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Objective In the actual metro construction, it is often necessary to lay turnouts on large-slope sections due to planning and construction constraints, land conservation or topographical limitations. However, it is found through practical application that the large-slope turnout structure leads to poor train stability and ride comfort during operation, thus an investigation on the factors influencing vehicle passing performance through large-slope metro turnouts is required. Method Based on multi-body dynamics theory, using simulation analysis software and taking the No.9 turnout installed on a 30‰ slope as research object, a coupled vehicle-turnout multi-body dynamics model is established. The dynamics performance indicators (including wheel-rail interaction, safety indicators, and stability indicators) of single vehicle passing through large-slope turnout at different operating speeds and friction coefficients are compared，aiming to analyze the impact of various factors on the vehicle passing performance through large-slope metro turnouts. Result & Conclusion It is revealed through simulation research that the impact of operating speed on wheel-rail interaction, stability indicators, and safety indicators is independent of the slope direction during vehicle passing turnouts. When a vehicle passes through turnouts on uphill and downhill slopes, the influence trends of operating speed on the dynamics indicators are consistent, with a more significant impact when going downhill; the friction coefficient greatly affects the wheel-rail dynamic interaction and the vehicle lateral acceleration. As the friction coefficient increases, the wheel-rail interaction force decreases, the carbody vertical acceleration shows no significant change, and the lateral acceleration increases significantly, with a more pronounced effect when going downhill. Therefore, certain strengthening and protective measures should be taken when vehicle going downhill.

Objective When turnouts are laid on slope, the longitudinal force increase on the track due to the cyclic braking of trains will cause uneven rail creeping phenomena， resulting in a more complex stress and deformation pattern for the turnout, and even affecting its normal service. Therefore, it is necessary to study the characteristics of stress and deformation of large-slope turnout rails under cyclic braking loads. Method Tests on fastener longitudinal resistance under CLA (cycling loads action) are conducted, and a non-linear finite element model of the No.9 turnout is established to analyze the turnout rail creeping pattern under CLA. Result & Conclusion The fastener system exhibits resistance degradation under CLA. The maximum creep of the turnout rail occurs after the first train braking. Under CLA, the cumulative increase in rail creeping gradually stabilizes with the increasing number of CLA. The presence of slope will significantly increase rail creeping amount under CLA. The train loading form has minimal influence on turnout rail creeping under cycling braking loads action.

[ Objective ] VQ proteins are plant-specific proteins with the conserved VQ motifs ( Fxxh- VQxhTG ), which play an important role in plant growth and development as well as in response to abiotic stresses. The role of the VQ gene family in litchi ( Litchi chinensis ) had not been systematically studied. We identified the LcVQ gene family members as well as their expression patterns in different tissues of ly- chee and their responses to abiotic stresses. This laid a foundation for studying its stress-resistant mecha- nism. [ Methods ] The sequences of LcVQ genes were obtained from the L . chinensis genome using bioin- formatics methods , and their physicochemical properties , subcellular localizations , gene structures , and conserved motifs were analyzed ; a phylogenetic tree was constructed using MEGA 6.0 to analyze the phy- logenetic relationships of the VQ proteins in L . chinensis , Arabidopsis , and Oryza sativa ; the responses to various abiotic stresses were verified by the quantitative real-time PCR ( qRT-PCR ) . [ Results ] A total of 18 LcVQ genes were identified from L . chinensis genome , named as LcVQ1 - 18 , which were clustered into 9 subgroups. They were widely distributed on 11 of 15 chromosomes of lychee. The amino acid num- bers of LcVQ proteins were ranged from 111 to 427 , and molecular weights from 12.48 kD to 45.49 kD. Subcellular localizations showed that except for LcVQ15 and LcVQ17 were localized at the cytoplasm , all other LcVQ proteins were localized at the nucleus. The LcVQ promoters contained a large number of growth and development , plant hormone , and stress-responsiveness related response elements. The LcVQ genes expression was varied at different tissues , which was divided into universal expression and specific expression. Under the treatment of low temperature , high temperature , drought , and salt stress , we found that 4 , 3 , 3 , and 4 LcVQ genes were significantly up-regulated at 3 hours of treatment , respective- ly , indicating that these genes could respond to the abiotic stresses. [ Conclusion ] There are 18 VQ mem- bers in the L . chinensis genome with typical VQ binding domains and participate in different stress re- sponses.

The global rate of Amphotericin B (AmB) resistance in Candida auris has surpassed 12%. However, there is limited data on available clinical treatments and microevolutionary analyses concerning reduced AmB sensitivity. In this study, we collected 18 C. auris isolates from five patients between 2019 and 2022. We employed clinical data mining, genomic, and transcriptomic analyses to identify genetic evolutionary features linked to reduced AmB sensitivity in these isolates during clinical treatment. We identified six isolates with a minimum inhibitory concentration (MIC) of AmB below 0.5 µg/mL (AmB0.5) and 12 isolates with an AmB-MIC of 1 µg/mL (AmB1) or ≥ 2 µg/mL (AmB2). All five patients received 24-hour AmB (5 mg/L) bladder irrigation treatment. Evolutionary analyses revealed an ERG3 (c923t) mutation in AmB1 C. auris. Additionally, AmB2 C. auris was found to contain a t2831c mutation in the RAD2 gene. In the AmB1 group, membrane lipid-related gene expression (ERG1, ERG2, ERG13, and ERG24) was upregulated, while in the AmB2 group, expression of DNA-related genes (e.g., DNA2 and PRI1) was up-regulated. In a series of C.auris strains with reduced susceptibility to AmB, five key genes were identified: two upregulated (IFF9 and PGA6) and three downregulated (HGT7, HGT13,and PRI32). In this study, we demonstrate the microevolution of reduced AmB sensitivity in vivo and further elucidate the relationship between reduced AmB sensitivity and low-concentration AmB bladder irrigation. These findings offer new insights into potential antifungal drug targets and clinical markers for the ‘super fungus’, C. auris.

We report a case of a young female patient with fatigue, hypokalemia, and hyperglycemia. She had past-history of diabetes mellitus, and was admitted to hospital with a history of fatigue and hypokalemia for 5 years. The patient's examination indicated hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria, and SLC12A3 gene pathogenic mutation. The diagnosis was Gitelman syndrome. Potassium and magnesium supplements were given to improve the patient's fatigue. Serum potassium and magnesium were normal. The blood glucose reached standard after treatment with oral hypoglycemic drugs. This article incorporates literature review to sort out the diagnosis and treatment of Gitelman syndrome, in order to provide feasible reference for clinicians.

Objective: Percutaneous nephrolithotomy (PCNL) is the main method for pyonephrosis or lithotripsy in urology. However, it often comes with high risk, as the inaccurate puncture inevitably causes bleeding, intra- and post-operative complications. So, a new inter-disciplinary approach is needed to perform the puncture more accurately. Methods: 3 signs made of lead were marked onto the skin of the posterior side of the waist of a domestic pig or a patient, which was scanned by computed tomography (CT). Based on the CT images, the computer design and the 3D printing, a navigation template made of the transparent resin material is constructed. They were attached onto the surgical area on pig or patient according to the signs. During the PCNL, with this template, the puncture position, angle and depth were optimized in order to precisely enter the targeted renal pelvis or calices. Results: With the 3D navigation templates, 18G puncture needles were used to enter the renal pelvis upon performing the PCNL on a porcine model and a patient. On the porcine model, the urine outflow was observed with minimal complication. Post-operative CT scans revealed that the needle was located in the renal pelvis. For the patient case, the puncture point was designed to target the calix with stone. No obvious bleeding and complication was found in renal puncture with template. Conclusions: The navigation template was made with the combination of 3D printing, CT images and computer design. This template allows for accurate puncture of the renal pelvis or calix. Surgical improvement in kidney stones and pyonephrosis was observed in porcine model and patient case. In the future, prospective, trandomized, controlled clinical trials are needed to further confirm its advantage.

Abstract Background Core stability exercise (CSE) is a globally acknowledged intervention for managing chronic low back pain. However, the sustained adherence of patients with chronic low back pain to CSE can be challenging, mainly due to the absence of supervision and guidance from physical therapists during home-based exercise sessions. Consequently, exercise compliance tends to decline, resulting in suboptimal long-term effectiveness of the intervention. In this trial, our primary aim is to evaluate the potential therapeutic equivalence between home-based rehabilitation training employing key point identification technology and exercise guidance administered in a hospital setting. Methods In this trial, we will randomly assign 104 adults with chronic low back pain (CLBP) to either an intervention or control group, with 52 participants in each group. Both interventions will consist of three weekly 0.5-h sessions of core stability exercise (CSE). The intervention group will engage in home rehabilitation training utilizing key identification technology for movement, while the control group will perform supervised exercises in a hospital setting. Outcome assessments will be conducted at 4 weeks and 16 weeks after randomization. The primary outcome measure will be the change in pain intensity based on numeric rating scale (NRS scores) from baseline to 4 weeks. Secondary outcomes will include changes in physical function (measured by the Oswestry Disability Index (ODI)) and lumbar spine mobility as well as activity participation and treatment satisfaction. Discussion If home-based rehabilitation method is demonstrated to be non-inferior or even superior to traditional face-to-face exercise guidance, it could significantly advance the adoption of digital medical care and contribute to improving the overall health of the population. Trial registration NCT05998434 . Registered on 16 August 2023.

Objective To summarize the characteristics of cognitive function and sleep structure in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and to explore the correlation between them. Methods Total 73 patients with iRBD who visited Fujian Medical University Union Hospital from August 2018 to August 2021 were included, all of whom underwent neuropsychological tests and polysomnography monitoring. Pearson and partial correlation analyses were used to explore correlation between cognitive function and sleep structure parameters. Results 1) Neuropsychological tests: iRBD patients had lower Mini ⁃ Mental State Examination (MMSE; t = ⁃ 3.703, P = 0.000), Montreal Cognitive Assessment (MoCA; t = ⁃ 4.811, P = 0.000), Verbal Fluency Test (VFT)⁃number of correct words (t = ⁃ 2.171, P = 0.032) than control group. Trail Making Test (TMT)⁃A (t = 2.500, P = 0.014), TMT⁃B (t = 2.430, P = 0.016) and Stroop Color Word Test (SCWT)⁃A (t = 2.507, P = 0.013), SCWT⁃B (t = 15.042, P = 0.000), SCWT⁃ C (t = 27.228, P = 0.000) completion times were longer than control group. 2) Polysomnography monitoring: total sleep time (t = 2.699, P = 0.008), sleep efficiency (Z = ⁃ 2.103, P = 0.035), number of sleep stage transitions (t = 3.965, P = 0.000), proportion of non⁃rapid eye movement sleep stage 1 (N1 stage) to total sleep time (t = 2.887, P = 0.005), periodic limb movement of sleep index (PLMSI; t = ⁃ 2.917, P = 0.004), periodic limb movement⁃related arousal index (Z = ⁃ 2.291, P = 0.022), and total arousal index (Z = ⁃ 2.609, P = 0.009) were higher than those in control group, and the time of wakefulness after sleep was less than those in control group (t = ⁃ 2.230, P = 0.027). 3) Correlation between cognitive function and sleep structure parameters: MoCA score was negatively correlated with the percentage of N1 stage (r = ⁃ 0.184, P = 0.035), and positively correlated with the percentage of N2 stage (r = 0.173, P = 0.049); SCWT⁃B completion time was negatively correlated with the number of awakenings (r = ⁃ 0.186, P = 0.033); SCWT⁃C completion time was positively correlated with the number of sleep phase transitions (r = 0.212, P = 0.015) and the percentage of N1 stage (r = 0.181, P = 0.039); VFT⁃number of correct words was negatively correlated with the periodic limb movement of wake index (PLMWI; r = ⁃ 0.216, P = 0.018); the number of correct China⁃Rey Auditory Verbal Learning Test (C⁃RAVLT) immediate recall was positively correlated with the rapid eye movement (REM) sleep latency (r = 0.183, P = 0.045); the number of correct C⁃RAVLT delay recall was negatively correlated with the PLMWI (r = ⁃ 0.196, P = 0.032) and PLMSI (r = ⁃ 0.180, P = 0.049); the Clock Drawing Test was positively correlated with sleep latency (r = 0.192, P = 0.035) and REM sleep latency (r = 0.199, P = 0.029), and negatively correlated with the percentage of REM sleep (r = ⁃ 0.189, P = 0.038). The Beck Depression Inventory (BDI) score was positively correlated with total sleep time (r = 0.347, P = 0.000), sleep efficiency (r = 0.319, P = 0.000) and the percentage of REM sleep (r = 0.204, P = 0.026), and negatively correlated with the time of wakefulness after sleep (r = ⁃ 0.280, P = 0.002) and the percentage of N1 stage (r = ⁃ 0.299, P = 0.001). Conclusions Patients with iRBD have cognitive dysfunction mainly manifested by decreased attention, executive function and language function, and sleep structural disorders may affect the cognitive function of such patients.

The essence of menopause is ovarian failure, which has a significant impact on women's health. The goal of menopausal management is to relieve menopause-related symptoms, and hopefully, prevent chronic diseases in old age. Based on comprehensive lifestyle management, various health care measures including menopausal hormone therapy have been carried out under the guidance of professional medical practitioners so as to improve and enhance the quality of life of middle-aged and elderly women. The 2023 Chinese Menopause Symptom Management and Menopausal Hormone Therapy Guidelines was officially published in January 2023, and this article interprets the core points of the guidelines, especially the main updates, in order to better guide clinical practice.

Narcissistic personality disorder is a severance mental health issue, and affect person from both biological and social aspects. The article reviewed the latest international researches about the etiology, subtypes of narcissistic personality disorder, and related treatment strategies of narcissistic personality disorder. Narcissistic personality disorder is defined by an inflated self-importance, eagerness for admiration, and lack of compassion. It encompasses two subtypes, grandiose and vulnerable. Impact of narcissism on individuals' self-esteem, Self Control was examined through reviewing prior research on Chinese population. Moreover, correlation between parenting style, narcissistic personality and parent child relationship was also discussed. The result revealed that the formation of narcissistic personality disorder was influenced by environmental and social factors. Long-term psychological therapy is the main treatment for narcissistic personality disorder. Medication is not a primary treatment option, and certain antidepressants may exacerbate symptoms. The challenge and study directions have been identified in the end, abundant clinical trails on biological study of narcissistic personality disorder are needed, and the further researches on subtypes of narcissistic personality disorder are expected

Aiming at the disconnection between theory and practice in the experimental teaching of electrical and electronic technology courses, students do not have a deep understanding of knowledge and cannot exercise their practical ability. This paper puts forward the application of simulation software to the experimental teaching process of electrical and electronic technology to form an experimental teaching model combining theory, simulation and practice. The results show that the proposed teaching method can deepen the students' understanding of theoretical knowledge, improve their interest in learning, enhance their innovative application ability, and significantly improve the teaching quality.

IntroductionCandida palmioleophila is a rare human pathogenic fungus, which has been poorly characterized at the genome level. In this study, we reported the first fatal case of C. palmioleophila infection in China and investigate the microevolution of C. palmioleophila in the human host environment.MethodsA series of C. palmioleophila stains were collected from the patient at different time points for routine microbial and drug sensitivity testing. The first C. palmioleophila isolate 07202534 was identified by de novo whole genome sequencing. The in vitro and in vivo genetic evolutionary characteristics of C. palmioleophila were discussed based on the analysis of bioinformatics data.ResultsThe six C. palmioleophila isolates displayed dose-dependent sensitivity to fluconazole. The C. palmioleophila genome contained homologous genes such as CDR1 and MDR1, which were recognized to be related to azole resistance. In addition, amino acid variation was detected at F105L and other important sites of ERG11. In addition, the mean divergence time between C. palmioleophila and Scheffersomyces stipites CBS 6054 was 406.04 million years, indicating that C. palmioleophila originated earlier than its closest relative. In addition, the six strains of C. palmioleophila isolated form the patient had higher homology and fewer mutation sites, which indicated the stability in C. palmioleophila genome. We also found that C. palmioleophila had a wide natural niche and may evolve slowly.DiscussionWe believe that this study will contribute to improve our understanding of the genetic evolution, pathogenicity, and drug resistance of C. palmioleophila and will aid in the prevention and control of its spread.

Abstract Background Osteoporotic vertebral fractures are often clinically silent and unrecognized. The present study aimed to determine whether routine chest radiographs could be a potential screening tool for identifying missed vertebral fractures in men aged over 50 years or postmenopausal women, especially those with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of undetected vertebral fractures in elderly Chinese patients with and without T2DM. Methods Clinical data and chest radiographs of 567 individuals with T2DM (T2DM group) and 583 without diabetes (nondiabetic group) at a tertiary hospital in central south China were extracted from the records. Vertebral fractures were specifically looked for on chest radiographs and classified using the Genant semi-quantitative scale. Prevalence was compared between the two groups. Results Mean age and sex composition were comparable between the two groups. Mean weight and body mass index were significantly lower in the T2DM group. In both groups, fractures mostly involved the T11–12 and L1 vertebrae. Moderate/severe fractures were identified in 33.3% individuals in the T2DM group (31.4% men and 36.0% women) versus 23.2% individuals (20.9% men and 25.5% women) in the nondiabetic group. Conclusions Routine chest radiographs could be a useful screening tool for identifying asymptomatic vertebral fractures. Trial registration The study was designed as an observational retrospective study, therefore a trial registration was not necessary.

ObjectiveBased on the investigation of the core capacity development of health emergency response of Shanghai disease prevention and control institutions after the COVID-19 pandemic， to analyze the shortcomings of health emergency response capacity of Shanghai disease prevention and control institutions， and to put forward suggestions to improve the core capacity of Shanghai's disease prevention and control system in the face of public health emergencies.MethodsUsing questionnaire surveys， investigations and evaluations were conducted on the emergency system development， epidemic monitoring and risk assessment， emergency team manpower and equipment， and actual response to COVID-19 in 16 district-level disease prevention and control institutions in Shanghai.ResultsThe overall public health emergency response capacity building of the district-level disease control agencies in Shanghai is relatively good， and the effect of capacity building has been proven during the handling of the new coronavirus. But at the same time， it also exposed some specific problems such as imperfect system construction， lack of emergency personnel and materials， insufficient on-site handling capabilities of personnel， and uneven allocation of emergency personnel and materials among different agencies.ConclusionShanghai district-level disease control should focus on the specific problems， such as strengthening the development of health emergency system， improving the human resources and material reserves of the emergency teams， and optimizing the laboratory testing ability， to further improve the core health emergency capacity of Shanghai disease control system.

ObjectiveTo establish a method for simultaneous determination of 11 aminoglycosides antibiotics （spectinomycin， dihydrostreptomycin， hygromycin B， streptomycin， gentamicin C1， amikacin， gentamicin C2， kanamycin， gentamicin C1a， tobramycin and apramycin） in liquid milk and milk powder samples by high performance liquid chromatography tandem mass spectrometry （HPLC­MS/MS）.MethodsThe dairy products were extracted by water containing 1% acetic acid， concentrated and purified by the immunoaffinity cartridges， and then analyzed by HPLC­MS/MS. A BEH Amide column was used for the separation of target drugs as well as acetonitrile and water containing 0.5% formic aid used as the mobile phase. Matrix matched calibration was applied in the quantitation.ResultsThe calibration curves achieved good linearity in the range of 5­500 μg/L with the correlation coefficients （r） greater than 0.99； the quantification limits of AGs in liquid milk and powder were 3 and 10 μg/kg， respectively. The average recovery ranged from 65.12% to 105.95% with relative standard deviations （RSD） ranged from 0.85% to 19.12%.ConclusionThis method presented good selectivity， high sensitivity and simple operation， which was suitable for the determination of 11 aminoglycoside antibiotics in dairy products.

ObjectiveTo establish a method for the determination of chlorate and perchlorate in seasoning samples by ultra-performance liquid chromatography tandems mass spectrometry (UPLC-MS/MS).MethodsSeasoning sample was ultrasonically extracted with acidic acetonitrile solution, and then purified with a graphitized carbon black (GCB) cartridge and an Ag/H cartridge. UPLC-MS/MS analysis was conducted under multi-reaction monitoring mode with isotope-labelled internal standard calibration for quantification.ResultsChlorate and perchlorate showed a good linearity (R2≥0.99) in the range of 1-1 000 μg/L and 0.1-100 μg/L, respectively. The limits of detection for chlorate and perchlorate were 3.0 μg/kg and 0.3 μg/kg, as well as the limits of quantification were 10 μg/kg and 1.0 μg/kg, respectively. The average recoveries of two compounds in seasoning samples at three spiked levels were 86.5%-113.7% and the relative standard deviations were 1.8%-15.3%. The detection rates of chlorate and perchlorate from 122 seasoning samples were 76.2% and 93.4%, with the maximum concentration of 30.4 mg/kg and 12.3 mg/kg, respectively.ConclusionThe method is suitable for qualitative and quantitative analysis of chlorate and perchlorate in seasoning. Further study should be focused on the perchlorate in seasoning products since its relative prevalence contamination.

Objective To investigate the incidence and risk factors for impulsive control disorders (ICDs) in Parkinson's disease (PD). Methods A total of 201 patients with PD were included from May 2016 to September 2017. ICDs were assessed by Questionnaire for Impulsive⁃Compulsive Disorders in Parkinson's Disease (QUIP). Mentation, behavior and mood, activities of daily living, motor function, and complications for therapy were assessed by Unified Parkinson's Disease Rating Scale (UPDRS). Disease severity was assessed by Hoehn⁃Yahr staging, and depression was assessed by Geriatric Depression Scale (GDS). Univariate and multivariate forward Logistic regression analyses were used to analyze the risk factors for PD patients with ICDs. Results Among 201 PD patients, 41 patients (20.40%) were diagnosed with ICDs, including 17 cases of compulsive medicine use (8.46%), 15 cases of compulsive eating (7.46%), 13 cases of punding (6.46%), 8 cases of compulsive shopping (3.98%), 3 cases of pathological gambing (1.49%) and one case of hypersexuality (0.49%). Logistic regression analysis showed that the longer treatment duration (OR=1.237, 95%CI: 1.038-1.474; P=0.018), severe complications for therapy (high UPDRS Ⅳ score; OR=1.389, 95%CI: 1.077-1.790, P=0.011), depression (OR=2.417, 95%CI: 0.174-0.984; P=0.046) were the risk factors for PD patients with ICDs. Conclusions The incidence of ICDs in PD is high, which is affected by many factors. The risk of ICDs can be evaluated by the QUIP scale to guide medication.

Accumulated evidence indicates that geniposide exhibits neuroprotective effects in ischemic stroke. However, the potential targets of geniposide remain unclear.

During the “14th Five-Year Plan” period (2021-2025), China will enter the era of mass tourism, and the development of tourism industry is still in an important strategic opportunity period, but there are new opportunities and challenges. The article analyses the development status of cultural tourism in China and the development trend of China’s cultural tourism industry, and proposes countermeasures for the problems faced by China’s cultural tourism industry during the “14th Five-Year Plan” period from the aspects of theme development, industry chain building, resource utilization and cultural creativity.

Based on combined data from Baccalaureate & Beyond (B&B:16/17), Integrated Postsecondary Education Data System (IPEDS), and Barron's Profiles of American Colleges, this study utilizes zero-inflated beta regression methods and analyzes individual and institutional factors that predict debt burden by gender. Results show that women are less likely than men to have a zero debt burden one year after college graduation. Interaction effect tests show that the relationship between gender and zero debt burden differs by race/ethnicity. Additional analyses disaggregating the debt and earnings components indicate that women's salary is significantly lower than men's salary. The combined results of lower probability of zero debt and lower salary for women than for men are concerning and demonstrate gendered inequities within current systems. Policy attention is needed to address these issues.