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This review discussed the synthetic applications of propiolic acids in the preparation of diverse N-heterocycles. 3~9-membered rings like azirines, β-lactams, oxazolidin-2-ones, 2-oxindoles, indoles, isoindolin-1-ones, imidazo[1,2-a]pyridines, triazoles, 2-pyridones, 2-quinolones, 1,4- benzothiazines, thiazinones, spiroindolines, etc. could be constructed via radical addition, fourcomponent Ugi reactions, 1,3-dipolar cycloadditions, or Diels-Alder reaction mechanism. We hope this review will promote future research in this area Introduction;: Synthesis of azirines; Synthesis of lactams; Construction of five-membered rings; Construction of six-membered rings; Double cyclization for N-heterocycles; Construction of 7~9- membered rings; Conclusion.

Graph Neural Networks (GNNs) aim to extend deep learning techniques to graph data and have achieved significant progress in graph analysis tasks (e.g., node classification) in recent years. However, similar to other deep neural networks like Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs), GNNs behave like a black box with their details hidden from model developers and users. It is therefore difficult to diagnose possible errors of GNNs. Despite many visual analytics studies being done on CNNs and RNNs, little research has addressed the challenges for GNNs. This paper fills the research gap with an interactive visual analysis tool, GNNLens, to assist model developers and users in understanding and analyzing GNNs. Specifically, Parallel Sets View and Projection View enable users to quickly identify and validate error patterns in the set of wrong predictions; Graph View and Feature Matrix View offer a detailed analysis of individual nodes to assist users in forming hypotheses about the error patterns. Since GNNs jointly model the graph structure and the node features, we reveal the relative influences of the two types of information by comparing the predictions of three models: GNN, Multi-Layer Perceptron (MLP), and GNN Without Using Features (GNNWUF). Two case studies and interviews with domain experts demonstrate the effectiveness of GNNLens in facilitating the understanding of GNN models and their errors.

The Pacific Decadal Oscillation (PDO) is the most dominant decadal climate variability over the North Pacific and has substantial global impacts. However, the interannual and decadal PDO prediction skills are not satisfactory, which may result from the failure of appropriately including the North Pacific midlatitude air-sea interaction (ASI) in the initialization for climate predictions. Here, we present a novel initialization method with a climate model to crack this nutshell and achieve successful PDO index predictions up to 10 years in advance. This approach incorporates oceanic observations under the constraint of ASI, thus obtaining atmospheric initial conditions (ICs) consistent with oceanic ICs. During predictions, positive atmospheric feedback to sea surface temperature changes and time-delayed negative ocean circulation feedback to the atmosphere over the North Pacific play essential roles in the high PDO index prediction skills. Our findings highlight a great potential of ASI constraints during initialization for skillful PDO predictions.

Both South Asia and East Asia are the most polluted regions of the world. Unlike East Asia, the aerosol optical depth (AOD) over South Asia keeps increasing for all recent years, which calls for more attention. This study investigates the impacts of anthropogenic emissions over South Asia on the downstream regional climate during spring with the Community Earth System Model 2 (CESM2). The model results suggest that South Asian pollutants have significant impacts on East Asian spring climate, and the impacts could be even larger than locally emitted aerosols. Two possible dynamical pathways (i.e., the northern and the southern pathways) bridging South Asian aerosol forcing and East Asian climate are proposed, and both ways are associated with the black carbon (BC)-induced climate feedbacks surrounding the Tibetan Plateau (TP). The northern pathway is mainly due to the TP warming induced by the BC snow darkening effect (SDE), which significantly reduces the surface air temperature (SAT) over northern East Asia. BC-induced TP warming increases the meridional thermal gradient and accelerates the midlatitude jet stream, which favors the cold-air advection over northern East Asia. The southern pathway is associated with the BC “elevated heat pump” hypothesis, which mainly affects the precipitation in southern East Asia. BC from South Asia accumulates near the south slope of TP, inducing an abnormal ascending motion near the Bay of Bengal. A compensating anomalous sinking motion is then forced in South China, which suppresses the precipitation there. A primary observational analysis is also performed to verify both dynamical pathways. Significance Statement The intensified air pollution over South Asia and its impacts on local climate have been extensively investigated, but its impacts on the climate of remote regions have not been well recognized. Two possible dynamical pathways bridging South Asian air pollutants and East Asian spring climate are proposed, and the black carbon (BC)-induced climate feedbacks surrounding the Tibetan Plateau (TP) are emphasized for both pathways. The findings of this study favor the projection of East Asian future climate under the background of Third Pole/TP warming.

Background. Both low skeletal muscle mass and delirium are prevalent in older hospitalized patients, while their associations are unclear. This systematic review and meta-analysis aim to investigate the associations between low skeletal muscle mass and the incidence of delirium in hospitalized patients. Methods. The PubMed, Web of Science, and Embase were searched for relevant studies published before May 2022, and we conducted this systematic review and meta-analysis according to the PRISMA and MOOSE guidelines. The summary odds ratios (OR) and 95% confidence intervals (CI) were estimated, and subgroup analyses were also conducted according to the age and major surgeries. Results. Finally, nine studies with 3 828 patients were included. The pooled result showed no significant association between low skeletal muscle mass and the incidence of delirium (OR 1.69, 95% CI 0.85 to 2.52). However, sensitivity analysis suggested that one study caused a significant alteration of the summary result, and the meta-analysis of the remaining 8 studies showed that low skeletal muscle mass was significantly associated with an 88% increased incidence of delirium (OR 1.88, 95% CI 1.43 to 2.33). Furthermore, subgroup analyses indicated that low skeletal muscle mass was associated with a higher incidence of delirium in patients ≥75 years old or undergoing major surgeries instead of those

Although computer-aided design has become popular, restorations are typically designed from static occlusion and dynamically by using an average-value virtual articulator. Patient-specific motion recorded by using an intraoral scanner has rarely been used to design restorations, and its design ability has not been analyzed.The purpose of this clinical study was to record patient-specific motion by using an intraoral scanner and to analyze its ability to design the morphology of the wear facets on mandibular first molar crowns.An intraoral scanner was used to scan complete arch digital casts and to record patient-specific motion of 11 participants. Right and left mandibular first molars were selected as the target teeth. The complete crown preparations of the target teeth were virtually prepared on the digital mandibular casts by using the Geomagic Studio 2013 software program. High points were created by elevating the wear facets of the target teeth by 0.3 mm in the occlusal direction to generate digital wax patterns. The Dental System software program was used to design crowns with the anatomic coping design method. Occlusal adjustment with static occlusion (STA crown), with the average-value virtual articulator (DYN crown), and with patient-specific motion (FUN crown) was carried out. The crowns adjusted with these 3 methods were compared with the original wear facets. The mean value and root mean square (RMS) of 3D deviation were measured. One-way ANOVA was used to analyze the influence of the occlusal surface design methods on the morphology of the wear facets (α=.05).The STA crowns had the poorest results with the mean ±standard deviation 3D deviation value of 0.15 ±0.05 mm and RMS value of 0.19 ±0.04 mm. The best results occurred in the FUN group, with the mean ±standard deviation 3D deviation value of 0.05 ±0.06 mm and RMS value of 0.13 ±0.03 mm. Significant differences were found among the 3 groups (P.01). Except for the RMS value between the STA and DYN groups, significant differences were found between groups from the pairwise comparisons.The occlusal surface of the crowns designed by using the patient-specific motion recorded with the intraoral scanner had the best coincidence with the morphology of the wear facets on the original teeth.

For space robots, it is difficult to track continuous time-varying manifolds on SE(3) by using traditional closed-loop control strategies, which are designed to track the position and the attitude separately. Therefore, the dynamics model should be rebuilt, and the corresponding control strategy should be redesigned. Firstly, the dynamics equations for a space robot in the joint space and workspace are established separately in the framework of Lie group SE(3) and screw theory based on the Lagrange principle. Secondly, based on the proposed feedback form, a PD (proportional derivative) control law of output force on the end-effector is designed, and a closed-loop continuous tracking control strategy is proposed using the force Jacobian matrix and the kinematic model. The simulation results show that the control scheme has good performance when the system state changes gently. Furthermore, a robust sliding mode tracking control scheme is designed. The simulation results show that the proposed robust control law has better accuracy than the PD control law because the system state changes wildly. Finally, a robust fuzzy sliding mode tracking control scheme is designed to deal with the chattering phenomenon. The simulation results show that the proposed robust fuzzy control law can eliminate the chattering well and decrease the joint control torque significantly. The robustness of the proposed robust fuzzy control law is also verified by numerical simulation.

BACKGROUND: Magnetic resonance imaging (MRI) is the preferred examination approach for patients with suspected cervical spondylotic myelopathy (CSM). OBJECTIVE: To investigate the predictive value of MRI spinal cord swelling on the prognosis of decompression surgery in patients with CSM. METHODS: A retrospective analysis of 115 patients with CSM who underwent decompression surgery was performed. According to whether cervical MRI showed spinal cord swelling, they were divided into a spinal cord swelling group and non-swelling group. The Modified Japanese Orthopaedic Association (MJOA) score, MJOA improvement rate and abnormal spinal cord enhancement rate in the two groups were compared before and after surgery. Multiple linear regression was used to analyse the influencing factors of the MJOA improvement rate. RESULTS: The time from symptom onset to operation (t= 2.400, p= 0.018) and preoperative MJOA score in the spinal cord swelling group were lower than those in the non-swelling group (t= 3.253, p= 0.002). The body mass index (t= 2.895, p= 0.005), anteroposterior diameter of the spinal canal (t= 4.421, p< 0.001), cross-sectional area (t= 3.136, p= 0.002), postoperative improvement rate (t= 4.277, p< 0.001) and proportion of abnormal enhancement of the spinal cord in the swelling group were higher than those in the non-swelling group (χ2= 3.136, p= 0.002). The preoperative MJOA score in the swelling group was lower than that in the non-swelling group (t= 2.583, p= 0.013). A multivariate linear regression model revealed that age and spinal cord swelling were independent predictors of MJOA score improvement, explaining 33.2% of the total variation. CONCLUSION: Patients with CSM with spinal cord swelling have less time from symptoms to surgery, and the degree of preoperative neurological deterioration is more obvious. Spinal cord swelling is an independent predictor of surgical prognosis in patients with CSM.

In this study, the fast response of East Asian summer precipitation to COVID-induced aerosol emission reductions is examined using the Community Earth System Model version 2.2 (CESM2.2). The emission reductions decreased aerosol optical depth and cloud cover over northern China in June 2020. The troposphere became warmer, strengthening the land-sea thermal contrast and anomalous southerly winds. The subtropical westerly jet accelerated and shifted southwards, favoring the low-level convergence, upward air motions, and subsequent condensational heating over the Yangtze River Basin (YRB). The feedback of condensational heating in return strengthened the convergence and ascent. The western North Pacific Subtropical High was intensified, which further enhanced the moisture advection and convergence over the YRB. Both the enhanced moisture convergence and ascent increased precipitation over the YRB during June 2020. Furthermore, local and remote emission reductions show different impacts on convection and moisture transport over the YRB. The emission reductions over China caused stronger convective precipitation (1.15 mm/day versus 0.63 mm/day), but weaker larger-scale precipitation (1.17 mm/day versus 2.24 mm/day) than the emission reductions outside China did. In addition to the emission reductions, the sea surface temperature (SST) anomalies in 2020 also play an important role in increasing precipitation over the YRB, contributing about 42.8%. And the relative contribution from SST anomalies even increases under the COVID-induced emission scenario.

As the new crown epidemic has gradually become a normalized disease similar to the flu, people are paying more and more attention to remote work and learning. Companies such as meta have spotted the development of the remote social track, and positioned the overall development direction of the company as the research and development of the metaverse virtual space. During the epidemic, the school’s population base was large, and the students’ demand for distance learning was also large. In the current distance teaching, students’ sense of participation, concentration, and learning effect were poor. With meta company’s all-round research on virtual technology, VR and other technologies are rapidly being applied in various industries. Among them, the application of VR technology to the creation of virtual classrooms has become a research hotspot in academia, but the probability of exposure of students’ personal information to virtual classrooms how to ensure the security of students’ information while carrying out efficient teaching in virtual classrooms is the focus of this paper. This paper first introduces VR and blockchain technology and their corresponding applications, and then uses a questionnaire to obtain the current information security issues and teaching atmosphere of distance learning, and summarizes the current distance learning for students and teachers according to the questionnaire. needs and actual problems. Finally, combined with the characteristics of VR virtual technology, a virtual classroom is designed to solve the current problems of distance learning. After a simulation test, it was found that the distance teaching classroom using virtual reality technology can achieve the same or even better teaching effect than the traditional offline classroom.

Creating a single complete denture against natural dentition can be challenging. To facilitate the clinical procedure and promote balanced occlusion, we developed a digital workflow of a single complete denture using a multi-functional diagnostic denture (DD). The DD was digitally designed and fabricated using a three-dimensional printing process to create a guide for tooth grinding in opposing dentition and a final impression that allows the jaw relationship and dynamic articulation to be recorded by an intraoral scanner. The definitive complete denture was combined with a milled artificial dentition and titanium-plated denture base. Within three clinical visits, this digital workflow provided better efficiency and easy implementation for a single complete denture.

Shuang Liang,1 Yan-Jun Liang,1 Zhao Li,2 Yong Wang,1 Xin-Ru Guo,1 Chao-yang Zhang,1 Chun Zhang,1 Jie Wu,1 Xiao-Long Wang,1 Yi-Sha Li,1 Guang-Yan Cai,1 Xiang-Mei Chen1 1Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, People’s Republic of China; 2Haikou People’s Hospital Affiliated to Xiangya School of Medicine, Haikou, People’s Republic of ChinaCorrespondence: Guang-Yan Cai, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, People’s Republic of China, Tel +86 13601062936, Fax +86 010-68130297, Email caiguangyan@sina.comPurpose: Tacrolimus is recommended by KDIGO Clinical Practice Guidelines as an initial therapy for the treatment of membranous nephropathy (MN). However, little is known about the factors that influence response and recurrence of the disease after tacrolimus therapy, and there are limited data regarding the duration of tacrolimus treatment. Here, we present a real-world retrospective cohort study of 182 MN patients treated with tacrolimus, aiming to assess the efficacy and safety of tacrolimus in the treatment of MN.Patients and Methods: The clinical data of 182 patients with MN treated with tacrolimus and followed up for at least one year were analyzed retrospectively for the efficacy and safety of tacrolimus.Results: The mean follow-up period was 27.3 (19.3– 41.6) months. A total of 154 patients (84.6%) achieved complete or partial remission, and 28 patients (15.4%) did not. Multivariate Cox regression analysis showed that male and higher baseline BMI were independently associated with lower, while higher serum albumin was associated with higher probability of remission. Among the responders, 56 patients (36.4%) relapsed. After adjustments for age and sex, Cox regression analysis revealed that the longer period of full-dose tacrolimus was administered, the lower the incidence of relapse. However, high levels of serum creatinine and proteinuria at the onset of tacrolimus discontinuation were risk factors for relapse. During the treatment of tacrolimus, a decline in renal function (≥ 50% increase in serum creatinine after the onset of tacrolimus treatment) was the most common adverse reaction, observed in 20 (11.0%) patients, followed by elevated blood glucose and infection, but the latter two occurred mostly during treatment with tacrolimus plus corticosteroids.Conclusion: Tacrolimus is effective in the treatment of MN, but the relapse rate is high. Clinical studies with larger sample sizes are needed to further explore the use of tacrolimus in the treatment of membranous nephropathy.Keywords: membranous nephropathy, tacrolimus, response, relapse, safety

Vibrio vulnificus is a fatal, opportunistic human pathogen transmitted through the consumption of raw/undercooked seafood or direct contact. V. vulnificus infection progresses rapidly and has severe consequences; some cases may require amputation or result in death. Growing evidence suggests that V. vulnificus virulence factors and regulators play a large role in disease progression, involving host resistance, cellular damage, iron acquisition, virulence regulation and host immune responses. Its disease mechanism remains largely undefined. Further evaluation of pathogenic mechanisms is important for selecting appropriate measures to prevent and treat V. vulnificus infection. In this review, the possible pathogenesis of V. vulnificus infection is described to provide a reference for treatment and prevention.