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Abstract Various dielectric response processes in the oil‐paper insulation are sensitively affected by the insulating states (ageing degrees and moisture contents). However, the existing research is still incomplete in revealing the microscopic mechanisms of various dielectric response processes in oil‐paper insulation with different insulating states. Given this issue, the genetic algorithm is first adopted to extract the Dissado–Hill (D–H) model parameters by simulating the frequency domain spectroscopy (FDS) of oil‐paper insulation. Then, the change laws of the extracted D–H model parameters are adopted to reveal the microscopic mechanisms of various dielectric response processes. Microscopic mechanisms of four dielectric response processes are studied, which are quasi‐dc relaxation, loss peak relaxation, optical frequency relaxation, and DC conductance. Meanwhile, due to the dielectric response processes being dominated by various polar particles (methanol, ethanol, furfural, and water molecule), the contents of various ageing by‐products dissolved in the insulating oil are measured to support the above analysis. In this respect, a dielectric theoretical reference for the FDS technique to research the insulating states of oil‐paper insulation is provided.

Abstract Background Endotoxic shock, particularly prevalent in intensive care units, represents a significant medical challenge. Endotoxin, upon invading the host, triggers intricate interactions with the innate immune system, particularly macrophages. This activation leads to the production of inflammatory mediators such as tumor necrosis factor‐alpha, interleukin‐6, and interleukin‐1‐beta, as well as aberrant activation of the nuclear factor‐kappa‐B and mitogen‐activated protein kinase signaling pathways. Objective This review delves into the intricate inflammatory cascades underpinning endotoxic shock, with a particular focus on the pivotal role of macrophages. It aims to elucidate the clinical implications of these processes and offer insights into potential therapeutic strategies. Results Macrophages, central to immune regulation, manifest in two distinct subsets: M1 (classically activated subtype) macrophages and M2 (alternatively activated subtype) macrophages. The former exhibit an inflammatory phenotype, while the latter adopt an anti‐inflammatory role. By modulating the inflammatory response in patients with endotoxic shock, these macrophages play a crucial role in restoring immune balance and facilitating recovery. Conclusion Macrophages undergo dynamic changes within the immune system, orchestrating essential processes for maintaining tissue homeostasis. A deeper comprehension of the mechanisms governing macrophage‐mediated inflammation lays the groundwork for an anti‐inflammatory, targeted approach to treating endotoxic shock. This understanding can significantly contribute to the development of more effective therapeutic interventions.

Abstract BackgroundThe creation of large language models (LLMs) such as ChatGPT is an important step in the development of artificial intelligence, which shows great potential in medical education due to its powerful language understanding and generative capabilities. The purpose of this study was to quantitatively evaluate and comprehensively analyze ChatGPT’s performance in handling questions for the National Nursing Licensure Examination (NNLE) in China and the United States, including the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the NNLE. ObjectiveThis study aims to examine how well LLMs respond to the NCLEX-RN and the NNLE multiple-choice questions (MCQs) in various language inputs. To evaluate whether LLMs can be used as multilingual learning assistance for nursing, and to assess whether they possess a repository of professional knowledge applicable to clinical nursing practice. MethodsFirst, we compiled 150 NCLEX-RN Practical MCQs, 240 NNLE Theoretical MCQs, and 240 NNLE Practical MCQs. Then, the translation function of ChatGPT 3.5 was used to translate NCLEX-RN questions from English to Chinese and NNLE questions from Chinese to English. Finally, the original version and the translated version of the MCQs were inputted into ChatGPT 4.0, ChatGPT 3.5, and Google Bard. Different LLMs were compared according to the accuracy rate, and the differences between different language inputs were compared. ResultsThe accuracy rates of ChatGPT 4.0 for NCLEX-RN practical questions and Chinese-translated NCLEX-RN practical questions were 88.7% (133/150) and 79.3% (119/150), respectively. Despite the statistical significance of the difference (PPPPPPPPPPP ConclusionsThis study, focusing on 618 nursing MCQs including NCLEX-RN and NNLE exams, found that ChatGPT 4.0 outperformed ChatGPT 3.5 and Google Bard in accuracy. It excelled in processing English and Chinese inputs, underscoring its potential as a valuable tool in nursing education and clinical decision-making.

IntroductionAcupoint Catgut Embedding (ACE) is an extended and developed form of traditional acupuncture that serves as a composite stimulation therapy for various diseases. However, its local stimulation effects on acupoints remain unclear. Acupuncture can activate mechanically sensitive calcium ion channels, TRPV2 and TRPV4, located on various cell membranes, promoting Ca2+ influx in acupoint tissues to exert effects. Whether ACE can form mechanical physical stimulation to regulate these channels and the related linkage effect requires validation.MethodsThis study investigates the influence of TRPV2 and TRPV4 ion channels on the local stimulation effects of ACE by embedding PGLA suture at the Zusanli (ST36) acupoint in rats and using TRPV2 and TRPV4 inhibitors. Flow cytometry, immunofluorescence, Western blot, and Real-time quantitative PCR were employed to detect intracellular Ca2+ fluorescence intensity, the expression of macrophage (Mac) CD68 and mast cell (MC) tryptase, as well as the protein and mRNA expression of TRPV2 and TRPV4 in acupoint tissues after PGLA embedding.ResultsThe results indicate that ACE using PGLA suture significantly increases the mRNA and protein expression of TRPV2 and TRPV4, Ca2+ fluorescence intensity, and the expression of Mac CD68 and MC tryptase in acupoint tissues, with these effects diminishing over time. The increasing trends are reduced after using inhibitors, particularly when both inhibitors are used simultaneously. Furthermore, correlation analysis shows that embedding PGLA suture at the ST36 acupoint regulates Mac and MC functions through Ca2+ signaling involving not only TRPV2 and TRPV4 but multiple pathways.DiscussionThese results suggest that embedding PGLA suture at the ST36 acupoint generates mechanical physical stimulation and regulates TRPV2 and TRPV4 ion channels, which couple with Ca2+ signaling to form a linkage effect that gradually weakens over time. This provides new reference data for further studies on the stimulation effects and clinical promotion of ACE.

This study aims to elucidate the anti-hypoxia mechanism of sesamoside, an active component of Phlomis younghusbandii Mukerjee , through a network pharmacology approach. Sesamoside has demonstrated potential anti-oxidant and antiglycation activities. The hypoxia-related disease targets were collected from databases like GeneCards and OMIM. Protein-protein interaction (PPI) networks were constructed using the STRING database. GO/KEGG enrichment analysis was performed using the Metascape database to identify biological processes and signaling pathways. Our results indicate that sesamoside interacts with multiple targets related to glucose and lipid metabolism, nucleotide metabolism, and inflammatory, and we find that AKR1B1 (AR) plays a crucial role in sesamoside responses to hypoxia. Molecular docking studies were performed using Autodock software, revealing good binding activity between sesamoside and AR. We then use CCK-8 assay, qPCR, WB, and ELISA analysis to validate the role of sesamoside in regulating AR and participating in anti-hypoxia through cell experiments. The results show that compared with the hypoxia group, sesamoside treatment significantly improves the expression of AR and inflammation cytokines. In summary, this study sheds light on the anti-hypoxia mechanism of sesamoside using a network pharmacology approach, providing a theoretical basis and experimental foundation for its application in the prevention and treatment of hypoxic diseases.

Abstract Background Frailty not only affects disease survival but also impacts the long-term function and quality life of all adults diagnosed with and/or treated for cancer.The American Heart Association has introduced Life’s Essential 8 (LE8) as a novel metric for assessing cardiovascular health. Currently, LE8’s application in evaluating the frailty of cancer survivors remains unreported. This research seeks to explore the connection between LE8 scores and frailty levels in cancer survivors across the United States, thereby addressing a significant void in existing studies. Methods This study analyzed data from cancer survivors enrolled in the National Health and Nutrition Examination Surveys (NHANES) spanning the years 2005 to 2018, providing a comprehensive dataset. Multivariable logistic regression models were used to examine the linkage between LE8 rankings and frailty condition in cancer survivors. Furthermore, the study delved deeper into this correlation using restricted cubic spline (RCS) curves and subgroup analyses. Results In the fully adjusted model, an increased LE8 level was closely associated with a reduced odds ratio of frailty among cancer survivors, with an OR of 0.95 (95% CI: 0.94–0.96, p

Abstract Ischemic stroke produces the highest adult disability. Despite successful recanalization, no-reflow, or the futile restoration of the cerebral perfusion after ischemia, is a major cause of brain lesion expansion. However, the vascular mechanism underlying this hypoperfusion is largely unknown, and no approach is available to actively promote optimal reperfusion to treat no-reflow. Here, by combining two-photon laser scanning microscopy (2PLSM) and a mouse middle cerebral arteriolar occlusion (MCAO) model, we find myogenic vasomotion deficits correlated with post-ischemic cerebral circulation interruptions and no-reflow. Transient occlusion-induced transient loss of mitochondrial membrane potential (ΔΨm) permanently impairs mitochondria-endoplasmic reticulum (ER) contacts and abolish Ca2+ oscillation in smooth muscle cells (SMCs), the driving force of myogenic spontaneous vasomotion. Furthermore, tethering mitochondria and ER by specific overexpression of ME-Linker in SMCs restores cytosolic Ca2+ homeostasis, remotivates myogenic spontaneous vasomotion, achieves optimal reperfusion, and ameliorates neurological injury. Collectively, the maintaining of arteriolar myogenic vasomotion and mitochondria-ER contacts in SMCs, are of critical importance in preventing post-ischemic no-reflow.

γ-Aminobutyric acid (GABA), a nonprotein amino acid, can accumulate in plants in response to abiotic stresses. The effects of postharvest treatments on endogenous GABA concentrations and exogenous GABA on whole horticulture product quality has recently received attention. However, knowledge of the effects of mechanical damage events such as peeling and cutting on GABA concentrations of fresh-cut products is limited. In this study, concentrations of GABA and antioxidants including total phenolics and ascorbic acid in fresh-cut cantaloupe, pineapple, and cauliflower during storage at 5 °C for 9 days were investigated. We found that GABA accumulated in fresh-cut pineapple and cauliflower during storage, but that the increase in cantaloupe was not significant. Total phenolics, total ascorbic acid, and dehydroascorbic acid (DHA) remained stable in fresh-cut cantaloupe and cauliflower. In pineapple, however, total phenolics and total ascorbic acid concentrations decreased, whereas the DHA concentration increased. No correlation was found between GABA and antioxidants in fresh-cut cauliflower and cantaloupe; however, GABA was negatively related to antioxidants, including total phenolics and total ascorbic acid, in fresh-cut pineapple. The results show that GABA accumulation may represent a stress response to damage that occurs during the preparation of fresh cut products, but that the degree of response is affected by the specific product. Further research of GABA metabolism in response to minimal processing, including GABA biosynthesis, in a wider range of horticultural products and relationships with antioxidants is warranted.

BackgroundChatGPT is a natural language processing model developed by OpenAI, which can be iteratively updated and optimized to accommodate the changing and complex requirements of human verbal communication. ObjectiveThe study aimed to evaluate ChatGPT’s accuracy in answering orthopedics-related multiple-choice questions (MCQs) and assess its short-term effects as a learning aid through a randomized controlled trial. In addition, long-term effects on student performance in other subjects were measured using final examination results. MethodsWe first evaluated ChatGPT’s accuracy in answering MCQs pertaining to orthopedics across various question formats. Then, 129 undergraduate medical students participated in a randomized controlled study in which the ChatGPT group used ChatGPT as a learning tool, while the control group was prohibited from using artificial intelligence software to support learning. Following a 2-week intervention, the 2 groups’ understanding of orthopedics was assessed by an orthopedics test, and variations in the 2 groups’ performance in other disciplines were noted through a follow-up at the end of the semester. ResultsChatGPT-4.0 answered 1051 orthopedics-related MCQs with a 70.60% (742/1051) accuracy rate, including 71.8% (237/330) accuracy for A1 MCQs, 73.7% (330/448) accuracy for A2 MCQs, 70.2% (92/131) accuracy for A3/4 MCQs, and 58.5% (83/142) accuracy for case analysis MCQs. As of April 7, 2023, a total of 129 individuals participated in the experiment. However, 19 individuals withdrew from the experiment at various phases; thus, as of July 1, 2023, a total of 110 individuals accomplished the trial and completed all follow-up work. After we intervened in the learning style of the students in the short term, the ChatGPT group answered more questions correctly than the control group (ChatGPT group: mean 141.20, SD 26.68; control group: mean 130.80, SD 25.56; P=.04) in the orthopedics test, particularly on A1 (ChatGPT group: mean 46.57, SD 8.52; control group: mean 42.18, SD 9.43; P=.01), A2 (ChatGPT group: mean 60.59, SD 10.58; control group: mean 56.66, SD 9.91; P=.047), and A3/4 MCQs (ChatGPT group: mean 19.57, SD 5.48; control group: mean 16.46, SD 4.58; P=.002). At the end of the semester, we found that the ChatGPT group performed better on final examinations in surgery (ChatGPT group: mean 76.54, SD 9.79; control group: mean 72.54, SD 8.11; P=.02) and obstetrics and gynecology (ChatGPT group: mean 75.98, SD 8.94; control group: mean 72.54, SD 8.66; P=.04) than the control group. ConclusionsChatGPT answers orthopedics-related MCQs accurately, and students using it excel in both short-term and long-term assessments. Our findings strongly support ChatGPT’s integration into medical education, enhancing contemporary instructional methods. Trial RegistrationChinese Clinical Trial Registry Chictr2300071774; https://www.chictr.org.cn/hvshowproject.html ?id=225740&v=1.0

Wave- and current-supported fluid mud on gently sloped continental shelves represents a type of sediment gravity flow capable of rapidly transporting substantial sediment over short periods, significantly contributing to coastal geomorphic evolution. To investigate the dynamics of intertidal fluid mud events, in-situ observations were conducted from May 9 to May 18, 2017, using a seabed tripod system at the lower intertidal flat of the central Jiangsu coast, China. Fluid mud was observed following a medium wind-wave event, with a maximum significant wave height of 0.42 m. The liquefied seabed, loosened by liquefaction, facilitated bed erosion and sediment resuspension. Fluid mud layers, with mean suspended sediment concentrations (SSCs) exceeding 10 g/L, periodically formed during high slack tide, early flood, and late ebb phases. These layers varied in thickness from 4 cm to 20 cm and exhibited strong stratification caused by suspended sediment. Fluid mud disappeared when the bottom turbulence kinetic energy exceeded a threshold of 0.00045 m²/s² due to an increase in current velocity. The downslope movement of intertidal fluid mud was estimated using a theoretical buoyancy-friction model and validated by observed offshore-directed velocity jets at 0.1 m above the seabed during high slack tide phases. Additionally, onshore winds favored fluid mud formation during early flood phases, while offshore winds favored it during late ebb phases. These observations suggest that fluid mud can form on intertidal flats under conditions where tidal flows and winds align, contributing to a deeper understanding of the formation mechanisms of shallow gravity flows and the improvement of sediment transport models.

Thyroid cancer, the most prevalent cancer of the endocrine system and cervical region, has experienced a significant increase in incidence over recent decades. Nanomedicine has fundamentally revolutionized cancer treatment, particularly through the development of multifunctional nano-therapeutics. The progress in this field has been facilitated by the distinctive properties of nanomaterials, such as their capacity to perform several functions, be modified, and offer various detection methods. These features allow for non-invasive and practical diagnostic techniques through versatile imaging. Surface engineering plays a pivotal role in the design of multifunctional nano-systems for localized drug delivery against thyroid cancer. Nano-systems can be customized via surface modification techniques, such as functionalization with targeting ligands and inclusion of therapeutic drugs. This customization allows the nano-systems to specifically target cancer cells while reducing the impact on non-target cells. As a result, bovine serum albumin-coated nanostructures have emerged as powerful diagnostic and targeting nanosystems for thyroid cancer. This targeted strategy enhances the effectiveness of cancer treatment while reducing overall body toxicity. This comprehensive review aims to provide an extensive overview of the latest advancements in surface-engineered nanoparticle-based approaches for both diagnosing and treating thyroid cancer. It highlights the promising research endeavors aimed at creating novel and effective multifunctional nanomedicine for localized delivery to thyroid cancer sites. The review examines different nanomedicines that have been developed for cancer treatment and diagnosis. It also analyzes the current trends, future possibilities, and obstacles in this rapidly advancing sector. By synthesizing the current state of knowledge on surface-engineered multifunctional nano-systems, this review contributes to a better understanding of their potential applications in thyroid cancer treatment and paves the way for future research directions in this promising field of nanomedicine.

BackgroundMalnutrition is strongly correlated with worsened treatment outcomes, reduced standard of living, and heightened mortality rates among individuals with cancer. Our research explores how the Geriatric Nutritional Risk Index (GNRI), a measure of nutritional status, relates to all-cause mortality, cancer-specific, and non-cancer mortality among middle-aged and older adult cancer patients.MethodsWe enrolled 3,253 participants aged 40 and above who were diagnosed with cancer. The data was obtained from the National Health and Nutrition Examination Survey (NHANES) dataset covering the period from 2001 to 2018, with a median follow-up duration of 83 months. According to the GNRI levels, patients in the study were classified into two distinct groups: the group with a low GNRI (

Computed tomography (CT) imaging is widely applied to identify tumors and internal injuries in the body. CT image retargeting involves reducing the size of less important areas (like normal organs) either horizontally or vertically, while maintaining the size of key areas (such as affected organs) in the CT image. This retargeting process can significantly improve the way CT images are displayed, which can be advantageous for further educational tasks, e.g., optimally displaying CT images to medical students. This paper focuses on effectively merging multiple channels of perceptual visual features for retargeting CT images with intricate spatial layouts. The key objective is to develop an active learning model that identifies where human attention is directed in a scenery. To capture both semantically and visually important elements in each CT image, we use the BING objectness descriptor, which quickly and accurately localize objects or their parts across multiple scales. Herein, multi-channel low-level features describe each object-aware patch. In an effort to characterize how humans perceive important scenic elements, we propose a locality-preserved and interactive active learning (LIAL) approach. This method sequentially generates gaze shift paths (GSP) for each CT image. Due to the high dimensionality of such GSP feature, a distribution-preserved feature selection (DPFS) is designed to acquire a few highly discriminative GSP features. Last, these refined GSP features are combined by a Gaussian mixture model (GMM) to retarget CT images. Extensive empirical studies demonstrate the power of the designed method.

Polyurethane (PU) materials are extensively utilized in power equipment. This paper introduces a comprehensive evaluation method that combines electromagnetics and computational chemistry based on the Density Functional Theory (DFT) to elucidate the impact of external electric fields on the molecular structure of PU during electrical contact. The study focuses on the microstructural and molecular energy changes in the hard (HS) and soft (SS) segments of PU under the influence of an electric field of uniform intensity. Findings indicate that the total energy of HS molecules decreases markedly as the electric field intensity increases, accompanied by a significant rise in both the dipole moment and polarizability. Conversely, the total energy and polarizability of the SS molecules decrease, while the dipole moment experiences a slight increase. Under the influence of a strong electric field, HS molecules tend to stretch towards the extremities of the main chain, leading to structural instability and the cleavage of hydroxyl O-H bonds. Meanwhile, the carbon chain of the SS molecules twists towards the center under the electric field, with no chemical bond rupture observed. At an electric field intensity of 8.227 V/nm, the HOMO-LUMO gap of the HS molecule narrows sharply, signifying a rapid decline in the molecular structure stability, corroborated by infrared spectroscopy analysis. These findings offer theoretical insights and guidance for the modification of PU materials in power equipment applications.

Background Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample. Methods and Results We analyzed data from young adults, aged 18 to 39 years, with untreated BP

Background: This study aimed to construct a nomogram based on CAF features to predict the cancer-specific survival (CSS) rates of locally advanced rectal cancer (LARC) patients. Methods: The EPIC algorithm was employed to calculate the proportion of CAFs. based on the differentially expressed genes between the high and low CAF proportion subgroups, prognostic genes were identified via LASSO and Cox regression analyses. They were then used to construct a prognostic risk signature. Moreover, the GSE39582 and GGSE38832 datasets were used for external validation. Lastly, the level of immune infiltration was evaluated using ssGSEA, ESTIMATE, CIBERSORTx, and TIMER. Results: A higher level of CAF infiltration was associated with a worse prognosis. Additionally, the number of metastasized lymph nodes and distant metastases, as well as the level of immune infiltration were higher in the high CAF proportion subgroup. Five prognostic genes (SMOC2, TUBAL3, C2CD4A, MAP1B, BMP8A) were identified and subsequently incorporated into the prognostic risk signature to predict the 1-, 3-, and 5-year CSS rates in the training and validation sets. Differences in survival rates were also determined in the external validation cohort. Furthermore, independent prognostic factors, including TNM stage and risk score, were combined to established a nomogram. Notably, our results revealed that the proportions of macrophages and neutrophils and the levels of cytokines secreted by M2 macrophages were higher in the high-risk subgroup. Finally, the prognostic genes were significantly associated with the level of immune cell infiltration. Conclusion: Herein, a nomogram based on CAF features was developed to predict the CSS rate of LARC patients. The risk model was capable of reflecting differences in the level of immune cell infiltration.

Microbial metabolites have been indicated to communicate with the host’s endocrine system, regulating hormone production, immune-endocrine communications, and interactions along the gut-brain axis, eventually affecting the occurrence of endocrine cancer. Furthermore, microbiota metabolites such as short-chain fatty acids (SCFAs) have been found to affect the tumor microenvironment and boost immunity against tumors. SCFAs, including butyrate and acetate, have been demonstrated to exert anti-proliferative and anti-protective activity on pancreatic cancer cells. The employing of microbial metabolic products in conjunction with radiation and chemotherapy has shown promising outcomes in terms of reducing treatment side effects and boosting effectiveness. Certain metabolites, such as valerate and butyrate, have been made known to improve the efficiency of CAR T-cell treatment, whilst others, such as indole-derived tryptophan metabolites, have been shown to inhibit tumor immunity. This review explores the intricate interplay between microbial metabolites and endocrine tumorigenesis, spanning mechanistic insights to the discovery of potential therapeutic biomarkers.

Abstract Engineering experience shows that for transformers with long service life and serious moisture exposure, the inter‐turn paper insulation inside the winding will precipitate bubbles under the condition of electric field and conductor heating, which will endanger the equipment insulation. In order to explore the influence factors of bubbles formation in the moist insulating paper of transformers, based on the existing research on the influence of moisture content and gas dissolution in transformer oil, this study further considers the influence of air pressure (AP) and electric field and establishes an experimental platform to change the air pressure and electric field, thereby studying the formation characteristics of bubbles in oil‐paper insulation. The results show that air pressure and electric field can affect the initial temperature, volume, and shape of bubble formation. From 0 to −0.05 MPa for air pressure, the initial temperature of bubble generation decreased by 41°C, its maximum two‐dimensional projected area increased by 418.4% with more severe distortion, and the breakdown voltage decreased. When the AC voltage applied on the needle plate electrode increased from 0 to 10 kV, the initial temperature of bubble formation increased by 29°C, and the maximum two‐dimensional projection area increased by 336.6%.

Infrared thermography has been widely used in the monitoring and diagnosis of power equipment to ensure the reliable functioning of power systems because of its non-contact and rapid capabilities. With the promotion of intelligent detection schemes in daily patrol inspection of power equipment by utilities, the amount of infrared images of power equipment (IIOPE) is growing geometrically. The research community has begun using deep learning technology to automatically detect objects in the IIOPE. However, the performance of existing detection methods is still not satisfactory because of the inherent attributes of power equipment infrared images, such as low contrast, complex background, and multi-scale object distribution. This research proposes an anchor-free detection model based on ConvNeXt to address these issues. An enhanced feature pyramid network (FPN) is presented to address the issue of multi-scale object distribution in the IIOPE. In addition, a dynamic soft label assignment strategy is proposed for precise object localization. Extensive experimental results on the self-built IIOPE dataset and the PASCAL VOC 2007 dataset demonstrate that the proposed method yields positive results. When compared to the current anchor-based as well as anchor-free infrared image detectors for power equipment, the proposed model offers improved accuracy while ensuring the detection speed that may satisfy the practical requirements.

Abstract The globally booming renewable power industry has stimulated an unprecedented interest in metals as key infrastructure components. Many economies with different endowments and levels of technology participate in various production stages and cultivate value in global renewable power industry production networks, known as global renewable power value chains (RPVCs), complicating the identification of metal supply for the subsequent low-carbon power generation and demand. Here, we use a multi-regional input-output model (MRIO) combined with a value chain decomposition model to trace the metal footprints (MFs) and value-added of major global economies’ renewable power sectors. We find that the MFs of the global renewable power demand increased by 97% during 2005—2015. Developed economies occupy the high-end segments of RPVCs while allocating metal-intensive (but low value-added) production activities to developing economies. The fast-growing demand for renewable power in developed economies or developing economies with upper middle income, particularly China, is a major contributor to the embodied metal transfer increment within RPVCs, which is partly offset by the declining metal intensities in developing economies. Therefore, it is urgent to establish a metal-efficient and green supply chain for upstream suppliers as well as downstream renewable power installers for just transition in the power sector across the globe.

Abstract Cellulose insulation paper is the main component of oil‐paper insulation systems in oil‐immersed transformers. However, the poor thermal conductivity and thermal stability of the cellulose can lead to thermal ageing. It is critical to address this issue by improving the performance of cellulose, nano‐SiC‐modified cellulose models were established by molecular simulation, while nano‐SiC composite papersheets were prepared based on the simulation results, and the effects of different contents of nano‐SiC on the papersheets were investigated. Macroscopically, doping nano‐SiC particles can enhance the thermal stability of cellulose; compared with the unmodified papersheet, the thermal conductivity and tensile strength of the modified papersheets are increased by 44.3% and 42.8%, respectively. The degree of polymerisation of the modified papersheet decreased more slowly than that of the unmodified papersheet under accelerated thermal ageing, showing that the modified papersheet has better anti‐ageing properties. Microscopically, with the addition of nano‐SiC, the simulations showed that the mean square displacement of the cellulose decreases dramatically and the distribution of the free volume becomes difficult to disperse, which corresponds to the decrease in porosity in the experiments. As a result, this research provides a way for improving the thermal‐mechanical properties of cellulose that has practical application significance.

Background Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long‐term impact of 4 hypertension management strategies in SPRINT‐eligible US adults. Methods and Results The validated Blood Pressure Control–Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT‐eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP

The insulation performance of oil-immersed paper bushings is prone to deteriorate, primarily due to moisture intrusion and thermal aging. The frequency domain spectroscopy (FDS) method is commonly employed to assess the insulation condition of the bushing. However, identifying and extracting relaxation polarization information from the low-frequency region of the FDS curve can be challenging, and there is little research about the condition evaluation under the combined effects of aging states and moisture content. To address this issue, this article uses the Taylor formula mathematical model to extract characteristic parameters from the dielectric modulus curve of OIP bushings and uses the KNN algorithm to achieve the evaluation of aging and moisture status. Then, the effectiveness and accuracy of the proposed method are validated on three field OIP bushings. The results demonstrate that the evaluation accuracy of the proposed method exceeds 83%, which has significant advantages compared to other classification algorithms. The innovation of this article lies in extracting new feature parameters and combining them with intelligent classification algorithms to evaluate the moisture and aging state of the bushing.

Land use transition (LUT) impacts regional land use and the ecological environment. To reveal LUT and its ecological effects in karst mountain areas (KMA) of Southwest China, this paper first constructs a correlation model between LUT and ecological restoration in the region and carries out an example verification in the typical KMA, the Huajiang Canyon. The study demonstrates that: (1) LUT has occurred in KMA of Southwest China, mainly, the area of sloping cropland has decreased, and the forest land has increased. Land use patterns have shifted from traditional farming to modernized economic and fruit forestry; (2) The driving forces of LUT in KMA of Southwest China can be summarized into three factors: socio-economic, natural, and policy, among which natural factors are the basic conditions of LUT, socio-economic factors play a decisive role in the process of LUT, and policy factors provide policy guarantee for LUT; (3) LUT in KMA of Southwest China has curbed land degradation, promoted ecosystem restoration, and made a certain contribution making China greener, which is conducive to achieving the goal of sustainable development. This paper explores the characteristics of LUT and its driving forces in KMA of Southwest China from the coupling analysis of LUT and ecosystem, reveals the effects of LUT in KMA of Southwest China, and provides some theoretical references for the balance between high-quality development and ecological protection in KMA of Southwest China from the perspective of LUT.

Abstract The low-carbon power transition, which is key to combatting climate change, has far-reaching effects on achieving the Sustainable Development Goals (SDGs) in terms of issues such as resource use, environmental emissions, employment, and many more. Here, we assess the potential impacts of the power transition on progress toward achieving multiple SDGs (covering 18 targets across the 17 goals) across 49 economies under nine socioeconomic and climate scenarios. We find that the low-carbon power transition under the representative concentration pathway (RCP)2.6 scenarios could lead to an approximately 11% improvement in the global SDG index score from 54.70 in 2015 to 59.89-61.33 in 2100. However, the improvement would be significantly decreased to 4.42%-7.40% and 7.55%-8.93% under the RCP6.0 and RCP4.5 scenarios, respectively. The power transition could improve the overall SDG index in most developed economies under all scenarios while undermining their resource-related SDG scores. Power transition-induced changes in international trade would improve the SDG progress of developed economies but jeopardize that of developing economies, which usually serve as resource hubs for meeting the demand for low-carbon power transition in developed economies.

Under a high-cost scenario for battery critical materials, the uptake of electric vehicles in China may be greatly reduced, leading to increased cumulative carbon emissions. This may jeopardize both China’s electric vehicle and climate targets.

Film capacitors have widely been used in modern electrical/electronic equipment because of their high insulation property and high-power density. However, the traditional dielectric films suffered a high conduction loss under high temperature and electric field conditions, which leads to the depression of high temperature energy storage properties. Herein, sandwich-structured composite films using biaxially oriented polyethylene terephthalate (BOPET) as the outer layers were prepared to construct the interfacial barrier, which was beneficial for hindering the propagation of breakdown path. In addition, epoxy resin was applied as the adhesive inner layer to bind the outer layers up tightly, while the boron nitride nanosheets (BNNSs) in the inner layer further improved the breakdown strength of the film and inhibited the conduction loss, especially under high temperature and electric field conditions. The composite film with optimized BNNSs content had a high discharged energy density of 9.11 J/cm3 and a ultrahigh charge–discharge efficiency of 95% at 25 °C, while the values were 6.45 J/cm3 and 70% at 150 °C, respectively, of which both were much higher than those of pure BOPET. Thus, the sandwich-structure method points out a promising way of preparing dielectric films with excellent energy storage performances.

In the rosacea an unstable skin microbiota is significant for disease progression. However, data on the influence on the skin microbiota of treatment with systemic antibiotics are limited. This single-arm trial recruited patients with rosacea. Oral minocycline 50 mg was administered twice daily for 6 weeks. The lesions on the cheek and nose were sampled for 16S rRNA amplicon sequencing and metagenomic sequencing at baseline, 3 weeks and 6 weeks of treatment. Physiological parameters were detected using non-invasive instruments. After treatment, distribution of the Investigator Global Assessment scores changed significantly. For the skin microbiota, a notable increase in α-diversity and a shift of structure were observed after treatment. Treatment was accompanied by a reduction in the relative abundance of Cutibacterium and Staphylococcus, indicating negative correlations with increased bacterial metabolic pathways, such as butyrate synthesis and L-tryptophan degradation. The increased butyrate and tryptophan metabolites would be conducive to inhibiting skin inflammation and promoting skin barrier repair. In addition, the abundance of skin bacterial genes related to tetracycline resistance and multidrug resistance increased notably after antibiotic treatment.

Background: The gut microbiota is a complex microbial community that changes in response to various intestinal diseases, including aging-related diseases such as sarcopenia. Several studies have shown that the metabolites of the gut microbiota affect the dynamic balance of the skeletal muscle. However, the effect of gut microbiota imbalance on sarcopenia is still largely unknown. Methods: We collected the baseline characteristics and fecal samples of 14 patients with sarcopenia and 21 patients without sarcopenia, and used the 16S rRNA sequencing technology to analyze the differences in the gut microbiota in the two groups. α-diversity and β-diversity were employed to assess the abundance and diversity of species and variations in microflora composition, respectively. Moreover, Tax4Fun was employed to predict the functional capacities of the microbial communities. Results: In the sarcopenia group, the abundances of beneficial bacteria such as Bacteroides, Faecalibacterium, Fusobacterium, and Prevotella were reduced, whereas those of pathogenic bacteria, such as Escherichia-Shigella and Klebsiella, were increased. The genera and species of the family Enterobacteriaceae were the main pathogenic bacteria in patients with sarcopenia, and Escherichia-Shigella and Klebsiella could be used as key biomarkers of sarcopenia. The defective protein processing and amino acid synthesis pathways in patients with sarcopenia indicated that protein synthesis and nutrient transport may be damaged. Moreover, the abundances of Escherichia-Shigella and Enterobacteriaceae have been found to have a negative correlation with muscle mass and were the main parameters predicting the change in muscle mass. Conclusions: In this study, we have identified changes in the gut microbiota of sarcopenic individuals, which were linked to the loss of muscle mass and function. Escherichia-Shigella is a conditional pathogen of sarcopenic patients, and its levels are found to have a significant negative correlation with muscle mass.

Abstract Harmful algal blooms (HABs), which are promoted by eutrophication and intensified by global warming, occur worldwide. Allelochemicals, which are natural chemicals derived from plants or microbes, are emerging weapons to eliminate these blooms. However, the cost and technical challenges have limited the discovery of novel antialgal allelochemicals. Herein, the decomposition of agricultural straws is manipulated by white‐rot fungi and achieved elevated antialgal efficiency. The transcriptomic analysis reveals that nutrient limitation activated fungal decomposition. By using a comparative nontarget metabolomics approach, a new type of allelochemical sphingosines (including sphinganine, phytosphingosine, sphingosine, and N‐acetylsphingosine) is identified. These novel natural algaecides exhibit superior antialgal capability, with as high as an order of magnitude lower effective concentration on blooming species than other prevalent allelochemicals. The co‐expression relationship between transcriptomic and metabolomic results indicate that sphinganine is strongly correlated with the differentially expressed lignocellulose degradation unigenes. The algal growth suppression is triggered by the activation of programmed cell death, malfunction of algal photosystem and antioxidant system, the disruption on CO2 assimilation and light absorption. The sphingosines reported here are a new category of allelochemicals in addition to the well‐known antialgal natural chemicals, which are potential species‐specific agents for HABs control identified by multi‐omics methodology.

Following the surge in power loads and continuous improvement in the voltage level, insulating papers' mechanical and electrical properties face new challenges. However, traditional inefficient “tentative” trial and error experiments are formidable to rapidly and efficiently prepare cellulose composite insulating paper because the direct scientific theory or simulation guidance is insufficient. To solve this problem, the nano-silica(nano-SiO2)/polyimide(PI)/cellulose composite models were designed and their mechanical, and dielectric properties were predicted by molecular dynamics (MD) simulation. The preparation of corresponding nano-SiO2/PI/cellulose insulating paper was guided by the MD simulation results and their surface morphology, mechanical properties, and electrical properties were investigated. The experimental results are in good agreement with the MD simulation results and confirmed that P3 insulating paper possesses the best comprehensive performance, and its tensile strength, relative permittivity, dielectric loss, volume resistivity, and breakdown strength are 71.44 MPa, 2.39, 0.2%, 5.16 × 1015 Ω∙m, and 75.8 kV∙mm−1, respectively. This work proves the feasibility and effectiveness of using MD simulation to guide the development of new insulating papers, and compared with the existing traditional preparation methods, this method is expected to be applied to study various new materials in the future and promote the vigorous development of new materials.

Abstract The ageing kinetic model is regarded as an effective tool to describe the degradation of transformer paper insulation. However, the temperature of the transformer winding is unevenly distributed, and the existing ageing kinetic models only depend on experimental data of accelerated thermal ageing at a constant temperature. Given this issue, this work proposes an improved second‐order kinetic model accounting for the non‐uniform thermal field. First, oil‐paper insulation samples with different ageing stages are prepared under the non‐uniform thermal field. Then, the sample's experimental data of moisture dispersion and distribution of degree of polymerisation are collected. On this basis, the improved second‐order kinetic model is derived to simulate insulating paper's ageing process subjected to an axial temperature gradient. Further, the relationship of the parameters in the improved second‐order kinetic model with the temperature and moisture content at different winding heights is obtained. Finally, the proposed model is validated, and the results show that the proposed model is more scientific than the traditional models to describe the degradation of paper insulation. In that respect, this work illustrates an improved second‐order kinetic model to provide a reference for the ageing assessment/life prediction of transformer paper insulation under the non‐uniform thermal field.

Research suggests that to eliminate undesirable effects of the scale layer, natural wool needs to be surface-modified before further application to textile manufacture, obtaining better properties of shrink-resistance, washing/felting and dyeing. However, previous methods exhibited some disadvantages, such as the adsorbable organic halogens (AOX) pollution from chloride treatment and severe fiber damage caused by enzyme treatment. Therefore, thiol-based ionic liquid was introduced onto the surface modification of wool to counter these defects. In this modification process, the surface modification was controlled on the wool surface using scanning electron microscopy (SEM) with evaluation of the effects of cleavage of disulfide bonds ascertained by the X-ray energy dispersive spectroscopy (EDS) results. The solubility in alkali and Fourier transform infrared spectroscopy (FTIR) spectra further indicated that the process could prevent main body damage of the fiber, the decreased content of the α-helix structure was evaluated from X-ray diffraction (XRD) and differential scanning calorimeter (DSC) curves. Furthermore, the hydrophilic performance of the modified wool, including wettability and the dye-ability, revealed an apparent enhancement compared to that of raw wool. In a summary, the thiol-based ionic liquid approach can efficiently improve hydrophilic properties of wool, and has the potential for large-scale production.

Objective: We evaluated the prospective association of midlife leisure-time physical activity (LTPA) and sedentary behavior (SB), and their temporal patterns, with MRI-measured carotid atherosclerotic morphology. Methods: Participants enrolled in the Carotid MRI substudy (2004–2006) of the Atherosclerosis Risk in Communities (ARIC) Study and with self-reported assessments of LTPA and SB at visits 1 (1987–1989) and 3 (1993–1995) were included in this study. LTPA was ascertained using the ARIC/Baecke physical activity questionnaire and categorized according to the American Heart Association's metric of poor, intermediate, or ideal physical activity. SB, measured as TV viewing frequency, was categorized as high, medium, and low. We used multivariable adjusted linear and logistic regression models to examine the associations between midlife (visit 3 only) and persistent (visit 1 to 3) LTPA and TV viewing with carotid artery plaque burden and components. Results: Among the 1,582 (mean age: 59 years, 43% male, 18% Black) participants, 45.7%, 21.7%, and 32.6% reported ideal, intermediate, or poor LTPA, respectively. High TV viewing was reported in 33.8% of participants, with 46.4% and 19.8% reporting medium or low TV viewing, respectively. Compared to poor LTPA, ideal LTPA in midlife was not associated with total wall volume (ß=0.01, 95% CI: -0.01, 0.03), maximum carotid wall thickness (ß=0.06, 95% CI: -0.08, 0.21), normalized wall index (ß=-0.01, 95% CI: -0.03, 0.01), or maximum stenosis (ß=-0.11, 95% CI: -1.98, 1.76). Low or middle, compared to high, TV viewing was also not associated with carotid artery measures of plaque burden. Compared to poor LTPA or high TV viewing, ideal LTPA (odds ratio (OR): 0.82, 95% CI: 0.55, 1.23) and low TV viewing (OR=0.90, 95% CI: 0.56, 1.44) was not associated with odds of lipid core presence, respectively. Conclusion: Overall, this study does not provide strong evidence for an association between LTPA and SB with carotid plaque measures.

Power transformers are one of the most expensive and important equipment in the power system. Significant differences exist in the insulation lifespan of transformers that have been in operation for more than 20 years, and using identical maintenance or scrapping methods may result in significant economic losses. However, most existing transformer life assessment methods only consider the impact of moisture content on the life decay rate without considering the impact of oil circulation cooling modes, which leads to some evaluation errors. In this study, we established a new transformer life assessment method that considers the influence of moisture content and oil circulation cooling modes, which is more accurate than most life assessment methods. Then, the proposed life evaluation method was validated on the on-site transformers, demonstrating its accuracy and effectiveness. The novelty of this study is that it establishes a new on-site transformer life assessment method that considers the comprehensive effect of moisture content and oil circulation cooling mode, which helps to evaluate the remaining lifespan of power transformers more accurately and thus extends the transformer lifespan systematically.

Intermountain basins are the granaries of the karst mountains of southwest China. Revealing the process and trend of land-use transformation in typical mountainous “granaries” is of great significance to optimizing land-use, food security, and rural revitalization in the karst mountains of southwest China. Lianjiang basin in Huishui County is the largest in Guizhou Province of southwest China, and a typical mountainous “granary” is used as a case study area. Based on seven periods of high-definition remote sensing images from 1966 to 2020 and on-the-spot investigation, we adopt the analysis methods of landscape pattern, moving window, and buffer zone and conduct an in-depth study on the spatial evolution of land-use and the land-use transformation law of the typical “granaries” of karst mountainous areas in southwest China from the perspectives of changes in the quantity of land-use, changes in the types of land-use, and changes in the landscape pattern. The results showed that the transformation of land-use in the basin was mainly manifested in the transformation of the function of cultivated land and the diversification of the function of cultivated land. The landscape pattern of the basin was gradually transformed from traditional rural landscape to modern agricultural landscape. The gradient effect of land-use evolution and transformation in the study basin was obvious. Traffic, location, and land resources significantly affect land-use transformation in the basin. Based on the above analysis, this paper proposes that the “granary” basins in karst mountainous areas should optimize the land-use of the basin by the trade-off between regional socio-economic development, ecological protection, and food security. The results of this paper provide a reference for land-use optimization and rural development in the granary-type basins and other similar areas in the karst mountains of southwest China.

Combined immune checkpoint blockade (ICB) and photodynamic therapies have huge potential but suffer from possible damage of the antibodies. Here, the authors create a ROS-responsive hydrogel that protects the ICB antibodies and allows for sustained co-delivery and demonstrate restrained regrowth of tumours in vivo.

Abstract In order to ensure the safe operation of submarine cables, it is of great significance to analyse the insulation state of submarine cables from the perspectives of microstructure, carrier transport characteristics and macroscopic dielectric properties. In this study, based on the high‐voltage frequency domain spectroscopy (HV‐FDS) measurement system, HV‐FDS experiments of fresh and thermally aged submarine cables were carried out under continuous (0.5, 2, 4 and 10 kV) and cyclic (2‐10‐2 kV) applied alternating voltages. Then, combining the changes of the microstructure structure of cross‐linked polyethylene (XLPE) insulation, the aggregate structure deterioration model of XLPE was proposed to discuss the physical mechanism of HV‐FDS characteristics of submarine cables under different voltages and insulation states. Results show that the HV‐FDS characteristics of submarine cables have significant voltage dependence under continuous voltage excitation. The HV‐FDS of submarine cables show memory characteristics under cyclic voltage excitation. Compared with the fresh submarine cable, the thermally aged submarine cable shows more significant voltage dependence and memory characteristics of HV‐FDS. The memory characteristics of HV‐FDS are mainly determined by the carriers transport and the interfacial polarisation caused by the accumulation of polar particles at the electrode/dielectric interface. This study covers the correlation mechanism among the microstructure, carrier transport and macroscopic HV‐FDS properties of submarine cable insulation, which lays a foundation for further research and condition evaluation of submarine cables.

Abstract The polarization information contained in the frequency‐domain spectroscopy (FDS) could be utilised for characterising the ageing degree of transformer oil‐immersed insulation. However, the polarization information will be obscured by its conductance effect, it is thus hard to analyse the polarization behaviour by using the traditional FDS technique. Given this issue, an alternative approach is proposed to analyse the polarization information using FDS decoupled by logarithmic‐derivative spectroscopy (LDS). Findings proved that the polarization loss information generated by polarization behaviour can be separated from the total dispersion loss. The proposed feature parameters are later used to analyse the polarization loss information under ageing impact. Also, the polarization loss surface is constructed by using these feature parameters to characterise the ageing degrees of oil‐immersed samples. Finally, the potential possibility of using the proposed method to analyse the polarization loss and ageing degree are respectively discussed.

Salt marshes, which commonly exist on the upper tidal flat, provide a natural barrier against sea level rise and coastal storm. The extremely shallow water stages (water depth< 0.2 m), including the initial stage of flood tides and the last stage of ebb tides, can induce a significant impact on sediment dynamics of saltmarshes and associated tidal flats, despite lasting for only a short time (around 10 min), which has been less studied. In this study, two parallel field sites were established to quantify erosion-accretion processes and morphological changes during extremely shallow water stages in salt marshes within Doulonggang tidal flat along the Jiangsu coast. Our results revealed that obvious accretion occurred during extremely shallow water stages, with a total deposition amount of +33.8 mm in vegetated areas and +20.8 mm in unvegetated areas. In contrast, erosion dominated during deep water stages, with a total erosion amount of -22.3 mm at the vegetated site and -32.7 mm at the unvegetated site. The magnitude of bed-level change during extremely shallow water stages was 7~8 times greater than that during deep water stages, even though the duration of extremely shallow water stages was only about 14~15% of the entire tidal cycle. Furthermore, strong winds significantly impacted deposition during extremely shallow water stages compared to calm weather. During the strong wind period, the average bed level change rate reached +0.15 mm/min and +0.12 mm/min in the vegetated and unvegetated areas, respectively. This is significantly higher than the +0.05 mm/min and +0.01 mm/min during the calm weather period. These results reveal that extremely shallow water stages have substantial impacts on sedimentary processes, which are vital for the maintenance of tidal flat systems.

Photodynamic therapy (PDT) provides an effective therapeutic option for different types of cancer in addition to surgery, radiation, and chemotherapy. The treatment outcome of PDT is largely determined by both the light and dark toxicity of photosensitizers (PSs), which can be technically improved with the assistance of a drug delivery system, especially the nanocarriers. Toluidine blue (TB) is a representative PS that demonstrates high PDT efficacy; however, its application is largely limited by the associated dark toxicity. Inspired by TB’s noncovalent binding with nucleic acids, in this study, we demonstrated that DNA nanogel (NG) could serve as an effective TB delivery vehicle to facilitate anticancer PDT. The DNA/TB NG was constructed by the simple self-assembly between TB and short DNA segments using cisplatin as a crosslinker. Compared with TB alone, DNA/TB NG displayed a controlled TB-releasing behavior, effective cellular uptake, and phototoxicity while reducing the dark toxicity in breast cancer cells MCF-7. This DNA/TB NG represented a promising strategy to improve TB-mediated PDT for cancer treatments.

Abstract The charge transport and accumulation in oil–paper can cause the insulation degradation. So far, the most widely used model to simulate space charge transport and accumulation is the bipolar charge transport (BCT) model, which can well simulate the space charge dynamics. However, there are two shortcomings in the algorithms for solving the BCT model. One is that there is almost no use of vectorisation technology, which may increase the complexity of the algorithm, the other is the usage of fixed step size which might bring extra computation cost. In view of this, an adaptive time‐stepping transient upstream finite element method (FEM) is developed to solve the BCT model considering trapping/detrapping, as well as the recombination phenomenon under DC condition in this article. Then, a vectorisation technology is used in the method to optimise the algorithm. Moreover, the adaptive time‐stepping method is introduced in simulation to reduce computation time and calculation amount. Simulation results are obtained by programing and later presented, which are basically consistent with the corresponding experimental results. Therefore, the proposed method is expected to promote the optimization design of the oil–paper insulation system.

Abstract Background The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach. Methods We retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n = 142), the transabdominal perineal approach for ISR (TPAISR, n = 57), or the transanal pull-through approach for ISR (PAISR, n = 36). Results The PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, 3-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups. Conclusions TAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.

Abstract Purpose To evaluate the impact of the log odds of positive lymph nodes (LODDS) on cancer‐specific survival (CSS) in colon mucinous adenocarcinoma (MAC) patients, compared with pN stage and the lymph nodes ratio (LNR). Methods A total of 10,182 colon MAC patients from the Surveillance, Epidemiology, and End Results database were divided into the training group. The external validation group included 153 patients from Fujian Medical University Union Hospital. The Cox regression method was used to identify prognostic risk factors. Nomograms were evaluated by Harrell's concordance index (C‐index) and calibration curves. Recursive partitioning analysis (RPA) was used to develop a novel staging system. Results Time‐dependent receiver operating characteristic curves (ROC) to predict CSS showed the areas under the ROC curve of LODDS were always higher than pN stage and LNR. LNR and LODDS classifications can well distinguish the prognosis of patients with the same pN stage. Cox analyses indicated that age, tumor size, pT stage, pN stage, LNR, and LODDS were independent predictors of CSS (p

Abstract Background Immunotherapies targeting ligand-receptor interactions (LRIs) are advancing rapidly in the treatment of colorectal cancer (CRC), and LRIs also affect many aspects of CRC development. However, the pattern of LRIs in CRC and their effect on tumor microenvironment and clinical value are still unclear. Methods We delineated the pattern of LRIs in 55,539 single-cell RNA sequencing (scRNA-seq) samples from 29 patients with CRC and three bulk RNA-seq datasets containing data from 1411 CRC patients. Then the influence of tumor microenvironment, immunotherapy and prognosis of CRC patients were comprehensively investigated. Results We calculated the strength of 1893 ligand-receptor pairs between 25 cell types to reconstruct the spatial structure of CRC. We identified tumor subtypes based on LRIs, revealed the relationship between the subtypes and immunotherapy efficacy and explored the ligand-receptor pairs and specific targets affecting the abundance of tumor-infiltrating lymphocytes. Finally, a prognostic model based on ligand-receptor pairs was constructed and validated. Conclusion Overall, through the comprehensive and in-depth investigation of the existing ligand-receptor pairs, this study provides new ideas for CRC subtype classification, a new risk screening tool for CRC patients, and potential ligand-receptor pair targets and pathways for CRC therapy.

Abstract The heterocharge accumulated in the oil‐paper insulation system of the converter transformer will enhance the local electric field and cause insulation deterioration. Numerical simulation is an effective method to analyze heterocharge. Currently, the numerical simulation of heterocharge is mainly based on the bipolar charge transport (BCT) model and the impurity ion transport (IIT) model. However, the effects of temperature, conductivity, and thickness of oil‐impregnated paper on charge transport have not been considered in these models. In view of this, a modified charge transport (MCT) model by introducing the Maxwell–Wagner model and heat conduction equation is proposed in this paper based on the BCT model and IIT model. Then, the influence of multi‐factors (temperature gradient, moisture content, and oil‐impregnated paper thickness) on heterocharge accumulation is investigated by using the MCT model. The simulation results obtained by the MCT model are more consistent with the experimental results than the BCT model, which proves the accuracy and superiority of the MCT model. Moreover, the increase in temperature gradient, moisture content, and oil‐impregnated paper thickness will enlarge the ion dissociation rate, conductivity, and trap density, and thus promote the generation of heterocharge. In that respect, the MCT model is expected to optimize the insulation design and provide a reference for space charge dynamic simulation.

BackgroundNo spatial analysis of hair selenium and Keshan disease (KD) on a nationwide county-level has been performed. Selenium deficiency is a recognized environmental risk factor for KD. Hair selenium is one of the recognized biomarkers of selenium nutrition. This study aimed to perform a geographically precise and visualized assessment of the achievement of KD prevention and control at the level of selenium nutrition in terms of etiology.MethodsA spatial ecological study was conducted. The hair selenium content of the residents was assayed using an atomic fluorescence spectrometer. The spatial analysis was performed using ArcGIS.ResultsThe median of the hair selenium levels of the 3,028 participants in the 1,174 counties was 0.38 mg/kg, and the content of inhabitants in KD endemic counties was significantly lower than that in KD non-endemic counties (0.34 vs. 0.39 mg/kg, z = −10.03, P < 0.0001). The proportion of Se-deficient and Se-marginal counties in KD endemic counties was significantly higher than that in KD non-endemic counties (59.4 vs. 29.0%, z = −7.45, P < 0.0001). The global autocorrelation analysis was not statistically significant (Moran's I = 0.0005, P = 0.68). Local autocorrelation analysis identified 174 low-low clusters of hair selenium levels, 83 (47.7%) of which are KD endemic counties located in KD endemic provinces of Henan, Gansu, Shaanxi, Inner Mongolia, Jilin, and Heilongjiang. The hair selenium featured a positive correlation with per capita GDP (rs = 0.20, P < 0.0001).ConclusionThe median of the hair selenium levels of inhabitants living in KD endemic counties was significantly lower than that in KD non-endemic counties. All the 83 KD endemic counties with low-low clusters of hair selenium levels should be prioritized in KD precision prevention and control. These findings are geographically precise and visualized evidence of the assessment of the effectiveness of KD prevention and control at the level of selenium nutrition in terms of etiology.

BackgroundIn the current tumor–lymph node–metastasis (TNM) staging system for colon neuroendocrine tumors, lymph node status is divided into N1 and N0. An assessment of the lymph node ratio (LNR) and a proposal for a modified mTNM staging system were the objectives of this study.MethodsSelecting the optimal cut-off value of LNR was done using X-tile. A Cox regression model and the Kaplan–Meier method were performed to calculate patient cancer-specific survival in the Surveillance, Epidemiology and End Results cohort. Recursive partitioning analysis was used to improve TNM staging.ResultsThe study included 674 patients. The current TNM staging system showed inadequate discriminatory power between stage I and stage II patients (p = 0.088). The optimal cut-off value was determined as 0.6 for LNR. Based on multivariate Cox regression analysis, the modified mN classification could be classified into mN 0 (LNR = 0.00), mN 1 (LNR = 0.01–0.60), and mN 2 (LNR > 0.60), and was found to be an independent factor affecting prognosis (p