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Leukemia inhibitory factor (LIF) is a pleiotropic cytokine of the interleukin-6 (IL-6) superfamily. LIF was initially discovered as a factor to induce the differentiation of myeloid leukemia cells and thus inhibit their proliferation. Subsequent studies have highlighted the multi-functions of LIF under a wide variety of physiological and pathological conditions in a highly cell-, tissue-, and context-dependent manner. Emerging evidence has demonstrated that LIF plays an essential role in the stem cell niche, where it maintains the homeostasis and regeneration of multiple somatic tissues, including intestine, neuron, and muscle. Further, LIF exerts a crucial regulatory role in immunity and functions as a protective factor against many immunopathological diseases, such as infection, inflammatory bowel disease (IBD), and graft-verse-host disease (GVHD). It is worth noting that while LIF displays a tumor-suppressive function in leukemia, recent studies have highlighted the oncogenic role of LIF in many types of solid tumors, further demonstrating the complexities and context-dependent effects of LIF. In this review, we summarize the recent insights into the roles and mechanisms of LIF in stem cell homeostasis and regeneration, immunity, and cancer, and discuss the potential therapeutic options for human diseases by modulating LIF levels and functions.

The choice of treatment is an unavoidable challenge faced in the day to day medical decision making pertaining to patients with organic heart disease. As a professional discipline, cardiac surgery focuses on creating and using the most advanced evidence-based patient decision aids (PtDAs) to achieve high-quality decision-making.To describe the basic situation, influencing factors, and the outcome of indicators of PtDAs among cardiac surgery patients.Seven electronic databases were systematically searched for relevant reviews on the application of PtDAs among cardiac surgery patients. The methodological framework proposed by Arskey and O'Malley was used to guide the scoping review. The extracted data was analyzed qualitatively and quantitatively.After dual, blinded screening of titles and abstracts, 12 articles were included in the review. 10 were quantitative studies, 1 was a mixed study, 1 was a qualitative study.Compared with the burden of heart disease and the huge evidence base, the application of PtDAs in cardiac surgery is obviously insufficient. The published literature mainly provide information about the factors to be solved from the perspective of researchers, and also summarize obstacle factors. This is the basis for the application and construction of PtDAs in cardiac surgery patients.

Berberine (BBR), an isoquinoline alkaloid, has been found in many plants, such as Coptis chinensis Franch. and Phellodendron chinense Schneid. Although BBR has a wide spectrum of pharmacological effects, its oral bioavailability is extremely low. In recent years, gut microbiota has emerged as a cynosure to understand the mechanisms of action of herbal compounds. Numerous studies have demonstrated that, due to its low bioavailability, BBR can interact with the gut microbiota, thereby exhibiting altered pharmacological effects. However, no systematic and comprehensive review has summarized these interactions and their corresponding influence on pharmacological effects. Here, we describe the direct interactive relationships between BBR and gut microbiota, including regulation of gut microbiota composition and metabolism by BBR and metabolization of BBR by gut microbiota. In addition, the complex interactions between gut microbiota and BBR as well as the side effects and personalized use of BBR are discussed. Furthermore, we provide our viewpoint on future research directions regarding BBR and gut microbiota. This review not only helps to explain the mechanism underlying BBR activity but also provides support for the rational use of BBR in clinical practice.

TNF-α elicits a cascade amplification effect in psoriasis. Macromolecule drugs targeting TNF-α are widely used for the clinical treatment of psoriasis. However, there are currently no effective small-molecule inhibitors that can be used in the clinic.Novel TNF-α inhibitor was identified via high-throughput screening (HTS) and its anti-inflammatory activity was evaluated.Two cell death models were established to identify inhibitors of TNF-α through HTS from a library of 3256 compounds. The effect of the inhibitor of TNF-α was tested by HaCaT cells in vitro and IMQ-induced psoriasis-like mouse model in vivo.Tiamulin fumarate (TF) was identified as an effective inhibitor of TNF-α. TF significantly blocked the NF-κB and MAPK signaling pathways in TNF-α-stimulated HaCaT cells. Additionally, systemic and topical administration of TF improved IMQ-induced psoriasis-like dermatitis in the mouse model.Our study established a HTS method to identify TF as an inhibitor of TNF-α. The protective roles of TF in psoriasis-related inflammation reveal the potential therapeutic value of TF for psoriasis.

As a novel form of repetitive transcranial stimulation, intermittent theta burst stimulation (iTBS) has potentials to be widely used in patients with stroke. Yet little is known about the idiographic actions of iTBS with different stimulation parameters on rehabilitative aspects of stroke patients, nor is the molecular mechanism underlying. In the present study, effects of iTBS with different stimulation parameters were evaluate to identify the optimal protocol of iTBS against damage induced by ischemia/reperfusion (I/R). Herein we found the short-term iTBS application seemed to have no significant effects on outcomes of rats during acute phase after I/R, including the neurological deficits, cerebral infarction and edema. However, behavioral functional tests demonstrated that long-term iTBS treatment provided effective therapy during subacute stage after two weeks post-stroke onset, which possibly by increasing proliferation and migration of adult neural stem cells. To explore the possible mechanisms of, microRNAs (miRs) expressional profiles were analyzed by microarray technology. Further bioinformatic analysis of binding sites revealed miR-551b-5p directly targeted the brain-derived neurotrophic factor (BDNF), which was confirmed by luciferase reporter and qRT-PCR. Moreover, the level phosphorylated-TrkB, the downstream of BDNF, was elevated accompanied by above-mentioned changes of long-term iTBS. Taken together, experimental data reveals a direct link between miR-551b-5p and BDNF-mediated signaling cascade in early convalescence of stroke. Our findings provide new insights into the molecular mechanisms underlying curative effects of iTBS on stroke, thus aiding in the prognosis and personalized therapies.

The current study aimed to explore the multimodal differences between the inattentive ADHD (ADHD-I) subtype and the combined ADHD (ADHD-C) subtype. A large sample of medication-naïve children with pure ADHD (i.e., without any comorbidity) (145 with ADHD-I, 132 with ADHD-C) and healthy controls (n = 98) were recruited. A battery of multiple scales and cognitive tests were utilized to assess the clinical and cognitive profiles of each individual. In addition, structural and diffusion magnetic resonance imaging (MRI) were acquired for 120 subjects with ADHD and 85 controls. Regional gray matter volume, white matter volume, and diffusion tensors, e.g., axial diffusivity (AD), were compared among the three groups in a whole-brain voxel-wise manner. Compared with healthy controls, both ADHD groups exhibited elevated levels of behavioral and emotional problems. The ADHD-C group had more behavioral problems and emotional liability, as well as less anxiety, than the ADHD-I group. The two ADHD groups were equally impaired in most cognitive domains, with the exception of sustained attention. Compared with healthy controls, the ADHD-C group showed a high gray matter volume (GMV) in the bilateral thalamus and a high white matter volume in the body of the corpus callosum, while the ADHD-I group presented an elevated GMV mainly in the left precentral gyrus and posterior cingulate cortex. Compared with participants with ADHD-C and healthy controls, subjects with ADHD-I showed increased AD in widespread brain regions. Our study has revealed a distinct, interconnected pattern of behavioral, cognitive, and brain structural characteristics in children with different ADHD subtypes.

Flower color is a key trait that determines the ornamental quality of aquatic lotus (Nelumbo nucifera). Color fading significantly decreases the ornamental value of lotus flowers. However, the molecular mechanism underlying lotus petal discoloration remains largely unknown. Here, the anthocyanin content and global transcriptional profiling of lotus petals of cultivar 'Qiusanse' in four developmental stages were analyzed. Five anthocyanin components were detected, and the total anthocyanin content decreased as the petal color changed from red to nearly white. Moreover, the malondialdehyde (MDA) content and peroxidase (POD) activity increased during color fading. RNA-seq analysis revealed a total of 4,092 differentially expressed genes (DEGs) between petal developmental stages. Notably, oxidoreductase and hydrolase activity related genes were overrepresented in DEGs. The expression pattern of key anthocyanin biosynthesis genes including, CHS, F3H, ANS, UFGT, and transcription factor regulators, including MYBs, WRKYs and bHLHs were correlated with anthocyanin accumulation. Interestingly, DEGs associated with anthocyanin degradation and vacuolar pH regulation, including peroxidase, proton pumps regulators such as WRKY3 and MYB5-like, were significantly upregulated during the late stages of flowering. This study reveals for the first time the transcriptional dynamics during lotus petal discoloration. Our results suggest the involvement of anthocyanin biosynthesis repressors and degrading genes as well as pH regulators in controlling color fading of lotus petals. The study also provides valuable information and candidate genes for improving the lotus flower color.

Background Fascial autografts, which are easily available grafts, have provided a promising option in patients with massive rotator cuff tears. However, no fascial autografts other than the fascia lata have been reported, and the exact healing process of the fascia-to-bone interface is not well understood. The objective of this study is to histologically and biomechanically evaluate the effect of the thoracolumbar fascia (TLF) on fascia-to-bone healing. Methods A total of 88 rats were used in this study. Eight rats were sacrificed at the beginning to form an intact control group, and the other rats were divided randomly into 2 groups (40 rats per group): the thoracolumbar fascia augmentation group (TLF group) and the repair group (R group). The right supraspinatus was detached, and a 3*5 mm defect of the supraspinatus was created. The thoracolumbar fascia was used to augment the torn supraspinatus in the TLF group, whereas in the R group, the torn supraspinatus was repaired in only a transosseous manner. Histology and biomechanics were assessed at 1, 2, 4, 8 and 16 weeks postoperatively. Results The modified tendon maturation score of the TLF group was higher than that of the R group at 8 weeks (23.00 ± 0.71 vs. 24.40 ± 0.89, P=.025) and 16 weeks (24.60 ± 0.55 vs. 26.40 ± 0.55, P≤.001). The TLF group showed a rapid vascular reaction, and the peak value appeared at 1 week. Later, the capillary density decreased, and almost no angiogenesis was observed at 8 weeks postoperatively. Immunohistochemistry results demonstrated a significantly higher percentage of collagen I in the TLF group at 4, 8 and 16 weeks (24.78% ± 2.76% vs. 20.67% ± 2.11% at 4 weeks, p=.046; 25.46% ± 1.77% vs. 21.49% ± 2.33% at 8 weeks, p=.026; 34.77% ± 2.25% vs. 30.01% ± 3.17% at 16 weeks, p=.040) postoperatively. Biomechanical tests revealed that the ultimate failure force in the TLF group was significantly higher than that in the R group at the final evaluation (29.13 ± 2.49 N vs. 23.10 ± 3.47 N, p=.022). Conclusions The TLF autograft can promote a faster biological healing process and a better fixation strength. It could be used as an alternative reinforcement or bridging patch when the fascia lata is not appropriate or available for SCR. Level of evidence Basic Science Study; Histology and Biomechanics

Hesperetin, a methoxylated flavanone, has numerous biological activities. Access to this compound is currently restricted by its low abundance in plants, which limits its practical applicability. To provide an alternative, eco-friendly production source, we developed a biosynthetic pathway of hesperetin in an engineered Escherichia coli consortium, which was fed with naringenin as a precursor and demonstrated good hesperetin production. The biosynthetic pathway was divided into two modules. The first recombinant host harbored the pathway genes from two different species: a flavonoid 3'-hydroxylase (F3'H) gene from Gentiana triflora and a cytochrome P450 reductase (CPR) gene from Arabidopsis thaliana. The second strain heterologously expressed a gene encoding a flavonoid 4'-O-methyltransferase (MpOMT) from Mentha × piperita, which was N-terminally fused to a Sumo tag. A construct expressing a 29 aa N-terminally truncated F3'H and CPR was the most effective combination for the conversion of naringenin. The strain expressing the Sumo-tagged MpOMT protein exhibited an increase in the final hesperetin titer, reaching 5.9 mg/L. Simultaneous overexpression of metK (coding for the endogenous S-adenosyl-l-methionine [SAM] synthase) further improved the hesperetin titer by 25.1%. Finally, the designed E. coli consortium harboring the two modules efficiently converted naringenin to hesperetin (37.1 mg/L). This work reports the construction of a multi-step in vivo cascade biocatalyst for the biotransformation of naringenin to hesperetin. It also illustrates the potential of the E. coli consortium system for producing other O-methylated flavonoids.

Background Pulmonary rehabilitation is recommended for most patients with lung diseases. However, some previous studies have shown that pulmonary rehabilitation has no obvious effect on short-term lung function in patients with lung cancer. Objective The purpose of this study was to evaluate the effect of the ABCDEF pulmonary rehabilitation program on lung cancer patients who have undergone surgery. Design This was a randomized controlled trial with repeated measures. Settings The study was conducted in the Cardiothoracic Surgery Department of a 4000-bed comprising training and research hospital from 2019 to 2020. Participants A total of 90 patients who underwent thoracoscopic pneumonectomy were divided into two groups of 45, using a completely randomized model. Methods Patients in the experimental group participated in an ABCDEF program (Acapella positive vibration pressure training, breathing exercise, cycling training, dance in the square, education, and follow-up) after surgery. In contrast, the regular care provided to the control group focused on breathing and expectoration guidance. The study outcomes were the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, 6 min walking distance, Borg score, incidence of postoperative complications, length of indwelling chest tube, and length of postoperative stay. Generalized estimating equation models were used to compare the changes in the outcomes between the groups over time. Results The ABCDEF pulmonary rehabilitation program for patients who underwent thoracoscopic pneumonectomy was found to be more effective in increasing lung function at 3 months after discharge (p0.05). However, there was no statistically significant difference on the day of discharge (p0.05). Exercise tolerance was different at both time points (p0.05). The incidence of postoperative complications in the experimental group was lower than that in the control group (p0.05). The length of postoperative stay in the experimental group was also shorter (p0.05), however, the length of the indwelling chest tube was not significantly different between the intervention and control groups (p0.05). Conclusions This study showed that the ABCDEF pulmonary rehabilitation program could effectively improve mid-term lung function and exercise tolerance in patients after thoracoscopic pneumonectomy, and reduce the incidence of postoperative complications along with the length of postoperative hospital stay.

A novel copper-based MOFs adsorbent (Cu-BTC-Th) was prepared using an one-step method by introducing a new organic ligand of 4-thioureidobenzoicacid (Th) with active groups for selectively adsorbing Pb(II) from aqueous solutions. The chemical composition and structure of the prepared MOFs materials were characterized by scanning electron microscope (SEM), X-ray diffraction (XRD), fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS ), Brunner−Emmet−Teller (BET) analysis, and zeta potential measurements. The adsorption capability of the prepared Cu-MOFs was significantly enhanced by introducing the new organic ligand of Th in the materials. The maximum adsorption capacity of the Cu-BTC-Th for Pb(II) attains 732.86 mg/g under the optimal conditions. In addition, the adsorption kinetics and adsorption isotherm analysis showed that the adsorption process followed the pseudo-second-order kinetic model and Langmuir adsorption model, indicating that the adsorption of Pb(II) by Cu-BTC-Th was a monolayer chemisorption. The adsorption mechanism of Cu-BTC-Th for Pb(II) was discussed and revealed. On one hand, the adsorption of Pb(II) is mainly through ion exchange with the Cu(II). On the other hand, the −NH2 and −C=S functional groups introduced in the Cu-BTC-Th materials have stronger coordination ability with the Pb(II) ions to enhance the adsorption capability.

China banned the use of colistin as animal growth promoter in April 2017. Herein, we report the prevalence of mcr-1 in the intestine of healthy humans and risk factors associated with mcr-1 carriage after the implementation of the ban.We recruited 719 healthy volunteers from Shenzhen City from 1 March 2018 to 31 December 2019 to investigate the prevalence of mcr-1 in human intestine, and undertook a case-control study to ascertain the risk factors associated with the mcr-1-positive population. A further comparative study was conducted to identify differences between genetic characteristics of mcr-1-positive and mcr-1-negative Escherichia coli.Overall, 56 (7.8%, 95% CI 5.9%-10.0%, n = 719) individual faecal samples were positive for mcr-1, and prevalence of mcr-1 among individuals in 2019 (2.4%, 95% CI 8.7%-15.0%, 7/294) was significantly lower than that in 2018 (11.5%, 95% CI 1.0%-4.8%, 49/425) (p 0.0001). After the colistin ban, animal-derived food (pork and chicken meat) was no longer a risk factor for mcr-1 carriage in human intestine, whereas a higher intake of fish and seafood (75 g/day) and whole grains (150 g/day) was associated with higher and lower risk of mcr-1 carriage, respectively (OR 2.175, 95% CI 1.047-4.517; OR 0.045, 95% CI 0.004-0.567). Compared with mcr-1-negative E. coli, the mcr-1-positive E. coli had different patterns of resistance genes and genetic heterogeneity.Our study implicates aquatic food as beeing associated with mcr-1 carriage in the healthy population, even after the ban on colistin. Dietary modification (e.g. whole grains) may help to combat mcr-1-positive bacterial colonization of the gut.

Inhibitor of nuclear factor kappa-B kinase subunit beta (IKKβ) is one of important kinases in inflammation to phosphorylate inhibitor of nuclear factor kappa-B (IκBα) and then activate nuclear factor kappa-B (NF-κB). Inhibition of IKKβ has been a therapeutic strategy for inflammatory and autoimmune diseases. Here we report that IKKβ is constitutively activated in healthy donors and healthy IkkβC46A (cysteine 46 mutated to alanine) knock-in mice although they possess intensive IKKβ–IκBα–NF-κB signaling activation. These indicate that IKKβ activation probably plays homeostatic role instead of causing inflammation. Compared to IkkβWT littermates, lipopolysaccharides (LPS) could induce high mortality rate in IkkβC46A mice which is correlated to breaking the homeostasis by intensively activating p-IκBα–NF-κB signaling and inhibiting phosphorylation of 5ʹ adenosine monophosphate-activated protein kinase (p-AMPK) expression. We then demonstrated that IKKβ kinase domain (KD) phosphorylates AMPKα1 via interacting with residues Thr183, Ser184, and Thr388, while IKKβ helix–loop–helix motifs is essential to phosphorylate IκBα according to the previous reports. Kinase assay further demonstrated that IKKβ simultaneously catalyzes phosphorylation of AMPK and IκBα to mediate homeostasis. Accordingly, activation of AMPK rather than inhibition of IKKβ could substantially rescue LPS-induced mortality in IkkβC46A mice by rebuilding the homeostasis. We conclude that IKKβ activates AMPK to restrict inflammation and IKKβ mediates homeostatic function in inflammation via competitively phosphorylating AMPK and IκBα.

Terahertz (THz) technology has made promising progress and attracted wide interests in the fields of communications, security, agriculture, and biological sciences. However, the lack of modulation materials and the great challenge of the miniaturized system have become the huge restriction of this technology. Although artificial metamaterials have shown impressive electromagnetic performances in this band, they suffer complicated and high-cost fabrication processes. In this work, we find that due to the high conductivity, laser-induced graphene (LIG) can be applied in THz wave modulation. A LIG metasurface fabrication system is developed based on a nanosecond laser, a telecentric scan lens, and scanning mirrors. Owing to the ultra-small focal spot (≤5μm) realized by the telecentric scan lens and the fast-scanning speed of the mirrors, a LIG-based THz metasurface with the size of 15 mm × 15 mm, and the resolution of 30 μm can be fabricated in 34 seconds. In addition, THz optical parameters of LIG are measured. It is anticipated that this fast-fabricating, large-area, and low-cost method may open up a brand-new way to develop THz devices.

This paper focuses on mean exponential stability and L1-gain analysis for nonlinear positive Markov jump systems (NPMJSs) based on a switching transition probability (STP), where sector nonlinear functions and delays are adopted. By developing a nonlinear stochastic copositive Lyapunov-Krasovskii functional (NSCLKF) approach, a sufficient condition for mean exponential stability of nonlinear positive time-delay Markov jump system is first presented under mode-dependent average dwell time (MDADT) switching by using linear programming (LP) approach. Further, L1-gain performance analysis is obtained. Moreover, the corresponding results for NPMJSs are given under average dwell time (ADT) switching. Illustrative results are provided to verify the validity of the theoretical results.

With the continuous improvement of rice production capacity and the accumulation of reserves year by year, rice sometimes has to be stored for a long time. However, long-term storage of rice has poor sensory properties, which may be related to the structural changes of starch. Different from the previous studies on short-term storage of rice (often 3-12 months), the focus of this study was to understand the differences in starch multi-layer structure, pasting, and rice eating quality between 7 years stored rice and fresh rice. Our research indicated that 7 years stored rice showed higher hardness and lower stickiness compared to fresh rice, which ultimately led to poorer eating quality. These bad changes were related to differences in starch multi-layer structure. The 7 years stored rice had lower amylose content, a lower thickness of crystalline lamellae and short-range ordered structure of starch, and more large starch granules. In particular, the volume mean diameter of 7 years starch was more than 4 times that of fresh starch. 7 years stored rice had more large granular starch and unstable crystal structure, which led to the increase of pasting temperature and the decrease of gelatinization enthalpy during starch gelatinization, and ultimately reduced the eating quality of the rice.

Frequent nightmares are related to depressive symptoms in adolescents. Little is known about pathways from frequent nightmares to depressive symptoms. This study aimed to examine the mediation effect of nightmare distress in the association between frequent nightmares and depressive symptoms in a large sample of Chinese adolescents.A total of 11,831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort were included in the analysis. A self-administered questionnaire was used to measure nightmare frequency, nightmare distress, depressive symptoms, sleep duration, insomnia, and demographic characteristics. Linear regressions and mediation analyses were performed to examine the associations between frequent nightmares, nightmare distress and depressive symptoms.Of 11,831 participates, 50.9% were males and the mean age was 14.97 ± 1.45. Adolescents with frequent nightmares scored significantly higher on nightmare distress (t = 29.87, P 0.001) and depressive symptoms (t = 20.05, P 0.001) than those adolescents without frequent nightmares. Frequent nightmares (β = 1.04, 95% CI: 0.48-1.60) and nightmare distress (β = 0.30, 95% CI: 0.28-0.32) were associated with depressive symptoms. Mediation analyses showed that nightmare distress accounted for 63.76% of the total effects in the entire sample, 51.17% in males and 80.00% in females, respectively.No causality could be made from the cross-sectional data and possible information bias due to self-report.The association between frequent nightmares and depressive symptoms appears to be substantially mediated by nightmare distress. Assessing and intervening distress associated with frequent nightmares may have important clinical implications for reducing the risk of depression in adolescents.

Hydroxyapatite (HAP) is the major mineral phase in bone and teeth. The interaction of individual amino acids and citrate ions with different crystallographic HAP surfaces has remained uncertain for decades, creating a knowledge gap to rationally design interactions with peptides, proteins, and drugs. In this contribution, we quantify the binding mechanisms and binding free energies of the 20 end-capped natural amino acids and citrate ions on the basal (0 0 1) and prismatic (0 1 0)/(0 2 0) planes of hydroxyapatite at pH values of 7 and 5 for the first time at the molecular scale. We utilized over 1500 steered molecular dynamics simulations with highly accurate potentials that reproduce surface and hydration energies of (hkl) hydroxyapatite surfaces at different pH values. Charged residues demonstrate a much higher affinity to HAP than charge-neutral species due to the formation of superficial ion pairs and ease of penetration into layers of water molecules on the mineral surface. Binding free energies range from 0 to −60 kJ/mol and were determined with ∼ 10% uncertainty. The highest affinity was found for citrate, followed by Asp(-) and Glu(-), and followed after a gap by Arg(+), Lys(+), as well as by His(+) at pH 5. The (hkl)-specific area density of calcium ions, the protonation state of phosphate ions, and subsurface directional order of the ions in HAP lead to surface-specific binding patterns. Amino acids without ionic side groups exhibit weak binding, between −3 and 0 kJ/mol, due to difficulties to penetrate the first layer of water molecules on the apatite surfaces. We explain recognition processes that remained elusive in experiments, in prior simulations, discuss agreement with available data, and reconcile conflicting interpretations. The findings can serve as useful input for the design of peptides, proteins, and drug molecules for the modification of bone and teeth-related materials, as well as control of apatite mineralization.

In this paper, the problems of stochastic finite-time stability and stabilization of discrete-time positive Markov jump systems are investigated. To deal with time-varying delays and switching transition probability (STP), stochastic finite-time stability conditions are established under mode-dependent average dwell time (MDADT) switching signal by developing a stochastic copositive Lyapunov-Krasovskii functional approach. Then a dual-mode dependent output feedback controller is designed, thus stochastic finite-time stabilization is achieved based on linear programming technique. Finally, two examples are given to show the effectiveness of our results.

Let D be a digraph and let α ( D ) , α ′ ( D ) and λ ( D ) be independence number, the matching number and the arc-strong connectivity of D , respectively. Bang-Jensen and Thommasse in 2011 conjectured that every digraph D with λ ( D ) ≥ α ( D ) is supereulerian. In [J. Graph Theory, 81(4), (2016) 393-402], it is shown that every digraph D with λ ( D ) ≥ α ′ ( D ) is supereulerian. In this paper, we introduced the symmetric core of a digraph and use it to show that each of the following holds for a strong digraph D on n ≥ 3 vertices with λ ( D ) ≥ α ′ ( D ) − 1 . ( i ) There exists a family D ( n ) of well-characterized digraphs such that for any digraph D with α ′ ( D ) ≤ 2 , D has a spanning trial if and only if D is not a member in D ( n ) . ( i i ) If α ′ ( D ) ≥ 3 , then D has a spanning trail. ( i i i ) If α ′ ( D ) ≥ 3 and n ≥ 2 α ′ ( D ) + 3 , then D is supereulerian. ( i v ) If λ ( D ) ≥ α ′ ( D ) ≥ 4 and n ≥ 2 α ′ ( D ) + 3 , then for any pair of vertices u and v of D , D contains a spanning ( u , v ) -trail.

Study Objective To describe the surgical techniques and short-term outcomes for 33 cases of robot-assisted transvaginal natural orifice transluminal endoscopic surgery (RvNOTES) to treat endometriosis. Design Retrospective case series study. Setting Academic tertiary care university hospital in Houston, TX. Patients Patients who underwent RvNOTES resection of endometriosis between March 2020 and March 2021. Interventions RvNOTES. Measurements and Main Results A total of 33 cases of patients, with pathology-confirmed endometriosis, who underwent RvNOTES total hysterectomy with resection of endometriosis were included in the study. Thirty-two cases were completed successfully by RvNOTES, and 1 case was converted to robotic transumbilical single-incision laparoscopic surgery plus 1 additional port owing to an obliterated posterior cul-de-sac and upper abdominal wall endometriosis. The average operative time was 141.93 ± 40.22 (85–264) minutes, and the mean estimated blood loss was 52.25 ± 33.82 (25–150) mL. The mean preoperative pain score using the visual analog scale (VAS) score was 8.08 ± 2.39 (2–10). The mean VAS pain score 1 week after surgery was 6.73 ± 2.62 (0–10), which was significantly lower than the preoperative scores (p = .059). The mean VAS pain score in the second and third week after surgery was 4.81 ± 2.42 (0–9) and 2.63 ± 2.36 (0–7) respectively, which were both significantly lower than those before surgery (p = .001). There were 4 postoperative complications: urinary tract infection, pneumonia, headache requiring admission, and conversion disorder. Conclusion RvNOTES is a safe and feasible approach for the treatment of endometriosis, with promising short-term improvements in pain.

This study analyzes the impact of internal features and external environmental attributes on room prices by using geographic weighted regression (GWR) in high-end rural homestays in China. The results show that (1) distance from the scenic spots (Sdistance) and the number of employees have the most significant effects on room prices; (2) the physical geography factors (slope and aspect) of the homestay have a positive impact on its room price; (3) the GWR coefficient clearly reflects the heterogeneity of the space and the verified GWR is more suited to homestay room pricing. The study expands the hedonic potential for market analysis in the homestay sector and provides operators of high-end rural homestays with the managerial implications of establishing an effective strategy for room pricing and has a certain guiding significance for the layout of homestay industry.

The purpose of this study was to examine 1) the relationship between apathy and leisure activity participation in nursing home residents with Alzheimer disease (AD) and 2) the moderator effect of the severity of dementia on this relationship. Data were collected from 290 residents with AD using the Apathy Evaluation Scale-informant version (AES-I), Leisure Activities Questionnaire (LAQ), and Clinical Dementia Rating scale (CDR). The multiple linear regression model showed that leisure activity participation (β=-0.452, p0.001) was negatively associated with apathy, while the severity of dementia (β=0.515, p0.001) was positively associated with apathy. The severity of dementia moderated the effect of leisure activity participation on apathy (β=-0.108, p=0.015). The results indicate that the effects of leisure activity participation on apathy diminish with the aggravation of AD. The severity of dementia should be considered when designing and delivering leisure activity interventions to manage apathy in nursing home residents with AD.