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Guansheng Zeng,1,* Jian Xu,1,* Huadong Zeng,1 Cuilan Wang,1 Lichang Chen,2 Huapeng Yu1 1Department of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huapeng Yu, Department of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, People’s Republic of China, Email huapengyu1960@163.com Lichang Chen, Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China, Email 519744491@qq.comPurpose: To investigate the differential clinical significance of fractional concentration of exhaled nitric oxide measured at a flow rate of 200 mL/s (FENO200) and concentration of nitric oxide in alveolar (CANO) in asthma, chronic obstructive pulmonary disease (COPD) or asthma-COPD Overlap (ACO).Methods: A total of 178 patients were included, with 82 patients in asthma group, 47 patients in COPD group and 49 patients in ACO group. Data for demographic data, spirometry and exhaled nitric oxide were collected for comparative analysis, correlation analysis and discriminant canonical analysis.Results: The values of FENO200 in asthma, COPD and ACO groups were 11.0(7.0– 22.3), 8.0(6.0– 11.0) and 9.0(6.5– 19.5) ppb, respectively. In the asthma group, FENO200 exhibited negative correlations with FEV1/FVC, MMEF and MEF50. No significant correlation was observed between CANO and pulmonary function parameters. In the COPD group, both FENO200 and CANO showed negative correlation with pulmonary function parameters including FVC, FEV1, PEF, MMEF, MEF75, MEF50. In the ACO group, FENO200 demonstrated no significant correlation with pulmonary function parameters, while CANO was correlated with FEV1, PEF, MMEF and MEF50. In COPD group, ΔFEV1 in the bronchodilator test was correlated with FENO200. As for the ACO group, ΔFEV1 was correlated with CANO. In the discriminant canonical analysis, four parameters including gender, age, MEF75 and FENO50 discriminated between the three groups of asthma, COPD and ACO.Conclusion: In asthma, COPD and ACO, FENO200 has demonstrated a robust correlation with CANO. Elevated FENO200 levels are predominantly indicative of pulmonary function impairment in asthma and COPD, whereas elevated CANO levels are mainly correlated with pulmonary function impairment in COPD and ACO. Compared with FENO200 and CANO, FENO50 may have a better discriminatory ability in distinguishing asthma, COPD and ACO.Keywords: FENO200, CANO, ACO, asthma, chronic obstructive pulmonary disease

Recent studies have reported that electroacupuncture (EA) can treat osteoporosis, but most of which were based on the “kidney governing bones” theory. However, the ancient Chinese medical textbook Huangdi Neijing pointed out that “Gallbladder Meridian of Foot Shaoyang” correlates with bone diseases, including osteoporosis, although the therapeutic regimens were lost after the Tang Dynasty. Here, we explored whether EA at GB points improves osteoporosis and its underlying mechanism. We constructed ovariectomized mice and treated them with EA at GB30 (Huantiao), GB34 (Yanglingquan), and GB39 (Xuanzhong) acupoints. EA treatment significantly improved bone parameters in osteoporotic mice, as evidenced by micro-computed tomography and histological assessment. Additionally, EA treatment elevated the serum levels of estradiol and SOD that were downregulated in osteoporotic mice. Transcriptome and qPCR results verified that EA treatment upregulated the expression of genes associated with bone formation. Moreover, transcriptome analysis revealed differential enrichment of the PI3K–Akt pathway. Furthermore, Western blot analysis demonstrated that estradiol partially counteracted a reduction in p-AKT expression induced by hydrogen peroxide. These findings indicate that EA treatment increases serum estradiol levels in mice, thus inhibiting osteoporosis induced by oxidative stress. This effect is achieved by activating the PI3K–Akt signaling pathway.

Nanofluid, a significant branch of fluid mechanics, plays a pivotal role in thermal management, optics, biomedical engineering, energy harvesting, and other fields. The nanoparticles present in the fluid render the continuum mechanics ineffective, necessitating the adoption of fractional calculus to elucidate the effects of nanoparticles on the motion properties of the nanofluid. This article applies the modified extended tanh-function technique to solve two classical Schrödinger equations, the fractional Phi-4 model and the conformable fractional Boussinesq model, for nanofluids. Multiple exact solutions are obtained, and the corresponding graphical representations are provided to elucidate the basic properties of the nanofluid. This article provides new research perspectives for the development of nanofluids.

Bo-Ran Deng,1,&ast; Yang Zhang,2,&ast; Zi-Feng Xie,3,&ast; Ding-Ding Wang,4,&ast; Tao Zeng,1 Dong-Bo Zhang,3 Li Huang,1 Qi-Yan Wang,1 Tu Shen,3 Qiao-Ling Wu3 1Surgical Anesthesia Center, Zigong Hospital of TCM, Zigong, 643000, People’s Republic of China; 2Department of Anesthesia, Da’an District Maternal and Child Health Hospital, Zigong, 643000, People’s Republic of China; 3Department of Anesthesia, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000, People’s Republic of China; 4Department of Anesthesia, EYE & ENT Hospital of Fudan University, Shanghai, 200031, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tu Shen; Qiao-Ling Wu, Department of Anesthesia, the First Affiliated Hospital of Jinzhou Medical University, No. 40, Section 3, Songpo Road, Linghe District, Jinzhou, 121000, People’s Republic of China, Email shentu2011@sina.com; wqiaoling2013@sina.comPurpose: The debate continues over the differential impact of remimazolam vs propofol on hemodynamic stability. This study aims to elucidate the effects of a combination of remimazolam and esketamine vs propofol and esketamine on hemodynamic parameters in elderly patients undergoing painless colonoscopies.Patients and Methods: We conducted a randomized controlled trial involving 754 patients, divided equally between two treatment groups. The remimazolam-esketamine group (RE group) received 0.15 mg/kg of remimazolam and 0.3 mg/kg of esketamine. Conversely, the propofol-esketamine group (PE group) was administered 1.5 mg/kg of propofol with 0.3 mg/kg of esketamine. Primary outcomes focused on the incidence of hypotension. Secondary outcomes assessed were other hemodynamic adverse events, intraoperative blood pressure and heart rate fluctuations, usage of vasoactive agents, sedation efficacy, and additional adverse reactions.Results: Hypotension occurred significantly less frequently in the RE group (9.78%, 95% confidence interval[CI]: 6.67– 12.87%) compared to the PE group (23.57%, 95% CI: 21.22– 30.52%), P< 0.001. The RE group also showed lower incidences of sinus tachycardia, sinus bradycardia, and required less support from vasoactive agents (P< 0.001). Additionally, the RE group experienced smaller fluctuations in blood pressure and heart rate (P< 0.05). Both groups achieved a 100% sedation success rate. Notably, the RE group had a longer induction period but a quicker recovery time (P< 0.001), and lower rates of respiratory depression (P=0.006) and injection pain (P< 0.001).Conclusion: Remimazolam combined with esketamine offers superior hemodynamic stability and significantly reduces adverse event rates compared to propofol plus esketamine in elderly patients undergoing painless colonoscopies, while maintaining effective sedation.Keywords: remimazolam, esketamine, colonoscopy, elderly patients, hemodynamic effects

A novel genus, Paradingleyomyces was introduced to accommodate Pa. lepidopterorum sp. nov., based on a multigene phylogenetic analysis and its distinct morphological characteristics. Maximum likelihood (ML) and Bayesian inference analyses (BI) of ITS, SSU, LSU, tef-1α, rpb1, and rpb2 sequence data shown that Pa. lepidopterorum formed an independent lineage nested between Perennicordyceps and Dingleyomyces. Morphologically, Paradingleyomyces is distinguished from Perennicordyceps by the presence of a white subiculum on the stromata of Ophiocordyceps cf. cochlidiicola. Perithecia are produced sporadically from the base to the apex of the stromata, and the secondary ascospores exhibit a notable length-to-width ratio. These characteristics distinguish Paradingleyomyces from Perennicordyceps which exhibits tortuous, branched, clavate to cylindrical stromata with rhizomorphs, parasitism of coleopteran and hemipteran larvae, and colonizes a broader range of fungal hosts. Additionally, perithecia in Perennicordyceps typically arise from the middle to the upper regions of the stromata, with secondary ascospores displaying a comparatively lower length-to-width ratio. Paradingleyomyces is morphologically identical to Dingleyomyces in its direct production of superficial perithecia on the stromata of Ophiocordyceps species. However, the phylogenetic analysis indicates that Paradingleyomyces and Dingleyomyces are not congeneric. Moreover, this study introduces another novel species, Polycephalomyces tengchongensis, and a novel sexual morph of Pleurocordyceps yunnanensis. Dimorphic phialides and conidia of Pleurocordyceps parvicapitata were observed and described for the first time based on a fresh collection from Tengchong County, Yunnan Province, China.

Abstract Though several anti-PD-1/PD-L1 antibodies approved for monotherapy in microsatellite instability-high or mismatch repair-deficient unresectable/metastatic solid tumors, novel immunotherapy with better anti-tumor activity is needed in clinic. In this single-arm, multicenter, pivotal, phase II study, patients received iparomlimab (a novel humanized anti-PD-1 mAb, 200 mg or 3 mg/kg for patients with body weight

Abstract Objective This study aims to examine the relationship and mechanism between sense of self and nonsuicidal self-injury among college students, providing a new theoretical basis for predicting and preventing such behavior. Methods A total of 1350 college students completed the Sense of Self scale, nonsuicidal self-injury questionnaire, frustration scale, and social problem-solving questionnaire. Results (1) Negative Sense of Self predicts frustration, and frustration positively predicts nonsuicidal self-injury. (2) Frustration serves as a partial mediator in the relationship between sense of self and nonsuicidal self-injury. (3) The impulsive-negligent social problem-solving style regulates the first half of the mediation model by influencing the relationship between sense of self and frustration. Conclusion Frustration, mediated by sense of self, increases the risk of nonsuicidal self-injury, and this relationship is moderated by the impulsive-negligent social problem-solving style. Sense of Self is a necessary but not sufficient condition for nonsuicidal self-injury, indirectly influencing such behavior through frustration triggered by stress events.

A-Mei Luo,1 Yuan-Sheng Yang,2 Yan Zhong,1 Rong-Fang Zeng,1 Qiao-Huo Liao,1 Jing Yuan,3 Wan-Ling Xiao,4 Lu-Lu Sun1 1Department of Paediatrics, The Third People’s Hospital of Shenzhen, Shenzhen, 518000, People’s Republic of China; 2Department of Hematology, The Third People’s Hospital of Shenzhen, Shenzhen, 518000, People’s Republic of China; 3Department of Infectious Disease, The Third People’s Hospital of Shenzhen, Shenzhen, 518000, People’s Republic of China; 4Department of Nursing, The Third People’s Hospital of Shenzhen, Shenzhen, 518000, People’s Republic of ChinaCorrespondence: Lu-Lu Sun, Department of Paediatrics, the Third People’s Hospital of Shenzhen, No. 29 of Bulan Road, Longgang District, Shenzhen, 518000, People’s Republic of China, Tel + 86 13510332310, Fax + 0755 61238983, Email sunlulusl@126.com Wan-Ling Xiao, Department of Nursing, The Third People’s Hospital of Shenzhen, No. 29 of Bulan Road, Longgang District, Shenzhen, 518000, People’s Republic of China, Tel +86 13 500 054 520, Fax +0755 61 238 983, Email wanling_x01@126.comObjective: To explore the factors that lead to occupational burnout among nurses in pediatric infectious disease wards after two consecutive years of frontline anti-epidemic work since the admission of COVID-19 patients in January 2020, in order to lay a scientific basis for reducing nurse occupational burnout.Methods: A total of 12 nurses who working in pediatric infection units were included in the study. Utilizing qualitative research methodologies, we used semi-structured interviews as the primary data collection method. The interview data underwent meticulous organization and were subjected to descriptive analysis.Results: 12 nurses assigned to pediatric infection wards frequently encounter occupational burnout, primarily attributed to increased work intensity, nurse-patient relationships, occupational frustration, psychological pressure, hospital infections, and various other contributing factors.Conclusion: We found that the severity of occupational burnout among nurses specializing in pediatric infectious diseases is noteworthy. Our recommendations include heightened consideration of this issue by government authorities and hospital administrators.Keywords: nurses, children, healthcare personnel, infectious infection area, occupational burnout, qualitative investigation

Lidan Yi,1,&ast; Qiao Liu,1,&ast; Chongqing Tan,1 Xiaomin Wan,1 Xia Luo,1 Yinbo Li,2 Haiying Li,3 Xiaohui Zeng3 1Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China; 2Hunan Center for Drug Evaluation and Adverse Reaction Monitoring, Hunan Provincial Food and Drug Administration, Changsha, People’s Republic of China; 3Department of Nuclear Medicine/PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaohui Zeng; Haiying Li, Email zengxiaohui2008@csu.edu.cn; lihaiying2013@csu.edu.cnObjective: To assess the cost-effectiveness of adding daratumumab to carfilzomib and dexamethasone (KdD) in patients with relapsed or refractory multiple myeloma (RRMM).Materials and Methods: A Markov model was established to estimate health and economic outcomes of carfilzomib and dexamethasone (Kd) with or without daratumumab for RRMM patients over a lifetime horizon. The patients and intervention of the two arms were modeled according to the CANDOR trial. Costs were collected from the Chinese health system perspective. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of our conclusions.Results: Compared with the Kd arm, KdD achieved an additional 0.537 quality-adjusted life-years (QALYs) at an incremental cost of &dollar;138,084, resulting in an incremental cost-utility ratios (ICURs) of &dollar;257,319 per QALY. Uncertainty analyses revealed that the model is robust to all the input parameters.Conclusion: From the Chinese healthcare system perspective, adding daratumumab to the Kd regimen for patients with RRMM appears to lack cost-effectiveness. Exploring alternative avenues such as negotiating for a more favorable price or introducing a financial assistance program dedicated to daratumumab and/or carfilzomib could prove to be an effective strategy in enhancing accessibility of this combination.Keywords: cost-effectiveness, daratumumab, multiple myeloma, Markov model, China

Lijuan Shi,1 Jieyu Xiao,1 Juanjuan Guo,1 Saijun Zeng,2 Suhong Wang,3 Jingbo Gong4 1School of Education, Hunan University of Science and Technology, Xiangtan, Hunan, People’s Republic of China; 2Yiyang Special Education School, Yiyang, Hunan, People’s Republic of China; 3Department of Clinical Psychology, The Third Affiliated Hospital, Soochow University, Changzhou, People’s Republic of China; 4Shanghai Changning Mental Health Centre, Affiliated Mental Health Center of East China Normal University, Shanghai, People’s Republic of ChinaCorrespondence: Jingbo Gong, Shanghai Changning Mental Health Center, Affiliated Mental Health Center of East China Normal University, Shanghai, 200335, People’s Republic of China, Email yefenhua@126.com Suhong Wang, Department of Clinical Psychology, the Third Affiliated Hospital, Soochow University, Changzhou, People’s Republic of China, Email yarmine@gmail.comBackground: Non-suicidal self-injury (NSSI) is a serious mental health problem among adolescents and young adults. Childhood trauma is a distal factor for NSSI and can also lead to cognitive abnormalities and maladaptive emotion regulation during the growth and development of individuals. However, it is unclear how childhood trauma and cognitive-emotional factors interact with NSSI.Objective: This study investigated the roles of childhood trauma and cognitive-emotional factors in NSSI among Chinese college students using network analysis.Methods: A total of 999 students from a university in central China were included in this study. Network analysis was used to examine the interrelationships between the frequency of NSSI thoughts and behaviors, childhood trauma subtypes (measured using the Childhood Trauma Questionnaire-Short Form), and cognitive-emotional factors such as early maladaptive schemas (EMSs) (measured using the Young Schema Questionnaire-Short Form), core self-evaluation (measured using the Core Self-Evaluations Scale), and emotion regulation (ER) strategies (measured using the Emotion Regulation Questionnaire). Structural equation modeling was used to further explore the role of the nodes most closely related to NSSI in the network analysis.Results: Emotional abuse and disconnection/rejection EMS are found to be directly related to NSSI thoughts (edge weight = 0.16 and 0.08, respectively). Disconnection/rejection EMS partially mediated (28.64%) the relationship between emotional abuse and NSSI thoughts, with a higher level of expression suppression corresponding to a greater positive relationship between emotional abuse and the disconnection/rejection EMS (p < 0.01).Conclusion: Our findings were in line with the cognitive-emotional model of NSSI, highlighting the importance of NSSI prevention in identifying risk groups who experienced emotional abuse in childhood and tended to use expressive suppression as an ER strategy.Keywords: childhood trauma, early maladaptive schema, emotion regulation strategy, non-suicidal self-injury, network analysis

Jingxia Mao,1,2,&ast; Guibo Yang,1,3,&ast; Qin Su,1,4,&ast; Zhonghong Zeng,1 Jueying Lin,2 Lin Kong,3 Lidun Zhang,4 Lidan Liu,1 Yihua Yang,1 Hongbo Wu1 1Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 2Department of Obstetrics, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 3Department of Obstetrics, The Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China; 4Department of Obstetrics, The First People’s Hospital of Yulin, Yulin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongbo Wu; Yihua Yang, Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China, Email 19587200@qq.com; workyyh@163.comObjective: To assess the safety and efficiency of in vitro fertilization/ intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on maternal and neonatal perinatal outcomes in women (≥ 40y) with singleton pregnancies.Methods: This multi-center retrospective cohort study, carried out from January 2018 to June 2023, enrolled 1762 women (≥ 40y) with singleton pregnancies of at least 28 weeks. Participants were divided into two groups: the IVF/ICSI-ET group (204 cases) and the spontaneous conception (SC) group (1558 cases). After 1:2 propensity score matching (PSM), the two groups were compared for maternal and neonatal outcomes. The SC group (1558 cases) was further divided by age into the < 43 years group (1195 cases) and the ≥ 43 years group (363 cases) for subgroup analysis.Results: Adverse maternal and neonatal outcomes were comparable between the IVF/ICSI-ET group and the SC group, with a higher cesarean section rate (78% vs 67.5%, P =0.013), an increased maternal ICU admissions rate (5.5% vs 1.3%, P =0.008), and a lower birth defects rate (1.1% vs 4.6%, P =0.037) in the IVF/ICSI-ET group. Subgroup analysis showed that women aged ≥ 43 years had higher incidences of gestational diabetes, gestational hypertension, cesarean section, and neonatal asphyxia compared to women aged < 43 years.Conclusion: This study indicated IVF/ICSI-ET is relatively safe for women ≥ 40 years with singleton pregnancies. However, advanced maternal age deteriorated maternal and neonatal outcomes, and IVF/ICSI-ET further heightened the risk of cesarean section and maternal ICU admissions. Therefore, enhanced care and vigilance are crucial for women over 40 undergoing IVF/ICSI-ET.Keywords: in-vitro fertilization, intracytoplasmic sperm injection, advanced maternal age, maternal outcomes, neonatal outcomes

Mengfei Wang,1 Jianyong Wei,2 Yao Zeng,3 Lisong Dai,4 Bicong Yan,4 Yueqi Zhu,4 Xiaoer Wei,4 Yidong Jin,1 Yuehua Li4 1School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China; 2Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Shenyang University of Technology, Shenyang, Liaoning, People’s Republic of China; 4Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Yuehua Li, Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Shanghai, 200233, People’s Republic of China, Email liyuehua0529@163.comIntroduction: Mechanical thrombectomy (MTB) is a critical procedure for acute ischemic stroke (AIS) patients. However, the free-text format of MTB surgical records limits the formulation of effective postoperative patient management and rehabilitation plans. This study compares the efficacy of large language models (LLMs) in structuring data from these free-text MTB surgical record.Methods: This retrospective study collected a total of 382 MTB surgical records from a tertiary hospital. An initial analysis of 30 surgical record from these records provided a guiding prompt for LLMs, focusing on basic and advanced characteristics, such as occlusion locations, thrombectomy maneuvers, reperfusion status, and intraoperative complications. Six LLMs—ChatGPT, GPT-4, GeminiPro, ChatGLM4, Spark3, and QwenMax—were assessed against data extracted by neuroradiologists and a junior physician for comparison. The all 382 surgical records were used to test the performance of LLMs. The performance of the LLMs was quantified using Accuracy, Sensitivity, Specificity, AUC, and MSE as an additional metric for advanced characteristics.Results: All LLMs showed high performance in characteristic extraction, achieving an average accuracy of 95.09 ± 4.98% across 48 items, and 78.05 ± 4.2% overall. GLM4 and GPT-4 were most accurate in advanced characteristics extraction, with accuracies of 84.03% and 82.20%, respectively. The processing time for LLMs averaged 73.10 ± 10.86 seconds of six models, significantly faster than the 427.88 seconds for manual extraction by physicians.Conclusion: LLMs, particularly GLM4 and GPT-4, efficiently and accurately structured both general and advanced characteristics from MTB surgical record, outperforming manual extraction methods and demonstrating potential for enhancing clinical data management in AIS treatment.Keywords: large language models, free-text report, mechanical thrombectomy, acute ischemia stroke

Fengshan Ouyang,1,2 Sheng Chen,1 Shuhuan Li,3 Lanyuan Liu,4 Senhong Guan,1 Zhaohan Yan,1 Shumin Wu,5 Yunying Zeng,1 Jiemei Liu,2 Jiankai Zhong1 1Department of Cardiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 2Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 3Department of Pediatrics, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 4Department of Ultrasound Medicine, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 5Department of Clinical Pharmacy, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of ChinaCorrespondence: Jiankai Zhong, Department of Cardiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), No. 1 Jiazi Road, Lunjiao Street, Shunde District, Foshan City, Guangdong Province, 528308, People’s Republic of China, Tel +86 13824530303, Email doctor-zh@smu.edu.cn Jiemei Liu, Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China, Email liujiemei90@hotmail.comObjective: This study aimed to examine the correlation and prognostic value of serum irisin levels in acute ischaemic stroke (AIS) and the subsequent development of hemiplegia.Methods: This study recruited participants from the Department of Neurology and Rehabilitation Medicine at Shunde Hospital, Southern Medical University. The Fugl–Meyer Assessment was used to assess functional impairment. Serum irisin levels were measured using the enzyme-linked immunosorbent assay method. Multivariate logistic regression was employed to explore the factors related to serum irisin levels and AIS.Results: Serum irisin levels in the AIS group were significantly lower than those in the control group. However, no significant association was observed between serum irisin and stroke severity within the AIS cohort. Multivariate logistic regression analysis revealed an inverse correlation between serum irisin levels and AIS risk, indicating that it serves as a protective factor against AIS. The increase in serum irisin levels (adjusted odds ratio (OR) 0.938, 95% confidence interval [CI]: 0.899– 0.977 per 100 pg/mL increment) was associated with a decreased risk of AIS. Analysis of the receiver operating characteristic curve confirmed the diagnostic value of serum irisin for AIS, with the area under the curve being 0.591 (95% CI: 0.522– 0.659, p = 0.012).Conclusion: Serum irisin levels were significantly lower in AIS and were identified as a protective factor, suggesting that serum irisin may have diagnostic value for AIS.Keywords: irisin, acute ischaemic stroke, hemiplegia, risk factors, predictive value

Shupeng Chen,1 Jie Liu,1 Guilian He,1 Nana Tang,2 Yingjian Zeng2 1School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330004, People’s Republic of China; 2Hematology Department, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, 330006, People’s Republic of ChinaCorrespondence: Yingjian Zeng, Jiangxi University of Traditional Chinese Medicine Affiliated Hospital, Hematology Department, Nanchang, 330006, People’s Republic of China, Email tcmdrc2023@outlook.comBackground: Cancer poses a major global health challenge, and immunotherapy, known as the third revolution in cancer treatment, has brought new hope to patients. The emerging field of immunometabolism has further enhanced the safety and efficacy of immunotherapy. Over the past two decades, this field has rapidly evolved in oncology, leading to numerous significant findings. This review systematically examines the literature on immunometabolism in cancer, visualizing research trends and identifying future directions.Methods: A comprehensive literature search was conducted in the Web of Science, PubMed, and Scopus databases, covering publications from January 2000 to December 2023. We employed tools like Citespace, VOSviewer, and RStudio for visual analysis of publication trends, regional contributions, institutions, authors, journals, and keywords.Results: A total of 3320 articles were published by 8090 authors across 1738 institutions, involving 71 countries. Leading contributors were China (n=469), the United States (n=361), and Germany (n=82). Harvard University was the most influential institution, while Frontiers in Immunology had the highest number of publications. The top research areas included glucose, lipid, and amino acid metabolism, the tumor microenvironment, and immune cell regulation.Conclusion: International collaboration and interdisciplinary efforts are advancing the field of cancer immunometabolism. Future research will likely focus on the interplay between metabolism and immunity, metabolic markers, immune cell reprogramming, and tumor-immune metabolic competition.Keywords: immunity, metabolism, tumor, metabolic reprogramming, immune evasion, bibliometrics

Ye Yang,1,&ast; Lin Wang,1,&ast; Zhiyang Zeng,2 Chunmeng He,1 Yanqiu Wang,1 Ying Huang1 1Department of Gastroenterology, Children’s Hospital of Fudan University/National Children’s Medical Center, Shanghai, 201102, People’s Republic of China; 2Department of Central Laboratory, Fengxian Central Hospital Affiliated to Southern Medical University, Shanghai, 201499, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ying Huang, Department of Gastroenterology, Children’s Hospital of Fudan University/National Children’s Medical Center, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People’s Republic of China, Tel +86-21-64931727, Email yhuang815@163.comPurpose: Spleen tyrosine kinase (Syk) is a widely-expressed cytoplasmic non-receptor tyrosine kinase involved in regulating various signaling pathways and plays an important role in chronic inflammation and autoimmune diseases. Gain-of-function SYK variants have been implicated in pediatric inflammatory bowel diseases. This study aimed to investigate the effects of gain-of-function SYK variants on the susceptibility to experimental colitis and macrophage function.Methods: Colitis was induced using dextran sodium sulfate and dinitrobenzene sulfonic acid in mice harboring a gain-of-function variant in SYK (SykS544Y). Intestinal inflammation was assessed via disease activity index, histological analysis, and Western blotting. The frequencies of macrophages, phagocytosis, and reactive oxygen species (ROS) production in bone marrow-derived macrophages (BMDM) were measured via flow cytometry. Chemokines and BMDM chemotaxis were analyzed using real-time quantitative reverse transcription polymerase chain reaction and Transwell assays. The expression of nucleotide-binding domain leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome-related proteins were detected using immunohistochemistry, enzyme-linked immunoassay and Western blotting.Results: SykS544Y mice exhibited increased susceptibility to experimental colitis, and macrophage infiltration in colon tissues significantly increased. We observed increased expression of macrophage chemokines in colon tissues and enhanced chemotaxis in SykS544Y BMDM. Additionally, we detected increased levels of fluorescent microspheres and 2.7-dichloride-hydro fluorescein diacetate-labeled ROS in SykS544Y BMDM. Moreover, enhanced levels of NLRP3 inflammasome-related proteins were observed in the colon tissues and BMDM from SykS544Y mice.Conclusion: Gain-of-function variant in SYK may contribute to the pathogenesis of pediatric inflammatory bowel diseases by promoting macrophage migration, phagocytosis, ROS production and activation of NLRP3 inflammasomes.Keywords: inflammatory bowel disease, SYK, gain-of-function variant, macrophage

Lian Chen,1,&ast; Yu-Huan Jiang,2,&ast; Mei-Yong Li,3 Bo Huang,3 Lei Yuan,2 Jin-Hua Wan,2 Ting-Yu Qin,2 Ting-Ting Zeng,2 Qing-Gen Chen2 1Department of Ultrasound Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 3Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China&ast;These authors contributed equally to this studyCorrespondence: Qing-Gen Chen, Department of Clinical Laboratory, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China, Tel/Fax +86 0791-86319420, Email 272880243@qq.comPurpose: The aim of the present study was to identify more effective laboratory markers to assess the severity of corona virus disease 2019 and predict the progression of the disease by collecting more laboratory markers and variables.Patients and Methods: In this study, most risk factors, including epidemiological characteristics, blood cell counts, cytokines, and infection markers, were collected from 126 patients with COVID-19 to assess their predictive value.Results: The area under curve (AUC) of Albumin (Alb) to fibrinogen (Fib) ratio (AFR) (0.791), Lactate dehydrogenase (LDH) (0.792), myoglobin (MYO) (0.795), C-reactive protein (CRP) (0.801) and lymphocyte count (0.859) were higher than other markers to distinguish severe from non-severe patients in receiver operating characteristic (ROC) analysis. In the univariate logistic regression analysis, thirty-six out of 46 risk factors, including 34 laboratory markers, were significantly associated with increased odds of severe patients. Multivariate logistic regression analysis showed that the CD19+ lymphocyte count, MYO, LDH, and AFR were associated with increased odds of severe disease. Moreover, Lymphocyte count and AFR levels increased, LDH and CRP levels decreased during hospitalization in recovered severe patients, whereas severe lymphocytopenia and continuously increasing LDH levels were observed in deteriorated patients. AFR level increased and CRP level decreased before the disease worsened in the deteriorated patients; however, when the patients deteriorated, AFR decreased and CRP increased significantly.Conclusion: CD19+ lymphocyte count, MYO, LDH, and AFR are independent biomarkers for early identification of severe COVID-19. Lymphocyte count, AFR, LDH, and CRP levels were helpful in predicting the clinical progression of the disease.\. Keywords: Albumin to fibrinogen ratio, C-reactive protein, Lymphocyte, Coronavirus Disease 2019, Inflammation

Jifeng Li, Yifei Zeng, Mengjie Wang, Yongxin Liu, Yubo Guo, Wenjie Zhao, Qiao Huang, Dongxiao Zhang Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Dongxiao Zhang, Department of Galactophore Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Art Museum Back Street, Dongcheng District, Beijing, 100010, People’s Republic of China, Tel +8617864190977, Email Tzdx_thinking@126.comPurpose: Granulomatous lobular mastitis (GLM) has seen a rising incidence, though its pathogenesis remains unclear, posing challenges for treatment and contributing to high recurrence rates with conventional therapies. While the role of inflammatory and immune factors in GLM has been recognized, a comprehensive clinical evaluation of these markers is still lacking. This study aims to identify potential diagnostic markers and therapeutic targets by comparing immune markers and cytokine levels in GLM patients and healthy controls.Methods: Conducted at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University from July 2023 to May 2024, this study enrolled 30 GLM patients and 15 healthy female controls in a 2:1 ratio. Serum levels of immune markers and cytokines were analyzed to explore their potential association with GLM.Results: The study population comprised 30 GLM patients with a mean age of 33.40 ± 4.12 years and 15 healthy female controls with a mean age of 32.13 ± 6.19 years. Significantly elevated levels of C-reactive protein (CRP), Immunoglobulin A (IgA), Complement Component 3 (C3), Complement Component 4 (C4), Compliment Component 1q (C1q), Alpha1-antit-rypsin (AAT), α 1-acidglycoprotein (AGP), Anti-histone antibodies (Anti-HIS), Anti-Ro52 antibodies (Anti-Ro52), Anti-double stranded DNA antibodies (Anti-dsDNA), Interleukin-6 (IL-6), Interleukin-10 (IL-10), and Tumor Necrosis Factor-α (TNF-α) were observed in GLM patients compared to controls (all P < 0.05). Subgroup analysis revealed higher levels of CRP, C3, C1q, AAT, and AGP in patients with larger mass areas and those with erythema nodosum (all P < 0.05). No significant differences were found in subgroups based on disease duration or recurrence (both P > 0.05).Conclusion: Serum levels of CRP, IgA, AAT, AGP, Anti-HIS, Anti-Ro52, Anti-dsDNA, C3, C4, C1q, IL-6, IL-10, and TNF-α may serve as diagnostic and prognostic indicators for GLM, with CRP, AAT, AGP, and C1q being particularly indicative of disease severity. These markers offer potential therapeutic targets for GLM.Keywords: granulomatous lobular mastitis, peripheral serology, immune markers, cytokine

Abstract The dynamic crack propagation trajectories play a crucial role in enhancing our understanding of spatial mechanisms involved in crack expansion. However, visualization of internal cracks under complex crack conditions has always been a challenge. Biological networks have been honed by many cycles of evolutionary selection pressure and are likely to yield reasonable solutions to such combinatorial optimization problems. This study applied the slime mould algorithm to improve the accuracy of internal crack localization in rocks and employed Minimum spanning tree and Gaussian mixture model to construct the crack propagation trajectories. By introducing the concept of bond length, the evolution characteristics of crack levels were effectively characterized. Research results showed that this approach effectively preserves essential crack localization information while mitigating the influence of interfering parameters, providing crack characterization results that exhibit high consistency with actual fracture patterns. The curves of cumulative bond length and relative bond length over time conform to the trend of a Growth/Sigmoidal curve. The strength of the bond was correlated with the temporal process of crack propagation. This result could be helpful for analyzing crack trajectories and predicting rock stability.

Abstract Branching networks are key elements in natural landscapes and have attracted sustained research interest across the geosciences and numerous intersecting fields. The prevailing consensus has long held that branching networks are optimized and exhibit fractal properties adhering to power-law scaling relationships. However, tidal networks in coastal wetlands and mudflats exhibit scaling properties that defy conventional power-law descriptions, presenting a longstanding enigma. Here we show that the observed atypical scaling represents a universal deviation from an ideal fractal branching network capable of fully occupying the available space. Using satellite imagery of tidal networks from diverse global locations, we identified an inherent “laziness” in this deviation—where the increased ease of channel formation paradoxically decreases the space-filling efficiency of the network. We developed a theoretical model that reproduces the ideal fractal branching network and the laziness phenomenon. The model suggests that branching networks can emerge under a localized competition principle without adhering to conventionally assumed optimization-driven processes. These results reveal the dual nature of branching networks, where “laziness” complements the well-known optimization process. This property provides more flexible strategies for controlling tidal network morphogenesis, with implications for coastal management, wetland restoration, and studies in fluvial and planetary systems.

Abstract Saccharomyces cerevisiae L7 was found to be an excellent starter and biological deacidification strain for Suanyu, however, the underlying mechanisms remain poorly understood. This study aimed to investigate the acid inhibition mechanism of S. cerevisiae L7. The strain enhances the sensory and flavor characteristics of Suanyu. The growth of Lactiplantibacillus plantarum is inhibited due to competition for carbon sources, resulting in a decrease in cell count from 9.00 Lg CFU/mL at 48 h to 7.70 Lg CFU/mL in co-culture. The addition of yeast reduces acidity, decreasing it from 5.83 g/kg to 0.82 g/kg at 48 h, while increasing sugar utilization to 94.52%. We found that cell contact was the main method of inhibition between the two microbials. Transcriptome analysis revealed that multiple pathways were affected under co-culture, ultimately leading to a decrease in lactic acid production. These findings provide valuable insights into the microbial interactions involved in biological deacidification.

Hui Zeng,1,&ast; Rong Liu,1,2,&ast; Chuanli Cheng,2,&ast; Nana Yang,2 Luwen Luo,1,2 Shengshuang Long,3 Renjia Zhou,4 Kai Yan,1 Huantao Huang1 1Nursing Department of the Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 2School of Nursing of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 3Infection Department of the Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 4ICU of the Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui Zeng, Email zenghui.1221@163.comObjective: This study investigated the distribution and resistance patterns of pathogens in the intensive care unit of a newly established hospital in Guizhou Province to promote the rational use of antibiotics to reduce multidrug resistance.Methods: A retrospective analysis was conducted on the distribution of pathogens and changes in drug resistance in the ICU of a newly built hospital in Guizhou Province from March 2019 to December 2023. WHONET 5.6 was used to analyze the results.Results: A total of 2444 culture samples were received, predominantly sputum (34.66%) and blood (23.36%) samples, with a steady annual increase in specimen types. A total of 572 pathogenic strains were isolated, predominantly from respiratory specimens (54.02%), including 345 Gram-negative bacteria (60.31%), 135 Gram-positive cocci (23.60%), and 92 fungi (16.08%). The most frequent pathogens included Acinetobacter baumannii (30.77%), Candida albicans (11.71%), and Klebsiella pneumoniae (9.97%). Drug sensitivity tests indicated a fluctuating resistance rate of Acinetobacter baumannii over the past five years. Staphylococcus aureus displayed strong in vitro activity against vancomycin, tigecycline, and linezolid, with no resistant strains identified. The detection rates of carbapenem-resistant Acinetobacter baumannii (CR-AB), carbapenem-resistant Pseudomonas aeruginosa (CR-PA), methicillin-resistant Staphylococcus aureus (MRSA), and strains producing extended-spectrum beta-lactamases (ESBL) were 86.78%, 26.79%, 32.45%, 70.27%, and 23.54%, respectively.Conclusion: Compared with other countries in the world, China has increased its data on the prevalence of MDR pathogens and antibiotic resistance.The high resistance rate of Acinetobacter baumannii in the ICU underscores the need for effective infection control measures. Enhanced monitoring of CR-AB, ESBL-producing bacteria, and MRSA is essential, along with improved management of antibacterial drugs and the pursuit of new therapeutic options.Keywords: new-built hospital, intensive care unit, pathogens, multidrug-resistant bacteria, antimicrobial resistance

Yang Xu,&ast; Qiankun Liu,&ast; Jiaxue Pang, Chunlu Zeng, Xiaoqing Ma, Pengyao Li, Li Ma, Juju Huang, Hui Xie College of Nursing, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui Xie, Bengbu Medical University, Donghai Avenue, Longzihu District, Bengbu City, Anhui Province, People’s Republic of China, Email hui2122@sina.comPurpose: Exercise is a vital adjunct therapy for patients with hypertension comorbidities. However, medical personnel and patients face significant obstacles in implementing exercise prescription recommendations. AI has been developed as a beneficial tool in the healthcare field. The performance of intelligent tools such as ChatGPT 4.0 and Intelligent Health Promotion Systems (IHPS) in issuing exercise prescriptions for patients with hypertension comorbidities remains to be verified.Patients and Methods: After collecting patient information through IHPS hardware and questionnaire systems, the data were input into the software terminals of ChatGPT 4.0 and IHPS according to the five stages of the Transtheoretical Model, resulting in exercise prescriptions. Subsequently, experts from various fields scored the accuracy, comprehensiveness, and applicability of each prescription, along with providing professional recommendations based on their expertise. By comparing the performance of both systems, their capability to serve this specific group was evaluated.Results: In most cases, ChatGPT scored significantly higher than IHPS in terms of accuracy, comprehensiveness, and applicability. However, when patients exhibited certain functional movement disorders, GPT’s exercise prescriptions involved higher health risks, whereas the more conservative approach of IHPS was advantageous.Conclusion: The path of generating exercise prescriptions using artificial intelligence, whether via ChatGPT or IHPS, cannot achieve a completely satisfactory state.But can serve as a supplementary tool for professionals issuing exercise prescriptions to patients with hypertension comorbidities, especially in alleviating the financial burden of consulting costs. Future research could further explore the performance of AI in issuing exercise prescriptions, harmonize it with physiological indicators and phased feedback, and develop an interactive user experience.Keywords: artificial intelligence, exercise prescription, hypertension, intelligent health promotion systems, transtheoretical model

Jinhong Zuo,&ast; Xiayang Zeng,&ast; Hongyi Ma, Peng Chen, Xinlei Cai, Zhenyu Fan, Jianpeng Qu Massage Department, Zhejiang Hospital, Hangzhou City, People’s Republic of China&ast;These authors contributed equally to this work and co-first authorsCorrespondence: Jianpeng Qu, Massage Department, Zhejiang Hospital, No. 12 Lingyin Road, Xihu District, Hangzhou City, 310000, People’s Republic of China, Email qjp0007@126.comBackground: Neck-type cervical spondylopathy (NTCS), a common degenerative disorder affecting the spine, poses challenges for patients and society. Research has demonstrated the effectiveness of traditional tuina techniques in treating NTCS, although some limitations still exist. Our study aimed to evaluate the effectiveness of combining regular massage techniques with three methods of neck movement (TCM) therapy for managing NTCS, utilizing musculoskeletal ultrasound measurements.Patients and Methods: In this study, 70 eligible patients with non-traumatic cervical spondylosis will be randomly assigned in a 1:1 ratio to either the experimental group, which will receive Tuina combined with a three-method neck movement treatment, or the control group, which will receive standard Tui Na manipulation. All participants will receive treatment for four weeks. Assessments will be conducted using musculoskeletal ultrasound, the McGill Pain Scale, and the Neck Disability Index (NDI) at three-time points: before treatment, at the end of treatment, and after 12 and 16 weeks of treatment.Conclusion: This paper investigates the utility of musculoskeletal ultrasound as a tool for evaluating the therapeutic efficacy of an integrated Traditional Chinese Medicine (TCM) strategy in alleviating pain and enhancing functional outcomes for patients with NTCS. The objective is to present a clinically viable and long-term treatment option.Trial Registration: Chinese Clinical Trial Registry, ChiCTR2300072648. Registered on June 20, 2023.Keywords: neck-type cervical spondylopathy, randomized controlled trial, therapeutic neck movement techniques, musculoskeletal ultrasonography

Weiquan Wu,1,&ast; Bing Zhang,1,&ast; Weiqi Wang,2 Qiujin Bu,3 Yuange Li,3 Peihua Zhang,2 Li Zeng1 1Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, People’s Republic of China; 2Institute of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 3Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Peihua Zhang, Institute of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China, Email zhangph@gdmu.edu.cn Li Zeng, Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, People’s Republic of China, Email lzeng@must.edu.moAbstract: The incidence of chronic wounds is steadily increasing each year, yet conventional treatments for chronic wounds yield unsatisfactory results. The delayed healing of chronic wounds significantly affects patient quality of life, placing a heavy burden on patients, their families, and the healthcare system. Therefore, there is an urgent need to find new treatment methods for chronic wounds. Plant-derived exosome-like nanovesicles (PELNs) may be able to accelerate chronic wound healing. PELNs possess advantages such as good accessibility (due in part to high isolation yields), low immunogenicity, and good stability. Currently, there are limited reports regarding the role of PELNs in chronic wound healing and their associated mechanisms, highlighting their novelty and the necessity for further research. This review aims to provide an overview of PELNs, discussing isolation methods, composition, and their mechanisms of action in chronic wound healing. Finally, we summarize future opportunities and challenges related to the use of PELNs for the treatment of chronic wounds, and offer some new insights and solutions.Keywords: exosomes, exosome-like nanovesicles, plants, chronic wound healing

Rong Yang,1,&ast; Qing Ma,1,2,&ast; Xiaolin Zhang,3 Qian Zhao,1,4,5 Suilan Zeng,6 Hechun Yan,7 Yi Lei,1,5 Shanye Yi,1 Xin Chen,8 Nianxi Wu9 1General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China; 3Preventive Health Section, Dayi County Shaqu Street Community Health Service Center, Chengdu, People’s Republic of China; 4Teaching & Research Section, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 5General Practice Medical Center and General Practice Research Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 6Guan Ge Center Health Center, Guangan, People’s Republic of China; 7Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China; 8Big Buddha Street Community Health Service Center, Leshan, People’s Republic of China; 9Chongqing Magic MedTech Co., Ltd., Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qian Zhao, Email 27355151@qq.comPurpose: Osteoporosis is a major health concern among the elderly, underscoring the importance of investigating its prevalence across different geographical regions. There is a current research gap regarding the incidence of osteoporosis and its variation by altitude within Sichuan, China. This study aimed to assess the prevalence of osteoporosis among populations residing at different altitudes in western Sichuan Province.Basic Procedures: This study utilized data from a population-based cohort in Sichuan, China. Representative locations were selected, and cluster random sampling was employed to conduct cohort studies across multiple sites in southwestern China. T Baseline data were collected from populations in Mianzhu, Kangting, and Sertar between July 2020 and August 2021. To assess differences in osteoporosis incidence among populations at different altitudes and with varying characteristics, we applied Chi-square and rank-sum tests.Main Findings: The study involved 4074 participants, including 1404 males (34.46%) and 791 individuals diagnosed with osteoporosis (19.42%). The prevalence of osteopenia in mid-altitude and high-altitude regions was 20.05% and 16.28%, respectively, while the prevalence of osteoporosis was significantly different, at 25.85% in mid-altitude areas compared to 13.00% in high-altitude areas (P < 0.001). Further analysis identified statistically significant differences in the prevalence of osteopenia and osteoporosis among females (P< 0.001), middle-aged (P=0.015) and elderly populations (P=0.038), as well as among individuals who were underweight (P=0.011), normal weight (P< 0.001), overweight (P< 0.001), and obese (P=0.038). As altitude increased, the prevalence of osteoporosis decreased in all groups except the elderly, while the prevalence of osteopenia decreased among women and across various BMI categories, but increased among middle-aged and elderly individuals. Additionally, in high-altitude regions, Kangting recorded an 18.10% prevalence of osteopenia and a 14.26% prevalence of osteoporosis, compared to Sertar, which exhibited a 6.54% prevalence of osteopenia and a 6.23% prevalence of osteoporosis, indicating significant differences (P< 0.001).Conclusion: This study demonstrates that higher altitudes are associated with a decreased prevalence of osteopenia and osteoporosis, particularly among females and middle-aged individuals. These results emphasize the importance of developing region-specific osteoporosis prevention strategies.Keywords: osteoporosis, aging, prevalence, altitude, Sichuan province

[Objective] The study aims to compare the genetic diversity and relationship between chloroplast genomes of olive varieties bred in China and those in the mediterranean olives, and to estimate the maternal diversity of olive varieties bred in China, in order to provide a basis for the development of Chinese olive accessions. [Methods] NOVOPlasty v.4.3.1 was used to assemble chloroplast genomes, which were based on the genome re-sequencing data of nine olive varieties bred in China and seven Iranian accessions, both of which were sequenced in this study, as well as fifty-two mediterranean olive accessions downloaded from the database. The sequence polymorphism was calculated. GPA, RAxML-NG, and Network 5.0, and other softwares were used to construct the chloroplast genome map, the relationship of phylogeny, and the network of haplotype, respectively. [Results] The chloroplast genomes of the tested olive accessions were consistent in terms of tetrad structure and number of genes. All chloroplast genomes identified seventeen haplotypes, among which the olive varieties bred in China had only one haplotype which was shared with the most mediterranean cultivated olives. The oleasters had the highest genetic diversity, followed by the mediterranean cultivated olives and then Iranian accessions, while nine olive varieties bred held all genetic diversity of 0. The phylogenetic relationship was consistent with the network of haplotype, and one branch contained most of the mediterranean cultivated varieties, including the Iranian olive accessions and all olive varieties bred in China. [Conclusion] The nine olive varieties bred in China shows an extremely low diversity of maternal origin. It is necessary to select and breed the olive varieties adapted to the habitats in China from a more comprehensive lineage of olive accessions in the later stages.

Kunzhao Huang,&ast; Xiaoyuan Yi,&ast; Huaying Xie, Jianzhang Luo, Qingyu Zeng, Feifei He, Liyan Wang Digestive Department, The Affiliated Hospital of Guilin Medical College, Guilin, 541001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Liyan Wang, Digestive Department, The Affiliated Hospital of Guilin Medical College, Guilin, 541001, People’s Republic of China, Tel +86-15295953938, Email 168wangliyan@163.comPurpose: Ferroptosis is a regulated form of cell death characterized by iron-dependent accumulation of associated lipid peroxides (LPO), which can induce cell death when a certain level is reached. However, the extremely complex tumor microenvironment (TME) has the characteristics of antioxidant, even if it induces ferroptosis of tumor cells, its killing effect on tumor cells is still very limited. To solve this problem, we constructed a novel nanomaterials (GOx/EC@Fe3O4@CCM). We evaluated the anticancer effect of this nanomaterial in inhibiting tumor growth through comprehensive in vitro and in vivo experiments.Methods: We successfully synthesized GOx/EC@Fe3O4 by one-pan synthesis method, then coated the Hepatocellular carcinoma cell membrane on its surface by co-extrusion technology, and finally synthesized the GOx/EC@Fe3O4@CCM nanoplatforms. We characterized the compounds in terms of morphology, particle size, and Zeta potential. In addition, we also studied the anti-tumor effect of GOx/EC@Fe3O4@CCM nanoplatforms from the following aspects, including the performance test of the nanoplatform, the intracellular effect of the nanoplatform, the anti-tumor effect in vitro, the intracellular ROS analysis, the intracellular effect of EC, and the anti-tumor effect in vivo.Results: The iron-based carriers in GOx/EC@Fe3O4@CCM nanoplatforms are released and produce ferrous ions (Fe2+) in an acidic environment. Due to the limitation of the endogenous level of hydrogen peroxide (H2O2), we introduced GOx into the TME or tumor cells. Under the catalysis of GOx, glucose reacted rapidly to produce a large amount of H2O2, which then combined with Fe2+ to produce a large number of Hydroxyl radical (·OH). Its toxicity leads to dysfunction of cell membrane and organelles, and then causes cell damage. EC inhibits Nuclear factor erythroid 2-related factor 2 (Nrf2) in cancer cells, which effectively down-regulates downstream gene products, including NAD(P)H quinone oxidoreductase 1 (NQO1) and heme oxygenase 1 (HMOX1). A series of chain reactions reduce the escape effect of oxidative stress (OS) and effectively maintain a high level of intracellular oxidation. Furthermore, it induces sustained and intense ferroptosis in tumor cells. Finally, the use of cancer cell membrane modified nanoplatforms due to the homology of membrane protein components improves the tumor cell targeting of the nanoplatforms, showing significant tumor cell inhibition and killing effect in vivo.Conclusion: The results showed that the GOx/EC@Fe3O4@CCM nanoplatforms successfully induced significant ferroptosis of Hepatocellular carcinoma cells through a cascade effect, and finally effectively promoted cancer cell regression. Keywords: ferroptosis, mesoporous Fe3O4, glucose oxidase, ethyl carbamate, Nrf2

Na Zhang,1,&ast; Yiran Xu,1,2,&ast; Beibei Liang,1 Jinru Zeng,1 Rui Wang,1 Yun Cai1 1Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, People’s Republic of China; 2Department of Pharmacy, The Second Naval Hospital of Southern Theater Command of PLA, Sanya, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yun Cai, Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, PLA General Hospital, Beijing, People’s Republic of China, Tel +86-10-6693-7166, Email caicai_hh@126.comAbstract: Colistin is the last-line option for the treatment of multidrug-resistant gram-negative bacterial infections with narrow therapeutic window. It is essential to ensure its efficacy and safety by therapeutic drug monitoring (TDM). Quantitative determination of colistin is difficult due to its complex ingredients. Previous determination methods demand intricate sample pre-treatment which are not only time-consuming but also costly, and is difficult to apply in clinical practice. Therefore, in order to carry out quantitative determination of colistin accurately and quickly, we establish a rapid high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) with simple sample pre-treatment process. The sample was purified by acetonitrile to remove the plasma protein. Then purified colistin was effectively separated from terfenadine, an internal standard (IS) using Phenomenex Kinetex C18 column (50.0× 2.1mm, 5μm) with acetonitrile and water mobile phase at a flow rate of 0.5 mL/min and 40°C column temperature. Colistin and IS were monitored in positive ion mode. Our method expressed good linearity in 50.0~6000 ng/mL of colistin B and 28.31~3397.51 ng/mL of colistin A in plasma. Methodology validations, including selectivity, precision, accuracy, recovery, stability, matrix effect, and dilution integrity met acceptance criteria of Bioanalytical Method Validation (M10) of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH).Keywords: colistin, HPLC-MS/MS, human plasma, protein precipitation, rapid and simple detection

Meng Xiang,1,&ast; Chengzhi Chen,2,&ast; Yuting Chen,1,&ast; Yuhan Zhang,1 Lei Shi,1 Yan Chen,1 Jie Li,2 Bowen Li,1 Bin Zeng,2 H Rosie Xing,1 Jianyu Wang,2 Zhen Zou2 1State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 2Molecular Biology Laboratory of Respiratory Disease, Key Laboratory of Clinical Laboratory Diagnostics (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhen Zou; Jianyu Wang, Email zouzhen@cqmu.edu.cn; 102758@cqmu.edu.cnIntroduction: Inhalation exposure to silica nanoparticles (SiNPs) is frequently inevitable in modern times. Although the impact of SiNPs on the ecological niche of the lungs has been extensively explored, the role and mechanism of SiNPs in the microenvironment of lung tumors remain elusive.Methods: In this investigation, Lewis lung carcinoma (LLC) was implanted into the left lung in situ after 28 days of intratracheal SiNPs injection into the lungs of mice. This study evaluates the effects of SiNPs on the tumor immune microenvironment both in vitro and in vivo. Our findings indicate that SiNPs can suppress lung cancer by modulating the immune microenvironment of tumors.Results: SiNPs treatment promotes macrophage M1 polarization by activating both NF-κB pathway and glycolytic mechanisms. This phenomenon may be associated with lung inflammation and fluctuation in the pre-metastatic and metastatic microenvironments induced by SiNPs exposure in mice. Additionally, we have shown for the first time that SiNPs have an inhibitory effect on lung carcinogenesis and its progression.Conclusion: This study uniquely demonstrates that SiNPs suppress lung cancer by promoting M1 polarization of macrophages in the immune microenvironment of lung tumors. Our findings are critical in exploring the interaction between SiNPs and lung cancer. Keywords: silicon nanoparticles, lung cancer, macrophage polarization, NF-κB, glycolysis

Abstract In order to investigate the association between the use of cardiomyopeptidin (CMP) and outcomes in critically ill patients with myocardial injury, we conducted a retrospective cohort study in Nanfang hospital, Southern Medical University. Clinical data of patients with myocardial injury were collected retrospectively and adjusted for possible confounders by propensity score weighting. The main outcome was the in-hospital mortality. Secondary outcomes included the major adverse cardiovascular events (MACE) occurring during the hospital, the individual components of MACEs, changes in high sensitive troponin T (hsTnT) levels, length of stay (LOS) in ICU and hospital. A Cox proportional hazards model was constructed to examine the association between the application of CMP and in-hospital mortality. Logistic regression and linear regression are used to analyze secondary outcomes. In total, 339 critically ill patients with myocardial injury were included in the analysis. After inverse probability of treatment weighting (IPTW), the use of CMP was associated with reduced in-hospital mortality (HR: 0.64, 95%CI: 0.43–0.96, P = 0.03). No significant differences were found in change of hsTnT, the occurrence of MACE and LOS in ICU as well as hospital after IPTW. The association was more significant in the subgroup with hsTnT > 3URL (HR: 0.41, 95%CI: 0.23–0.71, P

Ultrasonic metal welding machines are suitable for various complex applications (e.g., battery tabs) through unique mechanical design, special pressure application methods and high-precision welding. This work reports the weldability, forming quality and fractographic analysis of copper multilayered welded joints which were studied by SEM-EDS characterization, micro-hardness testing and tensile testing based on ultrasonic double roller welding (UDRW). Three groups of process parameters (A, B and C) were established to investigate the performance, production quality and welded joint surface interconnections. The tensile testing results of sample under parameter 3 in group A [S-P3(A)] indicate the maximum tensile strength of 69.859 N in T-peel test while the average tensile strength has increased by 58.525 N due to rise in welding time from 2 sec to 5 sec. The results analysis indicates that welding quality features in S-P3(A) joints under 4 bar, 100 mm/s, 45 % have been exploited. The over-welded zone was transformed into good-welded zone. The micro-cracks, fatigue stations and peeling texture in multilayers were reduced. It was found that when the welding energy was 10000 J then the tearing edges and interlayers cracks were minimized while keeping the other parameters constant. Moreover, when the amplitude increased up to 50 %, then numerous micro-cracks and micro-fissure stations were created, which leads to the occurrence of fracture in multi-layer welded joint. The EDS study investigated that the complex features are formed at the interface junction of sample 3 S3(A) in multilayer welds. The complex multilayer microstructures can induce and produce unique hardness properties for battery manufacturing. It leads to high quality and durable welds. Eventually, it is experimentally demonstrated that robust 40 layer welded joints can be obtained by the UDRW process. Data availability: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Objective To review the effect of resection of pediaric craniopharyngioma and the long-term quality of life. Methods The clinical datas before, during and after operation of 30 pediatric craniopharyngioma patients who were operated in Xuanwu Hospital, Capital Medical University from March 2014 to June 2024 were collected for retrospective analysis. The Katz index, body mass index (BMI), as well as one's ability to paparticipate in normal school life and physical exercise at last follow - up were recorded as key factors of long - term quality of life assesement. Results There were 7 (23.33%) of pediatric craniopharyngioma patients were identified as obese, 19 (63.33%) patients had endocrine dysfunction and 30 (100%) were identified as Katz index grade A before operation. Total resection of the tumor was achieved in 29 cases, while one case had subtotal resection. Median follow-up time was 38.00 (17.25, 53.00) months. The number of obese children increased to 9 (30%) during the last follow-up, but showed no statistic significance (χ2 = 0.125, P = 0.727). The number of patients with endocrine dysfunction increased to 27 (90%), and showed statistic significance (χ2 = 4.083, P = 0.039). All 30 cases remained Katz index grade A during the last follow-up. During the last follow-up, only one patient hadn't return to normal school life and 2 patients couldn't join physical exercise in school after total resection of craniopharyngioma. Conclusions Total resection in pediatric craniopharyngioma patients can still achieve good prognosis, and should be the target of surgical treatment.

The stigma associated with functional neurological disorder (FND) is greater than that associated with other neurological conditions, seriously affecting the quality of life of patients and increasing the burden on caregivers. This article reviews the concept, the current situation and harms, the influence factors and intervention strategies of FND stigma. The aim is to further develop our country as a reference for the study of stigma in FND.

There are many ships and ports in Shanghai coastal zones, where disastrous weather occurs frequently. Meteorological disasters often threaten the safety of people’s lives and properties along the coast and in the ports. In the past, the meteorological warnings for Shanghai coastal zones are mainly based on those issued for Yangshan Port by Shanghai Marine Meteorological Centre (SMMC), which are called “unified warnings”. However, there are obvious differences in the time and intensity of meteorological disasters in each region, and the unified warnings cannot meet the needs of the production and operation of the shipping and ports. In 2020, Shanghai coastal zones were divided into five sub-zones, where the meteorological forecast and warnings were carried out separately from July 2020. Based on hourly observational data of the representative stations in Shanghai coastal zones and warning signal data from 2016 to 2022, the gale events are selected to analyse the statistical characteristics of temporal and spatial distribution and evaluate the forecast quality and the economic benefits of the zonal warnings. The results show that: (1) The farther away from the coastline, the more gale days, the higher the wind speed and the longer the duration; the higher the wind speed during the process, the more obvious the difference of wind scale. In particular, the wind scale caused by typhoons can range up to 5 levels. (2) Compared with the “unified warning”, the missing alarm rate (MAR) of gale warnings in each sea area has been reduced significantly, by up to 5%, the false alarm rate (FAR) for the western part of Yangtze River estuary is reduced by more than 8% and the TS score is significantly improved by more than 10%. (3) The advance time of gale warnings has been reduced by more than 3 hours, the maintaining duration has been shortened by more than 16 hours at most, which can reduce the loss of nearly 18 million RMB and improve the production efficiency of the coastal zones of Shanghai greatly. The results of this paper show that refined marine meteorological forecasts and early warnings provide a safety guarantee for marine transportation and port production operations, resulting in significant social and economic benefits and the enhancement of the comprehensive guarantee level of marine meteorological services in Shanghai. In the next step, we will continue to research and develop more refined objective forecast methods adapted to this business, then build a regional shared operational system platform and extend it to the Yangtze River Delta region, so as to promote the high-quality development of shipping meteorological integration in the Yangtze River Delta region.

Abstract The ore pass wall in underground mines is often damaged by the impact and wear caused by unloaded ores. Studying the mechanisms of rock damage and failure under different impact angles can provide technical insights for the design and maintenance of the ore passes. This study employed an inclined impact experimental device along with a drop hammer loading test machine to perform cyclic low-energy impact tests on sandstone samples at five different inclined plane angles. The porosity of the rock samples was measured using a nuclear magnetic resonance (NMR) detection system, which provided data on porosity, T2 spectrum distribution, and NMR images of the samples after different numbers of impacts at different slope angles. The results indicate that: (1) Under cyclic inclined plane impact loading, an increase in the inclination angle, leads to reduced damage to the rock sample. The rock sample impacted at a 45° inclined plane exhibited the most severe damage. Rock samples with large inclination angles are more prone to experience rupture fractures at the tip of the inclined plane, primarily due to shear-tensile failure. The porosity changes dramatically at initially slope angles, resulting in greater damage. (2) As the number of impacts increases, the porosity of the samples first decreases, then increases, and subsequently decreases again. This progression corresponds to the closure of large pores following the first impact, followed by the expansion of micropores into macropores after 5 impacts, ultimately leading to gradual degradation of the samples until failure. (3) As the number of impacts increases, new cracks form within the rock sample and small cracks expand. Despite an increase in the number of micropores, the macropores still exert a significant influence on the rock samples, with the macropore spectrum area accounting for over 95%.

Abstract Background Irrational drug use has become a global problem threatening human health. As future health professionals, medical college students’ medication literacy (ML) is critical. Their mastery of medication-related knowledge will directly affect public medication safety in the future. Methods The initial scale was developed through a literature review and was modified through expert consultation and student interviews to form the initial scale with 14 items. In 2020, a questionnaire survey was conducted among students in a medical college for item analysis, reliability test, validity test and other analyses. Results The total Cronbach’s α coefficient was 0.826 and split-half reliability was 0.852. The Cronbach’s α coefficients for functional medication literacy, communicative medication literacy, and critical medication literacy were 0.901, 0.858, and 0.851, respectively. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett’s spherical test p 40%). The confirmatory factor analysis identified a three-factor model and showed goodness of fit indices for the scale: The χ²/df = 2.623, The Goodness of Fit Index (GFI) = 0.905, The Comparative Fit Index (CFI) = 0.950, Normed Fit Index (NFI) = 0.922, Tucker-Lewis index (TLI) = 0.938, and The Root Mean Square Error of Approximation (RMSEA) = 0.078. Conclusion A new scale for evaluating the medication literacy of Chinese medical college students was preliminarily developed, demonstrating good reliability and validity. Itcan be used as a preliminary measurement tool for assessing medical students’ medication literacy. However, due to the limitations of this study, the practical application of the scale needs to be further examined in a larger sample and should be refined in future studies.

In order to enhance the drug anti-tumor efficacy and biocompatibility，diselenide-hyaluronic acid has been developed as tumor therapy drug under irradiation in this research. In cellular toxicity evaluation，we observed that the introduction of hyaluronic acid had reduced the toxicity of diselenide agent. Under low therapeutic irradiation dose 4 Gy，remarkable anti-tumor effect has been realized，which tumor cellular viability can be realized with the drug concentration of only 27 μg/mL. The diselenide-hyaluronic acid developed in this research can provide an effective tumor therapy protocol under irradiation.

Bijun Li,1,&ast; Xinjian Cai,1,&ast; Lili Zhan,1 Xiaoyu Zhang,1 Yiteng Lin,1 Jiaomei Zeng2 1Department of Clinical Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China; 2Department of Nursing, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xinjian Cai, Department of Clinical Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Baohe Road No. 113, Longgang District, Shenzhen City, Guangdong Province, People’s Republic of China, Tel +86 13411968175, Email 14xjcai@gmail.comBackground: Quality assurance in laboratory testing significantly impacts patient care. The pre-analytical phase is particularly error-prone, contributing to around 70% of laboratory errors. High specimen rejection rates can delay diagnosis and treatment, cause patient discomfort, and increase healthcare costs. Quality Control Circles (QCC) have been introduced to medical institutions to improve process efficiency and reduce errors. This study aims to evaluate the effectiveness of QCC practices in reducing specimen rejection rates in a hospital clinical laboratory.Methods: A QCC initiative was implemented in the clinical laboratory from July 2021 to August 2022. The QCC comprised members from the clinical laboratory, nursing department, and administration. The initiative followed the PDCA (Plan-Do-Check-Act) cycle and involved multiple quality control methods, including flowchart analysis, Pareto analysis, and Fishbone diagrams. The effectiveness of the initiative was evaluated using statistical analyses of specimen rejection rates before and after implementation.Results: The QCC initiative led to a significant reduction in specimen rejection rates. The monthly specimen rejection rate decreased from an average of 1.13% before the intervention to 0.27% after the intervention. The most significant factors contributing to specimen rejection were identified as lack of sample collection information and blood clotting. Targeted interventions, such as appointing specimen collection liaisons, establishing a quality control team, and providing training on blood collection procedures, were implemented. These measures resulted in a notable decrease in the proportion of rejected specimens due to the identified factors.Conclusion: The implementation of QCC practices effectively reduced specimen rejection rates in the hospital laboratory. The study highlights the importance of systematic quality control methods and targeted interventions in improving laboratory processes. The success of the QCC initiative demonstrates its potential for broader application in other healthcare settings to enhance quality and efficiency.Keywords: quality control circle, specimen rejection, quality improvement, PDCA cycle, Pareto analysis

Changqin Li, Li Zeng, Meiling Jiang Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Li Zeng, Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China, Tel +86-18980607090, Email zengli998@163.comBackground and Objective: Concealed penis (CP) is a condition involving a congenital abnormality of the external genitalia, wherein the penile shaft is partially or completely obscured by surrounding skin tissues, negatively affecting the psychological and physical health of children. The guardians, who are primarily responsible for the daily care of children, play a crucial role in the early detection of this condition. Therefore, this study aims to explore knowledge, attitude, and practices (KAP) toward CP among guardians of young boys; results would provide a theoretical basis for the development of health education programs.Methods: This web-based cross-sectional study was conducted among guardians of boys in the Department of Pediatric Surgery, local hospital between June 2023 and September 2023. A self-designed questionnaire was developed to collect demographic information of the guardians and to assess their knowledge, attitudes and practices toward CP.Results: A total of 394 questionnaires were collected. Among the guardians, 143 (36.29%) of them were male, 375 (95.18%) were the parents of the children, 279 (70.81%) had a junior college or bachelor’s degree, and 46 (11.68%) reported their children had CP. The knowledge, attitudes and practices scores were 4.00± 2.00 (possible range: 0– 7), 35.63± 3.40 (possible range: 9– 45), and 23.03± 6.97 (possible range: 9– 45), respectively. The structural equation model demonstrated that knowledge had direct effects on attitudes (β=0.63, p< 0.001), and practices (β=0.81, p< 0.001). Moreover, attitudes had direct effects on practices (β=0.43, p< 0.001).Conclusion: This study found insufficient knowledge, positive attitudes, but poor practices toward the CP in guardians of boys, especially among participants from rural areas of families with lower income. It is recommended to tailor educational initiatives and implement strategies to bridge the knowledge-practice gap toward concealed penis in boys.Keywords: knowledge. attitudes, practices, concealed penis, cross-sectional study

Shiya Zeng,1,&ast; Yanyue Tan,1,2,&ast; Zhiwei Cao,3 Yunhao Zheng,1 Tiqian Liu,1 Yifei Deng,1 Xin Xiong1 1State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3School of Stomatology, Tianjin Medical University, Tianjin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xin Xiong, State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 15, West Section 3, Second Ring Road, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 028 85501425, Email drxiongxin@scu.edu.cnObjective: Growing researches explore vitamin D’s role in temporomandibular disorders (TMDs), but the link between vitamin D and TMDs remains debated. To clarify the causal relationship, we conducted a Mendelian randomization (MR) analysis using data from genome-wide association studies (GWAS).Subjects and Methods: The GWAS dataset of vitamin D (GWAS ID: ukb-d-30890_irnt; sample size: 329247) was obtained from the IEU Open GWAS project. And that of TMDs (GWAS ID: finn-b-TEMPORO; sample size: 134280), initiated on August 25th, 2017 and publicly released on December 18th, 2023, was extracted from the FinnGen dataset, whose cases were diagnosed based on the revised International Classification of Diseases, 10th Edition (ICD-10) code K07.6. Both datasets were obtained from the European population. According to three assumptions of MR analysis, a bi-directional MR analysis was performed to measure the causal relationship, with Inverse variance weighted (IVW) as the primary method and MR Egger and Weighted median as supplement. Moreover, diverse sensitivity analyses, including Cochran’s Q test, MR Egger intercept, Mendelian randomized polymorphism RESidual Sum and Outlier (MR-PRESSO), and leave-one-out analysis, were used to verify the stability of the findings.Results: The MR analysis supported causal effects of vitamin D levels on TMDs risks within the European population using IVW method [odds ratio = 1.316; 95% confidence interval = 1.086 to 1.595; P = 0.005], supported by MR Egger and Weighted median. While there was no indication that TMDs have a direct impact on vitamin D levels [β: − 0.00738, standard error = 0.00665; P = 0.568].Conclusion: The study revealed that within the European population higher levels of vitamin D led to higher risks of developing temporomandibular disorders, but found no obvious evidence that TMDs are causally associated with vitamin D. The conclusion should be cautiously interpreted, given the selection bias of TMDs patients sample.Keywords: Mendelian randomization analysis, temporomandibular joint disorders, vitamin D, 25-hydroxyvitamin D

Abstract Background Disorders of consciousness (DoC) are a group of conditions that affect the level of awareness and communication in patients. While neuroimaging techniques can provide useful information about the brain structure and function in these patients, most existing methods rely on a single modality for analysis and rarely account for brain injury. To address these limitations, we propose a novel method that integrates two neuroimaging modalities, functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), to enhance the classification of subjects into different states of consciousness. Method and results The main contributions of our work are threefold: first, after constructing a dual-model individual graph using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we introduce a brain injury mask mechanism that consolidates damaged brain regions into a single graph node, enhancing the modeling of brain injuries and reducing deformation effects. Second, to address over-smoothing, we construct a dual-level graph that dynamically construct a population-level graph with node features from individual graphs, to promote the clustering of similar subjects while distinguishing dissimilar ones. Finally, we employ a subgraph exploration model with task-fMRI data to validate the interpretability of our model, confirming that the selected brain regions are task-relevant in cognition. Our experimental results on data from 89 healthy participants and 204 patients with DoC from Huashan Hospital, Fudan University, demonstrate that our method achieves high accuracy in classifying patients into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), or normal conscious state, outperforming current state-of-the-art methods. The explainability results of our method identified a subset of brain regions that are important for consciousness, such as the default mode network, the salience network, the dorsal attention network, and the visual network. Our method also revealed the relationship between brain networks and language processing in consciousness, and showed that language-related subgraphs can distinguish MCS from UWS patients. Conclusion We proposed a novel graph learning method for classifying DoC based on fMRI and DTI data, introducing a brain injury mask mechanism to effectively handle damaged brains. The classification results demonstrate the effectiveness of our method in distinguishing subjects across different states of consciousness, while the explainability results identify key brain regions relevant to this classification. Our study provides new evidence for the role of brain networks and language processing in consciousness, with potential implications for improving the diagnosis and prognosis of patients with DoC.

Sining Zeng,1,2,&ast; Min Wu,1,&ast; Ling Xu,1 Zining Guo,1 Shufan Chen,1 Keyu Ling,1 Haihan Li,1 Xiaoli Yu,1 Xiaoping Zhu1 1Department of Nursing, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2School of Nursing, Soochow University, Suzhou, 215031, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaoping Zhu, Department of Nursing, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China, Tel +86-021-66300588, Fax +86-021-66307542, Email xiaopingzhu0424@163.comBackground and Objectives: While extensive research has examined the rehabilitation challenges faced by stroke survivors, there is limited literature addressing the difficulties encountered by older adult stroke survivors and their caregivers in accessing rehabilitation and long-term care within the Chinese community. This study aimed to investigate the specific challenges related to access, quality, and coordination of rehabilitation and long-term care experienced by older adult stroke survivors and their caregivers within the Chinese community.Methods: A qualitative phenomenological design was employed to explore the lived experiences of stroke survivors and their caregivers within the Chinese community. A purposive sampling method was used to recruit participants from June to August 2023. Participants engaged in face-to-face semi-structured interviews. The data were analyzed using an inductive thematic analysis approach to identify and understand key themes and sub-themes.Results: The study involved 38 participants, consisting of 21 older adult stroke survivors (13 males, 8 females) and 17 family caregivers (7 males, 10 females), recruited from five Chinese community health service stations. The analysis identified four distinct themes and 11 sub-themes that encapsulated the challenges faced by participants. These themes include (1) Difficulties in accessing medical services (insufficient medical resources, lack of rehabilitation resources, and time-consuming processes), (2) Challenges in daily life (inconvenience in daily mobility, inadequate financial support, and difficulties in applying for home care services), (3) Psychosocial stress (loneliness, powerlessness, and worry about burdening others), (4) Insufficient information (lack of awareness of available community services, and limited public health education activities).Conclusion: Older adult stroke survivors and their caregivers in Chinese communities face significant challenges. To improve their well-being and quality of life, it is crucial to address these challenges through enhanced access to healthcare, better support for daily living, and more effective information dissemination. Meeting these needs requires a coordinated effort from healthcare providers, community stakeholders, and policymakers to develop and implement effective, long-term care solutions.Keywords: stroke, survivors, caregivers, community, qualitative research

Jingyu Zhang,1,&ast; Shenhua Qu,2,&ast; Yuting Huang,1,&ast; Xia Zhang,1 Xiubing Tong,1 Yanping Fang,1 Tianyu Rao,1 Kezhi Liu,1 Jia Lin,1 Yuye Lin,1 Chufan Zeng,1 Guojun Zhang,1 Xianghong Jing,3 Jun Liao,1 Yu Kan1 1College of Acupuncture and Tuina, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, People’s Republic of China; 2Guangzhou Traditional Chinese Medicine Hospital, Guangzhou, 510000, People’s Republic of China; 3Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Liao; Yu Kan, Email 2007065@fjtcm.edu.cn; 2019035@fjtcm.edu.cnPurpose: Chronic cervical muscle injury is the first common cause of the development of cervical spondylosis, and Tuina can effectively promote the repair of chronic cervical muscle injury and alleviate neck pain, but the mechanism behind its efficacy is still unknown. The proliferation and differentiation of muscle satellite cells and the apoptosis of cervical myocytes play important roles in the repair of chronic cervical muscle injuries; therefore, this study aimed to explore the potential mechanisms of Tuina to promote the repair of cervical muscle injuries in terms of the proliferation and differentiation of satellite cells and the apoptosis of myocytes.Patients and Methods: Twenty-eight Wistar rats were randomly divided into control group, model group, Tuina group, and meloxicam group, with 7 rats in each group. Except for the control group, each group were establish a chronic cervical muscle injury model (CCMI). Meloxicam (0.79 mg/kg) was administered by gavage, and in the Tuina group, pressure was applied to the Fengchi acupoint on the affected side once a day. Morphological changes of cervical muscle tissues were detected by ultrasonic diagnostic instrument and HE staining, electrophysiological recordings of electromyographic changes, apoptosis rate was detected by TUNEL staining, and positive expression of Bax, Bcl-2, IGF-1, MyoD, and Pax-7 were detected by Immunohistochemistry and Western blot.Results: In CCMI model rats, we observed that the cervical muscle fibers were disorganized, with irregular morphology, and the amplitude of electromyography was significantly weakened, while Tuina could significantly improve these symptoms and effectively promote the repair of chronic cervical muscle injury. Meanwhile, compared with the model group, Tuina could significantly increase the expression levels of IGF-1 (P< 0.01) and MyoD (P< 0.05) and decrease the expression level of Pax7 (P< 0.05). In addition, we found that the number of apoptotic cells in cervical myocytes was reduced after Tuina intervention (P< 0.05), and Tuina inhibited the expression of pro-apoptotic factor Bax (P< 0.01) and promoted the expression of anti-apoptotic factor Bcl-2 (P< 0.05).Conclusion: Tuina can promote the proliferation and differentiation of satellite cells to repair chronic cervical muscle injury by regulating the expression of Pax7, MyoD, and IGF-1, as well as inhibiting the expression of Bax and promoting the expression of Bcl-2 to ameliorate the apoptosis of cervical myocytes in CCMI model rats.Keywords: Tuina, cervical spondylosis, neck pain, satellite cell

Yaojie Fu,1,&ast; Yujing He,2,&ast; Caixia Zheng,3 Jianyong Zeng,3 Hongjie Ou3 1Emergency Department, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China; 2Intense Care Unit, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China; 3Department of Infectious Diseases, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongjie Ou, Department of Infectious Diseases, The First Affiliated Hospital of Xiamen University, No. 10, Shanggu Road, Xiamen, Fujian, 361001, People’s Republic of China, Email ouhongjie@sina.com Yujing He, Intense Care Unit, The First Affiliated Hospital of Xiamen University, No. 10, Shanggu Road, Xiamen, Fujian, 361001, People’s Republic of China, Email heyujing1988@126.comIntroduction: Sepsis remains a significant global health challenge due to its high morbidity and mortality rates. Disseminated Intravascular Coagulopathy (DIC) represents a critical complication of sepsis, contributing to increased mortality and economic burden. Despite various prognostic scoring systems, there is a lack of a specific model for DIC prediction in sepsis patients.Methods: This observational study included 336 sepsis patients. Clinical and laboratory data were collected, and prognoses were defined according to established criteria.Results: We enrolled 336 patients, with 304 in the non-DIC group and 32 in the DIC group. Patients with DIC had notably lower platelet (PLT) and higher levels of prothrombin time (PT), lactate (LAC), and procalcitonin (PCT) compared to those without DIC. Univariate and multivariate analyses identified risk factors associated with the DIC, showing that PLT (OR = 0.985, 95% CI 0.978– 0.993, p < 0.001), PT level (OR = 1.140, 95% CI 1.004– 1.295, p = 0.044), and LAC (OR = 1.101, 95% CI 0.989– 1.226, p = 0.078) were related factors. A risk model was established, and its sensitivity and specificity in predicting DIC among sepsis patients were assessed by comparing it to the SOFA score. The area under the ROC curve for the model was 0.850, while the SOFA score was 0.813. With a model score >− 2.12, the sensitivity for predicting DIC was 84.4%, and the specificity was 75.0%.Conclusion: Our study introduces a predictive model for DIC detection in sepsis patients, emphasizing the need for clinicians to focus on patients with high model scores for timely intervention.Keywords: sepsis, risk model, disseminated intravascular coagulopathy, platelet, mortality

In China, higher education increasingly emphasizes innovation and entrepreneurship, recognizing its pivotal role in enhancing college students’ entrepreneurial skills. While extensive research exists on entrepreneurship education for undergraduate students in Chinese universities and vocational colleges, there is a notable gap in studies specifically addressing entrepreneurship coaching for vocational art and design students. This investigation addresses this gap by examining the development of entrepreneurship coaching indicators for vocational art and design majors through a comprehensive literature review. By employing the fuzzy Delphi method, a questionnaire survey involving 12 experts was conducted to establish entrepreneurship coaching indicators for vocational art and design majors in Guangdong, China. The findings reveal a framework comprising entrepreneurship knowledge, practical skills, entrepreneurial dispositions, and intentions, organized into 4 dimensions, 15 principal indicators, and 46 sub-indicators.

In this article, we work on vector optimization problems in linear topological spaces. Our vector optimization problems have weakened convex inequality constraints and weakened affine equality constraints. Our inequalities are given by partial orders that are induced by pointed convex cones. We prove a Farkas–Minkowski-type theorem of alternative and obtain some optimality conditions through the discussions of vector saddle points and scalar saddle points.

Objective Given the high operating speeds, minimal residual acceleration margin, and open-air track conditions of EMU (electric multiple units), as well as the deficiencies in conventional combination correction methods such as poor accuracy in criterion extraction and significant torque adjustment losses. It is aimed to optimize EMU adhesion utilization by analyzing and improving speed acquisition, fault identification, criterion extraction, and torque adjustment. Method A segmented T-method and median filtering method for speed acquisition is employed, and faulty speed data is identified and substituted to reduce the impact of speed interference/faults on adhesion control. The acceleration difference impact rate is used instead of impact rate and the differentiator is substituted with a high-pass filter to minimize the impact of complex track surface conditions on adhesion criterion extraction. For torque adjustment, it latches the torque at the previous wheel slip/skid trigger moment and uses this as a reference to calculate the reducing and increasing torque step sizes in real-time. The reducing and increasing step sizes are divided into 10 segments, executed from large to small to minimize torque losses. The feasibility of these methods is verified through experiments using a type of EMU as example. Result & Conclusion Experimental results demonstrate that during the entire acceleration and deceleration process of anti-slip and anti-skid tests, the deviation of the axle speed from the reference speed is limited. Torque adjustments do not exhibit significant repeated fluctuations, resulting in relatively less train impact. The traction and braking test data calculation analysis show that the adhesion utilization rates of traction anti-slip and braking anti-skid are both greater than 90%, effectively improving adhesion utilization.

Xingxing Zhu,1,&ast; Jialu Chen,2,&ast; Shengjie Wu,3 Jiling Zeng,4 Yahong Sun,1 Xiaohong Wu5 1Department of Pulmonary and Critical Care Medicine, Haining People’s Hospital, Haining, People’s Republic of China; 2Department of Gynaecology, Haining Maternal and Child Health Hospital, Haining, People’s Republic of China; 3Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaohong Wu, Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Shangcheng District, Hangzhou, 310000, People’s Republic of China, Tel +86 13588706901, Email 3192018@zju.edu.cnBackground: The incidence of community-acquired empyema caused by the Streptococcus anginosus group (SAG) has been on the rise in the 2020s. To the best of our knowledge, while empyema caused individually by either strain has been reported, there are no reports on empyema caused by concurrent infection with these two strains. Here, we report for the first time empyema caused by concurrent infection with Streptococcus intermedius and Streptococcus constellatus (both SAG species) in a postoperative patient who had been treated for floor of the mouth carcinoma.Case Presentation: A 61-year-old male patient who had undergone surgical treatment for floor of the mouth carcinoma 2 year earlier suddenly presented with left-sided chest pain. Chest computed tomography (CT) revealed encapsulated pleural effusion on the left side, which was diagnosed as empyema. Metagenomic next-generation sequencing(mNGS) of the pleural fluid sample indicated mixed infection caused by Streptococcus intermedius and Streptococcus constellatus. The patient’s condition improved about 5 weeks after treatment with thoracic fluid drainage and cephalosporin antibiotics.Conclusion: This case highlights the possibility of concurrent infection with two SAG strains in patients with empyema. Currently, it is unclear whether there is a definitive relationship between a surgical history of carcinoma of the floor of the mouth and empyema caused by infection with SAG strains. This case could, perhaps, serve as a reference for future related research on the topic.Keywords: Streptococcus intermedius, Streptococcus constellatus, oral carcinoma, pleural effusion, carcinoma of the floor of the mouth, empyema