory oxlipids are metabolic signatures of early HBV-ACLF.

Abstract In the quest for sustainable energy materials, wood is discovered to be a potential piezoelectric material. However, the rigidity, poor stability, and low piezoelectric properties of wood impede its development. Here, we obtained a superelastic roasted wood nanogenerator (RW‐NG) by unraveling ray tissues through a sustainable roasting strategy. The increased compressibility of roasted wood intensifies the deformation of cellulose microfibrils, significantly enhancing the piezoelectric effect in wood. Roasted wood (15 × 15 × 15 mm3, longitudinal × radial × tangential) can generate a voltage and current outputs of 1.4 V and 14.5 nA, respectively, which are more than 70 times that of natural wood. The wood sample can recover 90% of its shape after 5000 compressions at 65% strain, exhibiting excellent elasticity and stability. Importantly, roasted wood does not add any toxic substances and can be safely applied on the human skin as a self‐powered sensor for detecting body movements. Moreover, it can also be assembled into self‐powered wooden floors for energy harvesting. These indicate that roasted wood has great potential for sustainable sensing and energy conversion.

BackgroundNasopharyngeal carcinoma (NPC) is a highly invasive malignant tumor. Recurrence and distant metastasis represent the primary causes of treatment failure. This study aimed to identify biomarkers highly associated with NPC and investigate its roles in tumor progression.MethodsTranscriptome sequencing (RNA-seq) data of NPC and normal tissues were downloaded from the Gene Expression Omnibus (GEO) database. By analyzing the RNA-seq data, we found that G Protein Subunit Alpha 14 (GNA14) is closely associated with the diagnosis and prognosis of NPC. Immunohistochemistry (IHC) was used to detect the expression of GNA14 in tumor tissues of 165 NPC patients, and we analyzed the relationship between GNA14 expression and patient prognosis. The potential mechanisms by which GNA14 affects tumor prognosis were preliminarily analyzed using bioinformatics analysis.ResultsAnalysis of RNA-seq data and IHC showed that GNA14 expression was downregulated in NPC (p < 0.001, p < 0.01, respectively), and low expression of GNA14 was closely associated with poor prognosis. IHC analysis showed that patients with low GNA14 expression had significantly shorter progression-free survival (PFS) and distant metastasis-free survival (DMFS) than those with high GNA14 expression (p = 0.023, p = 0.008, respectively). Multivariate analysis indicated that the GNA14 expression was an independent risk factor for DMFS (p = 0.030). The DMFS nomogram included GNA14 expression, EBV DNA, and N stage as prognostic factors and the concordance index (C-index) of the nomogram was 0.73. Bioinformatics analysis indicated that NPC patients with low GNA14 expression might represent lower levels of immune cell infiltration and poorer drug sensitivity.ConclusionLow GNA14 expression may be a risk factor for poor prognosis in NPC.

Background The model for end-stage liver disease (MELD) score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure (ACLF). In this study, we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.Methods A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day/90-day outcomes of ACLF, which were validated in two large prospective cohorts. A prognostic score was developed by incorporating predictive parameters into the MELD score. The model was evaluated with a focus on discrimination and calibration.Results The meta-analysis incorporated 32 cohort studies with a total of 13 939 patients, of which 13 risk factors were identified, and 3 risk factors (age, neutrophil count and hepatic encephalopathy (HE) grade) besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts. A new model (Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score) was developed as follows: 0.028×age+0.3×HE grade+0.039×neutrophil count+0.079×MELD score. CATCH-LIFE-MELD score achieved a concordance index of 0.791/0.788 for 28-day/90-day outcomes, which is superior to other traditional scores. Other discrimination indices, including net reclassification improvement, integrated discrimination improvement and probability density function, and calibration including Nagelkerke’s R2 and Brier scores confirmed its superiority. Moreover, the accuracy of CATCH-LIFE-MELD score remained stable. It was highest in patients with or without hepatitis B virus infection, cirrhosis, liver failure or under the Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria or European Association for the Study of the Liver (EASL) criteria. All results were substantiated by an evaluation using an external cohort.Conclusions CATCH-LIFE-MELD score, a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.

Municipal solid waste (MSW) is an important destination for abandoned plastics. During the waste disposal process, large plastic debris is broken down into microplastics (MPs) and released into the leachate. However, current research only focuses on landfill leachates, and the occurrence of MPs in other leachates has not been studied. Therefore, herein, the abundance and characteristics of MPs in three types of leachates, namely, landfill leachate, residual waste leachate, and household food waste leachate, were studied, all leachates were collected from the largest waste disposal center in China. The results showed that the average MP abundances in the different types of leachates ranged from (129 ± 54) to (1288 ± 184) MP particles per liter (particles·L−1) and the household food waste leachate exhibited the highest MP abundance (p 80%) of small MPs (20–100 μm) in landfill leachates compared to other leachates. To the best of our knowledge, this is the first study discussing the sources of MPs in different leachates, which is important for MP pollution control during MSW disposal.

Despite the extensive application of advanced oxidation processes (AOPs) in water treatment, the efficiency of AOPs in eliminating various emerging contaminants such as halogenated antibiotics is constrained by a number of factors. Halogen moieties exhibit strong resistance to oxidative radicals, affecting the dehalogenation and detoxification efficiencies. To address these limitations of AOPs, advanced reduction processes (ARPs) have been proposed. Herein, a novel nucleophilic reductant—namely, the carbon dioxide radical anion (CO2·−)—is introduced for the simultaneous degradation, dehalogenation, and detoxification of florfenicol (FF), a typical halogenated antibiotic. The results demonstrate that FF is completely eliminated by CO2·−, with approximately 100% of Cl− and 46% of F− released after 120 min of treatment. Simultaneous detoxification is observed, which exhibits a linear response to the release of free inorganic halogen ions (R2 = 0.97, p 75%) in degrading a series of halogenated antibiotics, including chloramphenicol (CAP), thiamphenicol (THA), diclofenac (DLF), triclosan (TCS), and ciprofloxacin (CIP). The system shows high tolerance to the pH of the solution and the presence of natural water constituents, and demonstrates an excellent degradation performance in actual groundwater, indicating the strong application potential of CO2·−-based ARPs in real life. Overall, this study elucidates the feasibility of CO2·− for the simultaneous degradation, dehalogenation, and detoxification of halogenated antibiotics and provides a promising method for their regulation during water or wastewater treatment.

Objective: This study aims to estimate the overall in vitro activity of bedaquiline (BDQ) against clinical isolates of Mycobacterium abscessus complex (MABS) and M. avium complex (MAC), considering BDQ as a repurposed drug for non-tuberculous mycobacteria (NTM) infections. Methods: We conducted a systematic review of publications in PubMed/ MEDLINE, Web of Science, and Embase up to 15 April 2023. Studies were included if they followed the Clinical and Laboratory Standards Institute (CLSI) criteria for drug susceptibility testing (DST). Using a random effects model, we assessed the overall in vitro BDQ resistance rate in clinical isolates of MABS and MAC. Sources of heterogeneity were analysed using Cochran's Q and the I2 statistic. All analyses were performed using CMA V3.0. Results: A total of 24 publications (19 reports for MABS and 11 for MAC) were included. Using 1 µg/mL and 2 µg/mL as the breakpoint for BDQ resistance, the pooled rates of in vitro BDQ resistance in clinical isolates of MABS were found to be 1.8% (95% confidence interval [CI], 0.7–4.6%) and 1.7% (95% CI, 0.6–4.4%), respectively. In the case of MAC, the pooled rates were 1.7% (95% CI, 0.4–6.9%) and 1.6% (95% CI, 0.4–6.8%) for 1 µg/mL and 2 µg/mL, respectively. Conclusion: This study reports the prevalence of BDQ resistance in clinical isolates of MABS and MAC. The findings suggest that BDQ holds potential as a repurposed drug for treating MABS and MAC infections.

Abstract Background Liver diseases were significant source of early readmission burden. This study aimed to evaluate the 30-day unplanned readmission rates, causes of readmissions, readmission costs, and predictors of readmission in patients with acute liver failure (ALF). Methods Patients admitted for ALF from 2019 National Readmission Database were enrolled. Weighted multivariable logistic regression models were applied and based on Directed Acyclic Graphs. Incidence, causes, cost, and predictors of 30-day unplanned readmissions were identified. Results A total of 3,281 patients with ALF were enrolled, of whom 600 (18.3%) were readmitted within 30 days. The mean time from discharge to early readmission was 12.6 days. The average hospital cost and charge of readmission were $19,629 and $86,228, respectively. The readmissions were mainly due to liver-related events (26.6%), followed by infection (20.9%). The predictive factors independently associated with readmissions were age, male sex (OR 1.227, 95% CI 1.023–1.472; P = 0.028), renal failure (OR 1.401, 95% CI 1.139–1.723; P = 0.001), diabetes with chronic complications (OR 1.327, 95% CI 1.053–1.672; P = 0.017), complicated hypertension (OR 1.436, 95% CI 1.111–1.857; P = 0.006), peritoneal drainage (OR 1.600, 95% CI 1.092–2.345; P = 0.016), etc. Conclusions Patients with ALF are at relatively high risk of early readmission, which imposes a heavy medical and economic burden on society. We need to increase the emphasis placed on early readmission of patients with ALF and establish clinical strategies for their management.

ObjectivePelvic organ prolapse (POP) is a disease in which pelvic floor support structures are dysfunctional due to disruption of the extracellular matrix (ECM). The vascular system is essential for maintaining ECM homeostasis. Therefore, this study explored the potential mechanism of blood vessel development-related genes (BVDRGs) in POP.MethodsPOP-related datasets and BVDRGs were included in this study. Differentially expressed genes (DEGs) between the POP and control groups were first identified in the GSE12852 and GSE208271 datasets, and DE-BVDRGs were identified by determining the intersection of these DEGs and BVDRGs. Subsequently, the feature genes were evaluated by machine learning. Feature genes with consistent expression trends in the GSE12852 and GSE208271 datasets were considered key genes. Afterward, the overall diagnostic efficacy of key genes in POP was evaluated through receiver operating characteristic (ROC) curve analysis. Based on the key genes, enrichment analysis, immune infiltration analysis and regulatory network construction were performed to elucidate the molecular mechanisms underlying the functions of the key genes in POP.ResultsA total of 888 DEGs1 and 643 DEGs2 were identified in the GSE12852 and GSE208271 datasets, and 26 candidate genes and 4 DE-BVDRGs were identified. Furthermore, Hyaluronan synthase 2 (HAS2), Matrix metalloproteinase 19 (MMP19) and Plexin Domain Containing 1 (PLXDC1) were identified as key genes in POP and had promising value for diagnosing POP (AUC > 0.8). Additional research revealed that the key genes were predominantly implicated in immune cell activation, chemotaxis, and cytokine release via the chemokine signaling pathway, the Nod-like receptor signaling pathway, and the Toll-like receptor signaling pathway. Analysis of immune cell infiltration confirmed a decrease in the proportion of plasma cells in POP, and MMP19 expression showed a significant negative correlation with plasma cell numbers. In addition, regulatory network analysis revealed that MALAT1 (a lncRNA) targeted hsa-miR-503-5p, hsa-miR-23a-3p and hsa-miR-129-5p to simultaneously regulate three key genes.ConclusionWe identified three key BVDRGs (HAS2, MMP19 and PLXDC1) related to the ECM in POP, providing markers for diagnostic studies and investigations of the molecular mechanism of POP.

IntroductionIn the new era of higher education focusing on “double first-class” development, private universities in China face significant opportunities and challenges. The success of these institutions is closely linked to effective leadership, particularly transformational leadership, which is known to inspire and motivate employees toward extraordinary achievements. This study explores the existence and impact of transformational leadership on teachers’ work performance in Chinese private universities. It aims to fill a research gap regarding the role of transformational leadership in a resource-constrained environment and provide practical insights for enhancing teachers’ work performance, thereby contributing to the rapid development of private universities and the realization of “double first-class” goals.MethodsThis study employed an input-process-output approach, combining qualitative data from face-to-face interviews with 12 leaders at Guangdong University of Science and Technology and quantitative data from an electronic survey of 392 university teachers. Data were analyzed using SPSS26.0, AMOS24.0, and NVIVO14, including exploratory and confirmatory factor analyses, common method bias assessment, and correlation analysis. Structural equation modeling with AMOS24.0 was used to explore the relationship between transformational leadership and teachers’ work performance, evaluating the impact of each transformational leadership dimension.ResultsThe study findings demonstrated that transformational leadership styles are being employed in Chinese private universities, albeit not extensively, with moderate effects on teachers’ work performance. The research identified organizational vision, intellectual stimulation, and personal recognition as significant drivers of enhanced performance among faculty members. Nevertheless, the study did not confirm the impact of supportive leadership, inspiring communication, and moral modeling within the context of Chinese private universities.DiscussionThe results highlight areas for potential development in leadership practices, including improving teachers’ competencies, motivating teachers, providing good work opportunities and environments, and building good teacher teams.

ObjectiveIn several randomized controlled trials (RCTs), sacrospinous hysteropexy and other forms of hysteropreservation have been compared. Nevertheless, there is no definitively best treatment. This study summarized RCT evidence for various uterine preservation surgical procedures.MethodsFrom each database inception to August 2023, we searched PubMed, Embase, Cochrane Library, and Web of Science for eligible RCTs. A comparison was made between sacrospinous hysteropexy and other hysteropreservation, including vaginal and abdominal surgery. For categorical and continuous variables, relative risks (RRs) and mean differences (MDs) were calculated using random-effects models.ResultsWe reviewed a total 1,398 studies and ultimately included five RCTs that met all inclusion criteria. These five studies included a total of 1,372 uterine POP cases all of whom received transvaginal surgery and had a follow-up period for assessment of recurrence from 12 months to 5 years. There were no significant differences between sacrospinous hysteropexy and other hysteropreservation for the incidences of recurrence (RR,1.24; 95% CI, 0.58 to 2.63; p = 0.58) or hematoma (RR,0.70; 95% CI, 0.17 to 2.92; p = 0.62). Moreover, neither sacrospinous hysteropexy nor hysteropreservation had any significant effect on the risk of mesh exposure (RR,0.34; 95% CI, 0.03 to 4.31; p = 0.41), dyspareunia (RR,0.45; 95% CI, 0.13 to1.6; p = 0.22), urinary tract infection (RR,0.66; 95% CI, 0.38 to 1.15; p = 0.15), bothersome bulge symptoms (RR,0.03; 95% CI, −0.02 to 0.08; p = 0.24), operative time (MD, −4.53; 95% CI, −12.08 to 3.01; p = 0.24), and blood loss (MD, −25.69; 95% CI, −62.28 to 10.91; p = 0.17). However, sacrospinous hysteropexy was associated with a lower probability of pain (RR,4.8; 95% CI, 0.79 to 29.26; p = 0.09) compared with other hysteropreservation.ConclusionThere was no difference between sacrospinous hysteropexy and hysteropreservation in terms of recurrence, hematoma, mesh exposure, dyspareunia, urinary tract infection, bothersome bulge symptoms, operative time, pain, and blood loss.Systematic Review RegistrationPROSPERO [CRD42023470025].

Dedicator of cytokinesis 8 (DOCK8) deficiency represents a primary immunodeficiency with a wide range of clinical symptoms, including recurrent infections, atopy, and increased malignancy risk. This study presents a case of a 6-year-old girl with DOCK8 deficiency, characterized by severe, treatment-resistant herpetic infections who was successfully treated with siltuximab and glucocorticoids. The successful use of siltuximab in achieving remission highlights the pivotal role of interleukin-6 (IL-6) in DOCK8 deficiency pathogenesis and suggests that IL-6 modulation can be critical in managing DOCK8 deficiency-related viral infections, which may inform future therapeutic strategies for DOCK8 deficiency and similar immunodeficiencies.

C39H36N5O11Tb, triclinic, P 1‾ $\overline{1}$ (no. 2), a = 10.3365(12) Å, b = 13.0194(15) Å, c = 15.2064(18) Å, α = 108.769(2)°, β = 94.694(2)°, γ = 100.882(2)°, V = 1880.2(4) Å3, Dc = 1.607 g/cm3, Z = 2, Rgt (F) = 0.0315, wRref (F 2) = 0.0836, T = 296.15 K.

C75H76N10O23Tb2, triclinic, P−1‾ $P-\overline{1}$ (no. 2), a = 10.4524(13) Å, b = 12.9626(16) Å, c = 15.2003(18) Å, α = 108.674(2)∘, β = 94.931(2)∘, γ = 101.617(2)∘, V = 1885.8(4) nm3, Z = 1, R gt(F) = 0.0236, wR ref(F 2) = 0.0584, T = 296 K.

Modern food microbiology is a core compulsory course of Food Science and Engineering and an important course in the teaching system of Food majors. We have conducted a research on teaching reform in response to the current problems of outdated teaching content, single teaching methods, and unscientific teaching assessment methods in curriculum teaching. We have taken multiple strategies, including introducing hot cases related to food microbiology in class to update the teaching content, encouraging students to conduct microbiological thematic discussions and presentations in class, adding feedbacks after the “homework submission-review scoring” to achieve a closed-loop teaching. After three rounds of teaching reform practice, the students’ feedback was good, and the teaching effects of modern food microbiology has been significantly improved.

Abstract Objective This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection among mothers and newborns. Data sources We independently searched the PubMed, Web of Science, Cochrane Library and EMBASE databases for relevant studies published before February, 2024. Methods We included RCTs that evaluated the effect of prenatal oral or intravenous azithromycin or placebo on intrapartum or postpartum infection incidence. We included studies evaluating women who had vaginal births as well as caesarean sections. Studies reporting maternal and neonatal infections were included in the current analysis. Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. The risk of bias of each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, wound and surgical site infections, chorioamnionitis, and urinary tract infections) and neonatal outcomes (infections of the eyes, ears and skin). A random-effects model was used to test for overall effects and heterogeneity. Results The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55–0.77; I 2 , 0%; P

In this study, the antihypertensive effect of microcapsules containing a mixture of goji berry, hawthorn and cassia seed at a mass ratio of 4:1:1 and angiotensin converting enzyme (ACE) inhibitory peptide in spontaneously hypertensive rats (SHR) was assessed. The ACE inhibition rate of the microcapsules containing the mixture and ACE inhibitory peptide at a mass ratio of 1:2 was 78.19%, which was significantly higher than those of the mixture of medicinal and culinary plant materials (69.46%) and ACE inhibitory peptide (71.48%) alone (P < 0.05). Under optimized encapsulation conditions (solid content of 10%, inlet air temperature of 160 ℃, core-to-wall ratio of 1:15, and a 1:4 mixture of modified starch and maltodextrin as wall material), an encapsulation efficiency of 82.76% was obtained. After intestinal digestion for 240 min, the release rate of the as-prepared microcapsules was 81.40%, and the bitter taste was significantly reduced (P < 0.05). Animal experiments showed that the microcapsules significantly reduced blood pressure in SHR, significantly increased the plasma contents of ACE2 and angiotensin 1-7 (Ang(1-7)), and reduced plasma ACE content and the contents of angiotensin II (AngII) in the plasma, heart, kidney and thoracic aorta (P < 0.05). The effect was more pronounced than those of the mixture of medicinal and culinary plant materials and ACE inhibitory peptide, confirming the synergism between them. The composite microcapsules can not only reduce blood pressure by regulating the renin-angiotensin system but also significantly reduce the degree of cardiac and thoracic aorta fibrosis in SHR, thereby improving organ damage caused by hypertension.

BackgroundWomen may develop severe symptoms of stress disorder following childbirth， which may be exposed to a risk of developing mental health problems， and even lead to the recurrence of the illness in female patients with schizophrenia， while comparatively limited research has been undertaken concerning the clinical characteristics and treatment of puerperal schizophrenia in China.ObjectiveTo explore the clinical characteristics of puerperal schizophrenia， so as to provide references for the clinical treatment.MethodsA total of 24 patients with puerperal schizophrenia who were hospitalized in the female ward of adult psychiatry department of the Affiliated Brain Hospital of Guangzhou Medical University from 2012 to 2020 and met the Diagnostic and Statistical Manual of Mental Disorders， fourth edition （DSM-IV） diagnostic criteria for schizophrenia were included as puerperal group. Another 48 non-puerperal women with schizophrenia were concurrently enrolled as control group. Then the basic data， scores on Positive and Negative Symptom Scale （PANSS） and the discharge medication were recorded.ResultsThe percentages of newly onset and positive family history of psychosis in puerperal group were larger than those in control group， with statistical significance （χ2=9.321， 5.240， P

As one of the six major nutrients, lipids play important roles in various biological processes, including cell membrane construction, signal transduction, and energy metabolism. The diverse functions of lipids are intricately linked to the distinct structures. More than 48 000 molecular lipid structures have been curated in the database which can be further categorized into 8 categories and more than one hundred lipid classes and subclasses. The diverse structures of lipids pose challenges for their lipidomic analysis, especially the co-existence of isomers and isobar. Traditional tandem mass spectrometry (MS/MS) techniques based on collision-induced dissociation (CID) can provide the informations of molecular species and acyl chain composition of various types of lipids in a sensitive fashion. However, they typically fall short in providing detailed structural information, including C=C positions, sn-positions, functional group substitutions and their locations on the fatty acyl chains. In recent years, mass spectrometry methods capable of distinguishing lipid isomers at various structural levels have been developed, among which radical chemistry plays important role in both gas-phase ion activation and chemical derivatization. This article summarized the MS/MS techniques for lipid structural analysis at detailed structural levels via harnessing the power of both radical chemistry and tandem mass spectrometry in the past decade. Radical-induced dissociation (RID) refers to a group of gas-phase dissociation methods which can generate intrachain C-C cleavages in the fatty acyl chain and thus produce fragmentation patterns useful for identification of chain modification. Ultraviolet photodissociation (UVPD) and CID triggered radical-directed dissociation, and electron impact excitation of ions from organics (EIEIO) are the major RID methods. By coupling RID with separation methods, such as reversed-phase liquid chromatography (RPLC), identification and quantitation of lipid isomers consisting of methyl branching, hydroxy group, and cyclopropane modification and their locations have been achieved. The two major derivatization methods utilizing radical chemistry for C=C bond modification were discussed, including radical initiated epoxidation reactions and the Paternò-Büchi reaction. Furthermore, the future direction of combining radical chemistry and tandem mass spectrometry for deep lipidotyping was discussed, which included the coupling with advanced separation methods, integrated workflows for multi-level structure analysis, and development of automated annotation tools for data analysis.

ABSTRACT This study aimed to assess the possible causes of discordant results between Xpert MTB/RIF (Xpert) and Bactec MGIT 960 Culture System (MGIT960) regarding rifampicin (RIF) susceptibility in Mycobacterium tuberculosis. Patients with previous RIF-resistant tuberculosis who were admitted to Wenzhou Central Hospital from January 2020 to December 2022 were enrolled. The isolates obtained from these patients were subjected to RIF susceptibility tests using Xpert and MGIT960, and the minimum inhibitory concentration (MIC) of RIF was determined by the MYCOTB MIC plate test. Additionally, molecular docking and molecular dynamics (MD) simulations were performed to evaluate the binding efficacy of rpoB and RIF based on rpoB mutations detected in the isolates with discordant RIF susceptibility results. A total of 28 isolates with discordant RIF susceptibility test results were detected, 15 of them were RIF susceptible with MICs ≤ 0.5 µg/mL. Twelve out of 15 isolates contained borderline RIF resistance-associated mutations [L430P (n = 6), H445N (n = 6)], 1 isolate had D435Y and Q429H double mutation, and the remaining 2 isolates had a silent (Q432Q) mutation. Compared with the affinity of RIF toward the wild type (WT) (−45.83 kcal/mol) by MD, its affinity toward L452P (−55.52 kcal/mol), D435Y (−47.39 kcal/mol), L430P (approximately −69.72 kcal/mol), H445N (−49.53 kcal/mol), and Q429H (−55.67 kcal/mol) increased. Borderline RIF resistance-associated mutations were the main cause for the discordant RIF susceptibility results between Xpert and MGIT960, and the mechanisms of the resistance need further investigated.IMPORTANCEThis study is aimed at assessing discordant results between Xpert MTB/RIF (Xpert) assay and Bactec MGIT 960 Culture System (MGIT960) regarding the detection of rifampicin (RIF)-resistant Mycobacterium tuberculosis isolates in Wenzhou, China. The discordant results of RIF between these two assays were mainly caused by borderline RIF resistance-associated mutations, subsequently by silent mutations of rpoB. Borderline RIF resistance- associated mutations detected in our study were demonstrated to not be affected by the affinity of rpoB and RIF by molecular dynamics, and the mechanism of resistance was needed to be clarified. For the discordant results of RIF by Xpert and MGIT960 that occurred, rpoB DNA sequencing was recommended to investigate its association with resistance to RIF.

Background: The prevalence of nontuberculous mycobacterial (NTM) disease in children is increasing worldwide. The clinical manifestations of pediatric NTM patients are significantly different from those of adult patients, but the knowledge of the disease is generally poor. Methods: English databases (PubMed, Web of Science, Embase, BIOSIS) and Chinese databases (CNKI, Wanfan, VIP) were searched on October 15th, 2022. All the articles of cross-sectional and cohort studies reporting the species composition and lesion site of the NTM disease in children using well-recognized NTM species identification methods were taken into account. Using a random effects model, we assessed the disease lesion sites and the prevalence of different NTM species in pediatric NTM disease. Sources of heterogeneity were analyzed using Cochran's Q and the I2 statistic. All analyses were performed using CMA V3.0. Results: The prevalence rates of NTM disease in children ranged between 0.6 and 5.36/100,000 in different countries, and Europe reported the highest prevalence rate. The most common clinical lesion site was lymph node, accounting for 71.1 % (55.0 %–83.2 %), followed by lung (19.3 %, 9.8%–34.4 %）and then skin and soft tissue (16.6 %,13.5%–20.3 %). Mycobacterium avium complex (MAC) was the most isolated NTM pathogen in children, accounting for 54.9 % (39.4%–69.6 %). Inconsistent with adult patients, Mycobacterium avium accounted for a dominant proportion in MAC than Mycobacterium intracellulare. Conclusions: The lymph node was the most affected organ in pediatric NTM disease, while Mycobacterium avium was the most isolated pathogenic species in children.

Aims: The Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST) and Nutritional Risk Screening 2002 (NRS2002) were used by nurses to screen, compare, and analyze the nutritional status of patients with liver cirrhosis. The application value of different screening tools was summarized in the nutritional screening of patients with liver cirrhosis. Methods: In this study, LDUST, RFH-NPT, and NRS2002 were used by nurses to screen the nutritional status of hospitalized patients with liver cirrhosis within 24–48 h after admission. The study calculated validity indicators such as sensitivity, specificity, the area under the receiver operating curve (AUC), and reliability indicators such as the Kappa coefficient. The efficacy of these screening tools in the nutritional screening of patients with liver cirrhosis was compared. Results: Among the 207 patients, LDUST and NRS2002 identified 72.9 % and 23.7 % as undernourished, respectively. The sensitivity of LDUST and NRS2002 were 92.1 % and 30.0 %, respectively. The Kappa value of LDUST and RFH-NPT was 0.620, and the Kappa value of LDUST compared with NRS2002 was 0.144. Conclusion: This study shows that the Liver Disease Undernutrition Screening Tool, a special screening tool for patients with liver cirrhosis, has a more reliable screening effect and higher sensitivity than NRS2002. The Liver Disease Undernutrition Screening Tool is recommended for nutritional screening in patients with liver cirrhosis.

BackgroundNasopharyngeal carcinoma (NPC) has an extremely high incidence rate in Southern China, resulting in a severe disease burden for the local population. Current EBV serologic screening is limited by false positives, and there is opportunity to integrate polygenic risk scores for personalized screening which may enhance cost-effectiveness and resource utilization.MethodsA Markov model was developed based on epidemiological and genetic data specific to endemic areas of China, and further compared polygenic risk-stratified screening [subjects with a 10-year absolute risk (AR) greater than a threshold risk underwent EBV serological screening] to age-based screening (EBV serological screening for all subjects). For each initial screening age (30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, and 65–69 years), a modeled cohort of 100,000 participants was screened until age 69, and then followed until age 79.ResultsAmong subjects aged 30 to 54 years, polygenic risk-stratified screening strategies were more cost-effective than age-based screening strategies, and almost comprised the cost-effectiveness efficiency frontier. For men, screening strategies with a 1-year frequency and a 10-year absolute risk (AR) threshold of 0.7% or higher were cost-effective, with an incremental cost-effectiveness ratio (ICER) below the willingness to pay (¥203,810, twice the local per capita GDP). Specifically, the strategies with a 10-year AR threshold of 0.7% or 0.8% are the most cost-effective strategies, with an ICER ranging from ¥159,752 to ¥201,738 compared to lower-cost non-dominated strategies on the cost-effectiveness frontiers. The optimal strategies have a higher probability (29.4–35.8%) of being cost-effective compared to other strategies on the frontier. Additionally, they reduce the need for nasopharyngoscopies by 5.1–27.7% compared to optimal age-based strategies. Likewise, for women aged 30–54 years, the optimal strategy with a 0.3% threshold showed similar results. Among subjects aged 55 to 69 years, age-based screening strategies were more cost-effective for men, while no screening may be preferred for women.ConclusionOur economic evaluation found that the polygenic risk-stratified screening could improve the cost-effectiveness among individuals aged 30–54, providing valuable guidance for NPC prevention and control policies in endemic areas of China.

Introduction: DNA methylation is a critical epigenetic modification involving the addition of a methyl group to the DNA molecule, playing a key role in regulating gene expression without changing the DNA sequence. The main difficulty in identifying DNA methylation sites lies in the subtle and complex nature of methylation patterns, which may vary across different tissues, developmental stages, and environmental conditions. Traditional methods for methylation site identification, such as bisulfite sequencing, are typically labor-intensive, costly, and require large amounts of DNA, hindering high-throughput analysis. Moreover, these methods may not always provide the resolution needed to detect methylation at specific sites, especially in genomic regions that are rich in repetitive sequences or have low levels of methylation. Furthermore, current deep learning approaches generally lack sufficient accuracy.Methods: This study introduces the iDNA-OpenPrompt model, leveraging the novel OpenPrompt learning framework. The model combines a prompt template, prompt verbalizer, and Pre-trained Language Model (PLM) to construct the prompt-learning framework for DNA methylation sequences. Moreover, a DNA vocabulary library, BERT tokenizer, and specific label words are also introduced into the model to enable accurate identification of DNA methylation sites.Results and Discussion: An extensive analysis is conducted to evaluate the predictive, reliability, and consistency capabilities of the iDNA-OpenPrompt model. The experimental outcomes, covering 17 benchmark datasets that include various species and three DNA methylation modifications (4mC, 5hmC, 6mA), consistently indicate that our model surpasses outstanding performance and robustness approaches.

Abstract Our study aimed to investigate the prognostic value of neutrophil count to albumin ratio (NAR) in predicting short-term mortality of patients with decompensated cirrhosis (DC). A total of 623 DC patients were recruited from a retrospective observational cohort study. They were admitted to our hospital from January 2014 to December 2015. NAR of each patient was calculated and analyzed for the association with 90-day liver transplantation-free (LT-free) outcome. The performance of NAR and the integrated model were tested by a receiver-operator curve (ROC) and C-index. The 90-day LT-free mortality of patients with DC was 10.6%. NAR was significantly higher in 90-day non-survivors than in survivors (The median: 1.73 vs 0.76, P

The marine engineering industry is an internationalized sector, whose internationalization determines the intensity of competition. In the bidding process, it is crucial for company decision-makers to conduct accurate risk assessments, as this plays a vital role in the long-term development of the company. A high accuracy project risk assessment model is established after analyzing and identifying relevant risk factors in such projects based on quantifying qualitative problems using the fuzzy analytic hierarchy process (FAHP) and utilizing the high fault-tolerance and generalization capabilities of the back propagation (BP) neural network. Thus, the model provides an effective and efficient risk analysis tool for supporting enterprises in the marine engineering industry in the bidding decision-making process.

BackgroundPolycystic ovary syndrome (PCOS) is a prevalent endocrine disease in women, intricately linked to hormonal imbalances. The microbiota composition plays a pivotal role in influencing hormonal levels within the body. In this study, we utilized a murine model to investigate how intestinal and vaginal microbiota interact with hormones in the development of PCOS.MethodsTwenty female mice were randomly assigned to the normal group (N) and the model group (P), where the latter received daily subcutaneous injections of 0.1 mL DHEA (6 mg/100 g). Throughout the experiment, we evaluated the PCOS mouse model by estrus cycle, serum total testosterone (T), prolactin (PRL) and luteinizing hormone (LH) levels, and ovarian pathological morphology. The microbial composition in both intestinal content and vaginal microbiota were studied by 16S rRNA gene high-throughput sequencing.ResultsCompared with the N group, the P group showed significant increases in body weight, T, and PRL, with significant decrease in LH. Ovaries exhibited polycystic changes, and the estrous cycle was disrupted. The intestinal microbiota result shows that Chao1, ACE, Shannon and Simpson indexes were decreased, Desulfobacterota and Acidobacteriota were increased, and Muribaculaceae, Limosilactobacillus and Lactobacillus were decreased in the P group. T was significantly positively correlated with Enterorhabdus, and LH was significantly positively correlated with Lactobacillus. The analysis of vaginal microbiota revealed no significant changes in Chao1, ACE, Shannon, and Simpson indices. However, there were increased in Firmicutes, Bacteroidota, Actinobacteriota, Streptococcus, and Muribaculaceae. Particularly, Rodentibacter displayed a robust negative correlation with other components of the vaginal microbiota.ConclusionTherefore, the response of the intestinal microbiota to PCOS is more significant than that of the vaginal microbiota. The intestinal microbiota is likely involved in the development of PCOS through its participation in hormonal regulation.

Lactococcus lactis subsp. lactis (L. lactis subsp. lactis) is a commonly used starter cultures in fermented dairy products, contributing distinct flavor and texture characteristics with high application value. However, the strains from different isolates have different contributions to milk fermentation. Therefore, this study aimed to investigate the influence of L. lactis subsp. lactis isolated from various sources on the volatile metabolites present in fermented milk. In this study, L. lactis subsp. lactis from different isolation sources (yogurt, koumiss and goat yogurt) was utilized as a starter culture for fermentation. The volatile metabolites of fermented milk were subsequently analyzed by headspace solid phase microextraction gas chromatography-mass spectrography (HS-SPME-GC-MS). The results indicated significant differences in the structure and abundance of volatile metabolites in fermented milk produced with different isolates (R2Y = 0.96, Q2 = 0.88). Notably, the strains isolated from goat yogurt appeared to enhance the accumulation of ketones (goat yogurt vs yogurt milk: 50 %; goat yogur vs koumiss: 27.3 %)and aldehydes (goat yogurt vs yogurt milk: 21.4 %; goat yogurt vs koumiss: 54.5 %) in fermented milk than strains isolated from koumiss and yogurt milk. It significantly promoted the production of 8 flavor substances (1 substance with OAV ≥ 1 and 6 substances with OAV > 0.1) and enhanced the biosynthesis of valine, leucine, and isoleucine. This study provides valuable insights for the application of Lactococcus lactis subsp. lactis isolated from different sources in fermented dairy production and screening of potential starter cultures.

Abstract Purpose To observe the inhibitory effect of the small molecule tyrosine kinase inhibitor apatinib on small cell lung cancer in vitro and vivo. Material and methods Three small lung cancer cells were selected CCK‐8 and monoclonal assay was used to determine the effect of apatinib on proliferation. The effects on cell cycle and apoptosis were detected by flow cytometry and TUNEL. We observed the inhibitory effect of different doses of apatinib on xenograft tumor. The efficacy and safety of apatinib in 20 patients with advanced small cell lung cancer were observed. Results For small cell lung cancer with high expression of VEGFR2, apatinib has a significant inhibitory effect both in vitro and in vivo. It can play an inhibitory role by promoting apoptosis and cell cycle arrest pathways. For small cell lung cancer with low expression of VEGFR, the inhibitory effect on cells in vitro was not significant. It has certain inhibitory effect on nude mouse transplanted tumor and small cell lung cancer patients, but the effect is weaker than that of animal models and patients with small cell lung cancer cells with high expression of VEGFR2. Conclusion Apatinib has a significant inhibitory effect on small cell lung cancer with high expression of VEGFR2 and may be a treatment for small cell lung cancer patients.

Pelvic organ prolapse (POP) is a significant contributor to hysterectomy among middle-aged and elderly women. However, there are challenges in terms of dedicated pharmaceutical solutions and targeted interventions for POP. The primary characteristics of POP include compromised mechanical properties of uterine ligaments and dysfunction within the vaginal support structure, often resulting from delivery-related injuries. Fibroblasts secrete extracellular matrix, which, along with the cytoskeleton, forms the structural foundation that ensures proper biomechanical function of the fascial system. This system is crucial for maintaining the anatomical position of each pelvic floor organ. By systematically exploring the roles and mechanisms of biomechanical-biochemical transformations in POP, we can understand the impact of forces on the injury and repair of these organs. A comprehensive analysis of the literature revealed that the extracellular matrix produced by fibroblasts, as well as their cytoskeleton, undergoes alterations in patient tissues and cellular models of POP. Additionally, various signaling pathways, including TGF-β1/Smad, Gpx1, PI3K/AKT, p38/MAPK, and Nr4a1, are implicated in the biomechanical-biochemical interplay of fibroblasts. This systematic review of the biomechanical-biochemical interplay in fibroblasts in POP not only enhances our understanding of its underlying causes but also establishes a theoretical foundation for future clinical interventions.

This paper constructs a text mining and quantitative evaluation model for cultural and tourism integration policies based on LDA and PMC index models. We find research samples of cultural and tourism integration policies through relevant websites and databases and use the LDA model to mine high-frequency words in the policies and make a high-frequency glossary. The quantitative evaluation index system of cultural and tourism policies is constructed according to the glossary and the definitions of policy evaluation by authoritative scholars, and then the scores of each policy are calculated based on the PMC formula, and the PCM surface diagram is drawn for quantitative evaluation. The results show that 57.14% of the 63 policies belong to the excellent level, and most of the policies have high scores in terms of policy timeliness, subject, tool, field, evaluation, and function, ranging from 0.5 to 0.8. Thirteen policies were poorly rated in terms of policy nature, with only 0.333-05, and there is much room for improvement. Based on the results of the study, an optimization concept focusing on optimizing the nature of policies is proposed to improve the problems existing in the current policy formulation of cultural tourism integration.

Abstract Monocots are a major taxon within flowering plants, have unique morphological traits, and show an extraordinary diversity in lifestyle. To improve our understanding of monocot origin and evolution, we generate chromosome-level reference genomes of the diploid Acorus gramineus and the tetraploid Ac. calamus, the only two accepted species from the family Acoraceae, which form a sister lineage to all other monocots. Comparing the genomes of Ac. gramineus and Ac. calamus, we suggest that Ac. gramineus is not a potential diploid progenitor of Ac. calamus, and Ac. calamus is an allotetraploid with two subgenomes A, and B, presenting asymmetric evolution and B subgenome dominance. Both the diploid genome of Ac. gramineus and the subgenomes A and B of Ac. calamus show clear evidence of whole-genome duplication (WGD), but Acoraceae does not seem to share an older WGD that is shared by most other monocots. We reconstruct an ancestral monocot karyotype and gene toolkit, and discuss scenarios that explain the complex history of the Acorus genome. Our analyses show that the ancestors of monocots exhibit mosaic genomic features, likely important for that appeared in early monocot evolution, providing fundamental insights into the origin, evolution, and diversification of monocots.

Abstract Background We aim to clarify the controversial associations between EBV-related antibodies and gastric cancer risk. Methods We analysed the associations between serological Epstein-Barr nuclear antigen 1 immunoglobulin A (EBNA1-IgA) and viral capsid antigen immunoglobulin A (VCA-IgA) by enzyme-linked immunosorbent assay and the risk of gastric cancer in a nested case-control study originated from a population-based nasopharyngeal carcinoma (NPC) screening cohort in Zhongshan, a city of southern China, including 18 gastric cancer cases and 444 controls. Conditional logistic regression was used to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results All the sera of cases were sampled before diagnosis and the median time interval was 3.04 (range: 0.04, 7.59) years. Both increased relative optical density (rOD) values of EBNA1-IgA and VCA-IgA were associated with higher risks of gastric cancer with age adjusted ORs of 1.99 (95%CI: 1.07, 3.70) and 2.64 (95%CI: 1.33, 5.23), respectively. Each participant was further classified as high or medium/low risk based on a combination of two anti-EBV antibody levels. Participants in the high-risk group had substantially higher odds of developing gastric cancer than that in the medium/low risk group with an age adjusted OR of 6.53 (95%CI: 1.69, 25.26). Conclusions Our research reveals positive associations between EBNA1-IgA and VCA-IgA and gastric cancer risk in southern China. We thus postulate that EBNA1-IgA and VCA-IgA might appear to be potential biomarkers for gastric cancer. More research to further validate the results among diverse populations and investigate its underlying biological mechanism is needed.

Abstract Color quantization is used to obtain an image with the same number of pixels as the original but represented using fewer colors. Most existing color quantization algorithms are based on the Red Green Blue (RGB) color space, and there are few color quantization algorithms for the Hue Saturation Intensity (HSI) color space with a simple uniform quantization algorithm. In this paper, we propose a dichotomy color quantization algorithm for the HSI color space. The proposed color quantization algorithm can display images with a smaller number of colors than other quantization methods of RGB color space. The proposed algorithm has three main steps as follows: first, a single-valued monotonic function of the Hue (H) component in the from RGB color space to HSI color space (RGB-HSI) color space conversion is constructed, which can avoid the partition calculation of the H component in the RGB-HSI color space; second, an iterative quantization algorithm based on the single-valued monotonic function is proposed; and third, a dichotomy quantization algorithm is proposed to improve the iterative quantization algorithm. Both visual and numerical evaluations reveal that the proposed method presents promising quantization results.

(1) Background: Bifidobacterium plays a pivotal role within the gut microbiota, significantly affecting host health through its abundance and composition in the intestine. Factors such as age, gender, and living environment exert considerable influence on the gut microbiota, yet scant attention has been directed towards understanding the specific effects of these factors on the Bifidobacterium population. Therefore, this study focused on 98 adult fecal samples to conduct absolute and relative quantitative analyses of bifidobacteria. (2) Methods: Using droplet digital PCR and the PacBio Sequel II sequencing platform, this study sought to determine the influence of various factors, including living environment, age, and BMI, on the absolute content and biodiversity of intestinal bifidobacteria. (3) Results: Quantitative results indicated that the bifidobacteria content in the intestinal tract ranged from 106 to 109 CFU/g. Notably, the number of bifidobacteria in the intestinal tract of the school population surpassed that of the off-campus population significantly (p = 0.003). Additionally, the group of young people exhibited a significantly higher count of bifidobacteria than the middle-aged and elderly groups (p = 0.041). The normal-weight group displayed a significantly higher bifidobacteria count than the obese group (p = 0.027). Further analysis of the relative abundance of bifidobacteria under different influencing factors revealed that the living environment emerged as the primary factor affecting the intestinal bifidobacteria structure (p = 0.046, R2 = 2.411). Moreover, the diversity of bifidobacteria in the intestinal tract of college students surpassed that in the out-of-school population (p = 0.034). This was characterized by a notable increase in 11 strains, including B. longum, B. bifidum, and B. pseudolongum, in the intestinal tract of college students, forming a more intricate intestinal bifidobacteria interaction network. (4) Conclusions: In summary, this study elucidated the principal factors affecting intestinal bifidobacteria and delineated their characteristics of intestinal bifidobacteria in diverse populations. By enriching the theory surrounding gut microbiota and health, this study provides essential data support for further investigations into the intricate dynamics of the gut microbiota.

Introduction In view of the opioid epidemic and increasing caution surrounding prescription of opioids, addressing the competence of opioid management is important. There is minimal structured opioid education in Singapore. Online opioid education modules are available but lack real-time input, concise objectives, and program evaluation. This pilot online, modular, blended program aimed to efficiently instruct novice doctors on safe and appropriate practical opioid prescribing, optimizing its role in multimodal pain management while minimizing risks to patients and public health. Methods The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used. A multidisciplinary team developed the interactive blended program, “Comprehensive Opioid Management in Pain (COMP)”, consisting of three online modules, one case-based discussion (CBD) session, pre- and post-program evaluations. The program was designed to be concise, clinically relevant and engaging to maximize application of knowledge in clinically deficient areas. All junior anesthetists across Singhealth were invited to participate. We analyzed all self-reported and objective scores, as well as program feedback. Results 33 participants completed the online modules. Despite the moderate to high level of baseline self-reported confidence and competency scores, median scores for all variables increased post-program from pre-program. There was unanimous agreement on the relevance and utility of the training program. Conclusion This pilot achieved the aims of improving the knowledge and confidence levels of opioid management in novice doctors. Participants particularly enjoyed the succinct and interactive features of COMP. Further extension with modules focusing on opioid diversion and its use in high-risk populations would benefit intermediate learners.

Background: Here we report a rare case of citrullinemia type II (CTLN2) accompanied by mental derangement with a deficiency of multidrug resistance 3 (MDR3) in the liver. Case presentation: The clinical data of a 17-year-old girl were collected. Liver puncture was performed, and hepatic expression of MDR3 was determined by immunohistochemistry. Serum amino acids of the patient and her parents wwere determined by a chemical isotope labeling liquid chromatography−mass spectrometry (CIL LC-MS). Genetic mutations of ABCB4 and SLC25A13 were screened by whole-exome sequencing. Immunohistochemical analysis showed a remarkably lower expression of MDR3. Mutation in ABCB4 gene was not found and whole-exome sequencing revealed the SLC25A13 mutation 852–855 del. Elevated serum levels of citrulline, homocitrulline, and homoarginine in the patient and her mother were found. Conclusions: We reported a rare case of CTLN2 combined with MDR3 deficiency, without mutation of ABCB4. The link between MDR3 down-expression and CTLN2 warrants further investigation. Meanwhile, clinicians need to further rule out the possibility of CTLN2 if MDR3 decreases in adolescent patients with mental disorders and abnormal liver function.

Objective: The resistance of Mycobacterium tuberculosis (Mtb) to currently available fluoroquinolones (FQs), namely ofloxacin (OFX), levofloxacin (LFX), and moxifloxacin (MFX), renders the treatment of TB infections less successful. In this study, we aimed to evaluate the susceptibility and intracellular killing assay of Mtb to next-generation FQs in vitro and determine the correlation of FQs resistance and newly detected mutations in gyrB by molecular docking. Methods: Antimicrobial susceptibility test was performed to determine the minimum inhibitory concentrations (MICs) of six FQs, including currently available FQs (OFX, LFX, and MFX) and next-generation FQs, i.e., sitafloxacin (SFX), finafloxacin (FIN) and delafloxacin (DFX) against Mtb clinical isolates obtained in 2015 and 2022, respectively. Quinolone-resistance-determining regions of gyrA and gyrB were subjected to DNA sequencing and the correlation of FQs resistance and new mutations in gyrB were determined by molecular docking. Furthermore, the intracellular antibacterial activity of the six FQs against Mtb H37Rv in THP-1 cells was evaluated. Results: SFX exhibited the highest antibacterial activity against Mtb isolates (MIC90 = 0.25 μg/mL), whereas DFX and OFX exhibited comparable activity (MIC90 = 8 μg/mL). A statistically significant difference was observed among the MICs of the new generation FQs (SFX, P = 0.002; DFX, P = 0.008). Additionally, a marked increase in MICs was found in strains isolated in 2022 compared with those isolated in 2015. There might be correlation between FQs resistance and mutations in gyrB G520T and G520A. Cross-resistance rate between SFX and MFX was 40.6 % (26/64). At a concentration of 1 μg/mL, SFX exhibited high intracellular antibacterial activity (96.6 % ± 1.5 %) against the Mtb H37Rv, comparable with that of MFX at a concentration of 2 μg/mL. Conclusion: SFX exhibits the highest inhibitory activity against Mtb in vitro and THP-1 cell lines, which exhibits partial-cross resistance with MFX. There might be correlation between FQs resistance and mutations in gyrB G520T and G520A.Our findings provide crucial insights into the potential clinical application of SFX and DFX in the treatment of Mtb infections.

Non-tuberculous mycobacteria (NTM) are opportunistic pathogens that can infect all body tissues and organs. In particular, the lungs are the most commonly involved organ, with NTM pulmonary diseases causing serious health issues in patients with underlying lung disease. Moreover, NTM infections have been steadily increasing worldwide in recent years. NTM are also naturally resistant to many antibiotics, specifically anti-tuberculosis (anti-TB) drugs. The lack of drugs targeting NTM infections and the increasing drug resistance of NTM have further made treating these mycobacterial diseases extremely difficult. The currently recommended NTM treatments rely on the extended indications of existing drugs, which underlines the difficulties of new antibiotic discovery against NTM. Another challenge is determining which drug combinations are most effective against NTM infection. To a certain extent, anti-NTM drug development depends on using already available antibiotics and compounds. Here, we aimed to review new antibiotics or compounds with good antibacterial activity against NTM, focusing on their mechanisms of action, in vitro and in vivo antibacterial activities.

In order to provide more powerful support for forecasters in Sichuan and Chongqing with complicated terrain to carry out short-term (0-12 h) precipitation forecast, a convective scale ensemble forecast operational system is designed based on ensemble Kalman filter data assimilation method (31 ensemble samples) and WRF model with 3 km resolution (model domain: 24.5°-34.5°N, 99°-113°E) and lead time of 12 h, which is started by 3 h cycle. It is urgent to decide how many members should be used for the 12 h ensemble forecast to achieve the most representative probability distribution and optimal ensemble forecast skills. An ensemble forecast experiment is carried out on 16 heavy convective scale precipitation cases occurred in Sichuan and Chongqing with different amount of ensemble members, and the results are analyzed comprehensively. It is concluded that the precipitation forecast skills of the ensemble members for different magnitude of precipitation are roughly the same, so there is little difference in the totally averaged prediction skills of different ensemble size. Talagrand distribution becomes better with the increase of ensemble size first. However, when the ensemble size is larger than 17, the improvement by increasing ensemble size is no longer significant. Meanwhile, the forecast error probability becomes smaller with the increase of ensemble size first, but when the ensemble size reaches 16 to 18, the difference between the forecast error probability and the ideal value tends to be stable, indicating that the improvement by further increasing the ensemble size is no longer significant. The relative area of operational characteristic (AROC) score which represents the prediction probability forecast skills, improves gradually with the increase of ensemble size. However, when the ensemble size is large enough, the improvement by lager ensemble size is no longer significant and the AROC scores tend to be stable. The ensemble size required for stable AROC score increases with the magnitude of precipitation. Overall, when the AROC scores become stable, the ensemble size required for light rain, moderate rain, heavy rain, rainstorm (and heavy rainstorm) are 10, 14, 16 and 18, respectively. Based on the comparative analysis results and considering that there is generally little difference in forecasting skills when the number of members is different by 2, in order to achieve the most representative probability distribution and optimal ensemble forecast skills of precipitation, it is recommended to set the ensemble size of convective scale ensemble prediction system from 16 to 18.

Objective To summarize the clinical characteristics and explore the risk factors of Kawasaki disease(KD) with deep neck space involvement(DNSI). Methods This study was a case-control study. We reviewed KD complicated with DNSI patients in Department of Rheumatology and Immunology of Shenzhen Children's Hospital from January 2018 to December 2020 as DNSI group. Meanwhile, children with KD withoutDNSI during this period were selected by systematic sampling at a ratio of 1∶7 as control group. The clinical characteristics were analyzed by Chi-square test and the Mann-Whitney test and risk factors of KD complicated with DNSI were analyzed by Logistic regression. Results A total of 38 children in the DNSI group who met the inclusion and exclusion criteria and 288 children in the control group were selected. In the DNSI group, 38 children (100%) had fever and cervical lymph node enlargement, and the cervical lymph node enlargement occurred within 5 days of onset; 30 patients (78.9%) had cervical lymph node pain and 25 patients suffered (65.8%) limited movement of neck. Compared with the control group, the clinical data of children in the DNSI group showed a variety of significant changes. In terms of clinical characteristics, the age of onset in the DNSI group was older, the hospital stay was longer and the proportions of cervical lymphadenopathy, cervical lymph node pain, limited neck movement and upper airway obstruction were all higher (all P < 0.05); in terms of laboratory tests, the neutrophil count and its percentage, C-reactive protein (CRP), ferritin (FER), total bile acid, total bilirubin, direct bilirubin, and globulin levels all increased, while platelet and lymphocyte counts and their percentages all decreased(all P < 0.05); in terms of coronary artery damage and treatment effect, the Kobayashi score, Sano score and the proportion of hormone therapy in the DNSI group all increased (all P < 0.05). Multivariate Logistic regression analysis showed that neck lymph node pain (OR=5.523, 95% CI: 1.443-21.141, P=0.013), limited cervical movement (OR=3.947, 95% CI: 1.044-14.928, P=0.043), higher CRP (OR=1.016, 95% CI: 1.002-1.030, P=0.024) and higher FER(OR=1.004, 95% CI: 1.001-1.006, P=0.002) were independent risk factors for KD combined with DNSI. Conclusions Most children with KD complicated with DNSI have clinical symptoms such as cervical lymph node enlargement, cervical lymph node pain, and limited cervical movement, and hematology shows that there is a high-intensity inflammatory response. For KD children with neck pain and limited cervical movement as the main clinical manifestations, accompanied by elevated serum CRP and FER, we should be alert to the possibility of DNSI.