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Xichen Wan,1– 3 Tong Lin,1– 3 Yunzhen Luo,4 Jiaxu Hong,1– 3,5 Jingyi Cheng,1– 3,&ast; Keqing Zhao6,&ast; 1Department of Ophthalmology and Visual Science, Eye & ENT Hospital, Fudan University, Shanghai, People’s Republic of China; 2NHC Key Laboratory of Myopia and Related Eye Diseases, Shanghai, People’s Republic of China; 3Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, People’s Republic of China; 4Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China; 5Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 6Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Keqing Zhao, Department of Otolaryngology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People’s Republic of China, Email rhinoresearch@163.com Jingyi Cheng, Department of Ophthalmology and Visual Science, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People’s Republic of China, Email tippicjy@126.comPurpose: To evaluate the effect of vidian neurectomy (VN) on the ocular surface and the possibility of dry eye in the treatment of allergic rhinitis.Methods: Twelve participants were recruited in this prospective study. Prior to and after 1 and 6 months of VN, an ocular surface disease index (OSDI) questionnaire was obtained, and the Schirmer’s tear test (STT), break-up time (BUT), corneal fluorescence staining (CFS) score, and Keratograph 5M were used to evaluate the ocular surface condition.Results: Two patients (16.67%) met the dry eye diagnosis criteria one month after surgery; however, their symptoms were relieved after to 3– 4 months and none of them met the diagnostic criteria for dry eye after six months. Compared with the baseline values, the STT was significantly reduced (P=0.002), while the tear meniscus height (TMH) (P=0.262), break-up time (BUT) (P=0.916), first keratographic tear film break-up time (NK-BUTfirst) (P=0.791), and average keratographic break-up time (NK-BUTave) (P=0.970) did not change significantly 6 months after surgery. The degree of STT decreased from baseline to 6-month and was related to the basic STT (ρ= 0.837, P=0.001) and sex (ρ= − 0.584, P= 0.026) but not to age, OSDI score, BUT, NK-BUTfirst, NK-BUTave or CFS (all P> 0.05). Among these factors, STT at baseline was confirmed to be a predictor of a decline in tear secretion after surgery (B = 0.731, P< 0.001).Conclusion: In this 6-month prospective pilot study, decreased tearing was observed after VN, but this decrease did not increase the possibility of dry eyes.Keywords: vidian neurectomy, ocular surface, dry eye

Hao Zhang,1,&ast; Anqi Xu,2,&ast; Xiangxiang Li,3,&ast; Binbin Pan,1 Xin Wan1 1Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Quality Management, Nanjing Red Cross Blood Center, Nanjing, People’s Republic of China; 3Department of Nephrology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Binbin Pan; Xin Wan, Department of Nephrology, Nanjing First Hospital, No. 68, Changle Road, Nanjing, Jiangsu, 210006, People’s Republic of China, Tel +86 025-87726209, Email panbinbin@njmu.edu.cn; wanxin@njmu.edu.cnBackground and Objectives: Loss of immunoglobulin G (IgG) is accompanied with proteinuria, especially macroproteinuria. The complement system participates kidney disease resulting in proteinuria. Whether the ratio of complement and IgG is associated with macroproteinuria remains unknown.Design, Setting, Participants and Measurements: A total of 1013 non-dialysis chronic kidney disease (CKD) patients were recruited according to the electrical case records system with 268 patients who endured kidney biopsy. Patients were grouped via the estimated glomerular filtration rate or the levels of proteinuria determination. Biomarkers in different CKD groups or proteinuria groups were compared by one-way ANOVA or independent samples t-test. Pearson or spearman analysis was employed to analyze correlation between clinical indexes. Further, influence factor of macroproteinuria was studied by using binary logistic regression. The ROC curve was performed to explore probable predictive biomarker for macroproteinuria.Results: No significant difference of complement C3 and C4 among CKD1 to CKD5 stages, while higher level of complement C4 in patients with macroproteinuria. Further, C4 had a positive correlation with proteinuria (r=0.255, p=0.006). After adjusted for age, IgA, IgM, triglyceride and HDL, a binary logistic regression model showed lnC4/IgG (OR=3.561, 95% CI 2.196– 5.773, p< 0.01), gender (OR=1.737, 95% CI 1.116– 2.702, p=0.014), age (OR=0.983, 95% CI 0.969– 0.997, p=0.014), and history of diabetes (OR=0.405, 95% CI 0.235– 0.699, p< 0.01) were independent influence factors of macroproteinuria. The area under the ROC curve was 0.77 (95% CI: 0.75– 0.82, p< 0.001) for C4/IgG. The analysis of ROC curves revealed a best cut-off for complement C4 was 0.024 and yielded a sensitivity of 71% and a specificity of 71%. The area under the ROC curve was 0.841 (95% CI: 0.735– 0.946, p < 0.001) for C4/IgG in IgA nephropathy patients. The analysis of ROC curves revealed a best cut-off for complement C4/IgG was 0.026 and yielded a sensitivity of 75% and a specificity of 81.2%. The area under the ROC curve for C4/IgG in CKD1-5 stages were 0.772, 0.811, 0.785, 0.835, 0.674.Conclusion: Complement C4/IgG could be used to predict macroproteinuria.Keywords: complement C4, immunoglobulin G, macroproteinuria, chronic kidney disease, kidney biopsy

Binbin Liu,1,&ast; Pan Su,1,&ast; Peilei Hu,1,&ast; Mi Yan,1 Wenbin Li,1 Songlin Yi,1 Zhenhua Chen,1 Xiaoping Zhang,1 Jingwei Guo,1 Xiaojie Wan,1 Jue Wang,1 Daofang Gong,1 Hua Bai,1 Kanglin Wan,2 Haican Liu,2 Guilian Li,2 Yunhong Tan1 1Clinical Laboratory, Hunan Chest Hospital, Changsha, People’s Republic of China; 2National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yunhong Tan, Clinical Laboratory, Hunan Chest Hospital, Changsha, People’s Republic of China, Tel +86-13874947876, Email Tanyunhong@163.com Guilian Li, National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China, Tel +86-18519886112, Email liguilian@icdc.cnBackground: China is a country with a burden of high rates of both TB and multidrug-resistant TB (MDR-TB). However, published data on pyrazinamide (PZA) resistance are still limited in Hunan province, China. This study investigated the prevalence, transmission, and genetic diversity of PZA resistance among multidrug-resistant Mycobacterium tuberculosis isolates in Hunan province.Methods: Drug susceptibility testing (DST) with the Bactec MGIT 960 PZA kit and pyrazinamidase (PZase) testing were conducted on all 298 MDR clinical isolates. Moreover, 24-locus MIRU-VNTR and DNA sequencing of pncA, rpsA, and panD genes were conducted on 180 PZA-resistant (PZA-R) isolates.Results: The prevalence of PZA resistance among MDR-TB strains reached 60.4%. Newly diagnosed PZA-R TB patients and clustered isolates with identical pncA, rpsA, and panD mutations showed that transmission of PZA-R isolates played a significant role in the formation of PZA-R TB. Ninety-eight mutation patterns were observed in the pncA among 180 PZA-R isolates, and seventy-one (72.4%) were point mutations. Twenty-four of these mutations are new, including 2 base substitutions (V93G and T153S) and 22 nucleotide deletions or insertions. The W119C was found in PZA-S isolates, on the other hand, F94L and V155A mutations were found in both PZA resistant and susceptible isolates with positive PZase activity, indicating that they were not associated with PZA resistance. This is not entirely in line with the WHO catalogue. Ten novel rpsA mutations were found in 10 PZA-R isolates, which all combined with mutations in pncA. Thus, it is unpredictable whether these mutations in rpsA can impact PZA resistance. No panD mutation was found in all PZA-R isolates.Conclusion: DNA sequencing of pncA and PZase activity testing have great potential in predicting PZA resistance.Keywords: tuberculosis, pyrazinamide, transmission, pncA mutations, rpsA mutations, panD mutations, China

Xuan Yi,1 Xinxing Wan,1 Md Asaduzzaman Khan,2,3 Xiaoying Sun,1 Zhouqi Wang,1 Ke Chen,1 Lin Peng4 1Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China; 2Research Division, Nature Study Society of Bangladesh, Dhaka, 1000, Bangladesh; 3Pulmonary Department, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA; 4Department of Nephrology, The First Hospital of Changsha, Changsha, People’s Republic of ChinaCorrespondence: Lin Peng, Department of Nephrology, The First Hospital of Changsha, Changsha, People’s Republic of China, Tel +86-731-8466-7510, Email plin1018@163.com Ke Chen, Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China, Tel +86-731-8861-8239, Email chenke520@yeah.netPurpose: Adipogenesis is one of the major pathways for generating obesity or overweight that can cause a range of metabolic disorders. Circular RNAs (circRNAs), a specific type of RNAs, have a significant influence on metabolic disorders. This study aims to find differentially expressed circRNAs (DECs) during human subcutaneous adipose tissue (SATs) adipogenesis.Patients and Methods: The human adipose tissue-derived stromal cells (hADSCs) were isolated from human SATs (n = 3), and then induced into adipocytes. Total RNAs were extracted from hADSCs and adipocytes, and he DECs were detected using circRNA microarray. The GO and KEGG pathways of DECs were analyzed by bioinformatic methods, and partial DECs were further validated by quantitative polymerase chain reaction (qPCR).Results: Our study detected a total of 1987 DECs, among which, 1134 were found upregulated and 853 were downregulated. GO analysis showed that the upregulated DECs have catalytic activity in intracellular organelle and cytoplasms, whereas downregulated DECs are enriched in organelle lumen, and are involved in positive regulation of developmental process. In addition, pathway results demonstrated that upregulated DECs are involved in platinum drug resistance and cellular senescence, and downregulated DECs are enriched in proteoglycans in cancer and focal adhesion pathway. Two circRNAs, namely has_circ_0001600 and has_circ_0001947 were validated to be significantly upregulated in adipocytes compared to hADSCs.Conclusion: Our study explored DECs between hADSCs derived from SATs and adipocytes, and report that two circRNAs named has_circ_0001600 and has_circ_0001947 might be important factors involved in human adipogenesis, however, the molecular mechanism should be further explored.Keywords: circRNA microarray, subcutaneous adipose tissue, human adipose tissue-derived stromal cells, adipogenesis, SAT

Keke Zhang,1 Xinxing Wan,1 Md Asaduzzaman Khan,2 Xiaoying Sun,1 Xuan Yi,1 Zhouqi Wang,1 Ke Chen,1 Lin Peng3 1Department of Endocrinology, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China; 2The Research Centre for Preclinical Medicine, Southwest Medical University, Luzhou, People’s Republic of China; 3Department of Nephrology, the First Hospital of Changsha, Changsha, People’s Republic of ChinaCorrespondence: Lin Peng, Department of Nephrology, the First Hospital of Changsha, Changsha, People’s Republic of China, Tel +86-731-8466-7510, Email plin1018@163.com Ke Chen, Department of Endocrinology, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China, Tel +86-731-8861-8239, Email chenke520@yeah.netPurpose: Type 2 diabetes mellitus (T2DM) increases the incidence of diabetic nephropathy (DN) and eventually progresses to end-stage renal disease. Circular RNAs (circRNAs) are a class of non-coding RNAs that are promising as diagnostic biomarkers and therapeutic targets for human diseases. The aim of this study was to analyze the differential expression of circRNAs (DECs) in peripheral blood from patients with early type 2 diabetic nephropathy (ET2DN), T2DM and controls, which will facilitate to discover some new biomarkers for ET2DN.Patients and Methods: Twenty ET2DN patients, 20 T2DM patients, and 20 normal controls were included in this study. Blood samples from 3 random subjects of age- and sex-matched patients in each group, respectively, were used to detect circRNA expression profiles by circRNA microarray, and the circRNA expression of remaining subjects was validated by real-time quantitative polymerase chain reaction (qRT-PCR). Further functional assessment was performed by bioinformatic tools.Results: There were 586 DECs in ET2DN vs T2DM group (249 circRNAs were upregulated and 337 circRNAs were downregulated); 176 circRNAs were upregulated and 101 circRNAs were downregulated in T2DM vs control group; 57 circRNAs were upregulated and 5 circRNAs were downregulated in ET2DN vs control group. The functional and pathway enrichment of DECs were analyzed by GO and KEGG. qRT-PCR results revealed that hsa_circ_0001831 and hsa_circ_0000867 were significantly upregulated in ET2DN group compared to both of T2DM and control group. The ROC curve demonstrated that hsa_circ_0001831 and hsa_circ_0000867 have high sensitivity and specificity associated with ET2DN.Conclusion: Our study showed the expression profiles of circRNAs in ET2DN patients and demonstrated that hsa_circ_0001831 and hsa_circ_0000867 can be used as novel diagnostic biomarkers for ET2DN.Keywords: circRNAs microarray, diagnostic biomarkers, early type 2 diabetic nephropathy, inflammation

The suspension smelting oxidation step has favourable conditions to generate chemical flue dust from the low-boiling elements of the feed mixture due to the high particle temperatures in the reaction shaft where combusting sulphide mineral particles reach temperatures above the melting point of magnetite. Arsenic, antimony, lead, and zinc are common impurity elements of high volatility in copper concentrates. They tend to accumulate in the flue dust due to the high volatility and closed mode of the flue dust circulation practiced in most industrial smelting-converting processes. Then, the only outlets for the volatile impurities are the anodes and the discard slag. A separate flue dust treatment for impurity removal is an option but it creates an additional step for the smelting plant and cost in the processing. When the concentrate grades decrease, and their impurity levels rise this outlet for the trace elements may become necessary. The arsenic condensation mechanisms in dust-free conditions in the copper flash smelting process gas train have been recently studied in SO2-air-N2 gas mixtures. It seems that the formation mechanism of arsenic-containing dust deposits is kinetically constrained, and their chemistries are influenced by the condensation temperature and atmosphere.

Although the richness of spatial symmetries has led to a rapidly expanding inventory of possible topological crystalline (TC) phases of electrons, physical realizations have been slow to materialize due to the practical difficulty in ascertaining band topology in realistic calculations. Here, we integrate the recently established theory of symmetry indicators of band topology into first-principles band-structure calculations, and test it on a database of previously synthesized crystals. On applying our algorithm to just 8 out of the 230 space groups, we are able to efficiently unearth topological materials and predict a diversity of topological phenomena, including: a screw-protected three-dimensional TC insulator, β-MoTe 2 , with gapped surfaces except for one-dimensional helical hinge states; a rotation-protected TC insulator, BiBr, with coexisting surface Dirac cones and hinge states; non-centrosymmetric Z 2 topological insulators undetectable using the well-established parity criterion, AgXO (X = Na, K, Rb); a Dirac semimetal MgBi 2 O 6 ; a Dirac nodal-line semimetal AgF 2 ; and a metal with three-fold degenerate band crossing near the Fermi energy, AuLiMgSn. Our work showcases how recent theoretical insights into the fundamentals of band structures can aid in the practical goal of discovering new topological materials.

This paper introduces a novel Attention-based Bidirectional Long Short-Term Memory (BiLSTM) model for detecting stress in social media text, aiming to enhance mental health monitoring in the digital age. Utilizing the unique communicative nature of social media, this study employs user-generated content to analyze emotional and stress levels. The proposed model incorporates an attention mechanism with the Bi-LSTM architecture to improve the identification of temporal features and context relationships in text data, which is crucial for detecting stress indicators. This model stands out by dynamically focusing on text segments that significantly denote stress, thereby boosting the detection sensitivity and accuracy. Through rigorous testing against baseline models such as Text-CNN, LSTM, GRU, and standard Bi-LSTM, our method demonstrates superior performance, achieving the highest F1-score of 81.21%. These results underscore its potential for practical applications in mental health monitoring where accurate and timely detection of stress is essential. [ABSTRACT FROM AUTHOR]

Ling Gu,1 Huogen Liu,1 Xianhong Liu,2 Xi Zeng,3 Zuchen Lei,1 Xin Wan1 1Department of Critical Care Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian 355000, People’s Republic of China; 2Department of Nephrology, Mindong Hospital of Fujian Medical University, Fuan, Fujian 355000, People’s Republic of China; 3Department of Geriatrics, Mindong Hospital of Fujian Medical University, Fuan, Fujian 355000, People’s Republic of ChinaCorrespondence: Xin WanDepartment of Critical Care Medicine, Mindong Hospital of Fujian Medical University, No. 89 Heshan Road, Fuan City 355000, Fujian Province, People’s Republic of ChinaTel +86 15259367910Email wancy505@163.comBackground: Cardiovascular diseases (CVDs) are the main cause of death in patients with chronic kidney disease (CKD). Interleukin-4 (IL-4) is considered an inflammatory cytokine. However, few studies have investigated the association between serum IL-4 and cardiovascular events in CKD. This study investigated whether serum IL-4 levels were associated with an increased risk of cardiovascular (CV) events in patients with CKD.Patients and Methods: A total of 302 patients with stage 1– 5 CKD were followed up for a mean of 32 (range=4– 36) months for end points (CV events). Serum IL-4 levels were measured at baseline. The independent relationship between serum IL-4 and the risk of CV events was assessed with multivariate Cox regression analysis.Results: The average age of this cohort (N=302) was 65.4 years. A total of 69.9% of them were male. CV events numbered 41 (13.6%) during the follow-up period. The Kaplan–Meier analysis showed that the rate of CV events was higher in patients with CKD with IL-4 levels above the mean (126.2 pg/mL) than in those with IL-4 levels below the mean. The multivariate Cox proportional hazard analysis revealed that serum IL-4 (HR=1.650, 95% CI 1.266– 2.210, P< 0.001) was associated with CV events in these patients with CKD. Sensitivity analysis showed that the association between serum IL-4 and CV events was not affected by the use of anti-inflammatory medication. The significant association between higher IL-4 levels and increased risk of CV events existed in patients with CKD3-5 but not in patients with CKD1-2 by using the stratified analysis.Conclusion: Higher serum IL-4 levels were associated with an increased risk of CV events during follow-up. Elevated serum IL-4 levels may help clinicians predict early CV events in patients with CKD.Keywords: interleukin-4, chronic kidney disease, cardiovascular event, Cox regression, prognosis

Jinlin Li,1 Qi Wang,1 Qingping Zhang,2 Zhengyan Wang,1 Xin Wan,3 Chenfang Miao,4 Xi Zeng5 1Department of Respiratory Medicine, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei 441300, People’s Republic of China; 2Department of Otolaryngology Head and Neck Surgery, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei 441300, People’s Republic of China; 3Department of Critical Care Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian 355000, People’s Republic of China; 4Department of Anesthesiology, Mindong Hospital of Fujian Medical University, Fuan, Fujian 355000, People’s Republic of China; 5Department of Geriatrics, Mindong Hospital of Fujian Medical University, Fuan, Fujian 355000, People’s Republic of ChinaCorrespondence: Xi ZengDepartment of Geriatrics, Mindong Hospital of Fujian Medical University, No. 89 Heshan Road, Fuan City 355000, Fujian Province, People’s Republic of ChinaTel +86 18596658975Email 987295461@qq.comBackground: Vascular cell adhesion molecule-1 (VCAM-1) is associated with vascular-related inflammation and atherosclerosis. This study aimed to evaluate whether VCAM-1 can be used for an indication of increased risk of CV events in patients with COPD.Methods: Serum VCAM-1 levels were measured in 163 COPD patients. All COPD patients were prospectively followed up for a median period of 48 months (range=3– 54). Cox proportional hazard analysis was performed to evaluate the prognostic value of serum VCAM-1 for predicting CV events.Results: Serum VCAM-1 levels were higher in COPD patients with CV events than in those without CV events (1174.4± 365.3 ng/mL vs 947.8± 293.2 ng/mL; P< 0.001). The logistic regression analysis revealed that serum VCAM-1 (OR=1.750; 95% CI, 1.324– 2.428; Ptrend= 0.0012) was independently associated with CVD (cardiovascular disease) history after adjusting for age, sex, BMI, current smoker, current drinker, admission systolic and diastolic BP, LVEF and laboratory measurements in patients with COPD at baseline. The Kaplan–Meier analysis demonstrated that the rate of CV events was higher in COPD patients with serum VCAM-1 levels above the median (517.3 ng/mL) than in those with VCAM-1 levels below the median. The Cox proportional hazard analysis revealed that serum VCAM-1 (HR=2.617; 95% CI, 1.673– 5.328; Ptrend< 0.001) may be an independent prognostic factor for CV events in the COPD patients.Conclusion: Our results suggested that serum VCAM-1 was significantly and independently associated with CV events in COPD patients. The inflammatory marker may help clinicians predict CV complications early.Keywords: vascular cell adhesion molecule-1, chronic obstructive pulmonary disease, cardiovascular events, prognostic value

Hanchun Huang, Xueshuai Wan, Yi Bai, Jin Bian, Jianping Xiong, Yiyao Xu, Xinting Sang, Haitao ZhaoDepartment of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of ChinaBackground: The purpose of this study was to evaluate the relationship between preoperative inflammatory markers (neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR)) and different American Joint Committee on Cancer (AJCC) T stages in patients with hilar cholangiocarcinoma.Methods: A total of 101 patients who underwent surgical treatment for hilar cholangiocarcinoma between 2003 and 2014 in Peking Union Medical College Hospital were retrospectively analyzed. Receiver-operating curves were used to calculate optimal cutoff values for the NLR and the PLR. Univariate and multivariate analyses were used to identify whether the NLR and PLR can independently predict different AJCC T stages.Results: Multivariate analysis showed that higher NLR and PLR independently predicted advanced AJCC T stages (OR 3.74, 95% CI 1.09–12.83, P=0.036; and OR 7.86, 95% CI 2.25–27.43, P=0.001, respectively). At a threshold of 2.75, the NLR was 75.9% sensitive and 66.7% specific for different AJCC T stages; at a threshold of 172.25, the PLR was 65.5% sensitive and 80.6% specific.Conclusion: Preoperative NLR and PLR can be used as independent predictors of different AJCC T stages in patients with hilar cholangiocarcinoma.Keywords: neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, hilar cholangiocarcinoma

Chang-chun Cao,1,* Da-wei Chen,2,* Jing Li,2 Meng-qing Ma,2 Yu-bao Chen,3 Yi-zhi Cao,4 Xi Hua,2 Wei Shao,1 Xin Wan2 1Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; 2Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; 3Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; 4The First Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China *These authors contributed equally to this work Purpose: Previous studies have described the incidence, risk factors, and outcomes for patients with acute exacerbations of COPD (AECOPD) developing acute kidney injury (AKI). However, little is known about the differences between community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) in patients with AECOPD. Thus, in this study, we compared prevalence, risk factors, and outcomes for these patients with CA-AKI and HA-AKI. Patients and methods: This study was conducted from January 2014 to January 2017, and data from adult inpatients with AECOPD were analyzed retrospectively. A total of 1,768 patients were included, 280 patients were identified with CA-AKI and 97 patients were with HA-AKI. Results: Prevalence of CA-AKI was 15.8% and that of HA-AKI was 5.5%, giving an overall AKI prevalence of 21.3%. Patients with CA-AKI had a higher prevalence of chronic kidney disease (CKD) and lower prevalence of chronic cor pulmonale than patients with HA-AKI. Risk factors for developing HA-AKI and CA-AKI were similar, such as being elderly, requirement for mechanical ventilation, and a history of coronary artery disease and CKD. Patients with HA-AKI were more likely to have stage 3 AKI and worse short-term outcomes. In comparison with patients with CA-AKI, those with HA-AKI were more likely to require non-invasive mechanical ventilation (31.3% versus 16.8%; P = 0.003) and had a longer duration of mechanical ventilation (11 days versus 8 days; P = 0.020), longer hospitalization (14 days versus 12 days; P = 0.038), and higher inpatient mortality (32.0% versus 13.2%; P < 0.001). Patients with HA-AKI had worse (multivariate-adjusted) inpatient survival than those with CA-AKI (hazard ratio, 1.7 [95% confidence interval, 1.03–2.81; P = 0.038] for the HA-AKI group). Conclusion: AKI was common in patients with AECOPD requiring hospitalization. CA-AKI was more common than HA-AKI but otherwise demonstrated similar demographics and risk factors. Nevertheless, patients with HA-AKI had worse short-term outcomes. Keywords: acute exacerbation of COPD, community-acquired acute kidney injury, hospital-acquired acute kidney injury, short-term outcomes

Using observations from multi‐satellites at different altitudes, including the CHAllenging Minisatellite Payload (CHAMP), the Gravity Recovery and Climate Experiment, Swarm B, and Defense Meteorological Satellites Program F17, the ionospheric post‐midnight enhancement at mid‐latitudes and the associated inter‐hemispheric asymmetry during equinox are investigated in this study. During equinox months, the ionospheric electron density enhancement during post‐nighttime at mid‐latitudes is visible in both hemispheres, however, it is asymmetric between the Northern and Southern Hemispheres. At most longitudes, inter‐hemispheric asymmetry of Mid‐latitude Ionospheric Post‐midnight Enhancement (MIPE) reverses with altitudes, from a stronger electron density in the Northern Hemisphere at CHAMP altitude to a stronger electron density in the Southern Hemisphere at top ionosphere during equinox. The reversal altitude and reversal time have significant longitudinal differences. The effective ionospheric uplifting induced by the combination of neutral winds and geomagnetic field configuration is the main contribution to the asymmetry reversal of MIPE at lower altitudes, as shown in the simulations from the SAMI2 and HWM14 models. In comparison with that in the Southern Hemisphere, the stronger neutral winds in the Northern Hemisphere move the plasma along the geomagnetic field lines to a higher altitude with lower chemical recombination, resulting in the enhancement of electron density. Plain Language Summary: The mid‐latitude ionospheric post‐midnight enhancement is a phenomenon that the electron densities at mid‐latitudes are higher than that at low‐latitudes during post‐midnight. Recently, the mid‐latitude post‐midnight electron density bands during equinox months are found to have an inter‐hemispheric asymmetry and an altitudinal reversal at most longitudes. However, the potential physical mechanisms are poorly understood, which is key in the modeling and forecasting of near‐Earth space weather. Using simulation results from models, we found that neutral winds and geomagnetic field configuration are critical for the reversal of inter‐hemispheric asymmetry with altitude. Key Points: The mid‐latitude ionospheric post‐midnight enhancement exhibit significant inter‐hemispheric asymmetry during equinox months at various altitudes above F2‐peakAt most longitudes, the hemispheric asymmetry reversed with altitude and the reversal altitude shows significant longitudinal differencesThe effective ionospheric uplifting induced by neutral winds and geomagnetic field configuration is the key in the altitudinal reversal [ABSTRACT FROM AUTHOR]