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Thyroid cancer (TC) is a significant global healthcare burden. However, the lack of comprehensive data has impeded our understanding of its global impact. We aimed to examine the burden of TC and its trends at the global, regional, and national levels using data stratified by sociodemographic index (SDI), sex, and age. Data on TC, including incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021, were obtained from the Global Burden of Disease Study 2021. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, mortality, and DALYs trends. The incidence, mortality, and DALYs of TC in 2021 were 249,538 (95% uncertainty interval: 223,290–274,638), 44,799 (39,925–48,541), and 646,741 (599,119–717,357), respectively. The age-standardized incidence rate (ASIR) in 2021 was 2.914 (2.607–3.213), with an EAPC of 1.25 (1.14–1.37) compared to 1990. In 2021, the age-standardized death rate (ASDR) was 0.53 (0.47–0.575) and age-standardized DALYs rate was 14.571 (12.783–16.115). Compared with 1990, the EAPCs of ASDR and age-standardized DALYs rate showed decreasing trends, at − 0.24 (− 0.27 to − 0.21) and − 0.14 (− 0.17 to − 0.11), respectively. Low SDI regions showed the highest ASDR and age-standardized DALYs rate, at 0.642 (0.516–0.799) and 17.976 (14.18–23.06), respectively. Low-middle SDI regions had the highest EAPCs for ASDR and age-standardized DALYs rate, at 0.74 (0.71–0.78) and 0.67 (0.63–0.7), respectively. Females exhibited decreasing trend in ASDR and age-standardized DALYs rate, with EAPCs of − 0.58 (− 0.61 to − 0.55) and − 0.45 (− 0.47 to − 0.42), respectively. In contrast, males showed an increasing trend in ASDR and age-standardized DALYs rate, with EAPCs of 0.41 (0.35–0.46) for both. In high-income regions, most countries with decreased annual changes in deaths experience increasing age-related deaths. Over the past few decades, a notable increase in TC incidence and decreased mortality has been observed globally. Regions characterized by lower SDI, male sex, and an aging population exhibited no improvement in TC mortality. Effective resource allocation, meticulous control of risk factors, and tailored interventions are crucial for addressing these issues. [ABSTRACT FROM AUTHOR]

To shorten the wet-extraction process of vanadium slag and reduce the loss of a large number of valuable elements—such as iron, manganese, and chromium—this study directly used molten vanadium slag to smelt alloys. Vanadium slag with 16 wt.% carbon, 20 wt.% CaO (R = 0.97), and 5 wt.% Al2O3 was reduced at 1550°C for 2 h, and a Fe-V-(Cr-Mn) alloy with Fe-V as the matrix was obtained, which could be used as a raw material for vanadium alloy steel. The valuable elements of iron, vanadium, and chromium in the slag were almost completely reduced. The tailing was mainly composed of Ca3Si3O9, Ca(Mg,Mn)(Si,Al)2O6, and CaAl2SiO6, which are primarily silicates and aluminates. To obtain a better reduction rate of elements, the appropriate reduction temperature, reduction agent, and modification agent were 1500°C, 16–20 wt.% C, and 20 wt.% CaO (R = 0.97), respectively. In addition, by effectively controlling the process parameters, the recovery rate of iron and vanadium could reach as high as 98%, and the recovery rate of chromium and manganese could reach > 90% and 70%, respectively, which could effectively recover valuable elements in vanadium slag and the sensible heat, shorten the vanadium extraction process, and decrease the amount of the three waste types. [ABSTRACT FROM AUTHOR]

Treating Multiple sclerosis (MS), a well-known immune-mediated disease characterized by axonal demyelination, is challenging due to its complex causes. Naphthalenedione, present in numerous plants, is being explored as a potential medicine for MS due to its immunomodulatory properties. However, its effects on lymphocytes can vary depending on factors such as the specific compound, concentration, and experimental conditions. In this study, we aim to explore the therapeutic potential of 2-bromo-1,4-naphthalenedione (BrQ), a derivative of naphthalenedione, in experimental autoimmune encephalomyelitis (EAE), an animal model of MS, and to elucidate its underlying mechanisms. We observed that mice treated with BrQ exhibited reduced severity of EAE symptoms, including lower clinical scores, decreased leukocyte infiltration, and less extensive demyelination in central nervous system. Furthermore, it was noted that BrQ does not directly affect the remyelination process. Through cell-chat analysis based on bulk RNA-seq data, coupled with validation of flow analysis, we discovered that BrQ significantly promotes the expansion of CD8+ T cells and their interactions with other immune cells in peripheral immune system in EAE mice. Subsequent CD8+ T cell depletion experiments confirmed that BrQ alleviates EAE in a CD8+ T cell-dependent manner. Mechanistically, expanded CD8+ cells were found to selectively reduce antigen-specific CD4+ cells and subsequently inhibit Th1 and Th17 cell development in vivo, ultimately leading to relief from EAE. In summary, our findings highlight the crucial role of BrQ in modulating the pathogenesis of MS, suggesting its potential as a novel drug candidate for treating MS and other autoimmune diseases. [ABSTRACT FROM AUTHOR]

The traditional sparse recovery (SR) space-time adaptive processing (STAP) algorithms are greatly affected by grid mismatch, leading to poor performance in airborne bistatic radar clutter suppression. In order to address this issue, this paper proposes an SR STAP algorithm for airborne bistatic radars based on atomic selection under the Bayesian framework. This method adopts the idea of atomic selection for the process of Bayesian inference, continuously evaluating the contribution of atoms to the likelihood function to add or remove atoms, and then using the selected atoms to estimate the clutter support subspace and perform sparse recovery in the clutter support subspace. Due to the inherent sparsity of clutter signals, performing sparse recovery in the clutter support subspace avoids using a massive number of atoms from an overcomplete space-time dictionary, thereby greatly improving computational efficiency. In airborne bistatic radar scenarios where significant grid mismatch exists, this method can mitigate the performance degradation caused by grid mismatch by encrypting grid points. Since the sparse recovery is performed in the clutter support subspace, encrypting grid points does not lead to excessive computational burden. Additionally, this method integrates out the noise term under a new hierarchical Bayesian model, preventing the adverse effects caused by inaccurate noise power estimation during iterations in the traditional SR STAP algorithms, further enhancing its performance. Our simulation results demonstrate the high efficiency and superior clutter suppression performance and target detection performance of this method. [ABSTRACT FROM AUTHOR]

Space–time adaptive processing (STAP) based on sparse recovery achieves excellent clutter suppression and target detection performance, even with a limited number of available training samples. However, most of these methods face performance degradation due to grid mismatch, which impedes their application in bistatic clutter suppression. Some gridless methods, such as atomic norm minimization (ANM), can effectively address grid mismatch issues, yet they are sensitive to parameter settings and array errors. In this article, the authors propose a data and model-driven algorithm that unfolds the iterative process of atomic norm minimization into a deep network. This approach establishes a concrete and systematic link between iterative algorithms, extensively utilized in signal processing, and deep neural networks. This methodology not only addresses the challenges associated with parameter settings in traditional optimization algorithms, but also mitigates the lack of interpretability issues commonly found in deep neural networks. Moreover, due to more rational parameter settings, the proposed algorithm achieves effective clutter suppression with fewer iterations, thereby reducing computational time. Finally, extensive simulation experiments demonstrate the effectiveness of the proposed algorithm in clutter suppression for airborne bistatic radar. [ABSTRACT FROM AUTHOR]

Adaptive metabolic responses and innate metabolites hold promising therapeutic potential for stroke, while targeted interventions require a thorough understanding of underlying mechanisms. Adiposity is a noted modifiable metabolic risk factor for stroke, and recent research suggests that it benefits neurological rehabilitation. During the early phase of experimental stroke, the lipidomic results showed that fat depots underwent pronounced lipolysis and released fatty acids (FAs) that feed into consequent hepatic FA oxidation and ketogenesis. Systemic supplementation with the predominant ketone beta‐hydroxybutyrate (BHB) is found to exert discernible effects on preserving blood‐brain barrier (BBB) integrity and facilitating neuroinflammation resolution. Meanwhile, blocking FAO‐ketogenesis processes by administration of CPT1α antagonist or shRNA targeting HMGCS2 exacerbated endothelial damage and aggravated stroke severity, whereas BHB supplementation blunted these injuries. Mechanistically, it is unveiled that BHB infusion is taken up by monocarboxylic acid transporter 1 (MCT1) specifically expressed in cerebral endothelium and upregulated the expression of tight junction protein ZO‐1 by enhancing local β‐hydroxybutyrylation of H3K9 at the promoter of TJP1 gene. Conclusively, an adaptive metabolic mechanism is elucidated by which acute lipolysis stimulates FAO‐ketogenesis processes to restore BBB integrity after stroke. Ketogenesis functions as an early metabolic responder to restrain stroke progression, providing novel prospectives for clinical translation. [ABSTRACT FROM AUTHOR]

Positional OSA (POSA) is a recognized subtype of OSA that exhibits distinct endotypic characteristics when compared with nonpositional OSA (NPOSA). The basis for the disparity in endotypes between these subtypes remains poorly understood. (1) Do individuals with NPOSA and POSA have different underlying OSA endotypes? (2) Which endotypic characteristics are critical in determining NPOSA and POSA severity? Within the Shanghai Sleep Health Study cohort, individuals with OSA were recruited and classified as having POSA or NPOSA. Endotypes were calculated using polysomnography. Endotype analysis was conducted in 1,036 individuals with OSA. Compared with individuals with NPOSA, those with POSA had lower loop gain calculated during all sleep stages and all sleep positions (0.55; interquartile range [IQR], 0.46-0.66 vs 0.68, IQR, 0.52-0.90; P <.001), lower arousal threshold calculated during all sleep stages and all sleep positions (ArTH All) (138.67; IQR, 118.94-180.87 percentage of the eupneic ventilation [%Veupnea] vs 189.00; IQR, 129.71-257.76 %Veupnea; P <.001), lower pharyngeal collapsibility calculated during all sleep stages and all sleep positions (Vpassive All) (91.85; IQR, 83.13-95.15 %Veupnea vs 76.38; IQR, 23.77-92.08 %Veupnea; P <.001), and higher muscle compensation calculated during all sleep stages and all sleep positions (6.50; IQR, −6.77 to 16.39 %Veupnea vs 3.65; IQR, −10.47 to 12.14 %Veupnea; P =.003). Logistic regression analyses indicated that higher Vpassive All was associated with increased odds of POSA vs NPOSA. In NPOSA, fully adjusted linear regression analyses indicated that Vpassive All (β = −0.55; 95% CI, −0.68 to −0.42; P <.001) and lower loop gain calculated during all sleep stages and all sleep positions (β = 0.19; 95% CI, 0.08-0.30; P <.001) were significant independent predictors of the apnea hypopnea index, with Vpassive All being the most critical factor. In contrast, in POSA, collapsibility appeared to be less influential (β = −0.09; 95% CI, −0.21 to 0.03; P =.138). Nonanatomic endotypic characteristics (LG All : β = 0.29; 95% CI, 0.18-0.41; P <.001; arousal threshold in all sleep stages and all sleep positions: β = 0.15; 95% CI, 0.01-0.28; P =.031; muscle compensation in all sleep stages and all sleep positions: β = −0.21; 95% CI, −0.29 to −0.12; P <.001) were significant in determining the severity of POSA, with loop gain being the most crucial factor. This study highlights the differences in endotypes between NPOSA and POSA. In Chinese individuals, anatomic factors were more significant in determining the severity of NPOSA, whereas nonanatomic traits were more likely to determine the severity of POSA. Future research should focus on developing personalized management strategies for individuals with NPOSA and POSA based on their endotypes. Chinese Clinical Trial Registry; No.: ChiCTR1900025714; URL: https://www.chictr.org.cn/indexEN.html. [ABSTRACT FROM AUTHOR]

ZnO nanostructures show great potential in hydrogen sensing at atmospheric conditions for good gas adsorption abilities. However, there is less research on low-pressure hydrogen sensing performance due to its low concentration and in-homogeneous distributions under low-pressure environments. Here, we report the low-pressure hydrogen sensing by the construction of Al–N-co-doped ZnO nanorods based on the adsorption-induced field emission enhancement effect in the pressure range of 10−7 to 10−3 Pa. The investigation indicates that the Al–N-co-doped ZnO sample is the most sensitive to low-pressure hydrogen sensing among all ZnO samples, with the highest sensing current increase of 140% for 5 min emission. In addition, the increased amplitude of sensing current for the Al–N-co-doped ZnO sample could reach 75% at the pressure 7 × 10−3 Pa for 1 min emission. This work not only expands the hydrogen sensing applications to the co-doped ZnO nanomaterials, but also provides a promising approach to develop field emission cathodes with strong low-pressure hydrogen sensing effect. [ABSTRACT FROM AUTHOR]

Introduction: Allergic rhinitis (AR) is one of the leading allergic diseases worldwide. Allergen immunotherapy (AIT) induces persistent specific allergen tolerance to achieve remission of the symptoms in AR patients. We creatively conducted the intra‐cervical lymphatic immunotherapy (ICLIT) for AR patients. However, the underlying molecular mechanism of immune cell response of AIT in AR remains elusive. Method: To investigate the transcriptome profile in AR patients who underwent ICLIT, we comprehensively investigated the transcriptional changes in B cells from peripheral blood mononuclear cells of AR patient by single‐cell RNA sequencing. Immunoglobulins and relative key gene, which influences the B cell differentiation, was demonstrated. The biomarkers' association with different types of tumors was investigated. Results: Naive B cells, germinal center B cells, activated memory B cells, and memory B cells constituted the B cells subsets. The expression of IGHE, IGHGs, IGHA, IGHD, and IGHM from memory B cells was validated. Pseudotime analysis further indicated the dynamic change from the expression of the immunoglobulins in the memory B cells, suggesting that ITGB1 may contribute to the differentiation procedure of memory B cells. The cell–cell communication among these immune cells demonstrated the significantly enhanced CD23, BTLA signaling after ICLIT in AR patient. ITGB1 was upregulated in 13 tumors and downregulated in six others. High ITGB1 expression was linked to poor prognosis in eight types of tumors. ITGB1 expression showed correlations with tumor mutation burden, tissue purity, and microsatellite instability in different types of tumors. Discussion: ITGB1 was demonstrated as a potential biomarker for AR patients after ICLIT and is significant in identifying immune infiltration in tumor tissue and predicting tumor prognosis. [ABSTRACT FROM AUTHOR]

Background: The efficacy and safety of the novel immunotherapy method, intra‐cervical lymphatic immunotherapy (ICLIT), need to be investigated. Comparing it with subcutaneous immunotherapy (SCIT), we clarified the long‐term efficacy and safety of intra‐cervical lymphatic immunotherapy on allergic rhinitis (AR), and investigated the improvement of clinical efficacy of the booster injection at 1 year after ICLIT treatment. Methods: Ninety adult patients with dust mite allergy were randomly divided into 3 groups: 30 in the SCIT group, 30 in the ILCLIT group, and 30 in ICLIT booster group. Changes in total symptom score (TSS), nasal symptom score (TNSS), ocular symptom score (TOSS) and total medication score (TMS) were evaluated in the three groups. Adverse reactions were recorded, and serum dust mite specific IgE (sIgE) and specific IgG4 were assessed in the ICLIT group and ICLIT booster group. Results: TSS, TNSS, TOSS, and TMS scores were significantly lower in the three groups at 36 months after treatment (p < 0. 05). And at 36 months the ICLIT‐booster group showed results similar to SCIT and superior to ICLIT (p < 0. 05). Serum specific IgE decreased in all three groups at 12 and 36 months after treatment, p < 0.01. The ICLIT group and the ICLIT booster group showed a significant increase in sIgG4, p < 0.01. None of the patients in the three groups had any serious systemic adverse effects during the 3‐year follow‐up. Conclusion: The ICLIT treatment is effective and safe on AR. One booster injection of allergens at 1 year can greatly improve its long‐term efficacy. Trial Registry: Clinical trial registration number: ChiCTR1800017130. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the value of an integrated model incorporating deep learning (DL), hand-crafted radiomics and clinical and US imaging features for diagnosing central lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC). Methods: This retrospective study reviewed 613 patients with clinicopathologically confirmed PTC from two institutions. The DL model and hand-crafted radiomics model were developed using primary lesion images and then integrated with clinical and US features selected by multivariate analysis to generate an integrated model. The performance was compared with junior and senior radiologists on the independent test set. SHapley Additive exPlanations (SHAP) plot and Gradient-weighted Class Activation Mapping (Grad-CAM) were used for the visualized explanation of the model. Results: The integrated model yielded the best performance with an AUC of 0.841. surpassing that of the hand-crafted radiomics model (0.706, p < 0.001) and the DL model (0.819, p = 0.26). Compared to junior and senior radiologists, the integrated model reduced the missed CLNM rate from 57.89% and 44.74–27.63%, and decreased the rate of unnecessary central lymph node dissection (CLND) from 29.87% and 27.27–18.18%, respectively. SHAP analysis revealed that the DL features played a primary role in the diagnosis of CLNM, while clinical and US features (such as extrathyroidal extension, tumour size, age, gender, and multifocality) provided additional support. Grad-CAM indicated that the model exhibited a stronger focus on thyroid capsule in patients with CLNM. Conclusion: Integrated model can effectively decrease the incidence of missed CLNM and unnecessary CLND. The application of the integrated model can help improve the acceptance of AI-assisted US diagnosis among radiologists. [ABSTRACT FROM AUTHOR]

Background: Risk stratification systems for thyroid nodules are limited by low specificity. The fine-needle aspiration (FNA) biopsy size thresholds and stratification criteria are based on evidence from the literature and expert consensus. Our aims were to investigate the optimal FNA biopsy size thresholds in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and artificial intelligence (AI) TI-RADS and to revise the stratification criteria in AI TI-RADS. Methods: A total of 2596 thyroid nodules (in 2511 patients) on ultrasound examination with definite pathological diagnoses were retrospectively identified from January 2017 to September 2021 in 6 participating Chinese hospitals. The modified criteria for ACR TI-RADS were as follows: (1) no FNA for TR3; (2) FNA threshold for TR4 increased to 2.5 cm. The modified criteria for AI TI-RADS were as follows: (1) 6-point nodules upgraded to TR5; (2) no FNA for TR3; (3) FNA threshold for TR4 increased to 2.5 cm. The diagnostic performance and the unnecessary FNA rate (UFR) of modified versions were compared with the original ACR TI-RADS. Results: Compared with the original ACR TI-RADS, the modified ACR (mACR) TI-RADS yielded higher specificity (73% vs. 46%), accuracy (74% vs. 51%), area under the receiver operating characteristic curve (AUC; 0.80 vs. 0.70), and lower UFR (25% vs. 48%; all p < 0.001), although the sensitivity was slightly decreased (87% vs. 93%, p = 0.057). Compared with the original ACR TI-RADS, the modified AI (mAI) TI-RADS yielded higher specificity (73% vs. 46%), accuracy (75% vs. 51%), AUC (0.81 vs. 0.70), and lower UFR (24% vs. 48%; all p < 0.001), although the sensitivity tended to be slightly decreased (89% vs. 93%, p = 0.13). There was no significant difference between the mACR TI-RADS and mAI TI-RADS in the diagnostic performance and UFR (all p > 0.05). Conclusions: The revised FNA thresholds and the stratification criteria of the mACR TI-RADS and mAI TI-RADS may be associated with improvements in specificity and accuracy, without significantly sacrificing sensitivity for malignancy detection. [ABSTRACT FROM AUTHOR]

Purpose: Mice can develop arterial damage and even atherosclerosis under intermittent hypoxia (IH); however, the specific mechanism of arterial damage induced by IH remains unclear. Hence, this research aimed to illustrate the underlying mechanism linking IH to arterial injury. Materials and methods: The differential gene expression of the thoracic aorta under normoxia or IH mice was analyzed utilizing RNA sequencing. Furthermore, GO, KEGG pathway, and CIBERSORT analyses were carried out. For verification of the expression of candidate genes affected by IH, quantitative RT-qPCR (qRT-PCR) was conducted. Immunohistochemical (IHC) staining revealed immune cell infiltration in the thoracic aorta. Results: The thickness of the intima-media of the mouse aorta was increased, and the fiber structure was disordered under IH. Transcriptomics analysis showed that in the aorta, 1137 upregulated genes and 707 downregulated genes were affected by IH, significantly related to the activation of the immune system and cell adhesion. Furthermore, B cell infiltration around the aorta was observed under IH. Conclusions: IH might lead to structural changes in the aorta by activating the immune response and enhancing cell adhesion. [ABSTRACT FROM AUTHOR]

Background: Porous cages are considered a promising alternative to high-density cages because their interconnectivity favours bony ingrowth and appropriate stiffness tuning reduces stress shielding and the risk of cage subsidence. Methods: This study proposes three approaches that combine macroscopic topology optimization and micropore design to establish three new types of porous cages by integrating lattices (gyroid, Schwarz, body-centred cubic) with the optimized cage frame. Using these three porous cages along with traditional high-density cages, four ACDF surgical models were developed to compare the mechanical properties of facet articular cartilage, discs, cortical bone, and cages under specific loads. Results: The facet joints in the porous cage groups had lower contact forces than those in the high-density cage group. The intervertebral discs in all models experienced maximum stress at the C5/6 segment. The stress distribution on the cortical bone surface was more uniform in the porous cage groups, leading to increased average stress values. The gyroid, Schwarz, and BCC cage groups showed higher average stress on the C5 cortical bone. The average stress on the surface of porous cages was higher than that on the surface of high-density cages, with the greatest difference observed under the lateral bending condition. The BCC cage demonstrated favourable mechanical stability. Conclusion: The new porous cervical cages satifies requirements of low rigidity and serve as a favourable biological scaffold for bone ingrowth. This study provides valuable insights for the development of next-generation orthopaedic medical devices. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to develop and validate a nomogram integrating clinical and sonographic characteristics for the individualized SUI risk evaluation in the early postpartum stage. Methods: This was a prospective cross‐sectional study. From June 2020 to September 2022, singleton primiparas who underwent TPUS examination at 6–8 weeks postpartum were recruited. They were divided into the training and validation cohorts at a ratio of 8:2 according to the temporal split. All subjects were interviewed before TPUS examination. Univariate and multivariate logistic analyses were performed to develop three models: the clinical, sonographic, and combined models. The ROC curve was plotted to evaluate model discrimination ability. Finally, the combined model was selected to establish the nomogram. The nomogram's discrimination, calibration, and clinical usefulness were evaluated in the training and validation cohorts. Results: The performance of the combined model was better than that of the clinical and sonographic models. Six predictors (BMI, delivery mode, lateral episiotomy, SUI during pregnancy, cystocele, and bladder neck funneling) remained in the combined model. The nomogram based on the combined model had good discrimination with AUCs of 0.848 (95% CI: 0.796–0.900) and 0.872 (95% CI: 0.789–0.955) in the training and validation cohorts, respectively, and the calibration curve showed good efficiency in assessing postpartum SUI. Decision curve analysis showed that the nomogram was clinically useful. Conclusions: The nomogram based on clinical and sonographic characteristics showed good efficiency in assessing postpartum SUI risk and can be a convenient and reliable tool for individual SUI risk assessment. [ABSTRACT FROM AUTHOR]

Summary: In our large‐scale study, the correlation between obstructive sleep apnea (OSA) related to rapid eye movement (REM) sleep and cardiac autonomic dysfunction was assessed by standard polysomnography (PSG). Cardiac autonomic dysfunction was evaluated by the measurement of heart rate variability (HRV). The cardiovascular disease (CVD) risk was determined using the cross‐sectional prevalence of CVD and its overall 10 year risk according to the Framingham risk score (FRS). 4152 individuals were included in the study. A higher apnea–hypopnea index during REM sleep (AHIREM) was correlated with increased CVD risk. The adjusted odds ratios (95% CIs) for CVD prevalence and its high 10 year risk in participants having severe OSA during REM sleep (AHIREM ≥30 events/h) were 1.452 (1.012–2.084) and 1.904 (1.470–2.466) in the demographic adjusted model and 1.175 (0.810–1.704) and 1.716 (1.213–2.427) in the multivariate adjusted model, respectively, compared with the group with a AHIREM of <5 events/h. Fully adjusted multivariate linear regression models showed the independent association between AHIREM and a more elevated ratio of low‐frequency and high‐frequency (LF/HF) and LF in normalised units [LF (n.u.)] (P = 0.042, P = 0.027 in all participants and P = 0.033, P = 0.029 in participants with AHI during non‐REM sleep <5 events/h, respectively). Mediation analysis demonstrated that OSA during REM sleep and CVD risk was significantly mediated by LF/HF and LF (n.u.). OSA during REM sleep may be a marker behind CVD risk because it promotes cardiac autonomic dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Autonomic dysfunction is an independent risk factor for cardiovascular disease (CVD). Both obesity and obstructive sleep apnea (OSA) are associated with heart rate variability (HRV) (a hall marker of sympathetic arousal) and increased risk of CVD. This study aims to investigate whether anthropometric parameters could predict reduced HRV in adult OSA during wakefulness. Study Design: Cross‐sectional study. Setting: Sleep center of Shanghai Jiao Tong University Affiliated Sixth Hospital from 2012 to 2017. Methods: Total of 2134 subjects (503 non‐OSA and 1631 OSA) were included. Anthropometric parameters were recorded. HRV was recorded during a 5‐minute wakefulness period and analyzed by using time‐domain method and frequency‐domain method. Multiple step‐wise linear regressions were performed to determine significant predictors of HRV with and without adjustments. Multiplicative interactions between gender, OSA, and obesity on HRV were also determined and evaluated. Results: Waist circumference (WC) was significant negative determinant of root mean square of successive NN intervals (β = −.116, p <.001) and high‐frequency power (β = −.155, p <.001). Age was the strongest determining factor of HRV. Significant multiplicative interactions between obesity and OSA on HRV, gender, and obesity on cardiovascular parameters were observed. Conclusion: Anthropometric parameters could predict reduced HRV during wakefulness in patients with OSA, especially WC was the strongest influenceable factor. Obesity and OSA had significant multiplicative interaction on HRV. Gender and obesity had significant multiplicative interaction on cardiovascular parameters. Early intervention for obesity, especially centripetal obesity, may improve reduction of autonomic function and risk of CVD. [ABSTRACT FROM AUTHOR]

To study risk factors for central lymph node metastasis (CLNM) in papillary thyroid cancer (PTC) using the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS). We retrospectively analysed patients who underwent PTC surgery and central lymph node dissection at First People's Hospital of Foshan City. The clinical and ultrasonic data of the patients from 1150 cases were analysed by multivariate regression to evaluate the correlation between grayscale ultrasound (US) features, C-TIRADS score, and the classification of thyroid nodules and CLNM of PTCs. The C-TIRADS score was 3.0±1.0 in the CLNM group, which was higher than that in the non-CLNM group (p<0.001). Sex (male) (OR=1.586, 95% CI 1.232–2.042, p<0.001), age (≤45 years) (OR=1.508, 95% CI 1.184–1.919, p=0.001), location of nodes (lower pole) (OR=2.193, 95% CI 1.519–3.166, p<0.001), number (multifocal) (OR=2.204, 95% CI 1.227–2.378, p<0.001), microcalcification (OR=1.610, 95% CI 2.225–4.434, p=0.002), extrathyroidal extension (OR=2.204, 95% CI 1.941–3.843, p<0.001), maximum diameter of nodule (≥20 mm) (OR=3.211, 95% CI 2.337–4.411, p<0.001), and C-TIRADS score (OR=1.356, 95% CI 1.204–1.527, p<0.001) were PTC in independent risk factors for CLNM. The C-TIRADS score of PTC combined with the location, number, size, and ultrasound features of the lesion and the patient's sex and age are important in predicting whether they present with CLNM and provide a reference basis for the clinical formulation of a reasonable surgical treatment plan. [ABSTRACT FROM AUTHOR]

Atherosclerotic renovascular disease (RVD) leads to hypertension, chronic kidney disease (CKD), and heart disease. Intrarenal delivery of mesenchymal stem cells (MSCs) and MSC-derived extracellular vesicles (EVs) attenuate renal injury and suppress release of inflammatory cytokines in porcine RVD. We hypothesized that this strategy would also be useful for cardioprotection. Pigs with renovascular hypertension and metabolic syndrome were studied 4 weeks after treatment with a single intrarenal infusion of autologous MSCs, EVs, or vehicle. Cardiac structure and function were assessed in vivo, and myocardial remodeling and expression of the pro-fibrotic factor growth factor receptor-bound protein-2 (Grb2) were measured ex-vivo. Inflammatory cytokine levels were measured in the systemic circulation and myocardial tissue. Blood pressure was elevated in all RVD groups, but serum creatinine increased in RVD and decreased in both RVD + MSCs and RVD + EVs. RVD-induced diastolic dysfunction (lower E/A ratio) was normalized in both MSCs- and EVs- treated pigs. Intrarenal delivery of MSCs and EVs also attenuated RVD-induced myocardial fibrosis, collagen deposition, and Grb2 expression, yet EVs restored capillary density and inflammation more effectively than MSCs. These observations suggest that autologous EVs attenuate cardiac injury in experimental RVD more effectively than their parent MSCs. [ABSTRACT FROM AUTHOR]

CNTs and CNT-MgO, CNT-MgO-Ag, and CNT-MgO-Ag-BaO nanocomposites were grown on alloy substrates using an electrophoretic deposition method and their field emission (FE) and hydrogen sensing performances were investigated. The obtained samples were characterized by SEM, TEM, XRD, Raman, and XPS characterizations. The CNT-MgO-Ag-BaO nanocomposites showed the best FE performance with turn-on and threshold fields of 3.32 and 5.92 V.μm−1, respectively. The enhanced FE performances are mainly attributed to the reductions of the work function, and the enhancement of the thermal conductivity and emission sites. The current fluctuation of CNT-MgO-Ag-BaO nanocomposites was only 2.4% after a 12 h test at the pressure of 6.0 × 10−6 Pa. In addition, for the hydrogen sensing performances, the CNT-MgO-Ag-BaO sample showed the best increase in amplitude of the emission current among all the samples, with the mean IN increases of 67%, 120%, and 164% for 1, 3, and 5 min emissions, respectively, under the initial emission currents of about 1.0 μA. [ABSTRACT FROM AUTHOR]

Background: The use of cardiac implantable electronic devices has grown substantially over the past two decades, lead-related vascular issues are commonly encountered in clinical practice. Superior vena cava (SVC) syndrome due to pacemaker leads is an uncommon complication. Anticoagulation remains the mainstay of therapy to restore some degree of patency and relieve swelling. However, there are limited clinical trials on direct oral anticoagulants (DOACs). Case presentation: We report a case of an 80-year-old man who developed SVC syndrome after transvenous pacemaker implantation with symptoms of obstruction that were significantly relieved after four months of DOACs. His symptoms had completely resolved nine months later. Conclusions: DOACs are effective in the treatment of SVC syndrome after pacemaker implantation, representing an important new approach. It is a very good choice for patients who do not want to undergo interventional therapy. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic condition characterized by gastrointestinal tract inflammation and still lacks satisfactory treatments. Mesenchymal stromal cells (MSCs) show promising potential for treating IBD, but their therapeutic efficacy varies depending on the tissue of origin. We aim to investigate whether intestine Peyer's patch (PP)‐derived MSCs have superior immunomodulatory effects on T cells and better therapeutic effects on IBD compared with bone marrow‐derived MSCs. We isolated PPs‐derived Nestin+ MSCs (MSCsPP) and bone marrow‐derived Nestin+ MSCs (MSCsBM) from Nestin‐GFP transgenic mice to explore their curative effects on murine IBD model. Moreover, we tested the effects of IL‐22 knockdown and IL‐22 overexpression on the therapeutic efficacy of MSCsPP and MSCsBM in murine IBD, respectively. We demonstrated that Nestin+ cells derived from murine PPs exhibit MSC‐like biological characteristics. Compared with MSCsBM, MSCsPP possess enhanced immunoregulatory ability to suppress T cell proliferation and inflammatory cytokine production. Moreover, we observed that MSCsPP exhibited greater therapeutic efficacy than MSCsBM in murine IBD models. Interestingly, IL‐22, which was highly expressed in MSCsPP, could alleviate the severity of the intestinal inflammation, while knockdown IL‐22 of MSCsPP remarkably weakened the therapeutic effects. More importantly, IL‐22 overexpressing MSCsBM could significantly improve the symptoms of murine IBD models. This study systemically demonstrated that murine MSCsPP have a prominent advantage in murine IBD treatment, partly through IL‐22. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis. Methods: Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). Results: 18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR [95% CI]; 0.88 [0.80–0.97], 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95% CI]; 0.84 [0.78–0.90]), renal outcome (RR [95% CI]; 0.67 [0.60–0.74], HHF (RR [95% CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95% CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95% CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95% CI]; 0.86 [0.78–0.94]). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95% CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95% CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively) in renal outcome and HHF. Conclusions: In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis. Methods: Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). Results: 18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR [95% CI]; 0.88 [0.80–0.97], 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95% CI]; 0.84 [0.78–0.90]), renal outcome (RR [95% CI]; 0.67 [0.60–0.74], HHF (RR [95% CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95% CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95% CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95% CI]; 0.86 [0.78–0.94]). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95% CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95% CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively) in renal outcome and HHF. Conclusions: In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues. [ABSTRACT FROM AUTHOR]

Flood susceptibility modeling helps understand the relationship between influencing factors and occurrence of urban flooding and further provides spatial distribution of flood risk, which is critical for flood-risk reduction. Machine learning methods have been widely applied in flood susceptibility modeling, but traditional supervised learning requires both positive (flood) and negative (non-flood) samples in model training. Historical flood inventory data usually contain positive-only data, whereas negative data selected from areas without flood records are prone to be contaminated by positive data, which is referred to as case-control sampling with contaminated controls. In order to address this problem, we propose to apply a novel positive-unlabeled learning algorithm, namely positive and background learning with constraints (PBLC), in flood susceptibility modeling. PBLC trains a binary classifier from case-control positive and unlabeled samples without requiring truly labeled negative data. With historical records of flood locations and environmental covariates, including elevation, slope, aspect, plan curvature, profile curvature, slope length factor, stream power index, topographic position index, topographic wetness index, distance to rivers, distance to roads, land use, normalized difference vegetation index, and precipitation, we compared the performances of the traditional artificial neural network (ANN) and the novel PBLC in flood susceptibility modeling in the city of Guangzhou, China. Experimental results show that PBLC can produce more calibrated probabilistic prediction, more accurate binary prediction, and more reliable susceptibility mapping of urban flooding than traditional ANN, indicating that PBLC is effective in addressing the problem of case-control sampling with contaminated controls and it can be successfully applied in urban flood susceptibility mapping. [ABSTRACT FROM AUTHOR]

Objective: To determine if artificial intelligence–based modification of the Thyroid Imaging Reporting Data System (TI-RADS) would be better than the current American College of Radiology (ACR) TI-RADS for risk stratification of thyroid nodules. Methods: A total of 2061 thyroid nodules (in 1859 patients) sampled with fine-needle aspiration or operation were retrospectively analyzed between January 2017 and July 2020. Two radiologists blinded to the pathologic diagnosis evaluated nodule features in five ultrasound categories and assigned TI-RADS scores by both ACR TI-RADS and AI TI-RADS. Inter-rater agreement was assessed by asking another two radiologists to score a set of 100 nodules independently. The reference standard was postoperative pathological or cytopathological diagnosis according to the Bethesda system. Inter-rater agreement was determined using intraclass correlation coefficient (ICC). Results: AI TI-RADS assigned lower TI-RADS risk levels than ACR TI-RADS (p < 0.001) and had larger area under receiver operating characteristic curve (0.762 vs. 0.679, p < 0.001). The sensitivities of ACR TI-RADS and AI TI-RADS were similar (86.7% vs. 82.2%, p = 0.052), but specificity was higher with AI TI-RADS (70.2% vs. 49.2%, p < 0.001). AI TI-RADS downgraded 743 (48.63%) benign nodules, indicating that 328 (42.3% of 776 biopsied nodules) unnecessary fine-needle aspirations (FNA) could have been avoided. Inter-rater agreement was better with AI TI-RADS than with ACR TI-RADS (ICC, 0.808 vs. 0.861, p < 0.001). Conclusion: AI TI-RADS can achieve meaningful reduction in the number of benign thyroid nodules recommended for biopsy and significantly improve specificity despite a slight decrease in sensitivity. Key Points: • AI TI-RADS assigned lower TI-RADS risk levels than ACR TI-RADS, showing similar sensitivity but higher specificity. • Half of the benign nodules can be downgraded of which 42.3% of biopsy nodules avoided unnecessary fine-needle aspiration (FNA). • AI TI-RADS had a better overall inter-rater agreement. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of finerenone and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on reducing new-onset of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Method: We searched the PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to April 30, 2022. Randomized control trials comparing finerenone or SGLT2i with placebo in patients with T2DM and CKD were selected. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). Results: A total of 10 studies (35,841 patients) were included. Finerenone (RR 0.79, 95% CI 0.62–0.99) was associated with a decreased risk of AF compared with placebo, while SGLT2i were not. SGLT2i were associated with a decreased risk of hospitalization for heart failure (RR 0.78, 95% CI 0.63–0.98) compared with finerenone. They were comparable in AF(RR 0.84, 95% CI 0.48,1.46), major adverse cardiovascular events(MACE) (RR 0.93, 95% CI 0.81,1.06) and nonfatal stroke(RR 0.78, 95% CI 0.58,1.05). They both showed no significant risk of adverse events compared with placebo. Conclusion: There was no significant difference in the reduction of new-onset of atrial fibrillation between Finerenone and SGLT2i based on the indirect comparisons of currently available clinical studies. The large-sampled head-to-head trials was needed for the more precise conclusion. [ABSTRACT FROM AUTHOR]

Introduction. IgA nephropathy (IgAN) is a common issue. In China, Abelmoschus manihot (AM) is widely used in the treatment of IgAN. However, their combined effectiveness and safety for this purpose have not yet been explored. AM is an effective medicine for treating IgAN. This meta-analysis aimed to evaluate the effectiveness of AM for IgAN. Materials and Methods. The Cochrane Library, PubMed, EMBASE, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and Technique Journals Database (VIP), and the Wanfang Database were searched from their inceptions to June 2021. Random clinical trials (RCTs) comparing the effects of AM treatment in patients with IgAN were included. The study evaluated the efficacy or effectiveness of AM for IgAN and had clear outcome data, such as total effectiveness rate or proteinuria. Results. A total of 11 RCTs with 850 participants were included in this meta-analysis. The results of the meta-analysis showed that, compared with that of the conventional therapy alone, being combined with conventional treatment was significantly more effective for the total efficacy rate (OR = 4.33; 95% CI = 2.66, 7.04; P < 0.00001) and proteinuria (MD = −0.41 g/24 h; 95% CI = −0.44, −0.38; P < 0.00001) but had no effect on serum creatinine (Scr) (MD = −2.23 μmol/L; 95% CI = −5.90, 1.45; P = 0.24), eGFR (MD = −0.45 mL/min·1.73 m2; 95% CI = −1.24, 2.13; P = 0.60), Bun (MD = −0.22 mmol/L; 95% CI = −0.59, 0.14; P = 0.23), systolic blood pressure (MD = −0.04 mmHg; 95% CI = −2.59, 2.51; P = 0.98), diastolic blood pressure (MD = −0.34 mmHg, 95% CI = −1.65, 2.33; P = 0.74), systolic blood pressure (MD = −0.04 mmHg, 95% CI = −2.59, 2.51; P = 0.98), or serum albumin (MD = 1.70 g/L, 95% CI = −1.06, 4.45; P = 0.23). Conclusions. AM provided additional benefits to proteinuria individuals with IgAN. However, due to the high clinical heterogeneity and small sample size of the included trials, future studies should conduct more rigorous RCTs on the clinical efficacy and safety of AM and RCTs with a larger sample size involving multicenters. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prevalence, characteristics, and respiratory arousal threshold (ArTH) of Chinese patients with positional obstructive sleep apnea (POSA) according to the Cartwright Classification (CC) and Amsterdam Positional Obstructive Sleep Apnea Classification (APOC).Methods: A large-scale cross-sectional study was conducted in our sleep center from 2007 to 2018 to analyze the clinical and polysomnography (PSG) data of Chinese POSA patients. Low ArTH was defined based on PSG indices.Results: Of 5,748 OSA patients, 36.80% met the CC criteria, and 42.88% the APOC criteria, for POSA. The prevalence of POSA was significantly higher in women than men (40.21% and 46.52% vs. 36.13% and 42.18% for CC and APOC, respectively). Chinese POSA patients had a lower apnea hypopnea index (AHI) and lower oxygen desaturation index, shorter duration of oxygen saturation (SaO2) < 90%, and a higher mean SaO2 and higher lowest SaO2 value compared to subjects with non-positional OSA (NPOSA). More than 40% of the POSA patients had a low ArTH; the proportion was extremely high in the supine-isolated-POSA (si-POSA) group and APOC I group. In multivariate logistic regression analyses, higher mean SaO2 and lower AHI during sleep were positive predictors of POSA.Conclusions: According to the CC and APOC criteria, more than 1/3 of our Chinese subjects with OSA had POSA. Chinese POSA patients had less severe OSA and nocturnal hypoxia. Compared to NPOSA patients, significantly more patients with POSA had a low ArTH. A low ArTH may be an important endotype in the pathogenesis of POSA, especially in patients with si-POSA and APOC I. Further studies are necessary to develop personalized management strategies for POSA patients.Trial Registration: Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn ; No. ChiCTR1900025714 (retrospectively registered). [ABSTRACT FROM AUTHOR]

To effectively separate the valuable minerals in ludwigite, this study investigated the mineralogy of ore, particle-size distribution and mineral liberation characteristics. Most of the magnetite was intergrown with ascharite and serpentine. Nearly half of the serpentine existed in a dense, massive body. Most of the ascharite was encased in magnetite, and a small amount was embedded in the serpentine phase. After the microwave radiation, some intergranular and through cracks were formed to improve mineral liberation during the grinding process. The mass fractions for the +75 μm range decreased from 43.16 wt% for untreated samples to 24.31 wt% for treated samples with a microwave power of 3 kW for 40 s. By contrast, the mass fractions of particles in the −75 μm range increased from 56.84 wt% for untreated samples to 75.69 wt% for treated samples. D50 decreased from 53.54 µm for the untreated sample to 21.58 µm for the treated sample. The liberation degrees after the treated samples clearly improved and increased by 26.64% for magnetite, 18.92% for ascharite and 14.10% for serpentine. [ABSTRACT FROM AUTHOR]

Heterogeneity and limited comprehension of chronic autoimmune disease pathophysiology cause accurate diagnosis a challenging process. With the increasing resources of single-cell sequencing data, a reasonable way could be found to address this issue. In our study, with the use of large-scale public single-cell RNA sequencing (scRNA-seq) data, analysis of dataset integration (3.1 × 105 PBMCs from fifteen SLE patients and eight healthy donors) and cellular cross talking (3.8 × 105 PBMCs from twenty-eight SLE patients and eight healthy donors) were performed to identify the most crucial information characterizing SLE. Our findings revealed that the interactions among the PBMC subpopulations of SLE patients may be weakened under the inflammatory microenvironment, which could result in abnormal emergences or variations in signaling patterns within PBMCs. In particular, the alterations of B cells and monocytes may be the most significant findings. Utilizing this powerful information, an efficient mathematical model of unbiased random forest machine learning was established to distinguish SLE patients from healthy donors via not only scRNA-seq data but also bulk RNA-seq data. Surprisingly, our mathematical model could also accurately identify patients with rheumatoid arthritis and multiple sclerosis, not just SLE, via bulk RNA-seq data (derived from 688 samples). Since the variations in PBMCs should predate the clinical manifestations of these diseases, our machine learning model may be feasible to develop into an efficient tool for accurate diagnosis of chronic autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a common metabolic disease with significant health, social, and economic consequences. Traditional Chinese medicine (TCM) could effectively regulate blood sugar and influence gut microbiota in T2DM patients. Preliminary studies showed that the Coptis root and ginseng (RG) formula could relieve insulin resistance and prevent the progression of diabetes in mice.Objectives: The purpose of this study is to explore the efficacy and safety of RG formula in the treatment of adult patients with T2DM, as well as observing its effects on gut microbiota.Methods and Analysis: This trial is a randomized, double-blind, placebo-controlled study. A total of 60 participants will be randomized in a 1:1 ratio into an experiment group (RG formula) and a control group (placebo). Patients in both groups will be given diabetes education and basic blood glucose control. Glucose-lowering drugs with significant influence on gut microbiota will be avoided. This trial will last 25 weeks including 1-week run-in, 12-week intervention, and 12-week follow-up visit. The primary outcome is the change in the HbA1c. The secondary outcomes comprise the change in the fasting blood glucose (FBG), postprandial blood glucose (PBG), fasting insulin (FIL), fasting C-peptide(C-P), insulin resistance index (IRI), inflammatory factors, and species abundance of gut microbiota between the two groups. Safety of medication will also be evaluated. The correlation analysis will be explored between the glycemic indicators, inflammatory factors, and abundance of gut microbiota.Discussion: This study will provide the clinical evidence for the efficacy of RG formula in regulating blood sugar and influencing gut microbiota, which will be beneficial to form the integrated therapeutic regimen in T2DM with TCM.Trial Registration: "Clinical Study on the Intervention of Coptis Root and Ginseng," Chinese Clinical Trials Registry ChiCTR 2100042126 . Registered on 14 January 2021. [ABSTRACT FROM AUTHOR]

Mesenchymal stem cells (MSCs) show promising therapeutic potential in treating inflammatory bowel disease (IBD), and intraperitoneal delivery of MSCs have become a more effective route for IBD treatment. However, the underlying mechanisms are still poorly understood. Here, we found that intraperitoneally delivered MSCs significantly alleviated experimental colitis. Depletion of peritoneal B cells, but not macrophages, clearly impaired the therapeutic effects of MSCs. Intraperitoneally delivered MSCs improved IBD likely by boosting the IL-10-producing B cells in the peritoneal cavity, and a single intraperitoneal injection of MSCs could significantly prevent disease severity in a recurrent mouse colitis model, with lower proinflammation cytokines and high level of IL-10. The gene expression profile revealed that thrombospondin-1 (THBS1) was dramatically upregulated in MSCs after coculture with peritoneal lavage fluid from colitis mice. Knockout of THBS1 expression in MSCs abolished their therapeutic effects in colitis and the induction of IL-10-producing B cells. Mechanistically, THBS1 modulates the activation of transforming growth factor-β (TGF-β), which combines with TGF-β receptors on B cells and contributes to IL-10 production. Blocking the interaction between THBS1 and latent TGF-β or inhibiting TGF-β receptors (TGF-βR) significantly reversed the THBS1-mediated induction of IL-10-producing B cells and the therapeutic effects on colitis. Collectively, our study revealed that intraperitoneally delivered MSCs secreted THBS1 to boost IL-10+Bregs and control the progression and recurrence of colitis, providing new insight for the prevention and treatment of IBD. [ABSTRACT FROM AUTHOR]

Background. The aim of this retrospective study was to evaluate the risk factors for central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC), according to the guidelines of the 2017 Thyroid Imaging Report and Data System (TI-RADS) published by the American College of Radiology (ACR). Methods. This study included a retrospective analysis of 844 patients with PTC who were pathologically diagnosed, treated with central lymph node dissection, and divided into CLNM and nonmetastatic groups. Univariate and multivariate analyses were performed to determine the relationship between the TI-RADS score and CLNM. Results. Among 844 patients, 439 developed CLNM, with a metastasis rate of 52% and a TI-RADS score of 9.42 ± 2.262, which were higher than those of the non-CLNM group (P < 0.05). Univariate analysis demonstrated that the sex, location, maximum diameter of the nodule, multifocality, margin, shape, calcification, and TI-RADS score were related to CLNM (P < 0.05 for all). However, multivariate logistic regression analysis demonstrated that female, maximum diameter of the nodule, multifocality, a taller-than-wide shape, and high TI-RADS score were the independent risk factors for CLNM (P < 0.05 for all). Conclusion. The TI-RADS score combined with sex, nodule size, shape, and multifocality has a certain predictive effect on CLNM, which can provide a reference to the clinicians for further treatment strategies. [ABSTRACT FROM AUTHOR]

Chronic intermittent hypoxia (CIH) and chronic sleep fragmentation (CSF) are two cardinal pathological features of obstructive sleep apnea (OSA). Dietary obesity is a crucial risk intermediator for OSA and metabolic disorders. Gut microbiota affect hepatic and adipose tissue morphology under conditions of CIH or CSF through downstream metabolites. However, the exact relationship is unclear. Herein, chow and high-fat diet (HFD)-fed mice were subjected to CIH or CSF for 10 weeks each and compared to normoxia (NM) or normal sleep (NS) controls. 16S rRNA amplicon sequencing, untargeted liquid chromatography-tandem mass spectrometry, and histological assessment of liver and adipose tissues were used to investigate the correlations between the microbiome, metabolome, and lipid metabolism under CIH or CSF condition. Our results demonstrated that CIH and CSF regulate the abundance of intestinal microbes (such as Akkermansia mucinphila , Clostridium spp., Lactococcus spp., and Bifidobacterium spp.) and functional metabolites, such as tryptophan, free fatty acids, branched amino acids, and bile acids, which influence adipose tissue and hepatic lipid metabolism, and the level of lipid deposition in tissues and peripheral blood. In conclusion, CIH and CSF adversely affect fecal microbiota composition and function, and host metabolism; these findings provide new insight into the independent and synergistic effects of CIH, CSF, and HFD on lipid disorders. [ABSTRACT FROM AUTHOR]

The de Winter electrocardiography (ECG) pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain. We report a case of a 34‐year‐old man with a history of smoking who presented to the local emergency department with a 49 min history of chest pain. The first ECG of the patient indicated that ST‐segment elevation was noted in the lead V2–V4; 57 min later, a second ECG revealed a typical de Winter syndrome when the patient was transferred to the emergency chest pain centre of our hospital. A percutaneous coronary intervention (PCI) was performed approximately 8 h later because the patient initially refused the PCI. Acute coronary artery angiography showed that the proximal left anterior descending coronary artery was completely occluded. Our case suggests that ST‐segment elevation myocardial infarction may evolve in the direction of de Winter, which reflects a coronary thrombus in formation, so the de Winter ECG pattern should not be considered static. [ABSTRACT FROM AUTHOR]

Objective: Roux-en-Y gastric bypass (RYGB) surgery is an effective type of weight loss management and may improve obesity-related obstructive sleep apnea (OSA). Obese subjects who meet the criteria for surgery with OSA were enrolled. We investigated the metabolomic effects of RYGB on OSA. Methods: Clinical data, serum measurements including indices of glycolipid metabolism, and polysomnography (PSG) measurements were collected at baseline and 6 months after RYGB surgery. Metabolomic analysis was performed using ultra-performance liquid chromatography-mass spectrometry. Results: A group of 37 patients with obesity, type 2 diabetes (T2DM) and suspected OSA were enrolled of which 27 were OSA subjects. After RYGB surgery, metabolic outcomes and sleep parameters were all significantly improved. The OSA remission group had lower valine, isoleucine, and C24:1(cis-15) levels, and higher trimethylamine N-oxide, hippurate, and indole-3-propionic acid levels after RYGB surgery. A combination of preoperative indices (age, apnea-hypopnea index (AHI), fasting C-peptide level, and hippurate level) predicted the RYGB effect size in obese patients with T2DM and OSA, with an area under receiver operating characteristic curve of 0.947, specificity of 82.4%, and sensitivity of 100%. Conclusions: RYGB surgery may significantly improve the metabolic status of patients with obesity, T2DM and OSA. A combination of preoperative indices (age, AHI, fasting C peptide level, and hippurate level) may be useful for predicting the effect size of RYGB in obese patients with T2DM and OSA. The mechanisms underlying OSA remission need to be explored. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the efficacy of the Qingre Yiqi method in the treatment of type 2 diabetes mellitus (T2DM) with meta-analysis. Method. The randomized controlled trials (RCTs) of the Qingre Yiqi method in the treatment of T2DM in the PubMed, Medline, EMBase, Cochrane Library, Web of Science, Weipu Journal, China Knowledge Network (CNKI), and Wanfang database were conducted. Three reviewers independently conducted the screening, extracted the data, and assessed methodological quality. Data analysis was performed using Rev Man 5.3 software for statistical analysis. Results. A total of 15 RCTs, including 1440 patients, were included. The results showed that compared with oral hypoglycemic drugs alone, the add-on treatment of the Qingre Yiqi method could significantly improve Chinese medicine syndrome (OR (95%CI) = 3.66 [2.47,5.42], P < 0.00001) and lower the level of HbA1c (MD (95%CI) = −0.68 [0.91, −0.45], P < 0.00001), triglyceride (TG) (MD (95%CI) = −0.38 [−0.58,-0.17], P = 0.0004), low-density lipoprotein cholesterol (LDL-C) (MD (95%CI) = −0.25 [−0.37, −0.13], P < 0.0001), and total cholesterol(TC) (MD(95%CI) = −0.40[−0.67, −0.13], P = 0.003). In terms of fasting blood glucose (FBG) and postprandial blood sugar (PBG), subgroup analysis showed that the baseline of FBG and the number of combined oral hypoglycemic drugs of PBG were the major sources of heterogeneity. Conclusion. Compared with the standard treatment, the Qingre Yiqi method along with oral hypoglycemic drugs showed the more beneficial effects for T2DM on improving TCM syndromes and reducing the blood glucose and partial lipid parameter. [ABSTRACT FROM AUTHOR]

Purpose: Glutamine plays an important role in tumor metabolism and progression. This research aimed to find out how Gln exert their effects on laryngeal squamous cell carcinoma (LSCC). Methods: Cell proliferation was measured by CCK8 and EdU assay, mitochondrial bioenergetic activity was measured by mitochondrial stress tests. Gene expression profiling was revealed by RNA sequencing and validated by RT-qPCR. In LSCC patients, protein expression in tumor and adjacent tissues was examined and scored by IHC staining. RNAi was performed by stably expressed shRNA in TU177 cells. In vivo tumor growth analysis was performed using a nude mouse tumorigenicity model. Results: Gln deprivation suppressed TU177 cell proliferation, which was restored by αKG supplementation. By transcriptomic analysis, we identified CECR2, which encodes a histone acetyl-lysine reader, as the downstream target gene for Gln and αKG. In LSCC patients, the expression of CECR2 in tumors was lower than adjacent tissues. Furthermore, deficiency of CECR2 promoted tumor cell growth both in vitro and in vivo, suggesting it has tumor suppressor effects. Besides, cell proliferation inhibited by Gln withdrawal could be restored by CECR2 depletion, and the proliferation boosted by αKG supplementation could be magnified either, suggested that CECR2 feedback suppressed Gln and αKG's effect on tumor growth. Transcriptomic profiling revealed CECR2 regulated the expression of a series of genes involved in tumor progression. Conclusion: We confirmed the Gln-αKG-CECR2 axis contributes to tumor growth in LSCC. This finding provided a potential therapeutic opportunity for the use of associated metabolites as a potential treatment for LSCC. [ABSTRACT FROM AUTHOR]

Premature ovarian insufficiency (POI) is defined as the loss of ovarian activity under the age of 40. Theca cells (TCs) play a vital role during folliculogenesis and TCs dysfunction participate in the pathogenesis of POI. Therefore, transplantation of thecal stem cells (TSCs), which are capable of self-renewal and differentiation into mature TCs, may provide a new strategy for treating POI. To investigate the feasibility, safety, and efficacy of TSCs transplantation in clinically relevant non-human primate (NHP) models, we isolate TSCs from cynomolgus monkeys, and these cells are confirmed to expand continuously and show potential to differentiate into mature TCs. In addition, engraftment of autologous TSCs into POI monkeys significantly improves hormone levels, rescues the follicle development, promotes the quality of oocytes and boosts oocyte maturation/fertilization rate. Taken together, these results for the first time suggest that autologous TSCs can ameliorate POI symptoms in primate models and shed new light on developing stem cell therapy for POI. [ABSTRACT FROM AUTHOR]

The correlation between the optimal performance of indoor photovoltaics (IPVs) and spectral characteristics of white light-emitting diode (LED) sources has been investigated theoretically. We calculated the Schockley–Queisser limit of IPVs under multi-color white LEDs with different correlated color temperature (CCT), color rendering index (CRI) and luminous efficacy of radiation (LER). It is found that the optimal bandgap for an IPV cell is not only influenced by CCT, but also by LER and CRI. However, the main factor that affects the maximum power conversion efficiency (PCE) is CCT, and the maximum PCE is relatively independent of the CRI and LER under the same condition of CCT. The maximum PCE decreases with the increase of CCT. Based on the analysis of the energy loss within IPVs, it is found that the value of the optimal bandgap is sensitive to the fraction of red light in the spectrum of white LEDs. The maximum PCE is primarily limited by the relaxation to band edge loss, which is caused by the high-energy blue or cyan light in the spectrum of white LEDs. [ABSTRACT FROM AUTHOR]

Membranous nephropathy (MN) is an organ-restricted autoimmune disease mainly caused by circulating autoantibodies against podocyte antigens, including the M-type phospholipase A2 receptor (PLA2R) and thrombospondin domain-containing 7A (THSD7A). Antibodies against PLA2R are present in 70%-80% and against THSD7A in 2% of adult patients, which provides a paradigm shift in molecular diagnosis and management monitoring. Both antigens share some similar characteristics: they are expressed by podocytes and have wide tissue distributions; they are bound by autoantibodies only under nonreducing conditions, and the subtype of most autoantibodies is IgG4. However, the factors triggering autoantibody production as well as the association among air pollution, malignancy, and the pathogenesis of MN remain unclear. In this review, we discuss the similarity between the pathological mechanisms triggered by disparate antigens and their associated diseases. Furthermore, we demonstrated the possibility that PM2.5, malignancy, and gene expression specifically induce exposure of these antigens through conformational changes, molecular mimicry, or increased expression eliciting autoimmune responses. Thus, this review provides novel insights into the pathological mechanism of MN. [ABSTRACT FROM AUTHOR]

To effectively separate and recover the valuable elements iron and boron from ludwigite, this study investigated the magnetic properties and the magnetic separation efficiency. And the reactivity of boron component in the B-bearing tailing was studied. The results indicated that the saturation magnetization of ore samples was increased with the increase of microwave power and heating time. Under condition of 40 s with 4 kW, the saturation magnetization of ore samples increased from 12.73 emu/g for the raw ore to 24.70 emu/g for the treated ore, an increased of 94.03%. After magnetic separation, the grade and recovery rate of iron in the iron concentrate and the boron grade in the tailing for the treated sample with 4 kW for 40 s were increased by 19.74%, 31.46% and 86.46% in comparison with those of the untreated ore. The sample was heated to 600 °C at 4 kW and held for 20 min, the reactivity of boron component in the B-bearing tailing reached 86.68 wt%, which increased by 34.01% compared with that of the raw ore and 4.43% compared with that of the optimal traditional roasting value at 700 °C for 2 h, indicating that the roasting temperature and time were obviously decreased and the reactivity was significantly improved by the microwave radiation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate diagnostic performance and safety of ultrasound-guided needle biopsy in the diagnosis of peripheral pulmonary nodules (PPLs) ≤ 2 cm, and the influence factors of sample adequacy and safety. Materials and Methods: 194 patients (99 men, 95 women; mean age, 56.2 ± 13.7 years) who received biopsy for PPLs ≤ 2 cm between January 2014 to January 2019 were included. Variables including patient demographics, lesion location, lesion size, presence of lesion necrosis, presence of emphysema on CT, patient position, biopsy needle size and number of needle passes were recorded. Univariate analysis and multivariate logistic regression analysis were performed to explore the influence factor of sample adequacy and safety. Results: Biopsy specimens were adequate for diagnosis in 161/194 (83%) cases; the diagnostic accuracy was 81.4% (158/194). The overall complication rate was 8.8% (17/194), including pneumothorax, hemoptysis and pleural effusion, which occurred in 2.1% (4/194), 5.2% (10/194), and 1.5% (3/194) of patients, respectively. The incidence of pneumothorax in the 16-gauge-needle group were significantly higher than that of the 18-gauge-needle group (5.6% vs 0%, P =0.018). Adequate sampling of 16-gauge and 18-gauge needles were achieved in 90.3%(65/72) and 78.7%(96/122) cases, respectively. Multivariate logistic regression analysis revealed needle size (16-gauge vs 18-gauge) was an independent influence factors of sample adequacy (P =0.015, odds ratio=3.419). A receiver operating characteristic curve was plotted and the area under the curve was 0.774. Conclusion: US-guided percutaneous needle biopsy is a feasible and safe technique for small PPLs ≤ 2 cm. Needle size is an independent influence factor of sample adequacy and post-procedure pneumothorax. Sixteen-gauge needle has the advantage of achieving adequate sample for pathological analysis, though the risk of pneumothorax should be alerted. [ABSTRACT FROM AUTHOR]

Background: Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications.Materials and Methods: In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC.Results: The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05).Conclusion: Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice. [ABSTRACT FROM AUTHOR]