Search

ABSTRACT Objectives Intramedullary nailing is preferred for treating elderly proximal humeral fractures, but secondary reductions are common, particularly in elderly and osteoporotic patients. This occurs due to the intramedullary nail fixation's insufficient anti‐varus and anti‐rotational capacities and high stress at the bone–implant interface. We aim to enhance the anti‐varus and anti‐rotational stability of the fixation structure while reducing the stresses on the bone and internal fixation through structural design. Materials and Methods We developed a novel endosteal anatomical support nail (EASN) that integrates an endosteal torus construct into the proximal portion of the angle‐stable proximal humerus nail. The endosteal torus construct includes endosteal anatomical support (EAS) with a flat plane that allows direct fixation of the humeral head fragments and is shaped to conform to the medial side of the medullary cavity of the proximal humerus. We conducted finite element analysis to assess the biomechanical stability of four constructs: EAS with a calcar screw (CS), EAS without CS, non‐EAS with CS, and non‐EAS without CS. This analysis determined the contribution of the EAS to the mechanical stability of the proximal humerus in two‐part PHF with medial column disruption. Specimens were subjected to loads simulating partial‐weight‐bearing (as in rising from a chair or using crutches) and full‐weight‐bearing (as in rising from bed). We evaluated the stiffness of the construct, displacement at the fracture site, von Mises stress, and stress distribution. Results Under compressive or rotational loads, the EAS construct, with or without CS, was significantly stiffer than the non‐EAS construct. Displacement at the fracture site was significantly less with the EAS fixation than with the non‐EAS fixation. However, the stiffness and displacement at the fracture site of the EAS fixation without CS were comparable to those of the non‐EAS construct with CS. The EAS construct reduced the load on the nail and decreased the risk of implant failure. Both von Mises stress and stress distribution were significantly lower following fixation with the EAS constructs. Conclusions This study introduces a novel EAS concept to enhance the anti‐varus and anti‐rotational capabilities of the humeral head and distribute stress at the bone–implant interface in treating elderly PHFs. This strategy shows promise based on our limited analysis.

ABSTRACT Objectives To minimize the risk of V3 segment of vertebral artery (VA) injury in the atlantoaxial dislocation (AAD) patients with C1 pedicle height less than 4.0 mm and provide a strong toggle force in irreducible AAD and revision surgery. We evaluated the feasibility of C1 “Zero Angle” screw (C1ZAS) and safe entry point with “in–out–in” technique as an alternative option for C1 pedicle screw (PS) in cases with AAD. Methods Sixty‐one patients with AAD or atlantoaxial instability (AAI) (45 male and 16 female) who underwent cervical computed tomography and magnetic resonance imaging scans in our center between January 1, 2022 and December 31, 2023 were retrospectively reviewed. Measurements were made around the ideal trajectory and entry point of C1ZAS using computerized tomography (CT) and magnetic resonance imaging (MRI) in 61 patients. Radiographic measurements included (A) the distance from the recess to the transverse foramen (RTF); (B) the tricortical screw zone (TSZ); (C) the lateral mass height along the C1ZAS trajectory (LMH); (D) the screw length of C1ZAS (ZSL); (E) the screw length of C1 PS (PSL); (F) the distances from the recess to the dura (RD); (G) the distance from the recess to the spinal cord (RSC); (H) the distance from the inner of lateral mass to the spinal cord (ILMSC). During the period of January 1, 2022 to December 31, 2023, C1ZAS placement with “in–out–in” technique was used as an alternative option for C1 PS in 8 patients with AAD and unilateral/bilateral narrow C1 pedicles. Results The average RTF, TSZ, LMH, ZSL, RD, RSC, and ILMSC were 7.71, 6.14, 8.32, 33.23, 4.68, 10.02, and 2.91 mm respectively. The entry point of the C1ZAS was defined as the projection point of the inner of the recess to the posterior arch and the trajectory should be angled cephalad by 8.7° and medially by 0°. The 61 patients (122 sides) with AAD or AAI were classified into three groups: the low‐risk (76 sides, 62%), the intermedial‐risk (18 sides, 15%), and the high‐risk (28 sides, 23%) groups. Satisfactory C1ZAS placement and atlantoaxial reduction were achieved in all eight patients with AAD and unilateral/bilateral narrow C1 pedicles. No instance of C1ZAS placement‐related VA injury or dural laceration was observed. Conclusions When the placement of C1 PS is not feasible in patients with AAD and unilateral/bilateral narrow C1 pedicles, C1ZAS placement with “in–out–in” technique can be considered an effective alternative option, providing tricortical or quadricortical purchase for rigid fixation of the atlas.

ABSTRACT Background It is still unclear whether reverse total shoulder arthroplasty (RTSA) has advantages over traditional hemiarthroplasty (HA) and anatomic total shoulder arthroplasty (ATSA) in the treatment of complex shoulder joint diseases. Therefore, this study aims to evaluate the clinical effectiveness of RTSA in the treatment of complex shoulder joint diseases and further determine whether it is necessary to expand the indications of RTSA. Method We conducted a systematic search of studies published between January 1, 2012 and May 31, 2023 in PubMed, Embase, and Cochrane databases. The experimental group included patients who underwent primary reverse total shoulder arthroplasty (RTSA), while the control group consisted of patients who underwent primary hemiarthroplasty (HA) or anatomic total shoulder arthroplasty (ATSA). The minimum follow‐up period was 1 year, and a random‐effects model was utilized for data synthesis. Results A total of 45 studies were included in the meta‐analysis. Compare to HA, RTSA showed significant advantages in postoperative ASES scores (p = 0.004), forward flexion (p

ABSTRACT Objective The relationship between cervical disc degeneration and bone quality of adjacent vertebral body remains controversial. This study aims to investigate the relationship between cervical disc degeneration and bone quality of the adjacent vertebral body and sub‐endplate bone with a new MRI‐based bone quality score in patients over 50 years with cervical spondylosis. Methods We retrospectively reviewed 479 cervical disc segments from 131 patients. Disc degeneration at levels C3/C4–C6/C7 was graded using T2‐weighted MRI. Vertebral body quality (VBQ) score and sub‐endplate bone quality (EBQ) score from C3 to C7 were computed from T1‐weighted MRI images. Additionally, bone mineral density (BMD) of the cervical vertebrae was measured in 52 patients using a novel phantom‐less quantitative computed tomography (PL‐QCT) system. The correlation between bone quality score and Pfirrmann grade was analyzed and risk factors for VBQ and EBQ were further evaluated. Results Significant differences were found in cranial VBQ among different Pfirrmann grades, with a score of 2.55 ± 0.54 for Grade 5 discs, which was lower compared to Grades 4 (2.70 ± 0.56) (p

ABSTRACT Objective Osteoporosis is a crucial risk factor for screw loosening. Our studies indicate that the bone mineral density (BMD) in the screw trajectory is a better predictor of screw loosening than the BMD of the lumbar spine or the screw insertion position. Research has shown that anchorage on the screw tip is the most significant factor for screw anchorage ability, while others argue that decreased bony quality in the pedicle poses a significant risk for screw loosening. This study aimed to determine whether the bony quality of the screw tip, pedicle, or screw‐anchored vertebral body plays the most significant role in screw anchorage ability. Methods A total of 73 patients who underwent single–segment bilateral pedicle screw fixation, along with posterior and transforaminal lumbar interbody fusion (PLIF and TLIF), from March 2019 to September 2020 were included in this retrospective study. The Hounsfield unit (HU) value of the fixed vertebral bodies, the entire screw trajectory, screw tip, screw–anchoraged vertebral body, and pedicles were measured separately. Data from patients with and without screw loosening were compared, and regression analyses were conducted to identify independent risk factors. Additionally, the area under the curve (AUC) values were computed to assess the predictive performance of different parameters. Furthermore, fixation strength was calculated in numerical models with varying bony densities in different regions. Results HU values were found to be significantly lower in the loosening group across most measuring methods (HU values in the pedicle, 148.79 ± 97.04, 33.06 ± 34.82, p 0.9 and in the screw insertion position > 0.7). Additionally, computational results for fixation strength revealed a clear decline in screw anchorage ability in models with poor BMD in the pedicle region. Conclusions Pedicle bone quality plays a more significant role in screw anchorage ability than that in other regions. The innovation of bony augmentation strategies should pay more attention to this region to optimize the screw anchorage ability effectively.

ABSTRACT Objective Modic changes (MCs) classification system is the most widely used method in magnetic resonance imaging (MRI) for characterizing subchondral vertebral marrow changes. However, it shows a high degree of sensitivity to variations in MRI because of its semiquantitative nature. In 2021, the authors of this classification system further proposed a quantitative and reliable MC grading method. However, automated tools to grade MCs are lacking. This study developed and investigated the performance of convolutional neural network (CNN) in detecting and grading MCs based on their maximum vertical extent. In order to verify performance, we tested CNNs' generalization performance, the performance of CNN with that of junior doctors, and the consistency of junior doctors after AI assistance. Methods A retrospective analysis of 139 patients' MRIs with MCs was conducted and annotated by a spine surgeon. Of the 139 patients, MRIs from 109 patients were acquired using Philips scanners from June 2020 to June 2021, constituting Dataset 1. The remaining 30 patients had MRIs obtained from both Philips and United Imaging scanners from June 2022 to March 2023, forming Dataset 2. YOLOv8 and YOLOv5 were developed in PyCharm using the Python language and based on the PyTorch deep learning framework, data enhancement and transfer learning were applied to enhance model generalization. The model's performance was compared with precision, recall, F1 score, and mAP50. It also tested generalizability and compared it with the junior doctor's performance on the second data set (Dataset 2). Post hoc, the junior doctor graded Dataset 2 with CNN assistance. In addition, the region of interest was displayed using the class activation mapping heat map. Results On the unseen test set, the YOLOv8 and YOLOv5 models achieved precision of 81.60% and 61.59%, recall of 80.90% and 67.16%, mAP50 of 84.40% and 68.88%, and F1 of 0.81 and 0.60 respectively. On Dataset 2, YOLOv8 and junior doctor achieved precision of 95.1% and 72.5%, recall of 68.3% and 60.6%. In the AI‐assisted experiment, agreement between the junior doctor and the senior spine surgeon significantly improved from Cohen's kappa of 0.368–0.681. Conclusions YOLOv8 in detecting and grading MCs was significantly superior to that of YOLOv5. The performance of YOLOv8 is superior to that of junior doctors, and it can enhance the capabilities of junior doctors and improve the reliability of diagnoses.

High‐order interactions associated with non‐small cell lung cancer (NSCLC) survival may elucidate underlying molecular mechanisms and identify potential therapeutic targets. Our previous work has identified a three‐way interaction among pack‐year of smoking (the number of packs of cigarettes smoked per day multiplied by the number of years the person has smoked) and two DNA methylation probes (cg05293407TRIM27 and cg00060500KIAA0226). However, whether a four‐way interaction exists remains unclear. Therefore, we adopted a two‐phase design to identify the four‐way gene–smoking interactions by a hill‐climbing strategy on the basis of the previously detected three‐way interaction. One CpG probe, cg16658473SHISA9, was identified with FDR‐q ≤ 0.05 in the discovery phase and P ≤ 0.05 in the validation phase. Meanwhile, the four‐way interaction improved the discrimination ability for the prognostic prediction model, as indicated by the area under the receiver operating characteristic curve (AUC) for both 3‐ and 5‐year survival. In summary, we identified a four‐way interaction associated with NSCLC survival among pack‐year of smoking, cg05293407TRIM27, cg00060500KIAA0226 and g16658473SHISA9, providing novel insights into the complex mechanisms underlying NSCLC progression.

Abstract Introduction This study protocol specifies the primary research line and theoretical framework of the 2023 Survey of the Psychology and Behavior of the Chinese Population. It aims to establish a consistent database of Chinese residents' psychological and behavioral surveys through multi‐center and large‐sample cross‐sectional surveys to provide robust data support for developing research in related fields. It will track the public's physical and psychological health more comprehensively and systematically. Methods The study was conducted from June 20, 2023 to August 31, 2023, using stratified and quota sampling methods. A total of 150 cities across 800 communities/villages were surveyed, selected from China (Despite extensive coordination, we have been unable to contact our counterparts in the Taiwan region of China to obtain relevant statistical data). The questionnaires were distributed to the public one‐on‐one and face‐to‐face by trained surveyors. The questionnaires included basic information about the individual, personal health status, basic information about the family, the social environment in which the individual lives, psychological condition scales, behavioral level scales, other scales, and attitudes towards topical social issues. Supervisors conducted quality control during the distribution process and returned questionnaires, logically checked and cleaned for data analysis. Discussion Data collection has been finished, and scientific outputs based on this data will support the development of health promotion strategies in China and globally. In the aftermath of the pandemic, it will guide policymakers and healthcare organizations to improve their existing policies and services to maximize the physical and mental health of the Chinese population. Trial Registration This study was filed in the National Health Security Information Platform (Record No.: MR‐37‐23‐017876) and officially registered in the China Clinical Trials Registry (Registration No.: ChiCTR2300072573).

Abstract In this paper, a 280–300 GHz hybrid‐integrated transmitter is proposed. The advantages of the SiGe and InP chips are fully made use by integrating these two chips. For low cost and high integration, the local oscillator chain and mixer are based on chips in SiGe technology, and the 300‐GHz power amplifier and on‐chip antenna are realised in InP technology for high output power and small die size. The low‐cost bonding wires are introduced for the interconnection between these two chips, and the lens are attached above the on‐chip antenna for further EIRP enhancement. Finally, the proposed transmitter is fabricated and measured, which shows comparable performances with 21.9 dBm EIRP (equivalent isotropic radiated power) and 10 Gbps data rate.

Abstract Integrated electricity‐heat system (IEHS) has been paid more and more attention in recent years for its advantage in improving energy efficiency, reducing carbon emissions and increasing renewable energy penetration. To ensure the safety, reliability and economic operation of IEHS, several centralised state estimation (SE) methods for IEHS have been proposed. However, power systems and heat systems often belong to different management entities, and there are industrial barriers such as information privacy, operational differences, and target differences between them, which leads to less applicability of centralised SE methods. In addition, the robustness of existing distributed SE methods for IEHS is not satisfactory. To this end, a distributed robust state estimation (DRSE) model for IEHS based on the alternating direction method of multipliers (ADMM) is proposed. Firstly, by introducing auxiliary state variables and measurements, a robust linear SE model based on weighted least absolute values (WLAV) is proposed. Then, second‐order cone constraints composed of auxiliary state variables are added to the SE model, leading a SOCP‐based robust SE model. Finally, the ADMM algorithm is used to solve the proposed SOCP‐based robust SE model. Simulations demonstrate that the proposed method has higher estimation accuracy in both general and strongly correlated adverse data tests and also can ensure data privacy, good robustness and high estimation accuracy. This indicates that the method proposed has good robustness and solves the problem of weak robustness of existing distributed static state estimation methods.

Abstract Under the background of achieving the dual‐carbon goal, the park is a natural experimental field for practicing the dual‐carbon goal. A low‐carbon optimal scheduling strategy for a multi‐agent park‐integrated energy system (P‐IES) based on the Stackelberg–Nash game is proposed. Firstly, a low‐carbon P‐IES scheduling model is established, considering the two‐stage operation of power‐to‐gas (P2G) technology and reward–punishment stepwise carbon trading mechanism. Then, a two‐layer game optimisation model is proposed with a park‐integrated energy system operator (P‐IESO) as the leader and multiple low‐carbon P‐IESs as followers. Among them, the parks are connected with each other through the power trading channels. Then, the Nash equilibrium solution is obtained by the iterative search method, and the uniqueness of the equilibrium solution of the game is proven, so as to determine the optimal pricing strategy of the operator. Finally, a typical industrial park is taken as an example for simulation verification. The example analysis verifies that the model can effectively reduce the system's carbon emissions and improve the park's economic benefits and low‐carbon levels, thereby achieving the coordinated development of low‐carbon and economic performance in the park.

Abstract Beam‐matched linear accelerators (linacs) enable flexible patient scheduling and efficient treatment delivery in the event of unexpected machine downtime. The purpose of this study was to test the feasibility of 3D gamma index as an additional metric beyond standard measurement‐based comparisons for more efficient evaluation of treatment plans between linacs with nominally matched beam models to ensure safe patient transfer. Seventeen 3D conformal radiotherapy (3DCRT) plans and thirty‐six volumetric‐modulated radiation therapy (VMAT) plans for different disease sites were selected from the original linac. An in‐house script was used to automatically create new plans for the target linac and calculate dose using parameters of the original plans. 3D gamma analysis was performed to compare plan dose distributions between the target and original linacs using PyMedPhys. The 2%/2 mm gamma pass (γ≤1) rate was >99.99% for all 3DCRT plans. The median 1%/1 mm pass rate was 99.86% but two cases failed (< 90%). For VMAT plans, the median and minimum 2%/2 mm gamma pass rates were 99.43% and 93.81%. For 1%/1 mm, the median pass rate was 92.02% but ten cases failed. The results indicated using 3D gamma index can enhance the confidence and add an extra layer for safe patient transfer.

Abstract Background Autism and schizophrenia are environmental risk factors associated with prenatal viral infection during pregnancy. It is still unclear whether behavior phenotypes change at different developmental stages in offspring following the activation of the maternal immune system. Methods Sprague–Dawley rats received a single caudal vein injection of 10 mg/kg polyinosinic:polycytidylic acid (poly I:C) on gestational day 9 and the offspring were comprehensively tested for behaviors in adolescence and adulthood. Results Maternal serum levels of interleukin (IL)‐6, IL‐1β and tumor necrosis factor‐α were elevated in poly I:C‐treated dams. The offspring of maternal poly I:C‐induced rats showed increased anxiety, impaired social approach, and progressive impaired cognitive and sensorimotor gating function. Conclusion Maternal immune activation led to developmental specificity behavioral impairment in offspring.

Abstract Vehicle transportation of hazardous chemicals is one of the important mobile hazards in modern logistics, and its unsafe factors bring serious threats to people's lives, property and environmental safety. Although the current object detection algorithm has certain applications in the detection of hazardous chemical vehicles, due to the complexity of the transportation environment, the small size and low resolution of the vehicle target etc., object detection becomes more difficult in the face of a complex background. In order to solve these problems, the authors propose an improved algorithm based on YOLOv5 to enhance the detection accuracy and efficiency of hazardous chemical vehicles. Firstly, in order to better capture the details and semantic information of hazardous chemical vehicles, the algorithm solves the problem of mismatch between the receptive field of the detector and the target object by introducing the receptive field expansion block into the backbone network, so as to improve the ability of the model to capture the detailed information of hazardous chemical vehicles. Secondly, in order to improve the ability of the model to express the characteristics of hazardous chemical vehicles, the authors introduce a separable attention mechanism in the multi‐scale target detection stage, and enhances the prediction ability of the model by combining the object detection head and attention mechanism coherently in the feature layer of scale perception, the spatial location of spatial perception and the output channel of task perception. Experimental results show that the improved model significantly surpasses the baseline model in terms of accuracy and achieves more accurate object detection. At the same time, the model also has a certain improvement in inference speed and achieves faster inference ability.

ABSTRACT To explore the effects of lipids and emulsifiers on the release of strawberry aroma compounds in soy‐based emulsions, the release of seven strawberry aroma compounds (limonene, ethyl hexanoate, (Z)‐3‐hexenyl acetate, ethyl 2‐methylbutanoate, ethyl butanoate, (Z)‐3‐hexenol, and diacetyl) was examined using static headspace gas chromatographic analysis. Sensory evaluations revealed that the incorporation of soy protein isolate (SPI) emulsions led to a marked imbalance in the strawberry flavor profile. Although no direct correlation was found between emulsion viscosity or particle size and flavor release, lipid type and concentration (soybean oil and palm oil), and emulsifier type (sucrose ester, tween 80, and monoglyceride) significantly impacted flavor retention. Specifically, the hydrophilic compound diacetyl exhibited significantly higher retention in soybean oil emulsions (41%) than in palm oil emulsions (34%) (p

Abstract Aims Acute‐on‐chronic liver failure (ACLF) is defined as acute liver injury superimposed on chronic liver disease, resulting in a significantly increased short‐term mortality rate. Serum lipids are associated with the severity of liver disease and contribute to the prognostic assessment for cirrhosis and liver failure. However, the presentation of serum lipids varies in different studies, making it difficult to draw definitive conclusions. This study aimed to investigate the predictive value of serum lipids for short‐term prognosis in patients with ACLF. Methods This retrospective analysis was conducted using the clinical data of patients hospitalized for ACLF between January 2018 and December 2021. The collected data were subjected to Least Absolute Shrinkage and Selection Operator and logistic regression analyses to identify the independent predictors of 28‐day and 90‐day mortality. Separate regression models were developed for each identified serum lipid. These models were combined with the Model for End‐Stage Liver Disease (MELD), MELD combined with serum sodium concentration (MELD‐Na), Chronic Liver Failure Consortium Acute‐on‐chronic Liver Failure (CLIF‐C ACLF), and Chinese Group on the Study of Severe Hepatitis B‐ACLF (COSSH‐ACLF) scores to construct new models. The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC), Nagelkerke R2, Brier score, net reclassification index (NRI), and integrated discrimination improvement (IDI) to assess the prognostic ability of serum lipids. Results This study included 266 patients with ACLF, of whom 25.9% (69/266) died within 28 days and 38.5% (102/265, with 1 lost to follow‐up) died within 90 days. The independent predictors of 28‐day mortality were age, the presence of overt hepatic encephalopathy at admission, high‐density lipoprotein cholesterol (HDL‐C) levels, and international normalized ratio (INR). The independent predictors of 90‐day mortality were age, albumin levels, serum creatinine levels, and INR. The comparative analysis revealed that the AUC of all other models exceeded that of HDL‐C (p 0.050). Conclusions Serum HDL‐C is an independent predictor of 28‐day mortality in patients with ACLF. Although it has inferior predictive ability when considered alone, HDL‐C enhances the predictive capacity of MELD, MELD‐Na, and COSSH‐ACLF when incorporated into these models.

Abstract For adopting recently introduced hypertension phenotypes categorized using office and out of office blood pressure (BP) for the diagnosis of hypertension and antihypertension drug therapy, it is mandatory to define the corresponding out of office BP with the specific target BP recommended by the major guidelines. Such conditions include white‐coat hypertension (WCH), masked hypertension (MH), white‐coat uncontrolled hypertension (WUCH), and masked uncontrolled hypertension (MUCH). Here, the authors review the relevant literature and discuss the related issue to facilitate the use of corresponding BPs for proper diagnosis of WCH, MH, WUCH, and MUCH in the setting of standard target BP as well as intensive target BP. The methodology of deriving the corresponding BP has evolved from statistical methods such as standard deviation, percentile value, and regression to an outcome‐based approach using pooled international cohort study data and comparative analysis in randomized clinical trials for target BPs such as the SPRINT and STEP studies. Corresponding BPs to 140/90 and 130/80 mm Hg in office BP is important for safe and strict achievement of intensive BP targets. The corresponding home, daytime, and 24‐h BPs to 130/80 mm Hg in office BP are 130/80, 130/80, and 125/75 mm Hg, respectively. However, researchers have found some discrepancies among the home corresponding BPs. As tentative criterion for de‐escalation of antihypertensive therapy as shown in European guidelines was 120 mm Hg in office BP, corresponding home, daytime, and 24‐h systolic BPs to 120 mm Hg in office systolic BP are 120, 120, and 115 mm Hg, respectively.

Abstract In the last three decades, ablation of atrial fibrillation (AF) has become an evidence‐based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society

Abstract Objective To assess the efficacy and safety of perampanel (PER) as primary monotherapy in patients aged 4–18 years old with epilepsy. Methods A single‐center, prospective, observational study was conducted from October 2021 to October 2023, to evaluate PER monotherapy's efficacy and safety as initial therapy for pediatric epilepsy. Changes in seizure frequency, safety, and retention rate were observed at 3, 6, 9, and 12 months after initiating PER primary monotherapy. Results A total of 124 children aged 4–15 years (mean age = 8.25 ± 2.50 years) were included in the Analysis Sets. The retention rates at 3, 6, 9, and 12 months were 88.71% (110/124), 84.68% (105/124), 78.26% (90/115), and 71.58% (68/95), respectively. Seizure freedom rates at 3, 6, 9, and 12 months were 85.45%, 79.09%, 76.24%, and 75.31%, respectively. The responder rates (≥50% but 0.05) but associated with duration of treatment (p = 0.001) and maintenance dose (p = 0.022). Additionally, 124 patients were included in the safety analysis set. The overall adverse event rate was 38.71% (48/124), with irritability (19 cases, 15.32%) and dizziness (18 cases, 14.52%) being the most common adverse effects. One patient discontinued PER monotherapy within 1 month due to unbearable itching of the skin. Significance PER monotherapy as the primary anti‐seizure medication (ASM) for pediatric epilepsy demonstrates high efficacy and safety in real‐world clinical treatment. Patients who respond well to this drug and adhere to long‐term treatment can achieve favorable seizure control. Furthermore, patients achieving seizure freedom with a relatively lower dose can opt for the same dose as the maintenance dose. Plain Language Summary This study provided the efficacy and safety of PER monotherapy as the primary ASM for Chinese pediatric epilepsy. In total, 124 patients took part. The seizure freedom rates were over 70% at different observation points (OPs), along with a retention rate of 71.58% at the 12‐month OP. Most of adverse effects observed were mild to moderate.

ABSTRACT Background Nuclear receptor interaction protein (NRIP) is versatile and engages with various proteins to execute its diverse biological function. NRIP deficiency was reported to cause small myofibre size in adult muscle regeneration, indicating a crucial role of NRIP in myoblast fusion. Methods The colocalization and interaction of NRIP with actin were investigated by immunofluorescence and immunoprecipitation assay, respectively. The participation of NRIP in myoblast fusion was demonstrated by cell fusion assay and time‐lapse microscopy. The NRIP mutants were generated for mechanism study in NRIP‐null C2C12 (termed KO19) cells and muscle‐specific NRIP knockout (NRIP cKO) mice. A GEO profile database was used to analyse NRIP expression in Duchenne muscular dystrophy (DMD) patients. Results In this study, we found that NRIP directly and reciprocally interacted with actin both in vitro and in cells. Immunofluorescence microscopy showed that the endogenous NRIP colocalized with components of invadosome, such as actin, Tks5, and cortactin, at the tips of cells during C2C12 differentiation. The KO19 cells were generated and exhibited a significant deficit in myoblast fusion compared with wild‐type C2C12 cells (3.16% vs. 33.67%, p

ABSTRACT Background Obesity is a significant risk factor for the progression of non‐alcoholic fatty liver disease (NAFLD). However, a convenient and efficacious non‐invasive test for monitoring NAFLD progression in patients with obesity is currently lacking. This study aims to investigate the associations between CT‐based body composition and the progression of biopsy‐proven NAFLD in patients with obesity. Methods Liver biopsy was conducted in patients with obesity, and the progression of NAFLD was evaluated by the NAFLD activity score (NAS). Body composition was assessed through abdominal computed tomography (CT) scans. Results A total of 602 patients with an average age of 31.65 (±9.33) years old were included, comprising 217 male patients and 385 female patients. The wall skeletal muscle index (SMI), total SMI, and visceral fat index (VFI) were positively correlated with NAS in both male and female patients. Multivariate regression analysis demonstrated significant associations between high liver steatosis and wall SMI (HR: 1.60, 95% CI: 1.12 to 2.30), total SMI (HR: 1.50, 95% CI: 1.02 to 2.08), VSI (HR: 2.16, 95% CI: 1.48 to 3.14), visceral fat to muscle ratio (HR: 1.51, 95% CI: 1.05 to 2.18), and visceral to subcutaneous fat ratio (HR: 1.51, 95% CI: 1.07 to 2.12). Non‐alcoholic steatohepatitis (NASH) was significantly associated with wall SMI (HR: 1.52, 95% CI: 1.06 to 2.19) and VSI (HR: 1.50, 95% CI: 1.03 to 2.17). Liver fibrosis ≥ F2 was significantly associated with psoas muscle index (HR: 0.64, 95% CI: 0.44 to 0.93) and psoas skeletal muscle density (HR: 0.61, 95% CI: 0.41 to 0.89). Conclusions Our study suggested that certain CT‐based body composition indicators, notably high VFI, were significantly associated with the progression of NAFLD in patients with obesity. Great attentions and timely managements should be given to these patients with body composition characteristics associated with the risk of NAFLD progression.

Abstract Background The effects of lipid‐lowering drugs [including statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors] on hyperlipidaemia have been established. Some may have treatment effects beyond their reported properties, offering potential opportunities for drug repurposing. Epidemiological studies have reported conflicting findings on the relationship between lipid‐lowering medication use and sarcopenia risk. Methods We performed a two‐sample Mendelian randomization (MR) study to investigate the causal association between the use of genetically proxied lipid‐lowering drugs (including statins, ezetimibe, and PCSK9 inhibitors, which use low‐density lipoprotein as a biomarker), and sarcopenia risk. The inverse‐variance weighting method was used with pleiotropy‐robust methods (MR–Egger regression and weighted median) and colocalization as sensitivity analyses. Results According to the positive control analysis, genetically proxied inhibition in lipid‐lowering drug targets was associated with a lower risk of coronary heart disease [PCSK9 (OR, 0.67; 95% CI, 0.61 to 0.72; P = 7.7E‐21); 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase (HMGCR; OR, 0.68; 95% CI, 0.57 to 0.82; P = 4.6E‐05), and Niemann–Pick C1‐like 1 (NPC1L1; OR, 0.53; 95% CI, 0.40 to 0.69; P = 3.3E‐06)], consistent with drug mechanistic actions and previous trial evidence. Genetically proxied inhibition of PCSK9 (beta, −0.040; 95% CI, −0.068 to −0.012; P = 0.005) and circulating PCSK9 levels (beta, −0.019; 95% CI, −0.033 to −0.005; P = 0.006) were associated with reduced appendicular lean mass (ALM) with concordant estimates in terms of direction and magnitude. Validation analyses using a second instrument for PCSK9 yielded consistent results in terms of direction and magnitude [(PCSK9 to ALM; beta, −0.052; 95% CI, −0.074 to −0.032; P = 7.1E‐7); (PCSK9 protein to ALM; beta, −0.060; 95% CI, −0.106 to −0.014; P = 0.010)]. Genetically proxied inhibition of PCSK9 gene expression in the liver may be associated with reduced ALM (beta, −0.013; 95% CI, −0.035 to 0.009; P = 0.25), consistent with the results of PCSK9 drug‐target and PCSK9 protein MR analyses, but the magnitude was less precise. No robust association was found between HMGCR inhibition (beta, 0.048; 95% CI, −0.015 to 0.110; P = 0.14) or NPC1L1 (beta, 0.035; 95% CI, −0.074 to 0.144; P = 0.53) inhibition and ALM, and validation and sensitivity MR analyses showed consistent estimates. Conclusions This MR study suggested that PCSK9 is involved in sarcopenia pathogenesis and that its inhibition is associated with reduced ALM. These findings potentially pave the way for future studies that may allow personalized selection of lipid‐lowering drugs for those at risk of sarcopenia.

Abstract Aims The prognostic significance of N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) in heart failure with preserved ejection fraction (HFpEF) has been well established. HFpEF and atrial fibrillation (AF) commonly coexist, and each contributes to poor outcomes independently. Nevertheless, the ability of NT‐proBNP to predict AF in HFpEF patients remains uncertain. Methods and results A total of 367 HFpEF patients without baseline AF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included. The Cox proportional hazard model was used to assess the association of NT‐proBNP with the risk of AF. The C‐statistic, categorical net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the ability of NT‐proBNP in new‐onset AF prediction. During a median follow‐up of 2.91 years, 17 (4.63%) new‐onset AF cases occurred. Every 1000 pg/mL increase in NT‐proBNP was associated with a 16% increase in the risk of AF occurrence after adjustments (hazard ratio, 1.16 [95% CI, 1.02–1.32]). NT‐proBNP showed a moderate performance for new‐onset AF at 3 years (C‐statistic, 0.67). Adding NT‐proBNP to CHADS2/R2CHADS2/CHA2DS2‐VASc/C2HSET scores improved their predictive performance for AF risk (CHADS2: C‐statistic, 0.63, CHADS2+NT: C‐statistic, 0.69, NRI, 47.46%, IDI, 1.18%; R2CHADS2: C‐statistic, 0.65, R2CHADS2+NT: C‐statistic, 0.70, NRI, 48.03%, IDI, 0.51%; CHA2DS2‐VASc: C‐statistic, 0.67, CHA2DS2‐VASc+NT: C‐statistic, 0.72, NRI, 49.41%, IDI, 0.86%; C2HSET: C‐statistic, 0.77, C2HSET+NT: C‐statistic, 0.80, NRI, 50.32%, IDI, 1.58%). Conclusions Among patients with HFpEF, the NT‐proBNP level was positively associated with the incidence of new‐onset AF and may be a promising predictor.

Abstract Aims The aim of this study was to develop a simple, fast and efficient clinical diagnostic model, composed of exercise stress echocardiography (ESE) indicators, of the exercise capacity of patients with chronic heart failure (CHF) by comparing the effectiveness of different classifiers. Methods and results Eighty patients with CHF (aged 60 ± 11 years; 78% male) were prospectively enrolled in this study. All patients underwent both cardiopulmonary exercise test (CPET) and ESE and were divided into two groups according to the VE/VCO2 slope: 30 patients with VE/VCO2 slope ventilation classification (VC)1 (i.e., VE/VCO2 slope 0.05 for the above). Conclusions Compared with the LR, XGBT, CART and RF models, the LR model performed best at predicting the VE/VCO2 slope category of CHF patients. A score chart was created to predict VE/VCO2 slopes ≥ 30. ΔE, s′peak and sex are independent predictors of exercise capacity in CHF patients.

Abstract With the development of connected automated vehicles (CAVs), preview and large‐scale road profile information detected by different vehicles become available for speed planning and active suspension control of CAVs to enhance ride comfort. Existing methods are not well adapted to rough pavements of different districts, where the distributions of road roughness are significantly different because of the traffic volume, maintenance, weather, etc. This study proposes a comfortable driving framework by coordinating speed planning and suspension control with knowledge transfer. Based on existing speed planning approaches, a deep reinforcement learning (DRL) algorithm is designed to learn comfortable suspension control strategies with preview road and speed information. Fine‐tuning and lateral connection are adopted to transfer the learned knowledge for adaptability in different districts. DRL‐based suspension control models are trained and transferred using real‐world rough pavement data in districts of Shanghai, China. The experimental results show that the proposed control method increases vertical comfort by 41.10% on rough pavements, compared to model predictive control. The proposed framework is proven to be applicable to stochastic rough pavements for CAVs.

Abstract The increasing amount of distributed renewable energy (DRE) is participating in grid‐connected operation as an important unit of the virtual power plant (VPP) aggregation. VPP also contains a variety of flexible resources such as demand response (DR), energy storage (ES), and fuel cell (FC). How to achieve efficient energy utilization while reducing carbon emissions and resisting the risk of failure caused by extreme weather has attracted widespread attention. In this article, a cooperative game‐based low‐carbon scheduling model for multi‐VPPs under the consideration of typhoon‐induced grid outage risks is proposed. First, a cooperative game mechanism for multi‐VPPs is constructed. And a bi‐level model of multi‐VPPs low‐carbon scheduling is built under the framework of electricity‐carbon trading markets. Second, the bi‐level scheduling model is linearized based on the Strong Duality Theorem and Karush‐Kuhn‐Tucker (KKT) condition. Then, the dispatch scheme of each VPP under the cooperative game form is obtained. Finally, simulations are performed to verify the validity of the proposed model. The results show that the economic and low‐carbon performance of multi‐VPPs can be improved by applying the cooperative game, which can also enhance the power system ability of resisting line faults.

Abstract This paper proposes a multi‐level coordinated scheduling strategy for shared energy storage systems (SESS) under electricity spot and ancillary service markets to maximize the overall operational profit. At the upper level, an optimal day‐ahead bidding model is formulated to allocate optimal capacities of SESS for engaging in electricity transactions and offering peak shaving reserve over the scheduling horizon. Then, a joint market clearing model is presented to simultaneously optimize awarded capacities of SESS and marginal prices of electricity spot and ancillary service markets at the middle level. Furthermore, the lower level aims to correct the coordinated scheduling strategy for minimizing the intra‐day scheduling cost under the uncertainty of renewable energy sources and load demand. Finally, a linear relaxation method is applied to transform the proposed strategy into a mixed‐integer linear programming problem for enhancing the computation efficiency. Comparative case studies have validated the superior performance of the proposed strategy for better utilization of available storage capacity and arbitrage maximization.

Abstract Intestinal ischaemia–reperfusion (I/R) is a common clinical pathology with high incidence and mortality rates. However, the mechanisms underlying intestinal I/R injury remain unclear. In this study, we investigated the role and mechanism of chitinase 3‐like 1 (CHI3L1) during intestinal I/R injury. Therefore, we analysed the expression levels of CHI3L1 in the intestinal tissue of an intestinal I/R rat model and explored its effects and mechanism in a hypoxia–reoxygenation (H/R) IEC‐6 cell model. We found that intestinal I/R injury elevated CHI3L1 levels in the serum, ileum and duodenum, whereas H/R enhanced CHI3L1 expression in IEC‐6 cells. The H/R‐induced inhibition of proliferation and apoptosis was alleviated by CHI3L1 knockdown and aggravated by CHI3L1 overexpression. In addition, CHI3L1 knockdown alleviated, and CHI3L1 overexpression aggravated, the H/R‐induced inflammatory response and oxidative stress. Mechanistically, CHI3L1 overexpression weakened the activation of the phosphoinositide 3‐kinase (PI3K)/AKT pathway, suppressed the nuclear translocation of Nrf2, and promoted the nuclear translocation of nuclear factor κB (NF‐κB). Moreover, CHI3L1 knockdown had the opposite effect on the PI3K/AKT pathway, Nrf2, and NF‐κB. Moreover, the PI3K inhibitor LY294002 blocked the effect of CHI3L1 knockdown on the H/R‐induced inhibition of proliferation, apoptosis, inflammatory response and oxidative stress. In conclusion, CHI3L1 expression was induced during intestinal I/R and H/R injury in IEC‐6 cells, and CHI3L1 overexpression aggravated H/R injury in IEC‐6 cells by inhibiting the PI3K/AKT signalling pathway. Therefore, CHI3L1 may be an effective target for controlling intestinal I/R injury.

Abstract Mouse models are crucial for understanding pulmonary hypertension (PH) mechanisms and developing therapies, but existing mouse models under hypoxia only exhibit mild PH. To address this, we established a double‐hit model combining unilateral pneumonectomy (LPx) or left pulmonary artery ligation (LPAL) with hypoxia exposure in C57BL/6 mice. Our detailed haemodynamic and histological evaluations post‐surgery demonstrated pronounced elevations in right ventricular systolic pressure (RVSP) (LPAL: 41.1 ± 4.63 mmHg, P = 0.005; LPx: 38.4 ± 2.95 mmHg, P = 0.002; Sham: 32.1 ± 2.21 mmHg) and pulmonary vascular wall thickness (LPAL: 56.9 ± 3.34%, P = 0.02; LPx: 54.3 ± 4.65%, P = 0.04; Sham: 44.8 ± 3.76%) compared to hypoxia‐exposed sham‐operated controls, reflecting a more severe PH phenotype. These novel models, which exhibit haemodynamic alterations akin to the established hypoxia with SU5416‐induced PH model as per published data, could offer a substantial contribution to future PH research and therapeutic development.

Objective Imperfect fitting of the navigation template leads to prolonged surgery time and increased blood loss. These problems have not been effectively addressed in previous research. This study explores the efficacy of a novel 5‐point positioning point‐contact pedicle navigation template in complex pedicle situations in scoliosis. Methods This study employed a retrospective controlled design. From November 2019 to November 2023, 28 patients with scoliosis and complex pedicle were selected and underwent scoliosis correction surgery. A 5‐point positioning point‐contact pedicle navigation template was used intraoperatively to guide pedicle screw placement. Matched with 56 historical cases as a control group. The analysis included screw placement time, screw placement bleeding volume, fluoroscopy frequency, manual repositioning frequency, screw placement accuracy and grade, screw placement complications, and main curve correction rate. Continuous variables were compared using the independent samples t‐test. Categorical data were analyzed with the chi‐square test. Results All 28 patients successfully underwent surgery, with a total of 268 pedicle screws placed. The surgery duration ranged from 220 to 410 min, with an average of (283.16 ± 51.26) min. Intraoperative blood loss ranged from 630 to 1900 mL, with an average of (902.17 ± 361.25) mL. Pedicle screw placement time ranged from 60 to 130 min, with an average of (85.24 ± 24.65) min. Pedicle screw placement bleeding volume ranged from 40 to 180 mL, with an average of (76.47 ± 42.65) mL. Fluoroscopy frequency ranged from 3 to 7 times, with an average of (4.31 ± 1.14) times. Manual repositioning frequency ranged from 0 to 2 times, with an average of (0.46 ± 0.58) times. Pedicle screw placement grades: Grade I: 237 screws; Grade II: 25 screws; Grade III: 6 screws; Grade IV: 0 screws. There were no screw‐related complications. The correction rate ranged from 46% to 68%, with an average of (55.83 ± 9.22)%. Compared to the experienced screw group, the differences in screw placement time, screw placement bleeding volume, fluoroscopy procedures, and manual redirections were statistically significant (p

Mice are one of the most common biological models for laboratory use. However, wild‐type mice are not susceptible to COVID‐19 infection due to the low affinity of mouse ACE2, the entry protein for SARS‐CoV‐2. Although mice with human ACE2 (hACE2) driven by Ace2 promoter reflect its tissue specificity, these animals exhibit low ACE2 expression, potentially limiting their fidelity in mimicking COVID‐19 manifestations and their utility in viral studies. Here, we created and compared hACE2 mouse models generated with different strategies. Our findings show that distinct β‐globin insertion within hACE2 cassette significantly influences its expression, with downstream placement enhancing transcription. Moreover, optimizing hACE2 codons (opt‐hACE2) improves translation efficiency in multiple tissues. Notably, opt‐hACE2 mice displayed more active immune responses and severe COVID‐19 phenotypes following SARS‐CoV‐2 challenge compared to other models. Our study demonstrates the dual regulatory role of β‐globin element in transgene transcription and suggests that opt‐hACE2 mice might serve as valuable tools for SARS‐CoV‐2 research.

Oral squamous cell carcinoma (OSCC) is the one of the most common types of malignant tumor found in the head and neck area. Replication factor C subunit 4 (RFC4), an oncogene active in various human cancers, has been rarely studied in OSCC. In the present study, bioinformatics analysis identified RFC4 as a potential key target in OSCC progression. Additional experiments showed that RFC4 expression was significantly higher in OSCC tumor tissues than in normal tissues. Knockdown of RFC4 led to G2/M phase cell cycle arrest and inhibited the proliferation of OSCC cells both in vitro and in vivo. High RFC4 expression in OSCC tumors was linked to increased levels of MET, along with reduced levels of CD274 and CD160. Overall, the present study reveals that RFC4 may play a pivotal role in OSCC tumorigenesis and could serve as a potential predictive marker for the efficacy of immunotherapy.

ABSTRACT Background Anterior controllable antedisplacement and fusion (ACAF) is an emerging surgical approach for treating cervical ossification of the posterior longitudinal ligament (C‐OPLL), yet there is limited data on its long‐term efficacy and safety. The present study aimed to analyze the short‐ and long‐term postoperative clinical and radiological outcomes and perioperative complications of ACAF for patients with C‐OPLL. Methods This was a single‐center, retrospective, cohort study, with the mean duration of follow‐up of at least 24 months. A total of 111 patients with C‐OPLL in our institution from June 2017 to June 2019 were assessed preoperatively and at 3 days, 3, 6, 12, and 24 months postoperatively. The primary outcome was the recovery of neurological function, measured with the Japanese Orthopedic Association (JOA) score. The secondary outcomes included pain, Cobb angle, spinal canal invasion rate, and surgery‐related complications. Results The postoperative JOA score at each follow‐up was significantly better than the preoperative JOA score, regardless of preoperative spinal canal invasion rate, K‐line, and segment length. The visual analog scale (VAS) score also decreased dramatically 3 days after surgery and was maintained at a low level throughout the follow‐up period. Improvements in Cobb angle and invasion rate were observed right after the operation and were maintained for 2 years thereafter. Conclusions ACAF could achieve satisfactory recovery of neurological function in C‐OPLL patients during a follow‐up of 24 months, regardless of preoperative spinal canal invasion rate, preoperative K‐line, or surgical segment length.

ABSTRACT Objective Whether first coronal reverse vertebrae (FCRV) can directly cause biomechanical changes in adjacent segments remains unclear. The objective of this study was to explore the biomechanical changes in adjacent discs of the FCRV to better understand the stress distribution of adolescent idiopathic scoliosis (AIS). Methods According to the plain CT scan data of T8–T10 segment of an AIS patient, T9 was the FCRV, and a three‐dimensional FE model was established accurately. The T8–T9 segment disc was defined as the adjacent upper disc (UD), axial section as half of the upper disc (HUD). Similarly, T9–T10 segment disc was the adjacent lower disc (LD), axial section as half of the lower disc (HLD). The biomechanical changes in adjacent discs of the FCRV under different loads were assessed. Results The maximum Von‐Mises stress values of the LD were greater under various loads than those of the HLD, UD, and HUD. The average stress on the LD was greater than that of the other discs under the left lateral bending (LLB) or right lateral bending (RLB) load. It was noted that the concave side of the LD was subjected to greater stress under the neutral standing or LLB load compared with convex side. Additionally, the concave side of the LD was subjected to greater stress under the LLB or RLB load compared with that of other discs. Interestingly, the same trends were observed for the convex side of the LD. Conclusions FCRV caused LD to take on greater stress magnitudes. The stress showed a trend of local concentration, which was in the concave side of the scoliosis. These findings could contribute to further treatment planning for the patient and aid physicians' management decision‐making.

ABSTRACT Objective The rehabilitation methods after total knee arthroplasty (TKA) can affect the recovery of complications and joint function, and the selection and comparison of rehabilitation methods after TKA still need further research. Methods A comprehensive search of five databases and two clinical trial registration platforms was conducted from inception through March 31, 2024, and conducted to identify eligible randomized controlled trials (RCTs). We extracted the required data according to the Cochrane Handbook for Systematic Reviews of Interventions. Finally, 32 trials involving 2292 patients were included, the mean age of the enrolled patients was ~69.10 years, the sex ratio of males was (31.6%), and the longest follow‐up time was 2 years. And we have summarized nine rehabilitation intervention measures: conventional physical therapy (CPT), cryotherapy, thermal therapy (TT), acupuncture, hydrotherapy, neuromuscular training (NT), electrotherapy, continuous passive motion (CPM), continuous active motion (CAM). And use the range of motion (ROM), visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) as the outcome measure to evaluate the effectiveness of various interventions. A Bayesian network meta‐analysis (NMA) was carried out for calculating standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of improvement of knee joint function after TKA by different rehabilitation methods. Result After treatment, the ROM results showed that cryotherapy, electrotherapy, and NT had better therapeutic effects. Among them, cryotherapy (WMD = 10.3, 95% CI 1.63–18.2) had a significant therapeutic effect. In terms of VAS, NT and TT showed good therapeutic effects. Among them, NT had a more significant therapeutic effect, while CAM had less effect. After treatment, in terms of WOMAC, TT, hydrotherapy, cryotherapy, and NT had better therapeutic effects. TT had the best therapeutic effect, while Hydrotherapy and Cryotherapy also had certain advantages. Conclusion NT, TT, cryotherapy, hydrotherapy, and electrotherapy rehabilitation therapies have good therapeutic effects for TKA patients compared with other interventions. Among them, NT may be the best postoperative rehabilitation therapy.

ABSTRACT Purpose Following failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes. Methods Our retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components. Results The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p

ABSTRACT Objective Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications. Methods A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function. Results Eleven patients were followed up for an average of 66 months (range, 24–132 months). The average length of repaired bone defects was 13 cm (range, 2.5–32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow‐up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21–30). Three months post‐fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases. Conclusion The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.

Abstract Aims This study aims to develop explainable machine learning models and clinical tools for predicting mortality in patients in the intensive care unit (ICU) with heart failure (HF). Methods Patients diagnosed with HF who experienced their first ICU stay lasting between 24 h and 28 days were selected from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database. The primary outcome was all‐cause mortality within 28 days. Data analysis was performed using Python and R, with feature selection conducted via least absolute shrinkage and selection operator (LASSO) regression. Fifteen models were evaluated, and the most effective model was rendered explainable through the Shapley additive explanations (SHAP) approach. A nomogram was developed based on logistic regression to facilitate interpretation. For external validation, the eICU database was utilized. Results After selection, the study included 2343 records, with 1808 surviving and 535 deceased patients. The median age of the study population was 70.00, with ~3/5 males (60.31%). The median length of stay in the ICU was 6.00 days. The median age of the survival group was younger than the non‐survival group (69.00 vs. 73.00), and non‐survival patients spent longer time in the ICU. Seventy‐five features were initially selected, including basic information, vital signs, laboratory tests, haemodynamics and oxygen status. LASSO regression determined the shrinkage parameter α = 0.020, and 44 features were chosen for model construction. The linear discriminant analysis (LDA) model showed the best performance, and the accuracy reached 0.8354 in the training cohort and 0.8563 in the testing cohort. It showed satisfying area under the curve (AUC), recall, precision, F1 score, Cohen's kappa score and Matthew's correlation coefficient. The concordance index (c‐index) reached 0.7972 in the training cohort and 0.8125 in the testing cohort. In external validation, the LDA model achieved approximately 0.9 in accuracy, precision, recall and F1 score, with an AUC of 0.79. Univariable analysis was performed in the training cohort. Features that differed significantly between the survival and non‐survival groups were subjected to multiple logistic regression. The nomogram built on multiple logistic regression included 14 features and demonstrated excellent performance. The AUC of the nomogram is 0.852 in the training cohort, 0.855 in the internal validation cohort and 0.770 in the external validation cohort. The calibration curve showed good consistency. Conclusions The study developed an LDA and a nomogram model for predicting mortality in HF patients in the ICU. The SHAP approach was employed to elucidate the LDA model, enhancing its utility for clinicians. These models were made accessible online for clinical application.

Abstract Background There is conflicting evidence regarding whether heart failure (HF) increases the risk of developing cancer. Objective This study aimed to assess the association between HF and incident cancer, considering gender differences and HF phenotypes. Methods This retrospective study was conducted on data of adult individuals, free of cancer at baseline, from the First Affiliated Hospital of Wenzhou Medical University between January 2009 and February 2023. The patients with HF were categorized as HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). The primary outcome was incident cancer, including obesity‐related, tobacco‐related, lung, colorectal and breast cancers. Results Of 33 033 individuals enrolled, 16 722 were diagnosed with HF, including 10 086 (60.3%) with HFpEF and 6636 (39.7%) with HFrEF. During a median follow‐up period of 4.6 years (inter‐quartile range: 2.6–7.3), incident cancer was diagnosed in 10.5% (1707 patients) of the non‐HF group and 15.1% (2533 individuals) of the HF group. After adjusting for potential confounding factors, patients with HF had a 58% increased risk of cancer than those without HF [adjusted hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.48–1.69, P

Abstract Objective Heart failure with preserved ejection fraction (HFpEF) is a growing concern among the elderly population, significantly impacting morbidity and mortality rates. This study aimed to screen and investigate the characteristics and prognosis of early‐stage HFpEF in the elderly. Methods A total of 1789 community‐dwelling individuals aged over 65 from northern Shanghai were enrolled. According to American Heart Association (AHA) guidelines, participants were classified into four groups: HFpEF stage 0, HFpEF stage A, HFpEF stage B and HFpEF stage C. Major endpoints included major adverse cardiovascular events (MACEs), all‐cause death and cardiovascular death. Results After a mean follow‐up period of 7.10 ± 1.27 years, 1623 elderly subjects were included [HFpEF stage 0 (10.3%), HFpEF stage A (16.3%), HFpEF stage B (60.6%) and HFpEF stage C (12.8%)]. Patients with HFpEF stage A, HFpEF stage B and HFpEF stage C exhibited more MACEs than those in HFpEF stage 0 (P

Abstract Aims Prior evidence has shown a significant link between inflammation and the development of myocarditis. This study aimed to investigate the causal relationship between inflammation‐related genes (IRGs) and myocarditis. Methods and results In this study, the causal relationship between 167 IRGs and myocarditis were investigated using datasets from the Gene Set Enrichment Analysis and Integrative Epidemiology Unit open genome‐wide association study (IEU OpenGWAS) databases. The GWAS data (finn‐b‐I9 MYOCARD) contained single nucleotide polymorphisms (SNPs) data from 117 755 myocarditis samples (16 379 455 SNPs, 829 cases vs. 116 926 controls). Five algorithms [MR‐Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode regression] were employed for the MR analysis, with IVW as the primary method, and sensitivity analysis was conducted. Subcellular localization and protein–protein interaction (PPI) network analyses were performed for selected biomarkers. Results were verified in ebi‐a‐GCST90018882 (24 180 570 SNPs, 633 cases vs. 427 278 controls) and finn‐b‐I9 MYOCARD EXNONE (16 380 466 SNPs, 829 cases vs. 217 963 controls) to enhance reliability. Results IRF7 and ADORA2B were shown to be two exposure factors after screening. Univariable MR (UVMR) analysis revealed that IRF7 was a risk factor for myocarditis [IVW: odd ratio (OR) = 1.041, 95% confidence interval (CI) = 1.018–1.955, P = 0.039], while ADORA2B was a protective factors for myocarditis (IVW: OR = 0.799, 95% CI = 0.640–0.997, P = 0.047). Sensitivity analysis confirmed the robustness of these findings. Multivariable MR (MVMR) analysis further demonstrated a direct causal role of ADORA2B in preventing myocarditis. Subcellular localization analysis indicated predominant cytoplasmic expression and limited mitochondrial expression for both genes. The results of PPI analysis showed that 20 genes were predicted to be associated with IRF7 function, such as response to type I interferon, pattern recognition receptor signalling pathway, and toll‐like receptor signalling pathway. The results in finn‐b‐I9 MYOCARD EXNONE were consistent with MR analysis. Conclusions The findings indicated there was a causal connection between IRGs (IRF7 and ADORA2B) and myocarditis, which offered a crucial point of reference and guidance for future studies and myocarditis treatment.

Abstract Aims Heart failure (HF) is characterized by a heightened risk of melanoma, which often metastasizes to the heart. The overlap pathology between HF and melanoma includes chronic low‐grade inflammation and dysregulation of inflammatory cancer‐associated fibroblasts (iCAFs). The impact of HF on iCAF‐driven tumour inflammation remains obscure. Methods and Results To identify critical genes for HF development, transcriptomic data (GSE57338) containing 313 clinical HF samples [136 healthy controls, 95 ischaemia (ISCH) and 82 dilated cardiomyopathy (DCM)] were analysed to screen differentially expressed genes (DEGs) and perform enrichment analysis. Fifty‐one DEGs in ISCH and 62 DEGs in DCM were identified with log2|fold change (FC)| ≥ 1 and P value ≤0.05. All these genes are involved in extracellular matrix organization, immune/inflammatory responses and Wnt signalling pathways. Then, the overall survival curves and prognostic models of DEGs in melanoma were evaluated. The correlation of gene expression with lymphocyte infiltration levels was assessed. Only aldehyde oxidase 1 (AOX1) and amphiregulin (AREG) maintained the same trend in melanoma as in HF, negatively affecting prognosis by regulating lymphocyte infiltration (log‐rank P value = 0.0017 and 0.0019). The potential drug molecules were screened, and the binding energies were calculated via molecular docking. Eniluracil, a known AOX1 targeting drug, was found to stably bind with AREG (hydrogen bond binding energies: −65.633, −63.592 and −62.813 kcal/mol). Conclusions The increased prevalence of melanoma in HF patients and its propensity for cardiac metastasis may be due to AREG‐mediated systemic low‐grade inflammation. Eniluracil holds promise as a therapeutic agent that may block AREG signalling, inhibiting the activation of iCAF mediated by regulatory T cell (Treg) and neutrophil.

Abstract Aims We aim to explore the correlation between coronary artery calcification (CAC) score (CACS) and cardiac structure and function in chronic kidney disease (CKD) patients, create a clinical prediction model for severe CAC associated with cardiac ultrasound indexes. Methods and results The study included 178 non‐dialysis CKD patients who underwent CACS testing and collected general information, serological indices, cardiac ultrasound findings and follow‐up on renal function, heart failure (HF) manifestations and re‐hospitalization. The mean age of participants in the study cohort was 67.4 years; 59% were male, and 66.9% of patients had varying degrees of comorbid CAC. CKD patients with CACS > 100 were older, predominantly male and had a higher proportion of smoking, diabetes and hypertension (P

ABSTRACT In the context of the global transition to renewable energy sources, the offshore wind power sector is confronted with operational inefficiencies during the thermal processing and assembly of wind turbine spindles and components. The research, centered on General Electric's offshore wind turbine assembly facility, addresses the deficiencies in the thermal management of bearing heating systems, the prevalence of rework due to substandard thermal treatments, and the inefficiencies in energy utilization. The paper proposes a targeted strategy comprising three key interventions: (1) The synchronization of bearing heating procedures with the off‐peak electricity tariff regime to mitigate peak demand and associated energy expenditures and carbon footprints. (2) The deployment of a thermoelectric generator (TEG) system to harness and convert waste heat into electrical energy, with meticulous modeling of its thermal dynamics. (3) The engineering of a thermally insulated housing for bearings to curtail thermal losses. The projected outcomes of these interventions are a reduction in electricity costs by 127.83 yuan, a decrease in carbon emissions by 90.41 kg, and a substantial reduction in heat loss. The findings of this research underscore the efficacy of thermal process optimization, waste heat recuperation, and thermal insulation in enhancing the energy efficiency of bearing heating systems, thereby contributing to the broader objectives of energy conservation and emission reduction in the renewable energy sector, which is imperative in the contemporary era of climate change mitigation and sustainable development.

ABSTRACT A novel composite catalyst with readily preparation and good catalytic performance was designed and synthesized using sulfonation‐modified zeolite socony mobil‐5 (ZSM‐5) as the carrier and nano‐CoO/NiO as the active components. Compared with traditional in situ conversion, the composite catalyst could effectively reduce the activation energy of catalytic reactions, improve the efficiency of oil and gas conversion, and ameliorate the quality of oil products. When the loading amount of nano‐CoO/NiO was 20 wt% and the silicon/aluminum ratio of ZSM‐5 was 40–50, the required activation energy for oil shale cracking was as low as 43.64 kJ/mol, the yield of oil products was as high as 15.46 wt%, and the content of organic compounds in medium‐/low‐carbon hydrocarbon was as high as 71.50%. The prepared composite catalysts had low preparation cost, environmental friendliness, and significant catalytic effects, providing a feasible approach for the effective exploitation and utilization of oil shale.

ABSTRACT Steam‐assisted gravity drainage (SAGD) technology is an essential means of efficient development of heavy oil, super heavy oil, oil sands, and other unconventional resources in the world. Accurate prediction and evaluation of heavy oil output during SAGD production is a key step of construction optimization design and economic evaluation. The traditional prediction model of heavy oil production does not fully consider many geomechanical factors, such as rock deformation and permeability dynamic evolution. In this paper, a new mathematical model of crude oil production‐geomechanical coupling was established for three stages of the SAGD life cycle (steam chamber breakthrough stage, rising stage, and lateral dilation stage). The influence of the dynamic evolution of rock porosity and permeability on production was fully considered through the sensitivity coefficient of rock strain and permeability stress. It is found that the gap between the new model and the traditional model is larger when the strain and stress sensitivity of the reservoir body is larger. The value calculated by the conventional model is small when the reservoir dilates and large when the reservoir compresses. For Karamay heavy oil in Xinjiang, China, the steam breakout time predicted by the new model is 0.72, 1.50, 1.37, and 1.44 times the conventional model when the volumetric strain is 6%. The heavy oil production of Karamay, Xinjiang, China, Athabasca, and Cold Lake SAGD production areas in Canada was predicted. In the lateral dilation stage of the steam chamber, the predicted values of the model considering geomechanical factors were 1.44, 1.28, and 1.15 times the traditional model, respectively. This model can help field engineers obtain more accurate production of heavy oil and evaluate the significance of reservoir geomechanics in SAGD production.

ABSTRACT This study uses AVL FIRE 2020 R1 software for simulation and experimental verification to deeply analyze the impact of combustion chamber geometry and biodiesel on diesel engine performance at different injection timings. The study found that: With the advancement of injection timing, the indicated fuel consumption rate, cylinder pressure and NOx emissions of the two combustion systems increased, while the indicated thermal efficiency, temperature and Soot emissions decreased accordingly; The blending of low calorific value biodiesel will increase the indicated fuel consumption rate of the two combustion systems, but at the same time it can effectively reduce NOx and Soot emissions; The T: Turbocharger, C: Charger air cooling, D: Diesel particle filter (TCD) combustion system improves the utilization rate of cylinder air due to its unique combustion chamber geometry, thereby improving combustion performance. Compared with the Omega combustion system, the indicated thermal efficiency of the TCD combustion system increased by 6.16% to 8.38% and the indicated fuel consumption rate decreased by 5.80% to 7.73% when burning four types of fuel. In addition, the in‐cylinder pressure and temperature increased, and it performed better in reducing Soot emissions. The research results show that the TCD combustion system can effectively improve the combustion and emission performance of diesel engines, provide data support for the development of diesel engine combustion systems and the combustion of oxygen‐containing fuels in plateau environments, and provide an important reference for energy conservation and emission reduction.

Abstract Objective Approximately 7% of individuals with dystrophinopathy remain undiagnosed at the genetic level using conventional genetic tests like multiplex ligation‐dependent probe amplification (MLPA) and next‐generation sequencing (NGS). We used the optical genome mapping (OGM) technology to detect and analyze uncommon mutations or structural variations (SVs) within the DMD gene, thus contributing to more precise clinical diagnoses. Methods We herein included eight patients with dystrophinopathy (six males and two females) in whom pathogenic variants of the DMD gene could not be accurately identified using MLPA and NGS. Clinical data were collected for all patients and genetic testing was performed using OGM. Results Conventional methods (MLPA and NGS) failed to detect pathogenic mutations in six out of eight individuals (four males and two females). OGM testing uncovered rare mutations in the DMD gene in four patients, including a pericentric inversion in chromosome X (one male), a complex rearrangement (one male), and two X–autosome translocations (two females). No mutations were detected in the remaining two male patients. OGM also accurately mapped balanced X–autosome translocations in female patients, defining chromosomal breakpoints. In the other two male patients in whom MLPA suggested non‐contiguous exon duplications or deletions in the DMD gene, OGM characterized one case as a complex rearrangement and the other as a deletion within the DMD gene. Interpretation OGM is a valuable diagnostic tool for dystrophinopathy patients with negative results from conventional genetic tests. It can effectively elucidate complex SVs and pinpoint breakpoints in X–autosomal translocations in female patients, facilitating prompt and appropriate interventions.